A patient in sickle cell crisis has edema in the hands and feet. The nurse recognizes that this edema is caused by which condition?
1. fluid overload
2. poor venous return
3. small vessel infarction
4. dehydration
Correct Answer: 3
A vaso-occlusive or thrombotic crisis occurs when sickling develops in the microcirculation. Obstruction of blood flow triggers vasospasm that halts all blood flow in the vessel. Lack of blood flow leads to tissue ischemia and infarction. Infarction of small vessels in the extremities causes painful swelling of the hands and feet; large joints also may be affected. Fluid overload, poor venous return, and dehydration are not likely causes of swelling.
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