The home health nurse is visiting a 15-year old with sickle cell disease. Which information obtained on the visit would cause the most concern? The client?

1. A

   Likes to play baseball

2. B

   Drinks several carbonated drinks per day

3. C

   Has two sisters with sickle cell tract

4. D

   Is taking Tylenol to control pain

Appeared in: DHS 2018 shift 1st

Explanation

• The primary concern in sickle cell disease management is preventing vaso-occlusive crises.
• Dehydration is a major, well-established trigger for sickling and vaso-occlusion because it increases blood viscosity.
• Daily consumption of several carbonated drinks, which are often caffeinated and can act as diuretics, poses a significant and constant risk for dehydration.
• This dietary habit is a modifiable risk factor that directly contributes to the likelihood of a painful crisis.

Why Other Options Were Wrong

• Option A: Playing baseball is a form of moderate exercise, which is generally considered safe and beneficial for adolescents with sickle cell disease.
• Option C: This is a statement about the client's family history. Having relatives with sickle cell trait is a genetic fact and does not pose any immediate physical risk or trigger a crisis for the client.
• Option D: Acetaminophen (Tylenol) is a standard and appropriate first-line analgesic for managing mild to moderate pain in sickle cell disease.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of precipitating factors for sickle cell crisis to guide bedside assessment, documentation, and the next nursing action.
• Patient education is a cornerstone of nursing care for sickle cell disease. Nurses must teach patients and families to identify and avoid crisis triggers.
• The most effective interventions are often preventive. Emphasizing the importance of consistent, adequate hydration (preferably with water) over other beverages is a key teaching point.
• What if? If the client reported drinking a large bottle of water before and after every baseball game, it would show good self-management of exercise-related risks. This would make the daily carbonated drink habit an even more prominent concern as it represents an unmanaged, ongoing risk.

How to Approach the Question

• First, identify the central issue of the question. It asks for the most concerning finding in a teenager with sickle cell disease, which points to the greatest risk for an acute crisis.
• Recall the primary triggers for a sickle cell (vaso-occlusive) crisis. The main triggers are dehydration, hypoxia, infection, acidosis, and extreme temperatures.
• Systematically evaluate each option based on its potential to precipitate a crisis.
• Option A (baseball) is a conditional risk related to exertion and potential dehydration, but it's manageable and not inherently negative.
• Option B (carbonated drinks) presents a direct, daily risk for dehydration, a primary trigger.
• Option C (family history) is a non-modifiable genetic fact, not a trigger for a crisis.

Concept Tested & Keywords

• Concept Tested: Identification of precipitating factors for sickle cell crisis.
• Stem keywords: sickle cell disease, 15-year old, home health nurse, most concern
• Lead-in keywords: most concern
• Clinical cues: The patient has a chronic condition (sickle cell disease) with known triggers for acute exacerbations.

Question ID

QiBlAlxPLWPLHv48PBzSFz

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 762-764, 770-772

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 144-146