The 1-year-old with sickle cell disease is in crisis following gastroenteritis. While hospitalized, the patient abruptly exhibits seizures, decreased level of consciousness, right-sided facial asymmetry when crying, coughing and sputtering during a bottle feeding, and decreased movement of the right leg and arm. The nurse contacts the provider and prepares to provide which initial interventions? Select all that apply.

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Endotracheal intubation , Magnetic resonance imaging (MRI) scan , 20 mL/kg packed red blood cell transfusion , Complete blood count and reticulocyte count , Intravenous sedation infusion titrated to prevent crying. This patient in sickle cell crisis is exhibiting signs of an ischemic stroke (right-sided facial asymmetry and weakness, dysphagia, seizures, and decreased level of consciousness). Initial interventions include establishment of a patent airway because the infant is exhibiting signs of an inability to maintain one&rsquo;s own airway. An MRI is the gold standard imaging study to differentiate between an ischemic and hemorrhagic stroke, which determines the treatment course. However, the patient&rsquo;s symptoms are different than a hemorrhagic stroke, which presents with signs of increased intracranial pressure (vomiting, decreased LOC, and coma), so a 20 mL/kg packed red blood cell transfusion is initiated to increase the oxygen-carrying capacity of the blood while awaiting confirmation. A CBC and reticulocyte count determine how much blood the patient will need to receive. Intravenous sedation is likely necessary to keep the patient still during the MRI as well as prevent vasoconstriction caused by increased PaCO₂ that occurs with crying. An exchange transfusion will be performed once the MRI confirms the patient has experienced an ischemic stroke rather than a hemorrhagic stroke.

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