A nurse is planning care for an adolescent who has sickle cell anemia.
Which of the following immunizations should the nurse include in the plan?

Choice A rationale:

Limiting fluids at bedtime is not a suitable instruction for a child with sickle cell disease. These patients are at risk of dehydration due to increased red blood cell destruction, and limiting fluids can exacerbate this condition, leading to vaso-occlusive crises and pain episodes.

Choice B rationale:

Applying cold compresses to painful areas might provide temporary relief for pain associated with sickle cell disease, but it does not address the overall management of the illness. Encouraging physical activity, on the other hand, is essential as it promotes overall health and can prevent complications like thrombosis.

Choice C rationale:

Encouraging physical activity as tolerated is the correct choice. Regular physical activity helps improve circulation and can reduce the risk of vaso-occlusive crises in patients with sickle cell disease. The nurse should advise the guardians to encourage the child to engage in activities that are appropriate for their age and physical condition, while also being mindful of any signs of fatigue or pain.

Choice D rationale:

Having the child wear a surgical mask to school is not relevant to the management of sickle cell disease. This measure is more appropriate for preventing the spread of contagious diseases and is not a specific intervention for sickle cell disease management.

Choice A rationale:

Contacting the client's parents for phone consent might breach the adolescent's confidentiality, especially if they are seeking STI testing. In many jurisdictions, adolescents have the right to confidential healthcare, including STI testing and treatment, without parental consent. Respecting the adolescent's autonomy and confidentiality is crucial in this situation.

Choice B rationale:

Obtaining written consent from the client, if they are of legal age (which is often 16 or older in many jurisdictions), is appropriate and respects the adolescent's autonomy and legal rights. Written consent ensures that the adolescent fully understands the tests being conducted and gives informed consent for the procedure.

Choice C rationale:

Requesting verbal consent from the social worker is not appropriate. Verbal consent can be ambiguous and may not provide sufficient legal documentation of informed consent, especially for sensitive procedures like STI testing.

Choice D rationale:

Postponing the testing until the client's parents are present might not be in the best interest of the adolescent, especially if they are seeking timely healthcare. Delays in testing and treatment could lead to complications or the spread of STIs. Respecting the adolescent's autonomy and providing appropriate, timely care is essential in this situation.