A nurse is caring for an 8-year-old child who has sickle cell anemia and is recovering from a vaso-occlusive crisis. Which of the following precautions should the nurse include in the discharge teaching?
Drink eight glass of fluid daily.
Maintain an updated hemophilus influence type b immunisation
Avoid playground activities at school
Assume postural drainage positions every 6 hrs
The Correct Answer is A
A. Drink eight glasses of fluid daily: This is crucial advice for patients with sickle cell anemia, as adequate hydration helps prevent sickling of red blood cells and reduces the risk of vaso-occlusive crises. Therefore, this precaution is appropriate and should be included in discharge teaching.
B. Maintain an updated Haemophilus influenzae type b (Hib) immunization: While vaccination is essential for overall health, maintaining Hib immunization is not directly related to sickle cell anemia or vaso-occlusive crises. However, it's still important for the child's general well-being and should be addressed but may not be the priority in discharge teaching for sickle cell anemia.
C. Avoid playground activities at school: Children with sickle cell anemia are at risk of vaso-occlusive crises triggered by dehydration, fatigue, or extreme physical exertion. While playground activities can be strenuous, completely avoiding them may not be necessary. Instead, the child should be educated on the importance of staying hydrated, taking breaks when needed, and avoiding excessive physical strain.
D. Assume postural drainage positions every 6 hours: Postural drainage is not typically indicated for sickle cell anemia or vaso-occlusive crises unless there are specific respiratory complications. This precaution is not relevant to the management of sickle cell anemia and should not be included in discharge teaching for this condition.
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Related Questions
Correct Answer is D
Explanation
A. Instruct the client to cough. Coughing is generally encouraged after chest physiotherapy to help expel loosened secretions, but it is not the first action. The bronchodilator should be administered first to maximize the effectiveness of the chest physiotherapy.
B. Perform vibration while the client exhales slowly through the nose. Vibration is a component of chest physiotherapy used to help loosen secretions during exhalation, but it is performed after the bronchodilator is administered and once the client is positioned properly.
C. Percuss the upper posterior chest.Percussion helps to mobilize secretions but is typically done after the bronchodilator has been administered to allow for more effective airway clearance.
D. Administer albuterol by nebulizer.Administering albuterol first dilates the airways, making it easier to mobilize and clear secretions during percussion, vibration, and postural drainage.
Correct Answer is B
Explanation
A. Pulmonary function test:
Pulmonary function tests (PFTs) assess lung function by measuring airflow, lung volume, and gas exchange. While PFTs can provide valuable information about respiratory function, they are not specific to cystic fibrosis and may show abnormalities consistent with various respiratory conditions. However, PFTs are often performed in individuals with cystic fibrosis to monitor lung function over time and assess response to treatment. They are not considered the most definitive test for diagnosing cystic fibrosis.
B. Sweat chloride test:
This option is correct. The sweat chloride test is considered the most definitive diagnostic test for cystic fibrosis. It measures the concentration of chloride in sweat, which is typically elevated in individuals with cystic fibrosis due to defective chloride transport in sweat glands. A sweat chloride concentration above a certain threshold (usually ≥60 mmol/L) is diagnostic of cystic fibrosis, particularly when confirmed with repeat testing.
C. Stool fat content analysis:
Stool fat content analysis evaluates fat absorption and fecal fat excretion, which may be impaired in individuals with cystic fibrosis due to pancreatic insufficiency. However, while stool fat content analysis can provide supportive evidence of malabsorption in cystic fibrosis, it is not considered the most definitive test for diagnosing the condition. Stool fat content analysis is often used in conjunction with other diagnostic tests to assess pancreatic function and nutritional status in individuals with cystic fibrosis.
D. Sputum culture:
Sputum culture involves culturing respiratory secretions to identify bacterial pathogens, which can be useful for diagnosing respiratory infections in individuals with cystic fibrosis. However, sputum culture is not specific to cystic fibrosis and may show similar findings in other respiratory conditions. While respiratory cultures are important for guiding treatment in cystic fibrosis, they are not considered the most definitive test for diagnosing the condition.
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