SICKLE CELL CRISIS: Oxygen or Fluids??

[SiempreBella]

Which one do you do first? I have done a couple of questions and some books say fluids others say oxygen. I'd like to know which one the NCLEX people want. Any input is appreciated. Thank you.

[Bella_heather]

Fluids is definitely the correct answer.

Hydration acts kinda like draino, it helps remove the occlusion of sickled cells in the vessels.

Oxygen, although it may prevent further sickling, is not effective in reversing sickling or reducing pain because with the vessels clogged with cells the oxygen is not able to reach the sickled RBCs.

Hope that clears some things up.

[pauline0276]

Only one will reverse the cause. Fluids which cause hemodilution so that the sickled cells do not clump together. 02 treats symptoms. Fluids treat the cause this is first.

I agree...

[lilmissiD]

Okay all, Here is a twist to the topic of review for NCLEX

The priority nursing interventions for a child in sickle cell crisis include administering: (choices listed in this combo form)

a. Heparin/initiation of chelation therapy

b. opioid analgesics & providing oxygen

c. broad spectrum atb & assessing for splenic atrophy

d. iv fluids & monitoring serum bilirubin levels

(child and in SC crisis already - I have my initial answer/rational- wanting feedback- doubtful and all resources have different conclusions or not detailed enough

-thank you in advance for replies

(my NCLEX exam within next two weeks)

[morte, LPN, LVN]

Okay all, Here is a twist to the topic of review for NCLEX

The priority nursing interventions for a child in sickle cell crisis include administering: (choices listed in this combo form)

a. Heparin/initiation of chelation therapy

b. opioid analgesics & providing oxygen

c. broad spectrum atb & assessing for splenic atrophy

d. iv fluids & monitoring serum bilirubin levels

(child and in SC crisis already - I have my initial answer/rational- wanting feedback- doubtful and all resources have different conclusions or not detailed enough

-thank you in advance for replies

(my NCLEX exam within next two weeks)

i would be going with D

[lilmissiD]

Can you share your rational on coming to that decision?

I thought that is/was a good choice also- until I continued thought process, and research pointed me in other directions. Fluids as initial intervention in children can cause issues w/lungs,

"Children with SCD have increased risk for dehydration secondary to the inability of the kidneys to concentrate urine (hyposthenuria) In children with SCD, the body doesn't hold on to water, in response to dehydration. The urine specific gravity of a patient/child with sickle cell disease, therefore, is an inaccurate measure of hydration status because of the ongoing dilution of urine regardless of the body's hydration status.

Any increased need for fluid, such as during fever or due to decreased oral intake, must be met by increasing the overall intake of fluid without waiting for symptoms of dehydration, typically a late manifestation in the child with SCD- (Reid et al 1997)

Complications of acute painful episodes. The most common and dangerous complication of an acute painful episode is acute chest syndrome. (Vichinsky et al., 1997).

Although, in crisis situation, it would be considered late manifestation, so - again? not sure....- but all these factors are giving me the questions on each answer I think is the correct one.

I would love to hear your rational please!

[pauline0276]

kaplan says "fluids" is the priority..

[lilmissiD]

thank you all,

i posting answer/ & info that i was provided for anyone that is interested; i hope this is beneficial to you- we now have yet another outcome regarding sickle cell crisis.

according to ati, and nclex prep; answer; b -pain management and o2 is the answer to the posted question regarding first priority for a child in sickle cell crisis; then fluids-

til the next multi-optioned answer 'question' comes my way....have a great learning day!

[caliotter3]

Thanks for posting lilmissiD. Can see that answer when one focuses on the the word, "first".

[bbqPOtid]

This question is out of the new second edition LaCharity Prioritization, Delegation and Assignment...

A 32 year-old patient with sickle cell anemia is admitted to the hospital during sickle cell crisis. Which of these physician orders will you implement first?

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

2. Administer 100% oxygen using a nonrebreather mask.

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

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

Answer is 2. Rationale: Hypoxia and deoxygenation of the RBCs are the most common cause of sickling, so administration of oxygen is the priority intervention here. Pain control and hydration are also important interventions for this patient and should be accomplished rapidly.

[Nurse Shanta]

Fluids first...then Oxygen!

[-alwaysbelieve-]

when i think of sickel cell crisis i think: hop

hydrate

oxygen

pain meds

- given in that order...makes it easy for me to remember which comes first =)

[kgh31386, BSN, MSN, RN]

Bringing back a thread from the dead...all 3 sources give 3 different answers. one says oxygen first, one says fluids first, one says pain medicine first....what does the NCLEX! want?!?