Help!!! What is the priority for a sickle cell crisis.

Nursing Students NCLEX

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I'm currently using Lacharity PDA and today I came across with this question about Sickle cell anemia:

A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Which action prescribed by the healthcare provider will you implement first?

1. Give morphine sulfate 4 to 8 mg IV every hour as needed.

2. Administer 100% oxygen using a non-rebreather mask.

3. Start a 14-gauge IV line and infuse normal saline at 200 mL/hr.

4. Give pneumococcal (Pneumovax) and Haemophilus influenzae (ActHIB) vaccines.

I piked #3 because hydration helps to decrease the viscosity of the blood, fluids will help with better blood flow, improving oxygenation and tissue perfusion. However, the book states that the priority is #2 oxygenation because hypoxia and deoxygenation is the priority. but how will it help if there is a problem with occlusion of RBC?.

I need clarification. Thanks

I've learned that sickle cell crisis is due to the blood getting clogged. You'd need to push fluids. O2 won't help if the RBCs aren't able to carry them to where it's needed. Hydration is very important.

I've answered this question multiple times, and it's always fluids. The large gauge is to get it into the system quicker. Most patients get the normal 18-20g, now considered a DEHYDRATED, SICKLE CELL patient--you'd need a large bore IV.

https://allnurses.com/nclex-discussion-forum/sickle-cell-crisis-410226.html

I disagree. Its always oxygen first. You can improve oxygenation in a matter of seconds, but it takes waaaaay longer to reverse the effects of dehydration. So you would do oxygen first.

Specializes in OMFS, Dentistry.

This is how we were taught : The question asks *FIRST*... ABC's.

Think about what will happen if you DON'T do each answer:

1.) They aren't going to die because they didn't get pain meds

2.) They can die if they can't breathe

3.) They aren't going to die if they don't get IV fluids immediately. It takes time for hemodilation and by that time they haven't gotten O2

4.) They aren't going to die from non vaccination

You would give O2 and establish IV access with fluids but this question asks *FIRST*

I had a VERY similar question on U World and the answer was to administer IV fluids. I got the question wrong because I chose O2. Go figure.

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