A nurse in a pediatric clinic is talking with a parent of a toddler. The parent tells the nurse that her toddler drinks a quart of milk a day. The nurse should recognize that the toddler is at risk for which of the following disorders?

A. "He takes his medication between meals with water." Taking carbamazepine with food helps reduce gastrointestinal upset, but taking it between meals is not critical unless there are specific issues. This is not a priority unless the patient is experiencing significant GI discomfort.

B. "He only sleeps about 5 hours each night." Insufficient sleep can exacerbate seizure disorders, but it is not directly life-threatening. Improving sleep hygiene is important but not the most immediate concern compared to other symptoms.

C. "He seems to be getting a lot more bumps and bruises lately." Increased bruising can indicate thrombocytopenia, a potential side effect of carbamazepine, which can lead to serious bleeding issues. This is the priority as it may indicate a severe adverse effect requiring immediate medical attention and possible adjustment of medication.

D. "He has not been eating as much lately." Decreased appetite can be a side effect of many medications, including carbamazepine, but it is generally not immediately dangerous unless it leads to significant weight loss or nutritional deficiencies. It’s important but not the most urgent concern.

A. Assist with administering a blood transfusion. Blood transfusions are often necessary in sickle cell crisis to manage severe anemia and improve oxygen delivery to tissues. This action helps alleviate the symptoms of the crisis and prevent complications.

B. Withhold opioids to avoid dependence. Opioids are essential for managing the severe pain associated with sickle cell crises. Concerns about dependence should not prevent adequate pain management in an acute setting.

C. Encourage exercise. During a sickle cell crisis, rest is crucial to reduce oxygen demand and prevent further sickling of red blood cells. Exercise is contraindicated during a crisis.

D. Initiate a 2 L/day fluid restriction. Adequate hydration is critical in managing sickle cell crisis, as it helps prevent further sickling of cells. Fluid restriction is inappropriate and could worsen the condition.