Question

Case Study, Chapter 13, Intravenous Therapy Jordan Smith, a 52-year-old male client with a history of congestive heart failure (CHF),has physician orders for type and crossmatch for 2 units of packed red blood cells (PRBCs) to be administered over 4 hours each unit and receive 40 mg furosemide (Lasix) IVP in between the 2 units. The client currently has a 22-gauge saline lock in his right upper arm, dated with yesterday's date. There is no informed consent signed on the chart for the client giving permission to receive blood products. The LPN/L VN reviews the policy and procedure for the hospital on blood administration and gathers all supplies to prepare for the administration of the products in the near future. (Learning Objective 14) a. What steps should the LPN/LVN take before and during the administration of the blood products? b. During the very beginning of the administration of the second unit of PRBCs, the elient develops chills and a slight fever-increase of 2° above baseline (98.6° F to 100.6° F). What steps should the LPN/LVN take?

Answer 1

steps taken before the administration of blood :-

• the first step to be taken is checking the providers order for the type of blood products that are to be adminestered
• check for the blood bracelet that should be provided by the phlebotomist
• ensure that a recent type and cross match is available for review (ABO type and cross match compatibility
• evaluate the patients lab including the CBC
• ask to the patient if he had any kind of blood transfusion or organ transfusion or any tissue transplantation and any kind of reaction if he had
• sand the order for the blood products to the blood bank immediately and confirm it by call
• assess the iv assess site for patency catheter of 18 gauze should be used or itshould be according to hospital policy
• assess for all the vtal signs and urine output just prior to administration of blood transfusion
• instruct the patient to report any kin of flushing itching shortness ofbreath back or flank pain if he had as they can be the signs of blood transfusion reaction
• steps :-
• always ensure patency of iv line prior to obtaining blood from the lab
• obtain the blood products from theblood bank
• visually inspect the blood for any kind of any kind of clots ,sadimentation or bubbles and also check the temperature of the blood because the chilled blood may cause dysarrthmia and the patient may die .
• confirm the patients ID with two identifiers and ensure that the consent is signed
• perform hand hygiene and put your clean gloves
• obtain base line vital signs if the patient has any kind of fever then it should be reported to the physician
• two RNs must confirm the blood unit lab paperwork and blood ID band at the bad side

1. blood unit number
2. blood ABO andRH compatibility
3. unit expiration date unit unique identifiers
4. patients name
5. dob confirmed with ID bands

• close all the other clamps on theYtubing hang 0.9% NS
• gentily agitate blood bags pull back the TABS on the blood bag ports to expose them
• main tubing and NS Y arm clamps remain closed spike the blood bag with the short end of Y tubing and open the clamp to allow the blood to flow down and prime the filter with blood
• prepare inj pot per facility policy and connect the tubing to patient
• open the clamp and begin the infusion via pump
• begin the infusion slowly at the rate for first 15 minthe rate should not be increased more than 2-4 ml per kg per hour
• stay with the patient for first 15 min and note the vital signs again if the patient has any kind of reaction or not if he had then immediately stop the transfusion and report to the physician
• if not then continue to administer the blood at a prescribed rate and note the vital signs at the end of every hour till the administration of blood
• the hanging of blood should not be more then four hours as it may cause infection to the patient by the growth of microbes
• the tubing should be changed with the adminesteration of each unit
• once completion of all the transfusion related items should be discarded in a biohazerd waste according to facility policy

ans 2):- if any kind of reaction is suspected as told in the statement that the patient had chills at the begning of second unit of PRBC this is a symptom of transfusion reaction that the patient had then

• the transfusion should be immediately stopped and replacement of tubing should be done
• run 0.9% of NS
• report this reaction to the physician and to the blood bank immediately
• entire tubing connected with the bag should be immediately sent to the blood bank .