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Sickle cell crisis - Nclex world

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by noski noski (Member)

1,899 Visitors; 82 Posts

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For a patient in sickle cell crisis, what will be priority intervention : Hydrate with IV fluids or adm oxygen, which should come first?

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917 Visitors; 12 Posts

Hey noski,

Hydration, hydration, hydration. Oxygen is helpful for preventing a crisis, not reversing one. Hydration is ALWAYS the number one priority for a sickle cell crisis (well, pain too). It decreases the viscosity of the blood, therefore the sickled blood cells don't get caught in the small blood vessels.

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cmmny has 14 years experience.

2,784 Visitors; 52 Posts

Hydration first!

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1,899 Visitors; 82 Posts

Thanks 4 ur quick response Kbarko & cmmny,

we learned in school that you hydrate first, but i was studying the LaCharity book yesterday that had this same question, and to my surprise, their answer was adm oxygen 1st, their rationale was "Hypoxia and deoxygenation of RBC's are the most common cause of sickling, so administration of oxygen is priority" (Chap 7, Q 3)

I did choose hydrate 1st, but i wanted to know other people's thought, i dont want to get confused in the actual test....i'm trying to keep my sanity b4 my big day next week

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3,648 Visitors; 193 Posts

This question seems to come up often. Good luck figuring it out. I am not sure about in a crisis, but HYDRATION is important for prevention, not oxygenation: you wouldn't give O2 to someone who didn't need it yet, right? Now, the jury's still out on what to give during the crisis. It's a stupid question, if you ask me; we'd all slap the O2 on and start an IV without wondering which one to do and then going home!

:-) Good luck!

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3 Followers; 96,635 Visitors; 36,688 Posts

I just know I've seen this question before.

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1,242 Visitors; 6 Posts

I came across your post while searching for sickle cell-hydration. I missed a question on the HESI for PEDS and we have to answer 14questions on the topic of every question we missed. I missed a question on "sickle cell-hydration". I just found in our Peds textbook (Wong's Essentials of Pediatric Nursing, Hockenberry & Wilson, 8th edition, 2009, p.919-920) it says..Severe hypoxia must be prevented because this causes massive systemic sickling that can be fatal. Although oxygen may prevent more sickling, it usually is not effective in reversing sickling because the oxygen is unable to reach the enmeshed sickled erythrocytes in clogged vessels according to Perkins & Chiocca (as cited in Hockenberry & Wilson, 2009, p.919-920). In addition, prolonged administration can depress bone marrow, further aggravating the anemia according to Khoury & Grimsley, Dover & Platt (as cited in Hockenberry & Wilson, 2009, p. 920).

So the way I understand it is in a sickle cell crisis hydration must come first because oxygen can't even reach the cells once the sickling has begun. Once hydration has begun, electrolytes replaced to correct metabolic acidosis due to hypoxia, pain management instituted, blood replaced, and antibiotics for any infection, then the oxygen can be administered to prevent more sickling. At least thats how I understand it. If you have the same text book you can look it up on pg. 918-920. Hope this helps someone because I know I always have a hard time with sickle cell. :)

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367 Visitors; 1 Post

if question is implement first oxygen -LaCharity

if most important Hydration -kaplan

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jayjaybsnrn has 6 years experience and specializes in Dialysis.

4,296 Visitors; 143 Posts

yes i've already read this question.

-If the question is what should you implement FIRST: Oxygen

-What is the MOST IMPORTANT, PRIORITY, FOR PAIN: Liquids/Hydration

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1,916 Visitors; 66 Posts

No, it's definitely HYDRATION 1st if it is during a crisis. Just think about the patho behind a crisis...

The 02 will not get to the sickled cells if the pt is dehydrated and all the cells are clumped together and there is no circulatory mobilization, etc. I also confirmed this with Kaplan.

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