SICKLE CELL CRISIS: Oxygen or Fluids??

Nursing Students NCLEX


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.

I can't remember which material I've read but it said "fluids". But the question is on 'preventing' something like that. While reading that, I remembered this thread. I guess it all depends on what the question is asking.

Hurst says: Least invasive First.

So give O2 first priority.

IV fluids is second.

But like everyone said before...if the RBC can't carry oxygen, the oxygen won't help. Also fluids will help the actual problem...I just dunno.

Specializes in LTC/Pediatrics.

Fluid it is!

Fluid = dilution = more blood circulating, then OXYGEN comes in his role which then will decrease the pain

Just think of it this way, how will the oxygen works if there's not much fluid to move blood all over the body.

According to Comprehensive Review for NCLEX-RN (p.1329):

Care of client in sickle cell crisis

a. Recognize that client may have severe pain and medicate accordingly, usually with opioid analgetics

b.administer O2 to increase oxygenation to cell

c. Promote hydration to decrease blood viscosity, provide oral intake of at least 6 to 8 quarts daily or IV fluids of 3 liters daily.

d. monitor for complications such as vaso-oclusive diseaase(thrombosis), hypoxia....

With normal oxygenation, sickled RBCs resume normal shape, then hydrate to decrease blood viscosity.

My Lewis book also says that the "most common cause" of a sickling crisis is hypoxia. It says that with giving oxygen, it reverses the sickling. I'm still not sure who's more correct. I'll ask the Hurst people this week when I go.

Oxygen first because it's the easiest and non-invasive way.

Hey, Just focus on the big ones. The Kaplan book seems to have a good review of main disease processes. Check it out

If only it was that easy to give fluids and stop the pain. Not that this matters but in real life (a family member has Sickle Cell). He rests and takes pain meds. When it is so bad that he needs to go to the hospital, when he gets there they start by giving him oxygen while they prepare the pain meds. Then they cautiously give fluids and try to convince him to accept a blood transfusion...But of course I know the real world is nothing like that NCLEX hospital.

I do not think it's pain relief. If you unclump the sickled cells by giving fluids there wouldn't be any pain.

But I thought pain is psychological in "nclex land". I was confused on this too. So I guess I will choose fluids if I come across this in nclex.

Specializes in LTC/Pediatrics.
But I thought pain is psychological in "nclex land". I was confused on this too. So I guess I will choose fluids if I come across this in nclex.

But pain is the result of an underlying condition that IS needed to be treated right away which is sickling of the RBC. Pain associated with chronic conditions is an expected outcomes therefore I think those are considered more like psychological. That's just what I think.

I chose fluids too before but I'm going with oxygen this time. Its the least harmful between the 2 and its directly addressing or fixing the sickling. There goes my :twocents:

This question is very confusing due to the fact that every book has a different answer. My answer will be to administer oxygen and LaCharity PDA book support that answer. It said in chapter 7: hematologic problem question 3 answer

"hypoxia and deoxygenation of the red blood cells are the most common cause of sickling, so administration of oxygen is te priority intervention here. Pain control and hydration are also important interventions for this client and should be accomplished rapidly."

Lacharity, L., Kumagai, C., & Bartz B.(2006).Prioritization, Delegation, and Assignment: Practice Exercises for Medical-Surgical Nursing. Elsevier ( p. 43&181)

P.S: i suck at APA citing, sorry about that!!

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