Question

QUESTION ONE

Madam Zara Gravida 3 para 2A, visited the ANC of your facility. On assessment you noticed her gestational age is 26 weeks and she complain of extreme tiredness. A scan confirmed the gestational age and gender of baby as male. A follow up laboratory investigation shows a haemoglobin of 5.8mg/dl. and blood pressure of 168/100mmHg. The obstetrician on duty diagnosed her of anaemia with possible Pregnancy Induced Hypertension (PIH) and detained her for transfusion.

A. State FOUR (4) types of anaemia

B. Describe your specific responsibilities of blood transfusion

C. What is your midwifery management of Madam Zara relative to the PIH?

D. What education will you give to Madam Zara and the family on discharged after treatment

Answer 1

A. Four main types of anemia are:

Iron deficiency anemia. This most common type of anemia is caused by a shortage of iron in your body. Our  bone marrow needs iron to make hemoglobin and Without adequate iron, your body can't produce enough hemoglobin for red blood cells.

Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn't produce enough red blood cells.
Causes of aplastic anemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.

Hemolytic anemias. This anemia  develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction.

Vitamin deficiency anemia or perinicious anemia: our body needs folate and vitamin B-12 to produce enough healthy red blood cells. A diet lacking in these and other nutrients can cause decreased red blood cell production.

B.

1. Verify doctor’s order. Inform the client and explain the purpose of the procedure.
2. Check for cross matching and typing. To ensure compatibility
3. Obtain and record baseline vital signs
4. Practice strict asepsis
5. before transfusion 2 licenced nurses Check the following:
   • Serial number
   • Blood component
   • Blood type
   • Rh factor
   • Expiration date
   • Screening test (VDRL, HBsAg, malarial smear) – this is to ensure that the blood is free from blood-carried diseases and therefore, safe from transfusion.
6. Warm blood at room temperature before transfusion to prevent chills.
7. Identify client properly. Two Nurses check the client’s identification.
8. Use needle gauge 18 to 19 to allow easy flow of blood.
9. Start infusion slowly at 10 gtts/min. Remain at bedside for 15 to 30 minutes
10. Monitor vital signs. Altered vital signs indicate adverse reaction (increase in temp, increase in respiratory rate)
11. Do not mix medications with blood transfusion to prevent adverse effects and Do not incorporate medication into the blood transfusion.
12. Administer 0.9% NaCl before; during or after Blood transfusions. Never administer IV fluids with dextrose because Dextrose based IV fluids cause hemolysis.
13. Administer blood transfusion for 4 hours (whole blood, packed RBC)and For plasma, platelets, cryoprecipitate, transfuse quickly (20 minutes)because clotting factor can easily be destroyed.
14. Observe for potential complications and Notify doctor.

C. Nursing management is :

• Assess vital signs, especially blood pressure because an elevated blood pressure of 140/90 mmHg and above would show hypertension.
• Assess patient for the presence of edema on the face, fingers, and upper extremities.
• Promote bed rest in a recumbent position to facilitate in the secretion of sodium.
• Promote good nutrition.
• Provide emotional support to establish a trusting relationship and let the woman voice out her fears.

D.

• Take your blood pressure medicine exactly as directedand Don't skip doses.
• If you do miss a dose (or doses) check with your doctor.
• Don't take medicines that contain heart stimulants, including over-the-counter medicines.
• Stay at a healthy weight.
• Limit back on salt by avoiding: canned, dried, packaged, and fast foods and Don't add salt to your food at the table.
• Follow the DASH (Dietary Approaches to Stop Hypertension) eating plan. This plan recommends vegetables, fruits, whole gains, and other heart healthy foods.
• Eat food rich in potassium.
• Break the smoking habit.
• Limit drinks that contain caffeine such as coffee, black or green tea, and cola to 2 per day.
• Never take stimulants such as amphetamines or cocaine. These drugs can be deadly for someone with high blood pressure.
• Control your stress.