Health Promotion and Maintenance Q 34
A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. The nurse should anticipate the client’s need for:
A. Supplemental oxygen
B. Fluid restriction
C. Blood transfusion
D. Delivery by Caesarean section
Correct Answer: A. Supplemental oxygen
Clients with sickle cell crises are treated with heat, hydration, oxygen, and pain relief. The supply of extra oxygen with oxygen therapy may be beneficial for some patients with sickle cell disease. But the use of oxygen therapy in sickle cell disease is controversial because high levels of oxygen are known to suppress the formation of new red blood cells. Oxygen therapy is, therefore, only recommended when oxygen levels drop below a critical threshold.
Option B: Fluids are increased, not decreased. Vaso-occlusive crisis is treated with vigorous intravenous hydration and analgesics. Intravenous fluids should be of sufficient quantity to correct dehydration and to replace continuing loss, both insensible and due to fever. Normal saline and 5% dextrose in saline may be used. Treatment must be in an inpatient setting.
Option C: Blood transfusions are usually not required. Transfusions are not needed for the usual anemia or episodes of pain associated with SCD. Urgent replacement of blood is often required for sudden, severe anemia due to acute splenic sequestration, parvovirus B19 infection, or hyperhemolytic crisis. Transfusions are helpful in acute chest syndrome, perioperatively, and during pregnancy.
Option D: The client can deliver vaginally. Although activity is unrestricted, patients may not be able to tolerate vigorous exercise or exertion. Patients with avascular necrosis of the femur may not be able to tolerate weightbearing and may be restricted to bed rest. Patients with chronic leg ulcers may need to restrict activity that involves raising the legs.