# A 3-year-old toddler with sickle cell anemia is brought to the emergency department with severe abdominal pain, fever, and vomiting. The child appears lethargic and has decreased urine output. What is the priority nursing intervention?

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## 문제

A 3-year-old toddler with sickle cell anemia is brought to the emergency department with severe abdominal pain, fever, and vomiting. The child appears lethargic and has decreased urine output. What is the priority nursing intervention?

The child is experiencing a vaso-occlusive crisis with potential complications requiring immediate assessment and intervention. Laboratory results show hemoglobin 5.0 g/dL, white blood cell count 22,000/mm³, and elevated bilirubin.

## 보기

1. Administer prescribed analgesics for pain management
2. Encourage increased fluid intake to prevent dehydration
3. Apply warm compresses to the abdomen for comfort
4. Assess for signs of life-threatening complications **✔ 정답**

**정답: 4**

## 해설

Severe symptoms like lethargy, decreased urine output, and abnormal labs suggest life-threatening complications (e.g., acute chest syndrome, splenic sequestration) requiring immediate assessment. Pain management, hydration, and comfort are important but secondary to identifying these emergencies.

## 심화 해설

Clinical Scenario Analysis

This toddler is presenting with classic signs of an acute vaso-occlusive crisis (VOC) complicated by acute chest syndrome (ACS) or splenic sequestration. The laboratory values are critically deranged: hemoglobin is profoundly low at 5.0 g/dL (indicating severe anemia), the white blood cell count is elevated at 22,000/mm³ (suggesting infection or significant inflammation), and elevated bilirubin points to active hemolysis. The combination of lethargy, decreased urine output, and severe anemia signals a high risk for hypovolemic shock and acute kidney injury due to hypoperfusion. In the clinical severity assessment of sickle cell disease, such multi-system involvement defines a severe disease state requiring immediate, prioritized evaluation [1].

The nursing process mandates assessment before intervention. While pain management, fluid resuscitation, and comfort measures are all critical components of holistic care for a child in VOC, none of these can be safely implemented without first determining the precise nature and extent of the life-threatening complications. For instance, indiscriminate fluid administration without assessing cardiovascular and renal status could worsen the child's condition if heart failure from severe anemia is present. The rapid review on the role of nurses emphasizes that in the hospital setting, the nurse's primary function is comprehensive assessment to detect deterioration early and coordinate complex, multidisciplinary care [2].

Therefore, the priority nursing intervention is to assess for signs of life-threatening complications. This involves a rapid head-to-toe assessment focusing on airway, breathing, and circulation (ABCs), strict monitoring of vital signs and oxygen saturation, neurological status checks, and accurate measurement of intake and output. This immediate assessment will yield the data necessary to guide all subsequent interventions, including the safe administration of analgesics, the appropriate rate and type of intravenous fluids, and the application of supportive comfort measures.

References (research sources)

- [1]Development of a Clinical Severity Score for Indian Sickle Cell Anaemia Patients.Research articleNongmaithem SS, Biswas A, Iyer S, Vyshnavi J, Wath A, Chandak GR, Jain D. (2026) · DOI: 10.1002/jha2.70285

- [2]The Role of Nurses Caring for Children Diagnosed with Sickle Cell Anemia and Their Families in a Hospital Setting: A Rapid Review of the Recent Literature.Research articleFreitas E, Loura D, Inês M, Martins C, Duarte I. (2025) · DOI: 10.3390/healthcare13040413

## 임상 시나리오

Pediatric Sickle Cell Crisis: Triage & AssessmentPrioritizing life-threatening complications over symptomatic care
In a child with sickle cell disease presenting with lethargy, severe pain, and decreased urine output, the nurse's first action is a rapid focused assessment. Critical lab values like hemoglobin 5.0 g/dL and elevated bilirubin demand immediate evaluation for splenic sequestration and acute chest syndrome.

The nursing process dictates assessment before intervention. Administering fluids or analgesics without first checking lung sounds, spleen size, and hemodynamic stability can mask deterioration or worsen conditions like heart failure from severe anemia.

CautionDo not assume all distress is a simple pain crisis. Tachycardia, hypotension, and pallor with a rapidly enlarging spleen indicate a life-threatening emergency requiring immediate blood transfusion.

## 핵심 개념

- **Vaso-Occlusive Crisis** — A painful episode in sickle cell disease caused by sickled red blood cells obstructing blood flow, leading to tissue ischemia and inflammation.
- **Splenic Sequestration** — A life-threatening complication where sickled cells pool in the spleen, causing rapid enlargement, severe anemia, and hypovolemic shock.
- **Nursing Process** — A systematic framework (Assessment, Diagnosis, Planning, Implementation, Evaluation) guiding nursing care; assessment is always the first step.
- **Hemolysis** — The destruction of red blood cells, indicated by elevated bilirubin and low hemoglobin, a hallmark of sickle cell disease pathology.
- **Hypovolemic Shock** — An emergency condition caused by a significant loss of blood or fluids, leading to inadequate tissue perfusion and organ failure.

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