The nurse is caring for a child with sickle cell anemia. To prevent thrombus formation in capillaries, as well as other problems from stasis and clotting of blood in the sickling process, the nurse should?

1. A

   Administer oxygen

2. B

   Increase fluids by mouth

3. C

   Encourage the child to maintain bed rest

4. D

   Administer prescribed anticoagulants

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

• The core problem in sickle cell disease leading to thrombus formation is vaso-occlusion caused by misshapen red blood cells.
• Dehydration is a major trigger for sickling because it increases blood viscosity and the concentration of sickle hemoglobin within cells.
• Increasing oral fluid intake is a fundamental preventative measure. It helps to hemodilute the blood, reducing its viscosity and making it harder for sickled cells to clump together and obstruct capillaries.
• Adequate hydration promotes better circulation and perfusion, directly counteracting the stasis mentioned in the question stem.

Why Other Options Were Wrong

• Option A: Administering oxygen is a treatment for hypoxia, which can occur during a sickle cell crisis. However, it is not the primary preventative measure to avoid stasis and thrombus formation. The root cause of the stasis is the physical obstruction by sickled cells, which oxygen alone does not resolve.
• Option C: Encouraging bed rest can actually be detrimental. Immobility promotes venous stasis, which can increase the risk of developing a separate deep vein thrombosis (DVT). While rest is important to reduce metabolic demands during a painful crisis, complete bed rest is not a preventative strategy for capillary occlusion.
• Option D: The 'clots' in sickle cell crisis are primarily aggregations of rigid red blood cells blocking vessels, not fibrin clots that anticoagulants like heparin or warfarin target. Therefore, anticoagulants are not used as a standard preventative therapy for vaso-occlusive crises.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of Sickle Cell Anemia to guide bedside assessment, documentation, and the next nursing action.
• A key nursing role is educating the child and family on the critical importance of maintaining high fluid intake daily, not just when they feel thirsty, to prevent painful crises.
• Nurses must be vigilant in monitoring fluid status, including intake and output, especially in hospitalized children who may have poor appetite or are receiving IV fluids.
• Recognizing early signs of dehydration (e.g., dry mucous membranes, decreased urine output, irritability) is a critical assessment skill to prevent the onset of a vaso-occlusive crisis.

How to Approach the Question

• First, identify the core pathophysiology of the question: sickle cell anemia involves red blood cells changing shape and causing blockages (stasis, thrombus).
• Next, analyze the goal: the question asks for a preventative action to stop this from happening.
• Evaluate each option based on its effect on blood flow and sickling triggers.
• Option A (Oxygen): This treats a symptom (hypoxia) but doesn't prevent the physical blockage.
• Option B (Fluids): This directly addresses blood viscosity. More fluid makes blood thinner and flow better, preventing blockages.
• Option C (Bed rest): This promotes stasis, the opposite of the desired effect.

Concept Tested & Keywords

• Concept Tested: Management of Sickle Cell Anemia
• Stem keywords: sickle cell anemia, child, prevent thrombus formation, stasis, clotting
• Lead-in keywords: nurse should
• Clinical cues: The question asks for a preventative measure against stasis and clotting, which points to interventions that improve blood flow.

Question ID

QWmj0RoptOn6cdsWDn-cZm

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 365-367

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