A 24-year-old client with sickle cell disease is receiving treatment for a vaso-occlusive pain episode. Eighteen hours after admission, the client develops a temperature of 39.1°C (102.4°F), cough, and increasing chest pain. Oxygen saturation has fallen from 96% to 88% on room air, hemoglobin from 8.4 to 6.9 g/dL, and a new right-lower-lobe infiltrate is present. Complete the bowtie by selecting the condition, two actions the nurse should take, and two parameters the nurse should monitor.

Acute chest syndrome; oxygen with urgent escalation; antibiotics with transfusion evaluation; monitor oxygenation and hemoglobin response.

A new infiltrate plus fever or respiratory symptoms in sickle cell disease supports acute chest syndrome. The falling oxygen saturation and hemoglobin indicate progression rather than an uncomplicated pain episode.

Hypoxemia is treated immediately while the nurse escalates care. Empiric antibiotics and transfusion evaluation proceed without waiting for culture results when acute chest syndrome is suspected.

Oxygen saturation and work of breathing track respiratory response. Serial hemoglobin and transfusion response track worsening anemia and the effect of transfusion support.

Choose actions that address the immediate physiologic threat, then choose parameters that directly show whether those actions are effective.

Anticoagulation targets pulmonary embolism, delayed reassessment is unsafe, and culture delay postpones time-sensitive treatment. INR, calf size, and ketones do not measure response to acute chest syndrome therapy.

• Acute chest syndrome — A sickle cell complication characterized by a new pulmonary infiltrate with respiratory signs or symptoms.
• Transfusion evaluation — Urgent assessment of whether simple or exchange transfusion is needed for severe anemia or respiratory compromise.