Maria Hernandez Scenario 1
Assessment reveals: left knee swollen, red, and tender to touch. Pain is rated 9/10. Temperature is 102.3,
RR 49, B/P 130/74, HR 110 pulse oximeter is 86% on room air. Maria is crying, unable
...
Maria Hernandez Scenario 1
Assessment reveals: left knee swollen, red, and tender to touch. Pain is rated 9/10. Temperature is 102.3,
RR 49, B/P 130/74, HR 110 pulse oximeter is 86% on room air. Maria is crying, unable to be consoled. Her
mother is very anxious.
ord
er Step Explanation
1 Start O2 per face mask at 4 L/min Sickle cell crisis occurs and limits oxygenation of tissue resulting in
hypoxia and increased pain
2 Obtain urine specimen for
urinalysis and culture and
sensitivity
Should be taken prior to trauma of needle stick (lab draw)
3 Start IV and draw CBC, BMP This avoids multiple sticks (related to IV fluids altering lab values)
and gives baseline lab work to determine other issues or infections
4 Initiate IV fluids d5 ½ NS at 75
ml/hour
IV hydration is needed to prevent dehydration
5 Administer Morphine Sulfate 4
mg/IV per MD order
Relieve intense pain of sickle cell crisis
Six hours later, on the pediatric floor, the mother is asking how they could have prevented this crisis from
happening. Vital signs are improved, the child states pain is now a 2/10 in her left knee. Urinalysis comes
back positive for bacteria.
ord
er Step Explanation
1 Ask the mother what she knows about sickle cell crisis
and triggers for this disorder
Obtain baseline information before initiating
teaching
2 Assess the child’s nutritional status through a 24- hour
diet recall (child prefers chicken nuggets, French fries,
and soft drinks for lunch)
Poor nutrition can play a role in a sickle cell crisis
3 Ask the child what she most likes to drink Caffeinated drinks can cause dehydration
4 Provide additional information on nutrition, hydration,
prevention of illness to the mother
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