Rachel Kizer.

Peds. Week 2

Maria Hernandez, 6-year-old female, weighing 39.6 lbs. with a history of Sickle Cell Disease. She has
presented to the ED in sickle cell crisis and has a history of UTIs. Vital signs: Temp 101.8 F, 38.8 C, B/P
131/79, HR 108, PaO2 87% room air, RR 51

Health Increased acuity .

LOC Increased acuity

Pain Normal acuity

Psych Normal acuity

Safety increased

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Assessment has shown left knee swollen, red, and tender to touch. Pain is rated 9/10. Temperature is

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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.

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Start O2 per face mask at 4 L/min, Sickle cell crisis occurs and limits oxygenation of tissue
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resulting in hypoxia and increased pain

Obtain urine specimen for urinalysis and culture and sensitivity-Should be taken prior to trauma
of needle stick (lab draw)
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Start IV and draw CBC, BMP-This avoids multiple sticks (related to IV fluids altering lab values)
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and gives baseline lab work to determine other issues or infections

Initiate IV fluids d5 ½ NS at 75 ml/hour IV hydration is needed to prevent dehydration

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Administer Morphine Sulfate 4 mg/IV per MD order Relieve intense pain of sickle cell crisis
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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.

Ask the mother what she knows about sickle cell crisis and triggers for this disorder Obtain
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baseline information before initiating teaching

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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

Ask the child what she most likes to drink-Caffeinated drinks can cause dehydration
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Provide additional information on nutrition, hydration, and prevention of illness to the mother
The assessment of the mother and child demonstrates the need for further teaching and
reinforcement of teaching

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 Based on education, provide the child with healthy options for fluid intake-The child needs to
stay hydrated to reduce change of another sickle cell crisis

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This study source was downloaded by 100000762814619 from CourseHero.com on 12-01-2021 11:38:28 GMT -06:00

https://www.coursehero.com/file/67768061/Rachel-Kizer-pedsdocx/
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