Ms. Jasmine Williams, a 29-year-old woman with known HbSS si…
Ms. Jasmine Williams, a 29-year-old woman with known HbSS sickle cell disease, presents to the Emergency Department with severe generalized pain, fever (38.3°C), and new onset shortness of breath. She reports increasing fatigue and easy bruising over the past two days. Her medical history is significant for splenic infarcts during adolescence. Assessment and Initial Findings: Vitals: BP 100/64, HR 120, RR 26, SpO₂ 92% (RA), Temp 38.7°C Physical Exam: Icteric sclera, scattered petechiae and ecchymosis on extremities, tender abdomen (LUQ), low-grade confusion. Labs: Hgb: 6.8 g/dL (low) Platelets: 40,000/mm³ (low) WBC: 2,500/mm³ (low) Reticulocytes: 9% (high) LDH: markedly elevated Total bili: 4.7 mg/dL (high) Haptoglobin: low PT/INR: high, aPTT: high Fibrinogen: low D-dimer: very elevated Blood smear: sickled erythrocytes, schistocytes Additional History: No palpable spleen (“auto-splenectomy” documented in prior records from chronic infarction) Reports prior hospitalizations for pain crises and pneumonia Nursing Orders/Interdisciplinary Plan: Aggressive IV hydration Pain control with patient-controlled analgesia (PCA) Blood cultures, broad-spectrum antibiotics started Fresh frozen plasma and platelet transfusion ordered Monitoring for neurologic and respiratory changes, O2 as needed Protective isolation and neutropenic precautions Which clinical nursing intervention should the RN prioritize for Ms. Williams to address her highest, immediate risk based on her current presentation?
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