QLexNursing

A. Administer folic acid as prescribed

🩸 Folic acid is a key component of treatment in sickle cell disease to support ongoing erythropoiesis.

🩸 Due to chronic hemolysis, individuals with SCD have a high turnover of red blood cells, which increases the body's need for folate, a vitamin essential for DNA synthesis and cell division.

🩸 Folic acid supplementation helps prevent megaloblastic anemia and supports the production of healthy RBCs, which can reduce symptoms over time.

🩸 It is a maintenance therapy, not specific to the acute episode but critical for long-term management.

B. Monitor oxygen saturation continuously

🩸 Hypoxia is a potent trigger for sickling of red blood cells, which leads to vaso-occlusion, ischemia, and pain.

🩸 Continuous monitoring of oxygen saturation enables the nurse to detect early signs of desaturation, which may not be evident through clinical observation alone.

🩸 Ensuring oxygenation above 95% is essential to prevent further sickling and organ damage.

🩸 This allows for timely oxygen therapy and prevents complications like acute chest syndrome, a life-threatening condition in SCD patients.

D. Restrict oral intake

🩸 The adolescent has been vomiting for three days, placing them at risk for fluid and electrolyte imbalances, aspiration, and dehydration.

🩸 While hydration is critical in sickle cell crises to reduce blood viscosity and improve circulation, oral intake should be restricted temporarily until vomiting subsides.

🩸 IV fluids are the safer route to restore volume and maintain hydration during acute gastrointestinal symptoms.

🩸 Once symptoms resolve, gradual oral intake can be resumed with careful monitoring.

E. Instruct the parent to ensure the pneumococcal vaccine is current

🩸 Individuals with sickle cell disease are at high risk for encapsulated bacterial infections, especially Streptococcus pneumoniae, due to functional asplenia.

🩸 The pneumococcal vaccine is a critical preventive measure to reduce the risk of life-threatening infections such as sepsis, meningitis, and pneumonia.

🩸 Routine vaccination should be verified and kept up-to-date according to CDC guidelines for children with chronic illnesses.

🩸 This is part of comprehensive education and long-term management, even during hospitalization for acute crises.

H. Give oral hydroxyurea

🩸 Hydroxyurea is a disease-modifying medication that increases fetal hemoglobin (HbF) levels, reducing the number of sickled red blood cells.

🩸 While it's primarily used for long-term prevention, it is typically continued during hospitalization to maintain its effects.

🩸 Hydroxyurea reduces the frequency of vaso-occlusive crises, the need for transfusions, and the severity of chronic pain.

🩸 Its benefits are well-documented in reducing morbidity and mortality in adolescents with moderate to severe sickle cell disease.