The nurse is triaging a 7-year-old with sickle cell crisis. The client is short of breath and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate intervention?

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This client is exhibiting signs and symptoms of sickle cell crisis, which occurs when the client's sickle-shaped cells block blood flow through the vessels. These clients tend to have a small spleen due to repeated small splenic infarctions (autosplenectomy). Splenic sequestration crisis occurs when a large number of "sickled" cells get trapped in the spleen, causing splenomegaly. This is a life-threatening emergency as it can lead to severe hypovolemic (hypotensive) shock. The classic assessment finding is a rapidly enlarging spleen. (Option A) Normal red blood cells live about 120 days. Sickle cells break apart and die within less than 20 days; therefore, the client always has a shortage of red blood cells (anemia). Due to anemia, clients often report feeling fatigued. (Option C) Right arm weakness could indicate new-onset stroke, a common complication of sickle cell disease that needs to be assessed. However, splenic sequestration is immediately life-threatening and a priority. (Option D) Swelling of hands and feet (dactylitis) is another symptom of this disease due to the sickled red blood cells blocking blood flow to the hands and feet. This is often detected in babies as the first sign of the disease. Educational objective: Splenic sequestration crisis is a potentially life-threatening emergency of sickle cell disease. A rapidly enlarging spleen and hypotension are the characteristic assessment findings.

The Nurse Is Triaging a 7-Year-Old with Sickle Cell Crisis