Patient Introduction Lloyd Bennett is a 76-year-old male who was admitted throug
ID: 249069 • Letter: P
Question
Patient Introduction
Lloyd Bennett is a 76-year-old male who was admitted through the Emergency Department 2 days ago with a femoral head fracture sustained in a fall outdoors and underwent left hip arthroplasty. All drains have been removed. Provider changed the dressing this morning, and the dressing is currently clean, dry, and intact. Patient has complained of fatigue with physical therapy and does not tolerate changes in position without dizziness. Complete blood count this morning identified hemoglobin of 7 g/dL. The provider has ordered two units of packed red blood cells to be given. The lab has called and the first unit is ready.
1. How did the scenario make you feel?
2. Prior to blood administration, what assessments of the blood product and the patient are required to promote safe delivery and lessen potential complications?
3. What signs and symptoms first indicated the patient was having a transfusion reaction?
4. Review the immediate priorities when a transfusion reaction occurs and the rationale for each.
5. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.
6. What follow-up blood work may be required?
7. What follow-up disclosure is required with Lloyd Bennett and his family?
8. What would you do differently if you were to repeat this scenario? How would your patient care change?
Explanation / Answer
1. The scenario says that the patient has undergone hip arthroplasty ,and it is possible that there would have been blood loss during surgical intervention , due to blood loss and low Hb patient feels dizziness , although there is no evidence of infection as patient's wound is dry and intact ,to recover the blood loss there is a need of blood transfusion.
2. A no of lab test is performed before blood transfusion such as
. Blood type determination and cross match .
. Antibodies screening to prevent adverse effect if transfused.
. Screening for infectious agents that can be transmitted through transfusion.
MENDATORY TEST PERFORMED BEFORE BLOOD TRANSFUSION .ABO group and Rh type
.Serologic test for HIV 1,HIV 2 ,HTLV1,HTLV2,HEP C,CMV,MALARIA DENGUE etc.....
Patient's vitals are checked his body temperature should be normal , as blood transfusion is contraindicated in fever.
3 . Acute hemolytic reaction is seen and confirmed by fall of Hb ,rise in LDH, and positive DAT ,positive crossmatch .
SIGN AND SYMPTOMS OF BLOOD TRANSFUSION REACTION ARE.
. Fever , chills ,back pain,hemorrhage , breathing difficulty,low blood pressure ,flushing ,rashes ,purpura.
4. The first and foremost priority is to STOP the blood transfusion . Monitor vital signs after every 5 mins, give the patient Fowler's position and if breathing difficulty is present start administration of oxygen . Disconnect the transfusion but keep the IV line open with 0.9 %of normal saline, send the blood bag to the lab for typing and culture again, draw another blood sample for Hb ,plasma ,cultu cuand retyping, collect sample of urine for Hb determination as soon as possible.
5. SABR for this case will be .
S - situation
Pain because of hip surgery , difficulty in taking position and physical exercise, patient get dizziness with little exercise ,Hb is 7 gm /dl.
B - Background
Patient is 78 years old male came with the chief complaint of hip fracture and undergone arthroplasty he was admitted in emergency department 2 days before .
A- Assessment and action
Activity intolerance related to hip surgery ,and self care deficit related to dizziness as evidence by low Hb count .
Patient needs support for every little work for correction of Hb level blood is prescribed ,his dressings are changed and there is no signs of infection.
R- Response and Rationale
Patient is monitored continuously.
As Hb count is low to correct this blood demand is given .
Complete dressing care is given to the patient to prevent any further complication.
6 .Follow up work are ,
.Check for error in identification .
.Recheck all the steps .
.check post reaction plasma for elevated bilirubin by 5 to 7 hrs.
. Serological check for incompatibility DAT .
7. Tell the patient to come for follow up after 6 to 8 weeks .
. Educate client regarding nutrition and calcium rich diet .
. Educate client family to observe for any sign of infection such as redness ,warmness ,tenderness at surgical site and elevated body temperature.
. Educate client regarding importance of physiotherapy in healing process .
8. If this scenario has to be repeated then as a nurse I will check vitals of the client to get the base line data regarding his present situation, I will be checking all the necesanecdocuments and reports thrice to avoid any mistake in delivering care to the client , to prevent acute hemolytic reaction, as a nurse I will check all the relevant data three times to avoid adverse transfusion reaction , clean and dry dressing will be done to avoid infection. I will encourage client to perform physical exercise as tolerated with little effort.