Which of the following would the nurse identify as the priority nursing diagnosis during a toddler’s vaso-occlusive sickle cell crisis?
A. Ineffective coping related to the presence of a life-threatening disease
B. Decreased cardiac output related to abnormal hemoglobin formation
C. Pain related to tissue anoxia
D. Excess fluid volume related to infection
Correct Answer: C. Pain related to tissue anoxia
For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia. Provide support and carefully position affected extremities. Massage gently affected areas. Apply warm, moist compresses to affected joints and other painful areas. Avoid the use of ice or cold compresses.
Option A: Although ineffective coping may be important, it is not the priority. Monitor and note changes in the level of consciousness, reports of headache, dizziness, development of sensory and motor deficits (hemiparesis or paralysis), and seizure activity.
Option B: Decreased cardiac output is not a problem with this type of vaso occlusive crisis. Accumulation and sickling in peripheral vessels may lead to complete or partial blockage of a vessel with diminished perfusion to surrounding tissues. Sudden massive splenic sequestration of dead cells can lead to shock.
Option D: Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration. Dehydration causes an increase in sickling and occlusion of capillaries other than hypovolemia or a decrease in blood volume. Decreased renal perfusion may indicate vascular occlusion.
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