# A 12-year-old child with sickle cell anemia is admitted to the pediatric unit with complaints of severe abdominal and chest pain. Which assessment finding would be most concerning and require immediate nursing intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542132 > language: ko > subject: Adult Health ## 문제 A 12-year-old child with sickle cell anemia is admitted to the pediatric unit with complaints of severe abdominal and chest pain. Which assessment finding would be most concerning and require immediate nursing intervention? The nurse is caring for a pediatric patient experiencing a sickle cell crisis. ## 보기 1. Temperature of 100.2°F (37.9°C) with mild dehydration 2. Heart rate of 110 bpm with reports of joint pain in knees and elbows 3. Oxygen saturation of 88% on room air with increased respiratory rate **✔ 정답** 4. Hemoglobin level of 7.2 g/dL with fatigue and pallor **정답: 3** ## 해설 Oxygen saturation of 88% with increased respiratory rate indicates severe hypoxemia and potential acute chest syndrome, a life-threatening complication requiring immediate intervention. Other findings are common in sickle cell crisis but less urgent. ## 심화 해설 Clinical Context This child with sickle cell anemia presenting with severe chest and abdominal pain is experiencing a vaso-occlusive crisis (VOC). While pain is the hallmark of VOC, the nurse must rapidly differentiate between an uncomplicated pain episode and the onset of a life-threatening complication. The primary concern here is recognizing the early signs of Acute Chest Syndrome (ACS), a leading cause of mortality in children with sickle cell disease [1]. Analysis of the Most Concerning Finding The finding of an oxygen saturation of 88% on room air accompanied by an increased respiratory rate is the most critical. This combination is highly suggestive of Acute Chest Syndrome, a medical emergency. ACS is defined by a new pulmonary infiltrate on imaging, accompanied by fever and/or respiratory symptoms, and its pathophysiology involves vaso-occlusion, pulmonary infarction, and hypoventilation, which can be rapidly triggered by infection in children [1]. A declining oxygen saturation signals that pulmonary gas exchange is already compromised. Without prompt intervention, this can progress swiftly to respiratory failure and acute pulmonary hypertension, a major cause of death in these patients [2]. The nurse must intervene immediately by administering oxygen, notifying the provider, and preparing for further diagnostic evaluation like a chest X-ray. Why the Other Options Are Less Immediately Critical 1. Temperature of 100.2°F (37.9°C) with mild dehydration A low-grade fever and mild dehydration are common findings during a VOC and can be triggers for complications like ACS [1]. While this requires intervention with antipyretics and fluid replacement, it does not represent an immediate, life-threatening deterioration in the same way that frank hypoxemia does. Fever is a component of the ACS definition but is a less specific and less urgent standalone finding than hypoxemia. 2. Heart rate of 110 bpm with reports of joint pain in knees and elbows Tachycardia and joint pain are classic, expected manifestations of an uncomplicated vaso-occlusive crisis. Pain from bone marrow ischemia drives the heart rate up. This requires prompt and aggressive pain management, which is a priority, but it does not signal an immediate threat of respiratory collapse. 4. Hemoglobin level of 7.2 g/dL with fatigue and pallor A hemoglobin of 7.2 g/dL represents significant anemia, which is a baseline characteristic of sickle cell disease due to chronic hemolysis. Fatigue and pallor are consistent with this chronic state. While this finding must be monitored and may eventually require transfusion, it is an expected chronic issue, not an acute, rapidly progressive pulmonary emergency like the hypoxemia in option 3. Pathophysiology and Clinical Decision-Making The danger of ACS lies in its multifactorial and rapidly progressive nature. A VOC in the ribs or sternum causes hypoventilation due to pain, leading to atelectasis. This, combined with a potential infection and the underlying inflammatory state, triggers a cascade of vaso-occlusion in the pulmonary vasculature, infarction, and worsening hypoxia [1]. The study by Patil et al. underscores that specific clinical factors can predict the progression from a simple VOC to ACS, making early differentiation critical for survival . The nurse’s recognition of hypoxemia is the pivotal first step in this differentiation. A case report by Prada et al. illustrates the devastating synergy of uncontrolled ACS, where initial respiratory symptoms can spiral into fulminant multiorgan failure, reinforcing the need for immediate action at the earliest sign of respiratory compromise . The nurse must prioritize airway and breathing, applying oxygen to maintain saturations above 95%, and prepare for interventions such as incentive spirometry, pain control to improve ventilation, and potentially a blood transfusion to reduce the concentration of sickle hemoglobin.References (research sources) - [1]Acute Chest Syndrome in Children with Sickle Cell Disease: A Narrative Review.Research articleRamirez V, Mercier-Ross J. (2026) · DOI: 10.3390/children13050670 - [2]Case Report: Optimizing ICU management of sickle cell crisis: the impact of bedside ultrasound on clinical decision-making.Case reportMehta D. (2026) · DOI: 10.3389/fmed.2026.1804466 ## 임상 시나리오 Acute Chest Syndrome (ACS) RecognitionEarly Signs in Sickle Cell Crisis Any child with sickle cell disease and chest pain must be evaluated for Acute Chest Syndrome. A drop in oxygen saturation to 88% on room air with tachypnea is a critical finding, indicating compromised pulmonary gas exchange and possible pulmonary infarction. Immediate actions include administering supplemental oxygen to maintain SpO₂ above 95%, notifying the provider, and preparing for a chest X-ray. This differentiates a life-threatening emergency from an uncomplicated vaso-occlusive pain crisis. CautionACS is a leading cause of death in pediatric sickle cell disease. Do not attribute tachypnea solely to pain; it is a hallmark of developing respiratory failure. Prompt intervention prevents rapid progression to acute pulmonary hypertension. ## 핵심 개념 - **Acute Chest Syndrome (ACS)** — A life-threatening complication of sickle cell disease involving pulmonary infiltrates, hypoxemia, and respiratory distress, often triggered by infection or fat embolism. - **Vaso-Occlusive Crisis (VOC)** — The most common manifestation of sickle cell disease, caused by sickled red blood cells obstructing blood flow, leading to ischemic pain. - **Hypoxemia** — An abnormally low concentration of oxygen in the blood, a critical sign of respiratory compromise in sickle cell disease. ## 같은 주제 문제 - [A nurse is assessing a 35-year-old Hispanic client with sickle cell anemia who presents to…](https://mymerci.kr/pages/nclex_q.php?qn_id=540787) - [A 28-year-old African American client with sickle cell anemia is admitted to the emergency…](https://mymerci.kr/pages/nclex_q.php?qn_id=540788) - [A 35-year-old Hispanic client with sickle cell disease is admitted to the emergency depart…](https://mymerci.kr/pages/nclex_q.php?qn_id=540789) - [A nurse is caring for a 22-year-old client with sickle cell anemia who is experiencing a v…](https://mymerci.kr/pages/nclex_q.php?qn_id=540790) - [A nurse is caring for a 28-year-old African American client with sickle cell anemia who is…](https://mymerci.kr/pages/nclex_q.php?qn_id=540791) - [A 35-year-old African American client with sickle cell anemia is admitted to the emergency…](https://mymerci.kr/pages/nclex_q.php?qn_id=540792) - [A 12-year-old child with sickle cell anemia is admitted to the pediatric unit with complai…](https://mymerci.kr/pages/nclex_q.php?qn_id=542133) - [A 15-year-old adolescent with sickle cell anemia is admitted to the pediatric unit with co…](https://mymerci.kr/pages/nclex_q.php?qn_id=542134) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._