Passage / Scenario

Nurse's Notes (0700hrs): The adolescent is alert and oriented but appears distressed. Reports severe pain in the right side and lower back, rating it as 8/10. Hands and right knee are painful and swollen. The adolescent's parent reports a low-grade fever and vomiting for the past 3 days. The adolescent is lying in a fetal position, clutching their abdomen. Skin is warm and dry to touch. The adolescent is tearful and intermittently moaning in pain; Medical History: Diagnosed with sickle cell disease at age 2. History of multiple hospitalizations for vaso-occlusive crises. Last hospitalization was 6 months ago. No known drug allergies. Current medications include hydroxyurea and folic acid; Vital Signs (0700hrs): Temperature: 38.2°C (100.8°F), Heart rate: 110 beats per minute, Respiratory rate: 22 breaths per minute, Blood pressure: 130/80 mmHg, Oxygen saturation: 95% on room air; Physical Examination Results (0700hrs): Abdomen: Soft, non-distended, tender in the right lower quadrant. Musculoskeletal: Swelling and tenderness in the right knee and both hands. Neurological: Alert and oriented, no focal deficits. Skin: Warm, dry, no rashes or lesions; A nurse is caring for a 15-year-old adolescent who is admitted with a vaso-occlusive crisis in the emergency department.