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frequently and corrected quickly. Avoid using aspirin, which may increase acidosis. Children may not express the need for pain medication because of fear of the route of administration. Patient-controlled analgesia, therefore, may be used, with morphine sulfate as the drug of choice. Iron supplements may be used if folic acid levels are lower than normal.

Independent

Counsel children and families on the importance of maintaining hydration even when the child is ill or during hot weather. Encourage oral fluid intake in addition to intravenous fluids when children are in the hospital. Increase fluid intake to 1.5 times the normal maintenance volume if the child's cardiac function is adequate.

In cases of acute crisis, pain is the overriding problem. In addition to prescription medicines, employ other pain-reducing interventions, such as diversion, imagery, and general comfort measures. Keep the pain level within tolerable limits for the individual. Encourage families to maintain a normal life for the child with sickle cell disease. Arrange for genetic counseling so that families can make informed decisions. When appropriate, and depending on the age, include siblings in the care.

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