The parents of a child hospitalized with sickle cell anemia tell ...

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The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics:
 
  a. Are often ordered but not usually needed.
  b. Rarely cause addiction because they are medically indicated.
  c. Are given as a last resort because of the threat of addiction.
  d. Are used only if other measures such as ice packs are ineffective.

Question 2

Which statement most accurately describes the pathologic changes of sickle cell anemia?
 
  a. Sickle-shaped cells carry excess oxygen.
  b. Sickle-shaped cells decrease blood viscosity.
  c. Increased red blood cell destruction occurs.
  d. Decreased red blood cell destruction occurs.

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Answer to Question 1

ANS: B
The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild-to-moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few if any patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

Answer to Question 2

ANS: C
The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation.

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