Question

Case Scenario

80 year-old male that presented with a clinical history of CVA with right hemiparesis and aphasia, chronic atrial fibrillation, and currently on anticoagulants.

Patient’s had developed abdominal, constipation, wheezing, and shortness of breath 1-week PTA. The patient was diagnosed with a 1.5 cm ureteral stone, pulmonary congestion, and bilateral pleural effusions.

Labs:

WBC 15.0.

Hgb 5.8

MEWS: 2

Interventions:

1 Unit PRBC

VS:

Pre- Transfusion: BP 120/75, Temp 97.5, HR 80 bpm, RR- 20 on 2 lpm at 97% Saturation

During Transfusion: BP 180/95, Temp 98.2, HR 124, and RR 18 on 2 lpm at 96% Saturation

Post Transfusion: BP 150/85, Temp 99.2, HR 120, RR 25 on Venti Mask 50% Fi02 at 95% Saturation

Transferred to ICU at 04:00

Question

What is the process for Blood Transfusion?

What are the signs and Symptoms of Blood Transfusion Reaction?

Are there any abnormal findings? If yes, what would you do?

Case Progression

Patient was admitted to ICU at 04:05. Patient in critical condition due to multiple acute medical conditions upon arrival to the ICU and continued to decline, you immediately placed a call with Intensivist to inform of the patient condition, but the physician never return your call.

VS: BP 90/85, Temp 99.2, HR 130, RR 25 on Venti Mask 50% Fi02 at 88% Saturation.

Labs: Stat ABG: PH 7.1, SPO2 78, CO2 45, Bicarb 23; lactic acid 6

MEWS: 6

Questions:

Chain of Command

What is the process for Chain of Command?

What action will be taken if chain of command was used but the patient condition is deteriorating?

Case Progression

After following the chain of command, you are able to speak with the doctor and received the following orders.

Immediate intubation

Insert central venous catheter and arterial line for IV access and hemodynamic monitoring

Additional units of FFP and PRBC ordered

Labs: CBC, CMP, ABG, CXR, Lactic Acid, Pan- culture

Antibiotics, Sedation

Your shift is finally over,

Questions:

What communication tool should you utilize to provide thorough report to oncoming nurse?

Case Scenario

80 year-old male that presented with a clinical history of CVA with right hemiparesis and aphasia, chronic atrial fibrillation, and currently on anticoagulants.

Patient’s had developed abdominal, constipation, wheezing, and shortness of breath 1-week PTA. The patient was diagnosed with a 1.5 cm ureteral stone, pulmonary congestion, and bilateral pleural effusions.

Labs:

WBC 15.0.

Hgb 5.8

MEWS: 2

Interventions:

1 Unit PRBC

VS:

Pre- Transfusion: BP 120/75, Temp 97.5, HR 80 bpm, RR- 20 on 2 lpm at 97% Saturation

During Transfusion: BP 180/95, Temp 98.2, HR 124, and RR 18 on 2 lpm at 96% Saturation

Post Transfusion: BP 150/85, Temp 99.2, HR 120, RR 25 on Venti Mask 50% Fi02 at 95% Saturation

Transferred to ICU at 04:00

Questions:

1. What is the process for Blood Transfusion?
2. What are the signs and Symptoms of Blood Transfusion Reaction?
3. Are there any abnormal findings? If yes, what would you do?

Case Progression

Patient was admitted to ICU at 04:05. Patient in critical condition due to multiple acute medical conditions upon arrival to the ICU and continued to decline, you immediately placed a call with Intensivist to inform of the patient condition, but the physician never return your call.

VS: BP 90/85, Temp 99.2, HR 130, RR 25 on Venti Mask 50% Fi02 at 88% Saturation.

Labs: Stat ABG: PH 7.1, SPO2 78, CO2 45, Bicarb 23; lactic acid 6

MEWS: 6

Questions:

Chain of Command

1. What is the process for Chain of Command?
2. What action will be taken if chain of command was used but the patient condition is deteriorating?

Case Progression

After following the chain of command, you are able to speak with the doctor and received the following orders.

1. Immediate intubation
2. Insert central venous catheter and arterial line for IV access and hemodynamic monitoring
3. Additional units of FFP and PRBC ordered
4. Labs: CBC, CMP, ABG, CXR, Lactic Acid, Pan- culture
5. Antibiotics, Sedation

Your shift is finally over,

Questions:

1. What communication tool should you utilize to provide thorough report to oncoming nurse?

   Case Scenario

   82 year-old male that presented with a clinical history of CVA with right hemiparesis and aphasia, chronic atrial fibrillation, and currently on anticoagulants.

