A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include which intervention? (Select all that apply.).
Correction of acidosis.
Adequate hydration.
Pain management.
Administration of heparin.
Replacement of factor VIII.
Correct Answer : B,C,E
Choice A rationale:
Correction of acidosis is not the primary intervention for vaso-occlusive sickle cell crisis. The crisis primarily involves pain due to the obstruction of blood flow by sickled cells. Correcting acidosis is not a direct treatment for this condition.
Choice B rationale:
Adequate hydration is essential in managing vaso-occlusive sickle cell crisis. Proper hydration helps prevent dehydration, which can worsen the crisis and lead to complications. Hydration helps maintain blood flow and prevent further sickling of red blood cells.
Choice C rationale:
Pain management is a crucial intervention for a child with vaso-occlusive sickle cell crisis. Pain results from tissue ischemia caused by sickled red blood cells. Effective pain management, often with analgesics, helps improve the child's comfort and quality of life during the crisis.
Choice D rationale:
Administration of heparin is not indicated for vaso-occlusive sickle cell crisis. Heparin is an anticoagulant that prevents blood clot formation. In sickle cell crisis, the primary issue is the obstruction of blood flow by sickled cells, not the formation of clots. Administering heparin may not address the underlying problem and can lead to potential complications.
Choice E rationale:
Replacement of factor VIII is not relevant to vaso-occlusive sickle cell crisis. Factor VIII is a protein involved in blood clotting and is primarily used in the treatment of hemophilia, a different condition unrelated to sickle cell crisis.
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Correct Answer is D
Explanation
Choice A rationale:
Abdominal respirations do not directly predispose toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections. Abdominal respirations are a normal breathing pattern in toddlers, transitioning from the diaphragmatic breathing seen in infants. This change is due to the toddler's increased chest wall compliance and stronger intercostal muscles, facilitating more efficient breathing.
Choice B rationale:
Slower pulse and respiratory rates in toddlers compared to infants are part of normal physiological development. Toddler's heart rates range from 70 to 110 beats per minute, and respiratory rates range from 20 to 30 breaths per minute. These rates are considered normal for toddlers and do not predispose them to frequent infections.
Choice C rationale:
Toddlers do have less efficient defense mechanisms than infants, making them more susceptible to infections. This is due to the immature immune system in toddlers, which is still developing and learning to respond to various pathogens. However, this choice is not the most important factor predisposing toddlers to frequent infections; other factors play a more significant role.
Choice D rationale:
The presence of short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue in toddlers is the most important factor predisposing them to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections. These anatomical features make it easier for bacteria and viruses to enter and infect the respiratory and ear passages, leading to recurrent infections.
Correct Answer is A
Explanation
Choice A rationale:
The symptoms described by the baby's father, including confusion and having conversations with herself, are concerning and could indicate a severe mental health issue or a neurological problem. Urgent evaluation in an emergency room is necessary to rule out any acute medical or psychiatric condition that could be causing these symptoms. This is crucial for ensuring the safety and well-being of both the mother and the newborn.
Choice B rationale:
Bringing the wife to the office for medication is not appropriate in this situation without a proper evaluation. The symptoms described are severe and require immediate attention in an emergency room setting, where comprehensive assessments can be conducted.
Choice C rationale:
Outpatient care is not suitable for the described symptoms. The mother's confusion and hallucinations suggest a severe condition that requires urgent evaluation in a controlled environment like an emergency room. Outpatient care might be considered after the initial assessment and stabilization, but the immediate concern is the acute nature of the symptoms.
Choice D rationale:
Behavioral therapy is not appropriate for the described
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