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Posted: July 20th, 2022
Case Scenario
You are the nurse working in the emergency department of S College Hospital. Your patient is Neela Sukanth, a 65-year-old individual, who presented to triage via ambulance following a syncopal episode at home. Their partner, Inesh, informs you that Neela recently had surgery for a ruptured appendix. Past Medical history is significant for Beta-Thalassemia minor; stable angina diagnosed 3 years ago; and Diabetes Mellitus Type 2, managed with Metformin. Neela states that she “can’t seem to catch her breath” and that she has had a headache for a few days that isn’t relieved by Tylenol. Inesh notes that Neela has been sleeping a lot recently, and seems very weak, and always cold, even if wearing a sweater.
Upon assessment, you observe Neela to be diaphoretic and pale. VS are as follows
BP
92/50
Resp
24
Pulse
135
SpO2
95% on RA
Temp
36.8 C orally
Physical assessment shows a surgical wound in the right lower quadrant of the abdomen, with closed wound edges that are slightly raised and pink. Abdominal assessment reveals a distended abdomen, tender to palpation. Bowel sounds are absent in all 4 quadrants.
Blood work drawn when the patient arrived in Emerge, as per the Medical Directive is as follows:
CBC
Result
Reference Range
RBC
2.80
4.00-5.10
WBC
7.4
4.0-11.0
Hgb
66
120-160
MCV
76
80-100
Questions
Explain the indications in which a physician may order a Blood transfusion.
What do you think is the most responsible reason that a blood transfusion would be ordered in this scenario? Support your answer with information from the case scenario and the evidence.
Before starting the transfusion, how does the nurse ensure the safety of the patient? What should the nurse do if there is something missing or incorrect? What is the rationale for pre-transfusion vital signs? What do you believe is the most plausible reason for a blood transfusion in this scenario? Provide evidence and information from the case scenario to back up your answer.
How does the nurse ensure the patient's safety before beginning the transfusion? What should the nurse do if anything is missing or incorrect? What is the reasoning behind pre-transfusion vital signs?
Neela’s blood type is AB-. What blood type(s) can they receive? What steps should the nurse take if the wrong blood type was sent?
Explain what a hemolytic reaction is, and what it’s associated signs and symptoms are. What steps should the nurse take if Neela is suspected of having a hemolytic reaction?
Assume the hospital’s policy is to run blood at 50ml/hr for the first 15 minutes. Calculate the starting gtt/min if the drop factor of the tubing is 15gtt/ml. Please show your work.
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