A nurse is assisting with the care of a 7-year-old child.

Exhibits

The nurse is reviewing the data collection findings and diagnostic results. For each data collection finding, click to specify if the finding is consistent with leukemia, sickle cell anemia, or hemophilia. Each finding may support more than 1 disease process.

Reported pain

• Leukemia: Possible, as bone pain can occur due to marrow involvement.
• Sickle Cell Anemia: Yes, common due to vaso-occlusive crises.
• Hemophilia: No, hemophilia typically causes bleeding rather than pain from blood cell abnormalities.

Bleeding

• Leukemia: Yes, due to thrombocytopenia.
• Sickle Cell Anemia: No, bleeding is not typical in sickle cell crises.
• Hemophilia: Yes, hemophilia is a bleeding disorder due to a clotting factor deficiency.

Temperature

• Leukemia: Yes, fever can indicate infection due to immunosuppression.
• Sickle Cell Anemia: Yes, fever can be a sign of infection during crises.
• Hemophilia: No, hemophilia does not cause fever unless there is an infection.

Bruising

• Leukemia: Yes, thrombocytopenia can lead to easy bruising.
• Sickle Cell Anemia: No, bruising is not typical in sickle cell crises.
• Hemophilia: Yes, due to a clotting factor deficiency, easy bruising is common.

WBC count

• Leukemia: Yes, often elevated due to immature or abnormal white cells.
• Sickle Cell Anemia: No, WBC count is usually normal unless there is an infection.
• Hemophilia: No, WBC count is typically normal in hemophilia.

A. Initiate a 2 L/day fluid restriction: Hydration is crucial in sickle cell crisis to prevent further sickling and reduce blood viscosity. A fluid restriction would worsen the crisis.

B. Assist with administering a blood transfusion: Blood transfusions are commonly given during sickle cell crisis to manage anemia and reduce the concentration of sickled cells, which can improve oxygen delivery and relieve pain.

C. Withhold opioids to avoid dependence: Pain management, including opioids if needed, is essential during a sickle cell crisis. The risk of dependence is secondary to controlling acute pain.

D. Encourage exercise: Rest is recommended during a crisis to reduce oxygen demand and prevent further sickling. Exercise would increase oxygen needs, worsening the crisis.