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fatigue, sleepiness

Sequestration crisis: Occurs in infants between 8 and

Lethargy, pale skin

24 mo; massive pooling of RBCs in the liver and

Hypovolemia: Tachycardia, cool extremities,

spleen

dropping urinary output, delayed capillary refill

Aplastic crisis: Results from bone marrow depression

Lethargy, pale skin

and is associated with viral infections; leads to

Shortness of breath

compensatory increase in RBCs and RBC lysis

Altered mental status, sleepiness

Hyperhemolytic crisis: Rare; result of certain medica-

Abdominal distension

tions or infections

Jaundice, dark urine

Note: Sickle cell crisis may be preceded by a recent infection or a stressor such as dehydration, strenuous activity, or high altitude. Other assessment findings include changes in mental status, such as sleepiness, listlessness, and irritability Fever, severe pain, bloody urine, and pallor of the lips, tongue, palms, and nails may also occur.

Note: Sickle cell crisis may be preceded by a recent infection or a stressor such as dehydration, strenuous activity, or high altitude. Other assessment findings include changes in mental status, such as sleepiness, listlessness, and irritability Fever, severe pain, bloody urine, and pallor of the lips, tongue, palms, and nails may also occur.

PSYCHOSOCIAL. Children with sickle cell disease have a chronic, potentially fatal genetic disorder. Frequent hospitalizations and delayed growth and development put them at risk for low self-esteem and body image problems. In addition, because of the genetic nature of the disease, parents may experience guilt feelings. Families need extensive genetic and psychological counseling to avoid problems. Assess the child and the family for coping skills and knowledge deficits about the cause and prevention of sickle cell crisis.

844 Sickle Gell Disease

Diagnostic Highlights

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