sickel cell crisis

i was always taught to hydrate first.

wanted to know what do u do first

oxygen or hydrating the pt.

kaplan says hydrate first then oxygen

la charity says oxygen first ??? a little confusing?

thanks for your help

hydrate first in sickle cell crisis...i got from saunders book.....in sickle cell crisis pt.first u have to see about hydrate than u have to see about pain relief...

Thanks so much :)

Whoa, hold the phone!

A,B,C's people! You have a patient that is hypoxic from their sickle cell crisis. Yes, they need hydration. Yes, they need pain relief. But what's going to kill them? The hypoxia. Airway, BREATHING, then circulation. They need oxygen.

It takes about 15 second to put oxygen on a patient. Rehydrating them can take over an hour.

after doing my research on this, i have come to an understand that the key word is paying attention to how the question is worded. sickle cell has about 7 crisis...example

vaso- occlusive crisis hops hydration, oxygen, pain, support-which includes bed rest, exchange transfusion, warm compresses

splenic sequestration: more common in children

i checked and compared with various sources and they pretty much state the same. so it is definitely abc if the client is having respiratory distress..other wise i will stick with hydrate unless kaplan, saunders, cram prep, fuere, hurst are all wrong. hydration as marlene hurst stated is what will stop the sickling. thanks for all your help

excuse all the misspelled words, dont have much time to check, gotta study :)

Whoa, hold the phone!

A,B,C's people! You have a patient that is hypoxic from their sickle cell crisis. Yes, they need hydration. Yes, they need pain relief. But what's going to kill them? The hypoxia. Airway, BREATHING, then circulation. They need oxygen.

It takes about 15 second to put oxygen on a patient. Rehydrating them can take over an hour.

I agree. I say oxygen too. NCLEX will not bother with the different crisis...they could care less. It's not for a newbie RN to know. ABC's always.

In relation to hydration and pain relief....yes HYDRATION first.

But, when you have oxygen and whatever else, always pick oxygen!!

Best of luck for all the NCLEX takers :)

I'm currently studying for the NCLEX and I learned to hydrate first (I also learned this from the nurses on the hem/onc floor during my clinical rotation). The reasoning behind is to prevent occlusion. Sickle cell patients during a crisis are at HIGH risk for a stroke/occlusion so you want to address that first with hydration. Oxygenating will only do so much if the cells are unable to travel through the vessels. Did you read the rationale behind the kaplan question? They usually (sometimes) provide good explanations for it.

Perhaps in the real world you would throw oxygen on first because it's fast, but remember NCLEX world does NOT equal real world.

Good luck!

I'm currently studying for the NCLEX and I learned to hydrate first (I also learned this from the nurses on the hem/onc floor during my clinical rotation). The reasoning behind is to prevent occlusion. Sickle cell patients during a crisis are at HIGH risk for a stroke/occlusion so you want to address that first with hydration. Oxygenating will only do so much if the cells are unable to travel through the vessels. Did you read the rationale behind the kaplan question? They usually (sometimes) provide good explanations for it.

Perhaps in the real world you would throw oxygen on first because it's fast, but remember NCLEX world does NOT equal real world.

Good luck!

Thank you, and yes i read the rationale on Kaplan and the explanation is what made me do more research on it....i appreciate everyone's input

Did the rationale give you a choice between oxygen and hydration, or did it simply say hydration was first? Not all patients who come in with sickle cell crisis are hypoxic. If they are not hypoxic, by all means, hydrate them. If they are hypoxic, they need oxygen.

I would certainly question Kaplan's answer if they said hydration above oxygen. I understand the need to hydrate a patient in sickle cell crisis (we see them all the time in Pediatric ICU), and I stand behind my first answer that oxygen is most important in a hypoxic patient. Also, does the Kaplan question say what is "most important" or "first action"? That makes a difference too. Hydration is probably the most important, over all, but applying oxygen would be the first nursing action.

Just another example of how the NCLEX does not prepare students for actual nursing.

I would have picked oxygen on nclex if I would have gotten that question. Good luck!!

diana, i went back to the notes i took during my live review with feuer and it is OXYGEN first. In big bold letters.

Oxygen. Remember sickle cell is a disease that effects the hemoglobin of the RBC. When cells sickle they cannot carry much oxygen and decrease tissue oxygenation. Also when oxygen level is lowered, it causes more cells to sickle. So while hydration is important in crisis treatment, the first priority should be oxygenation which as Ashley pointed out only takes a few seconds.

Here is an excerpt from PubMed:

Sickle cell anemia is caused by an abnormal type of hemoglobin called hemoglobin S. Hemoglobin is a protein inside red blood cells that carries oxygen. Hemoglobin S changes the shape of red blood cells, especially when the cells are exposed to low oxygen levels. The red blood cells become shaped like crescents or sickles.

The fragile, sickle-shaped cells deliver less oxygen to the body's tissues. They can also get stuck more easily in small blood vessels, and break into pieces that interupt healthy blood flow.