1. The basic principle of client care

1. The basic principle of client care during transfusion is to ensure the client’s safety. The client receiving a transfusion must be actively monitored for a possible transfusion reaction as serious reactions can occur within a few minutes of the transfusion commencing. Any suspected problems must be dealt with promptly and followed through appropriately. It is also important that the effectiveness of the transfusion is evaluated and documented. Each blood pack transfused carries the risk of an acute or delayed adverse effect. So that these are recognised and managed promptly, the client must be observed and their vital signs (TPR, BP) measured and recorded. Additional vital sign measurements, including oxygen saturation, are at the discretion of each clinical area/hospital policy. Discuss the adverse reactions that you need to be aware of. http://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard7_Oct_2012_WEB.pdf 2.Outline your actions In the event of a suspected blood transfusion reaction. http://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard7_Oct_2012_WEB.pdf 3. A record of the administration of blood components must be kept in the client’s medical record. What would you include in your documentation? http://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard7_Oct_2012_WEB.pdf 4. Blood transfusion involves a chain of decisions and actions by health professionals. Every link in this chain is vital to the patient’s safety, and every person along that chain can make an error. These mistakes can be fatal. Human blood is fragile, and in order to prevent damage and deterioration, including bacterial growth that can be fatal, blood must always be stored under appropriate conditions. This is a designated, temperature-monitored blood fridge for red cells that may be located within the transfusion provider’s laboratory or the hospital. If, for some reason, blood is required to be stored or transported for longer than 30 minutes outside a blood fridge, a validated transport container and packing procedure must be used to ensure appropriate temperature control complies with the current Australian Standard Contact, the transfusion provider for more information. When should blood be picked up from the laboratory of the blood fridge? How do you correctly identify the correct client for the blood? 5. Joseph is a 45-year-old male who works as a roofer for a building contractor. He fell from a third-floor roof, suffering from multiple fractures and a severe head injury. He has been in a comatose state ever since. Unable to take food orally, a nasogastric tube was inserted for feeding. Full strength Ensure at 50 cc/hour was ordered initially, and then advanced to 75 cc/hr after the first 24 hours. Joseph had mild diarrhoea when the tube feeding was first initiated, but this resolved after 2 days. At the time of admission, Joseph was 5’8″ tall and weighed 82 kg, his usual body weight. One month later, Joseph who has no gag reflex, was transferred to an extended care facility. By this time, he weighed 71kg. A PEG line was inserted and full-strength Ensure Plus was begun at 65cc/hr with the goal of anabolism (weight gain). The formula was tolerated well. However, after several weeks, constipation developed. The formula was changed to Jevity at 75cc/hr. The protocol was also changed from a continuous drip to bolus feedings to equal the amount provided by the continuous drip. 1. Jevity comes in a bag of 500ml. How many hours will this bag take to run through? 2. Give two reasons why a PEG tube would be used. 6. Joseph is a 45-year-old male who works as a roofer for a building contractor. He fell from a third floor roof, suffering from multiple fractures and a severe head injury. He has been in a comatose state ever since. Unable to take food orally, a nasogastric tube was inserted for feeding. Full strength Ensure at 50 cc/hour was ordered initially, and then advanced to 75 cc/hr after the first 24 hours. Joseph had mild diarrhoea when the tube feeding was first initiated, but this resolved after 2 days. At the time of admission, Joseph was 5’8″ tall and weighed 82 kg, his usual body weight. One month later, Joseph who has no gag reflex, was transferred to an extended care facility. By this time, he weighed 71kg. A PEG line was inserted and full-strength Ensure Plus was begun at 65cc/hr with the goal of anabolism (weight gain). The formula was tolerated well. However, after several weeks, constipation developed. The formula was changed to Jevity at 75cc/hr. The protocol was also changed from a continuous drip to bolus feedings to equal the amount provided by the continuous drip. 1. Give two complications of a PEG. 2. List two signs and symptoms for each complication. 7.Joseph is a 45-year-old male who works as a roofer for a building contractor. He fell from a third floor roof, suffering from multiple fractures and a severe head injury. He has been in a comatose state ever since. Unable to take foods orally, a nasogastric tube was inserted for feeding. Full strength Ensure at 50 cc/hour was ordered initially, and then advanced to 75 cc/hr after the first 24 hours. Joseph had mild diarrhoea when the tube feeding was first initiated, but this resolved after 2 days. At the time of admission, Joseph was 5’8″ tall and weighed 82 kg, his usual body weight. One month later, Joseph who has no gag reflex, was transferred to an extended care facility. By this time, he weighed 71kg. A PEG line was inserted and full-strength Ensure Plus was begun at 65cc/hr with the goal of anabolism (weight gain). The formula was tolerated well. However, after several weeks, constipation developed. The formula was changed to Jevity at 75cc/hr. The protocol was also changed from a continuous drip to bolus feedings to equal the amount provided by the continuous drip. Joseph is complaining of abdominal pain 8/10 with no effect from Panadol. Morphine elixier 5gm is ordered stat. Morphine strength is 10mgs in 10mls. 1. What schedule drug is morphine? 