A 7-year-old child is admitted to the hospital with a diagnosis of acute rheumatic fever. In obtaining a health history from the child's mother, the recent occurrence of which illness is most significant?

A. Jaundice is a common finding in individuals with sickle cell disease due to the breakdown of sickled red blood cells. While jaundice should be monitored and reported, it is not as immediately concerning as chest pain in the context of a sickle cell crisis.

B Chest pain.

Sickle cell disease is characterized by the presence of abnormal hemoglobin that can lead to the formation of sickled red blood cells. During a sickle cell crisis, these abnormal cells can block blood vessels, leading to tissue damage and severe pain. Chest pain in a child with sickle cell disease can be indicative of a potentially life-threatening complication called acute chest syndrome, which is a serious condition that requires immediate medical attention. Acute chest syndrome can lead to impaired oxygen exchange and respiratory distress, making it a medical emergency.

C. Swelling in the hands or feet can be associated with vaso-occlusive episodes in sickle cell disease, but it may not be as immediately concerning as chest pain.

D. Ulcers on the legs can be a complication of sickle cell disease, but they are not typically as acutely life-threatening as chest pain due to acute chest syndrome.

Chest pain should be treated as a medical emergency in a child with sickle cell disease during a sickle cell crisis, and the healthcare provider should be informed immediately to initiate appropriate intervention.

A. Giving the injection in the arm, one to 2 inches below the acromion process, is a technique typically used for adults or older children. It may not be suitable for a toddler of this age.

B. Using a needle length of 1/2 inch is not appropriate for intramuscular injections in a toddler. It may not reach the muscle tissue, leading to ineffective administration.

C. Dividing the gluteal area into quarters and giving the injection into the upper outer quadrant is a technique typically used for older children and adults, not for toddlers. It's also important to avoid intramuscular injections in the gluteal area for young children due to the risk of injury to the sciatic nerve.

D. Administering the injection into the middle of the lateral aspect of the thigh is the preferred technique for intramuscular injections in toddlers. The thigh muscles are a safe and effective site for IM injections in this age group. The middle of the lateral aspect of the thigh is commonly chosen because it provides a sufficient muscle mass for proper absorption of the medication and minimizes the risk of injury to nerves or vessels. This technique is recommended for toddlers who are walking and have developed sufficient muscle mass in the thigh area.