Critical Thinking Exercise Indicate TRUE or FALSE

Critical Thinking Exercise Indicate TRUE or FALSE Particular to the following Statements: RNs should expect a Doctor’s Order to Type and Crossmatch patients who have experienced Severe Trauma in anticipation of needing a Blood Transfusion. true Patients undergoing Surgery, Hemodialysis, and Chemotherapy may be at a Higher Risk of requiring a Blood Transfusion. true Mrs. Belinda Carmichael who has Crohn’s Disease in addition to Anemia may be at a Higher Risk of Blood Transfusion Reaction. true Mr. Martin Sobeleski has undergone Multiple Blood Transfusions during treatment for his Stomach Cancer, so the RN has determined him to be at a Decreased Risk of Blood Transfusion Reaction. false RNs are experienced in managing the process of Type & Crossmatch as well as administering Blood Transfusions so there is Decreased Risk of Acute Hemolytic Reaction or Bacterial Contamination Reaction. true Indicate APPROPRIATE or INAPPROPRIATE ACTION on the part of the RN. If INAPPROPRIATE, correct the statement… Steve RN received a written order from Dr. William Bertrand for Type and Crossmatch for 2 units of Packed Red Blood Cells for his patient Mrs Belinda Carmichael. Steve RN has collected his patient’s blood for Type & Crossmatch after using two identifiers and proceeded to label his patient’s blood sample at the bedside with Patient Name, Patient MRN, Patient DOB, Blood Band Number, and the date, time and his initials. Steve RN has placed his blood tube in a biohazard bag and sent the specimen to the Blood Bank. Steve RN witnessed Dr Bertrand speaking to Mrs Carmichael and determined that the physician obtained a signed consent for the Blood Transfusion. Steve RN collected a set of Vital Signs as well as performed a Head to Toe Assessment on Mrs Carmichael in which he determined there was no concern for Fever, Hypertension or Risk of Fluid Overload. Steve RN assessed Mrs Carmichael’s IV and determined the Blue 22 g Catheter was satisfactory for the Blood Transfusion. Steve RN called the Blood Bank and stated he was ready for the first unit of blood at 1130 am when another of his patients was due to return from Endoscopy. Steve RN primed his IV Y Set Tubing with a 250 mL bag of 0.45% Saline. Steve RN could not locate his colleague RN so he asked Sue the Nurses’ Aide to double check the Blood Unit with him. Steve RN spiked the bag of Packed Red Blood Cells. Steve RN asked Mrs Carmichael if she had any questions about receiving a Blood Transfusion. Steve RN connected the Y Set Tubing to the Saline Lock and set the IV Pump to run at 2 mL/minute. Steve RN asked Sue the Nurses’ Aide to stay with the patient for the first 15 minutes and then collect a set of Vital Signs. Mrs Carmichael reported itching and Sue the Nurses’ Aide noticed facial flushing and reported to Steve the RN. Steve RN requested a liter of 0.9% Saline from the PIXIS and primed a new IV Primary Line. Steve RN stopped the Blood Transfusion and connected the 0.9% Saline on the new IV Primary Line. Steve RN delegated Vital Signs every 5 minutes to Sue the Nurses’ Aide. Steve RN called the Charge Nurse Regina RN for assistance. Charge Nurse Regina contacted Dr Bertrand and informed him of the possible Blood Transfusion Reaction. Dr Bertrand determined the allergic reaction to be mild and entered a STAT order for 50 mg Diphenhydramine IV Push to be given and to resume the Blood Transfusion. Steve RN gave the Diphenhydramine through the Blood Tubing and restarted the Blood Transfusion at 150 mL/hour to assure that the Blood Transfusion would be complete in 3 hours. Charge Nurse Regina contacted the Blood Bank and informed them of the mild allergic reaction. Steve RN determined the bag of Packed Red Blood Cells was empty at 1420 so he disconnected the Y Set Tubing and disposed of it in a Biohazard Bag. Steve RN delegated the 1530 H & H draw to Sue the Nurses’ Aide. Indicate APPROPRIATE or INAPPROPRIATE ACTION on the part of the RN. If INAPPROPRIATE, correct the statement… Betsy RN received a written order from Dr. Nancy Sandoval for Type and Crossmatch for 2 units of Packed Red Blood Cells for her patient Mr Martin Sobeleski. Betsy RN has collected her patient’s blood for Type & Crossmatch after using two identifiers and proceeded to label her patient’s blood sample at the bedside with Patient Name, Patient MRN, Patient DOB, Blood Band Number, and the date, time and his initials. Betsy RN has placed his blood tube in a biohazard bag and sent the specimen to the Blood Bank. Betsy RN determined that Mr Sobeleski has received several units of Packed Red Blood Cells previously and was informed of the risks and benefits of the Blood Transfusion by Dr Sandoval. Betsy RN instructed Mr Sobeleski on the signs and symptoms of Blood Transfusion reaction and after determining that the patient was able to repeat the risks, benefits and signs & symptoms of reaction, Betsy RN witnessed a signed consent for the Blood Transfusion. Betsy RN collected a set of Vital Signs as well as performed a Head to Toe Assessment on Mr Sobeleski in which she determined there could be a risk for Fever, as he had previously had fevers with Blood Transfusions, Hypertension and Risk of Fluid Overload due to a mild Congestive Heart Failure diagnosis. Betsy RN contacted Dr Sandoval and discussed the previous history of fever and risk of fluid overload. She obtained an order to administer 650 mg Acetaminophen orally as well as 20 mg Furosemide via IV Push immediately prior to beginning the Blood Transfusion. Betsy RN started a new Saline