A nurse is caring for an adolescent. Exhibits For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Potential Order Anticipated Nonessential Contraindicated Ambulate in hallway with supervision ✓ Ketorolac IV for pain ✓ Ice packs to affected area 15 min or 5 min off ✓ Meperidine for pain ✓ Intravenous fluids (IVF) at maintenance rate ✓ Oxygen in 2L/min via nasal cannula ✓ Ambulate in hallway with supervision: While mobility helps prevent complications, it is not a priority during an acute pain crisis. The client is in severe pain and resisting movement, so ambulation would be inappropriate until pain is better controlled. Ketorolac IV for pain: Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is commonly used adjunctively in sickle cell crises for its analgesic and anti-inflammatory effects, especially when opioids alone are ineffective. Ice packs to affected area: Cold therapy causes vasoconstriction, which can worsen sickling and ischemia in clients with sickle cell disease. Heat therapy is preferred for promoting circulation during a vaso-occlusive episode. Meperidine for pain: Meperidine is avoided in sickle cell disease due to the risk of neurotoxicity (e.g., seizures) from its metabolite, normeperidine, especially with repeated doses or in renal impairment. Intravenous fluids (IVF) at maintenance rate: Hydration is critical in sickle cell crises to reduce blood viscosity and prevent further sickling. IV fluids are a standard component of treatment during acute pain episodes. Oxygen 2 L/min via nasal cannula: The client is not hypoxic and has a normal respiratory rate (18 / min), and routine oxygen is not required unless oxygen saturation decreases. Overuse of oxygen can suppress erythropoiesis in chronic use.