Final answer:
The priority nursing action for a child with sickle-cell anemia who reports severe pain and fever is to administer pain medications. Elevated WBC suggests an infection, necessitating initiating IV access for treatment. During a sickle-cell crisis, Hgb levels are decreased, WBC count is elevated, bilirubin is elevated due to hemolysis, and reticulocyte levels are elevated as the bone marrow compensates.
Step-by-step explanation:
Prioritizing Nursing Actions for a Child with Sickle-Cell Anemia
When caring for a child with sickle-cell anemia who presents with severe pain and fever, prioritizing nursing actions is crucial for effective management. Given the laboratory values indicating a white blood cell count of 18,000/mm3, hemoglobin of 6.6 mg/dl (66 g/L), and bilirubin of 8 mg/dl (136.83 µmol/L), the priority nursing action should be to administer pain medications. Sickle-cell crises can cause intense pain and managing this symptom is imperative for patient comfort and to prevent further complications.
Additionally, the child is likely suffering from an infection, indicated by the elevated white blood cell count and fever. Initiating intravenous access is also a priority to administer fluids, medications, and possibly blood transfusions. Assessing the child's temperature and monitoring for signs of infection are important as well. Depending on the overall clinical picture, initiating antibiotics and considering preparations for an exchange transfusion may follow as essential steps.
Sickle-Cell Crisis Laboratory Values
During a sickle-cell crisis, certain laboratory values are typically altered. Hemoglobin (Hgb) levels are usually decreased due to hemolysis of the sickled cells. White blood cell (WBC) count often is elevated in response to infection or inflammation. Bilirubin levels are usually elevated due to increased red blood cell turnover, and reticulocyte levels typically increase as the bone marrow tries to compensate for anemia by producing more new red blood cells.