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 Reason:

Moisten the mucosa with lemon glycerin swabs. Lemon glycerin swabs might be too acidic and can cause irritation or discomfort in oral ulcers. Using them could exacerbate the toddler's condition.

Choice B Reason:

Cleanse the gums with saline-soaked gauze. This action can help maintain oral hygiene and reduce the risk of infection in the oral ulcers. Saline is gentle and can help keep the affected area clean without causing further irritation.

Choice C Reason:

Administer oral viscous lidocaine. Lidocaine is a local anesthetic that may be used in some cases for pain relief, but its use in oral ulcers for toddlers might not be recommended due to potential risks and concerns about ingestion, especially in young children.

Choice D Reason:

Schedule routine oral care every hour. While oral care is essential, performing it too frequently (every hour) might cause more discomfort and irritation to the already sensitive oral ulcers. Gentle, regular care is important, but excessive cleaning can be detrimental.

Choice A Reason:

Insert an IV catheter for the toddler. While establishing IV access is important for administering medications and fluids, in this scenario, securing the airway takes precedence due to the immediate threat to the child's ability to breathe. Intubation to ensure a clear airway and adequate oxygenation is more critical at this moment.

Choice B Reason:

Prepare the toddler for nasotracheal intubation. These symptoms—hyperpyrexia, severe dyspnea, and drooling—can be indicative of epiglottitis, a potentially life-threatening condition where the airway can become severely compromised due to swelling of the epiglottis. Immediate intervention to secure the airway is crucial in such cases to ensure the child can breathe adequately.

While obtaining an IV catheter, blood culture, and administering antibiotics are important in managing the condition, securing the airway takes precedence in this critical situation to maintain the child's breathing and prevent further respiratory compromise.

Choice C Reason:

Obtain a blood culture from the toddler. Obtaining a blood culture is an essential diagnostic step in identifying potential infections or causes but is not the immediate priority when a child is experiencing severe respiratory distress. Stabilizing the airway and breathing take precedence in this critical situation.

Choice D Reason:

Administer an antibiotic to the toddler. Administering antibiotics might be part of the treatment plan, especially if an infection is suspected, but in an emergent situation where the airway is compromised, securing the airway is the primary concern to ensure the child's ability to breathe and maintain oxygenation.