The nurse is caring for an adult patient with sickle cell anemia. Which of these vital signs is concerning? Select all that apply.

A. Respiratory rate 29/minute: Tachypnea in a sickle cell patient may indicate acute chest syndrome or compensatory mechanisms for systemic hypoxia. Rapid breathing suggests pulmonary complications or significant physiological stress that requires immediate clinical evaluation. This rate is significantly above the normal adult range of 12 to 20 breaths per minute. B. Blood pressure 118/68: This blood pressure reading is within the normal physiological range for an adult and indicates stable hemodynamics. It does not suggest hypovolemia or hypertensive crisis in the context of a sickle cell vaso-occlusive episode. Normal vascular pressure is a reassuring finding during a routine nursing assessment. C. Pulse rate 112/minute: Tachycardia is a concerning sign that may reflect severe pain, dehydration, or anemic compensation to maintain cardiac output. It can also be an early indicator of infection or an impending sickle cell crisis. A heart rate exceeding 100 beats per minute necessitates further diagnostic investigation. D. Temperature 37° Celsius: This represents a normal core body temperature, suggesting the absence of an acute febrile illness or systemic infection. Since infection is a frequent trigger for sickle cell crises, a localized or systemic normothermia is a stable finding. It does not currently indicate an inflammatory or infectious process.