Lock with a Pink 20 g IV Catheter. Betsy RN administered the Acetaminophen and Furosemide and placed a urinal at the bedside and instructed Mr Sobeleski to use the urinal and not get out of bed. Betsy RN raised the Head of the Bed. Betsy RN primed her IV Y Set Tubing with a 250 mL bag of 0.9% Saline. Betsy RN requested a liter of 0.9% Saline from the PIXIS and primed a new IV Primary Line. Betsy RN called the Blood Bank and stated she was ready for the first unit of blood at 1000 am after all morning medications and treatments were up to date. Betsy RN located her Charge Nurse Rhonda RN to double check the Blood Unit with her. Together they reviewed: the Patient’s Name, MRN, DOB, Blood Band and Blood Unit Numbers as well as Inspected the Blood Unit with its Expiration Date/Time. Additionally, they checked the written orders from Dr Sandoval, the signed consent, the previous vital signs, the orders for pre-medications and signs and symptoms of Blood Transfusion Reaction. Betsy RN asked Mr Sobeleski if he had any questions about receiving a Blood Transfusion after reviewing the Signs and Symptoms of Blood Transfusion Reaction. Betsy RN spiked the bag of Packed Red Blood Cells. Betsy RN connected the Y Set Tubing to the Saline Lock and set the IV Pump to run at 2 mL/minute. Betsy RN informed the Nurses’ Station Desk that she had initiated a Blood Transfusion and must stay at Mr Sobeleski’s bedside for the first 15 minutes and then collect a set of Vital Signs. Betsy RN was able to turn the rate to 120 mL/hour after the first 15 minutes because Mr Sobeleski had Vital Signs within normal parameters and no signs of dypnea, rales or jugular venous distension. Betsy RN noticed the bag of Packed Red Blood Cells was empty at 1300. She clamped the bag and opened the bag of 0.9% Saline to clear the IV Y Set of all the Blood. Betsy RN disconnected the IV Y Set Tubing at 1315 and disposed of the bags and tubing in a Biohazard bag. Betsy RN collected another set of Vital Signs at 1315. Betsy RN primed a new Y Set Tubing with a new 250 mL bag of 0.9% Saline. Betsy RN contacted to Blood Bank and asked for the second unit of Packed Red Blood Cells. Fill in the Blanks for the questions below: Betsy RN must use ___ Y Set Tubing for ____ unit of Packed Red Blood Cells. Betsy RN must hang any unit of Packed Red Blood Cells within ___ minutes of leaving the Blood Bank. Betsy RN must complete the Blood Transfusion of each unit in less than ____ hours. Failure of any of the correct steps in questions 49, 50, 51 may put Mr Sobeleski at risk for ___________ ____________ ___________. Which is considered an avoidable _________ ______. Betsy RN may need to hang _________ and place the patient in _________________ position to address severe ____________. Betsy RN should be prepared to collect ______ _______ and then administer IV __________. Betsy RN should complete an _______ ________ specific to the Blood Transfusion Reaction experienced in 52. Fill in the Blanks for the questions below: Betsy RN must perform an H & H draw in the _____________ arm ____ hour after the completion of the Blood Transfusion. Betsy RN must instruct the patient on the following signs of Graft Vs Host Reaction _____________, _________, __________, and _________which may occur ____ days after Blood Transfusion. It has been a busy evening in the Emergency Department and a multiple car accident has occurred with several patients en route. Carla Nurses’ Aide is working in the ED drawing blood from the accident victims and has moved outside the Trauma Bay to label blood specimens. Ted RN is working in the ICU caring for Ms Esther Rios who suffered a hemopneumothorax as the result of the car accident. Ted RN has been given the order by the Intensivist Dr Marcel Dubois to transfuse two units of Packed Red Blood Cells. Within the first 10 minutes of the Blood Transfusion, Ms Rios is diaphorectic with chills, dyspneic, and suddenly complaining of low back pain. The monitor shows tachycardia and the alarm has gone off on the blood pressure monitor. Ted RN has also noticed a red tinge to her urine in the Foley Urimeter. Ted RN is thinking there possibly was a Type & Crossmatch error. Based on the information above, it is likely that Ms Rios is experiencing an _________ __________ __________ Prioritize the following Actions: Ted RN immediately STOPS the transfusion and CALLS for HELP from Rosario RN. Rosario RN calls the Blood Bank to inform them of the situation. There are other car accident victims that have had Type and Crossmatch and those patients should be re-drawn Ted RN draws a new Type & Crossmatch, H & H, Clotting Factors, Electrolytes. Ted RN collects a Urinalysis Ted RN calls Dr Dubois to inform him of the situation. Ted RN hangs IV 0.9% Saline through a new IV Primary Line. Rosario RN collects all Blood Unit and 0.9% Saline Bags as well as Y Set Tubing, places them in a Biohazard Bag and sends to the Blood Bank Rosario RN places Ms Rios in Trendelenberg position. Ted RN must complete an Incident Report containing all the facts associated with this event. Indicate APPROPRIATE or INAPPROPRIATE ACTION on the part of the RN. If INAPPROPRIATE, correct the statement… Ted RN and Rosario RN should anticipate the need to give Platelets, Fresh Frozen Plasma, Fibrinogen in Cryoprecipitate in the event of hemorrhage. Ted RN and Rosario RN should anticipate the need to give Heparin in the event of Disseminated Intravascular Coagulation with venous thromboembolism. SCIENCE HEALTH SCIENCE NURSING NURSING 3001

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