Question

       Five –year-old Jemal Jones: Sickle Cell

• Orders:
  • 0.9% NaCl IV continuous at 50mL/hr
  • Continuous oxygen to keep O2 sats greater than 95% (OR for symptomatic control?)
  • Morphine PCA
  • Ketorolac 30mg IV push every 6 hours
  • Monitor I/O
  • VS every 4 hours and PRN if unstable
  • Naloxone PRN for respiratory depression

Shift 2

1. What are your nursing interventions based on your initial assessment at 1530 during shift 2? List each intervention and describe WHY you are doing that intervention.

1.

2.

3.

2. Write an SBAR to the provider based on your findings.

S

A

B

R

3. What were your top 3 important assessment when you re-assessed Jemal?

4. How are you going to answer Jemal’s mother’s questions?

5. Why has he been having trouble breathing?

6. He has never had this issue before. Will he recover? If so, how long will that take?

7. What can we be doing to help him recover faster?

Answer 1

1.The first intervention is to administer the oxygen as prescribed to maintain the oxygen saturation.

Morphine and keterolac administration as prescribed to alleviate pain.

Vitals monitoring and input output monitoring to ensure that the patient is maintaining the saturation and other vitals within normal limits.

2.SABR:the provider should be advised that the patient is having a crisis of the sickle cell anemia. All the aggravating factors for the sickle cell crisis should be addressed ,what to do immediately after getting such crisis, what are the signs and symptoms of crisis should be explained to the provider.

3.Oxygen saturation, pain relief, respiratory rate are the important parameters that should be considered while reassessment.

4.Mother's questions should answered compassionately. What is the underlying cause, what are the aggravating factors, how to avoid or prevent this, all such kinds of information should be included while answering the questions.