N211: Health Differences Across the Lifespan I The red blood cells are rigid and rough, forming an elongated sickle shape and impairing circulation by “clumping” together. This happens during periods of hypoxia which can be provoked by strenuous exercise, high altitude, unpressurized aircraft, cold and vasoconstrictive drugs. Nursing Assessment Includes aching bones, jaundice, pallor, tachycardia, family history, frequent infections, delayed physical growth, cerebrovascular accidents, joint swelling and leg ulcers, especially on the ankles. 1.29 Vaso-Occlusive Crisis Vaso-occlusive crisis includes fever, hand and foot syndrome (infants); painful edematous hands and feet and arthralgias. Sickle cell crisis is very painful. For the child who is hospitalized in crisis: • Administer IV fluids and electrolytes to increase hydration and treat acidosis • Monitor I&O • Administer blood products as prescribed • Administer analgesics, including parenteral morphine for severe pain • Use warm compresses (not ice) • Administer prescribed antibiotics to treat infection Diagnostics Decreased RBC, elevated WBC and platelet counts, decreased ESR. Hemoglobin electrophoresis differentiates trait from disease Nursing Diagnosis • Acute pain related to… • Risk for infection related to… • Deficient knowledge (crisis prevention) related to… Nursing Interventions Iron and folic acid supplements, teach to prevent dehydration and provide analgesics for pain. Interventions during crisis include warm compresses to painful areas, (cold aggravates the condition) maintain bed rest to reduce workload on the heart and to reduce pain, encourages fluid intake to prevent dehydration, which can precipitate a crisis. Teach family how to prevent crisis (hypoxia) and to keep child from exercising strenuously. Administer pneumococcal vaccine, meningococcal vaccine and HiB vaccine as prescribed. Refer family for genetic counseling and support child and family experiencing chronic disease.
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