A patient is to be discharged in a plaster spica cast. Which statement would indicate the need for further teaching with the patient's parent?

Choice A rationale:

Ketonuria is the presence of ketones in urine and is not directly associated with vaso-occlusive crisis in sickle cell anemia. This crisis typically involves pain and ischemia in various body parts.

Choice B rationale:

Diplopia refers to double vision and is not a typical symptom of vaso-occlusive crisis. Pain, not vision changes, is the primary concern in this scenario.

Choice C rationale:

Severe abdominal pain can be a symptom of vaso-occlusive crisis in sickle cell anemia, but the patient's complaint of left elbow pain would not directly correlate with this choice.

Choice D rationale:

Hyperactive patellar reflex is the correct answer. During vaso-occlusive crisis, the body's response to pain can lead to increased muscle tone and reflexes, including hyperactive deep tendon reflexes like the patellar reflex. This is an indicator of neurologic involvement in the crisis. Remember that these rationales are intended to provide a concise understanding of the correct answers based on the information provided in the questions. Always refer to medical literature and consult with healthcare professionals for comprehensive and accurate information.

Choice A rationale:

Strict isolation should begin immediately after exposure. This choice is incorrect because chickenpox does not require strict isolation immediately after exposure. The incubation period of chickenpox is about 10-21 days, during which communicability has not yet begun.

Choice B rationale:

Communicability begins prior to the eruption of lesions. This choice is correct. Chickenpox is highly contagious, and individuals can transmit the virus to others even before the characteristic skin lesions appear. This understanding is crucial for appropriate room assignment to prevent the spread of the virus to other patients.

Choice C rationale:

Strict isolation should begin as soon as the skin lesions erupt. This choice is incorrect. While isolation precautions are necessary for patients with active chickenpox lesions, waiting until the lesions erupt is not sufficient to prevent transmission, as communicability starts before this stage.

Choice D rationale:

Communicability begins 14 days after exposure. This choice is incorrect. The correct timing for the onset of communicability is much earlier than 14 days after exposure. Waiting until this point for isolation would not effectively prevent transmission.