Quick Question

[IcanHealYou]

During sickle cell, vaso occlusive crisis we are taught HOPS - hydration, oxygen, pain medication, and support

According to the nclex if all four of these options were given for a questions, what do you do first? You would give oxygen correct?

Thank you in advance.

[kanzi monkey]

That's an excellent question.

I may get this wrong. Instinct would say oxygen. But since you asked, I'll go with hydration on the theory that you need adequate volume to enable non-sickled cells to deliver O2.

So, "C" for circulation (since you have airway and breathing).

[libbyjeanne]

I would say oxygen, just because my testing instinct would go with the ABCs.

[ElliShay]

I am going to go with hydration.

check out this link: http://emedicine.medscape.com/article/205926-treatment

[kanzi monkey]

So, looking further I'd say your priorities are:

1. hydration

2. pain control

then, if the patient is having a difficult time maintaining 02 sat, give some oxygen. Both 1 & 2 can cause respiratory issues--give 02 as needed whilst giving IV hydration and pain control.

Again, going by logic, not data....

[Key_]

I would have to say oxygen is first for two reasons:

1st, which has already been mentioned, is ABCs

2nd, it's the easiest and the quickest. It takes two seconds to throw on some oxygen and it helps within seconds

[kanzi monkey]

I would have to say oxygen is first for two reasons:

1st, which has already been mentioned, is ABCs

2nd, it's the easiest and the quickest. It takes two seconds to throw on some oxygen and it helps within seconds

I agree. I'd have them on O2 immediately, if it alleviated symptoms. But airway isn't necessarily an issue, and the patient is breathing. I don't think low 02 sat is one of the standard initial presentations of sickle cell crisis. If there is O2 compromise, it would be due to abnormally shaped RBCs occluding vessels--fluid would help maintain patentcy, facilitating transport of the 02 carrying cells. Pain medication would alleviate the initial symptoms of hypoxia. So, for testing purposes, I'd still pick hydration and pain over oxygen.

[JustEnuff2BDangerous, BSN, RN]

In the real world, you would probably do oxygenation first because it takes the least amount of time. Oxygenation is necessary because the shape of the cells alters their ability to carry oxygen.

However, in NCLEX world, I would personally go with hydration first and foremost because one of the major aggravating/causation factors for sickle cell crisis is dehydration. Hydration is a major factor in alleviating the crisis.

[litbitblack, ASN, RN]

Correct me if im wrong but I distinctly remember pain being one of the first things to do

[kanzi monkey]

Correct me if im wrong but I distinctly remember pain being one of the first things to do

Definitely. But you won't get adequate pain control until fluid status is improved. Yeah, again, in the real world, I'd throw on the oxygen, give a dose of IV narcotic, then get the fluids going because that's the most efficient way to handle it.

[JustEnuff2BDangerous, BSN, RN]

Correct me if im wrong but I distinctly remember pain being one of the first things to do

It is one of your first interventions, but it is not your priority - hydration is the first and foremost thing you should initiate. According to NCLEX. :) We all know the real world is a completely different story a lot of the time!