Help!!!!! What is the priority in sickle cell cris?

[Sulyan, BSN]

Hi there , I'm going to NCLEX RN next month. Currently I'm using Lacharity PDA and today I came across with this question about Sickle cell anemia : A patient with sickle disease arrives to the unit with sickle cell crisis. which action prescribed by the health care provider will you implement first?

1. administer analgesic (morfine)

2. administer O2 (nonrebreather mask)

3. start IV line(14 gauge) NS

4. administer vaccines

I piked #3 because hydration helps to decreased the viscosity of the blood, (since the blood is too thick) 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 are priority. but how it will help if there a problem occlusion of RBC?. Please somebody help me to clarify this doubts.

[LadyFree28, BSN, LPN, RN]

Think about the pathology of Sickle Cell Anemia and Sickle Cell Crisis, as well as RBCs and what they need; once you research that, then you will know why #2 is correct.

Let us know what you find out!

[loving2024, BSN, RN]

Anemia is when there is not enough RBC or hemoglobin(RBC binds with oxygen). So what would you do first?

[akulahawkRN, ADN, RN, EMT-P]

#2 is the priority for two reasons... one is that sickled RBC's don't carry oxygen and lack of oxygen can make RBC's sickle. Think about Maslow's...

[Heliantus]

ABC- airway, breathing, curculation.

Sickle cells are defective red blood cells, therefore they do not carry enough oxygen -thus hypoxia. So administering oxygen would be the priority. I'd then probably administer morfine to decrease O2 demand, Then start an IV.

[loving2024, BSN, RN]

When in doubt, use ABC and Maslow

[Christy1019, ASN, RN]

I second what others have said, however, for a real situation I'm not likely to use a non-rebreather unless the pt appears to be in distress, a nasal cannula should work just fine. However, the NCLEX never makes it an obvious answer so you have to work with what options you're given, and as others have said, oxygen is the number one priority. Then you'll be starting an IV, giving fluids and analgesics. Not sure what vaccines have to do with it unless they are referring to how illness can increase the chances of having a sickle cell crisis due to the stress on the body and/or dehydration.

[Sulyan, BSN]

RBCs binds with O2 to work well, In SCA RB cells get the S shape(hmgbn A become in hmgbn S ) due to lack of O2, they become rigid and difficult to flow,causing obstruction of the capillaries. So in a crisis this condition get worst, the patient has decrease oxygenation and administration of O2 is priority. I think I've been looking different resources I found this other post about the same topic https://allnurses.com/nclex-discussion-forum/sickle-cell-crisis-488580.html which made me doubt even more. Thank you so much for your answers that made me realize never forget patho. I have a better understanding sorry for the poll, it was a mistake.

[Sulyan, BSN]

yap Maslow and ABC thank you all of you!!!!!!!!!

[cayenne06, MSN, CNM]

yep, and you can also use your common sense to guide you in these situations- obv you can rule out #4 without much thought. An IV is going to be needed to administer analgesics in a timely fashion (PO/IM is less than ideal in this situation- slower rate of absorption, possible need for NPO, and pain from an injection). Not ONLY does ABC tell you to address breathing first, but think about it logically- how long does it take to throw on some O2 vs starting a line?

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Just a little FYI: think about how BIG a 14 gauge IV is when you're performing you elimination process. I would never attempt or even consider such a size unless it was an urgent situation and there was absolutely no other size available. The largest that I would use is an 18.