The emergency department nurse performs an admission assessment for a client with priapism of about 3 hours duration who also has sickle cell anemia. What assessment finding is of most concern and warrants immediate notification of the health care provider?

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Priapism is a sustained, painful erection often associated with sickle cell anemia, as the sickling (crescent shaping) of red blood cells can lead to penile vascular occlusion, erectile tissue hypoxia, and tissue necrosis. Bluish discoloration is of most concern as it can be a sign of ischemia to the penis. (Option B) Some factors, such as alcohol intake; spinal cord injury; and phosphodiesterase-5 enzyme inhibitor (ie, sildenafil), psychotropic (ie, trazodone), and illegal (ie, cocaine) drugs can contribute to the development of priapism. Possible penile ischemia is a more urgent concern than alcohol intake. (Option C) Extreme pain related to tissue hypoxia is an expected, characteristic manifestation of priapism and requires analgesia, but it is not as urgent a concern as possible penile ischemia. (Option D) Difficulty voiding and urinary retention are complications associated with priapism. It is important to monitor urine output as catheterization may be necessary, but this is not as urgent a concern as possible penile ischemia. Educational objective: Priapism is a sustained, painful erection that lasts for more than 2 hours. Common associated clinical manifestations include discoloration of the penis, intense pain, rigid penis, difficulty voiding, and anxiety and embarrassment.

The Emergency Department Nurse Performs an Admission Assessment for a Client