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Which advice to follow, Kaplan or Saunders SICKLE CELL

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A patient with sickle cell and experiencing pain

Saunder's says: do not give demerol because of risk for normeperidine induced seizures , give analgesics round the clock

Kaplan says: give demerol to decrease pain (Qtrainer 6 question 101)

What if im presented with the same question on NCLEX? and with the same options? Which answer choice should i pick? saunders or kaplan?

thanks

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

Not knowing what NCLEX would choose, I'd lean toward the evidence-based choice: Saunders.

You'll note that many hospitals are removing demerol as a pain medication and automatically replacing demerol orders with morphine or dilaudid for this very reason. Also, giving medications around the clock makes sense because it's easier to prevent pain than it is to relieve it and there's a definite expectation of severe pain in acute sickle cell crisis.

Morphine sulfate as I have remembered in my review is the drug of choice for pain in sickle cell crisis

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

It's true that morphine is a vasodilator, but so is dilaudid and other opiates. I would imagine they'd both be acceptable choices.

Kaplan says: give demerol to decrease pain (Qtrainer 6 question 101

what were the other choices? or was this the rationale?

Demerol is rarely being used for acute pain control in the hospital settings any longer, it is used more for chronic type pain so would not be first choice for someone with sickle cell crisis.

I can promise that you are not going to be seeing this same question on the exam. You do need to understand how sickle cells move thru the body, this may help you pick the right answer.

What do you think would help in making the patient more comfortable, and why? Try to think of disease processes like this, it will make it easier for you to get thru the exam. What would be your priority in someone presenting in crisis? Think along those lines as a start.

i have encountered stuff like this too, wherein i read from kaplan is different from what i learned from saunders or from what i learned on my medical surgical textbooks in nursing school, i hope there's some advices on how we can answer those types of questions.

Kaplan says: give demerol to decrease pain (Qtrainer 6 question 101

what were the other choices? or was this the rationale?

2 of the choices were obviously wrong (position of the patient)

the other option is analgesic.

rational for giving demerol in a sickle cell crisis according to kaplan is that "it is used to treat mild to severe pain"

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

2 of the choices were obviously wrong (position of the patient)

the other option is analgesic.

rational for giving demerol in a sickle cell crisis according to kaplan is that "it is used to treat mild to severe pain"

While it is no doubt true that demerol treats mild to severe pain, and I can see how it would have been the correct answer in the past, it is no longer best practice to use demerol.

Here is an article describing this exact topic:

Meperidine for acute sickle cell crisis: what is the rationale?

Ann Emerg Med. 2008 Dec;52(6):766-7.

The full text isn't free-- you need institutional access otherwise I'd post it here. Basically, it reviews and determines the only reason demerol is used over other opiates is physician habit and patient's stated preference.

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

Pub med has other articles on the topic:

Why meperidine should not make a comeback in treating patients with sickle cell disease.

Ann Emerg Med. 2008 Feb;51(2):202-3

Here's a nursing journal reference:

A shift from demerol (meperidine) to dilaudid (hydromorphone) improves pain control and decreases admissions for patients in sickle cell crisis.

J Emerg Nurs. 2004 Oct;30(5):439-46.

The risk of normeperidine toxicity-the buildup of the meperidine's pharmacologically ac- tive metabolite-is especially high for patients with sickle-cell disease (who often have impaired renal function and cerebrovascular deficits), patients with renal insufficiency, and elderly patients. Without treatment, normeperidine toxicity can lead to death.

Because of the potential for toxic effects, meperidine is no longer a first-line choice for opioid analgesia. Patients with a history of hypersensitivity to morphine may be given meperidine for acute pain, under close monitoring. For patients in sickle-cell crisis, who need high opioid dosages, I.V. morphine is a better choice for pain management.

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