   Patient’s had developed abdominal, constipation, wheezing, and shortness of breath 1-week PTA. The patient was diagnosed with a 1.5 cm ureteral stone, pulmonary congestion, and bilateral pleural effusions.

   Labs:

   WBC 15.0.

   Hgb 5.8

   MEWS: 2

   Interventions:

   1 Unit PRBC

   VS:

   Pre- Transfusion: BP 120/75, Temp 97.5, HR 80 bpm, RR- 20 on 2 lpm at 97% Saturation

   During Transfusion: BP 180/95, Temp 98.2, HR 124, and RR 18 on 2 lpm at 96% Saturation

   Post Transfusion: BP 150/85, Temp 99.2, HR 120, RR 25 on Venti Mask 50% Fi02 at 95% Saturation

   Transferred to ICU at 04:00

   Questions:

2. What is the process for Blood Transfusion?
3. What are the signs and Symptoms of Blood Transfusion Reaction?
4. Are there any abnormal findings? If yes, what would you do?

5. Case Progression

   Patient was admitted to ICU at 04:05. Patient in critical condition due to multiple acute medical conditions upon arrival to the ICU and continued to decline, you immediately placed a call with Intensivist to inform of the patient condition, but the physician never return your call.
   

   VS: BP 90/85, Temp 99.2, HR 130, RR 25 on Venti Mask 50% Fi02 at 88% Saturation.

   Labs: Stat ABG: PH 7.1, SPO2 78, CO2 45, Bicarb 23; lactic acid 6

   MEWS: 6

   Questions:

   Chain of Command

6. What is the process for Chain of Command?
7. What action will be taken if chain of command was used but the patient condition is deteriorating?

8. Case Progression

   After following the chain of command, you are able to speak with the doctor and received the following orders.

9. Immediate intubation
10. Insert central venous catheter and arterial line for IV access and hemodynamic monitoring
11. Additional units of FFP and PRBC ordered
12. Labs: CBC, CMP, ABG, CXR, Lactic Acid, Pan- culture
13. Antibiotics, Sedation

14. Your shift is finally over,

    Questions:

15. What communication tool should you utilize to provide thorough report to oncoming nurse?

Answer 1

Blood transfusion

A blood transfusion is a routine medical procedure in which donated blood is provided to you through a narrow tube placed within a vein in your arm. This potentially life-saving procedure can help replace blood

TRANSFUSION REACTIONS

Acute Transfusion Reactions

• Mild allergic: Attributed to hypersensitivity to a foreign protein in the donor product.
• Anaphylactic: Similar to a mild allergic reaction, however resulting in a more severe reaction.
• Febrile non-hemolytic: Generally thought to be caused by cytokines released from blood donor leukocytes (white blood cells).
• Septic: Caused by bacteria or bacterial byproducts (such as endotoxin) which may contaminate blood.
• Acute hemolytic transfusion reactions: Can result in intravascular or extravascular hemolysis.
• Transfusion-associated circulatory overload (TACO): Occurs when the volume of the transfused component causes hypervolemia (volume overload).
• Transfusion-related acute lung injury: Acute lung injury is due to antibodies in the donor product (human leukocyte antigen or human neutrophil antigen) reacting with antigens in the recipient.

Delayed Transfusion Reactions

• Delayed hemolytic transfusion reaction: Typically caused by an anamnestic response to a foreign antigen that the patient was previously exposed to (generally by prior transfusion or pregnancy).
• Transfusion-associated graft-versus-host disease: Results from engraftment of donor lymphocytes (commonly found in cellular blood products) into an immunocompromised recipient’s bone marrow.

Yes. There is abnormal findings during transfusion. If you find abnormal findings stop the infusion immediately and call physician

CHAIN OF COMMAND = Line of authority

PROCESS FOR CHAIN OF COMMAND

Head Nurse

Director of Nursing

Chief Nursing officer

Director

If chain of command fails call emergency physician or Doctor incharge

PATIENT HAND OVER COMMUNICATION TOOL

Use of the SBAR (Situation, Background,
Assessment, and Recommendation) technique