2. How many mls would you give? 8.Joseph is a 45-year-old male who works as a roofer for a building contractor. He fell from a third-floor roof, suffering from multiple fractures and a severe head injury. He has been in a comatose state ever since. Unable to take food orally, a nasogastric tube was inserted for feeding. Full strength Ensure at 50 cc/hour was ordered initially, and then advanced to 75 cc/hr after the first 24 hours. Joseph had mild diarrhoea when the tube feeding was first initiated, but this resolved after 2 days. At the time of admission, Joseph was 5’8″ tall and weighed 82 kg, his usual body weight. One month later, Joseph who has no gag reflex, was transferred to an extended care facility. By this time, he weighed 71kg. A PEG line was inserted and full-strength Ensure Plus was begun at 65cc/hr with the goal of anabolism (weight gain). The formula was tolerated well. However, after several weeks, constipation developed. The formula was changed to Jevity at 75cc/hr. The protocol was also changed from a continuous drip to bolus feedings to equal the amount provided by the continuous drip. Erythromycin suspension 500mg is ordered on QID. 1. What is the schedule of Erythromycin? 2. In stock is Erythromycin 250mg in 5mls. Joseph is ordered 500mg. How many mls is required every 6 hours? 9.Joseph is a 45-year-old male who works as a roofer for a building contractor. He fell from a third-floor roof, suffering from multiple fractures and a severe head injury. He has been in a comatose state ever since. Unable to take foods orally, a nasogastric tube was inserted for feeding. Full strength Ensure at 50 cc/hour was ordered initially, and then advanced to 75 cc/hr after the first 24 hours. Joseph had mild diarrhoea when the tube feeding was first initiated, but this resolved after 2 days. At the time of admission, Joseph was 5’8″ tall and weighed 82 kg, his usual body weight. One month later, Joseph who has no gag reflex, was transferred to an extended care facility. By this time, he weighed 71kg. A PEG line was inserted and full strength Ensure Plus was begun at 65cc/hr with the goal of anabolism (weight gain). The formula was tolerated well. However, after several weeks, constipation developed. The formula was changed to Jevity at 75cc/hr. The protocol was also changed from a continuous drip to bolus feedings to equal the amount provided by the continuous drip. 10 minutes post administration of erythromycin Joseph looks pale and clammy, RR increases to 40 and he suddenly collapses. What steps would you do in this medical emergency? 10.Shelly is a 30-year-old female patient who presents to the clinic with an asthma attack. Clinical records show that she has been admitted to the hospital on several occasions and once to ICU within the past 12 months. On assessment, she was finding it difficult to complete full sentences and had a 48-hour history of an upper respiratory illness with increasing shortness of breath and wheezing for the past six hours. Her prescribed asthma medication was a twice-daily inhaled corticosteroid in combination with a long-acting beta-2 agonist and inhaled salbutamol. She normally used salbutamol once or twice a day but over the past two days her use had increased to eight to 10 times per day and she could not sleep because of her breathlessness and wheezing. Her vital signs are temperature 37° C, blood pressure 190/88 mm Hg, pulse 122 beats/minute, and respiratory rate 32 breaths/minute, oxygen saturation (O2 sat) is 88%. 1. Discuss the policy and procedure for administering nebulisation. 2. Discuss the maintenance and cleaning of nebulisers as per the policies and procedures. https://www.asthmahandbook.org.au/Links to an external site. 11.https://www.asthmahandbook.org.au/Links to an external site. Shelly is a 30-year-old female patient who presents to the clinic with an asthma attack. Clinical records show that she has been admitted to the hospital on several occasions and once to ICU within the past 12 months. On assessment, she was finding it difficult to complete full sentences and had a 48-hour history of an upper respiratory illness with increasing shortness of breath and wheezing for the past six hours. Her prescribed asthma medication was a twice-daily inhaled corticosteroid in combination with a long-acting beta-2 agonist and inhaled salbutamol. She normally used salbutamol once or twice a day but over the past two days her use had increased to eight to 10 times per day and she could not sleep because of her breathlessness and wheezing. Her vital signs are temperature 37° C, blood pressure 190/88 mm Hg, pulse 122 beats/minute, and respiratory rate 32 breaths/minute, oxygen saturation (O2 sat) is 88%. Shelly states that she sometimes suffers from anxiety and chest pain after an asthma attack. Shelly states that she would prefer not to take medications for her anxiety and chest pain and is refusing her analgesia. Discuss your actions and consider the complementary therapies that you may suggest to Shelly to consider. No reference given SCIENCE

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