A teenage client with sickle cell disease is admitted with a diagnosis of crisis. The client's current prescription is morphine 2 mg intravenous push every 4 hours prn. The client appears comfortable while watching television and tells the nurse "I have severe intolerable pain," and rates it a "10." What action should the nurse take?

Question

A teenage client with sickle cell disease is admitted with a diagnosis of crisis.  The client's current prescription is morphine 2 mg intravenous push every 4 hours prn.  The client appears comfortable while watching television and tells the nurse "I have severe intolerable pain," and rates it a "10."  What action should the nurse take?

Quizplus · Accepted Answer

Clients with sickle cell crisis often have excruciating pain related to the occlusion from the sickling and resulting ischemia. These individuals usually need large doses of narcotics as prior treatment has led to drug tolerance; they may also metabolize the drugs differently. Using only external cues to judge a client's pain is invalid as these clients have often learned how to distract themselves from focusing on the pain. Use of continuous PCA is recommended for relief rather than prn administration. (Option A) Nonsteroidal anti-inflammatory drugs (eg, ibuprofen) are not very effective in treating the pain of sickle cell crisis. (Option C) Meperidine (Demerol) is contraindicated for a sickle cell crisis as large frequent doses can result in normeperidine (toxic metabolite) accumulation. Symptoms start with tremors and can result in a seizure. (Option D) Clients with sickle cell crisis are often undertreated due to the suspicion of drug abuse. However, studies have shown that the risk of abuse is small (0%-9%) and this range is similar to substance abuse risk in the general population. Therefore, the client's self-report is valid and appropriate treatment in the acute setting is warranted. Educational objective: Clients with sickle cell crisis often have excruciating pain and need large doses of narcotics. The most effective method is PCA of morphine or hydromorphone (Dilaudid).

A Teenage Client with Sickle Cell Disease Is Admitted with a Diagnosis