Your ESRD patient is receiving 2 units of packed red blood cells ...

[nautica902]

Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back.
 
  His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?
  A)
  Slow the rate of the blood infusion to 50 mL/hour.
  B)
  Document the assessment as the only action.
  C)
  Discontinue the transfusion and begin an infusion of normal saline.
  D)
  Recheck the type of blood infusing with the chart documentation of patient's blood type.

Question 2

In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production?
 
  A)
  An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive
  B)
  A 55-year-old man with dehydration secondary to Crohn disease
  C)
  A 66-year-old woman with a diagnosis of lung cancer with bone metastases
  D)
  A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

[bfulkerson77]

Answer to Question 1

Ans:
C

Feedback:

An immediate hemolytic reaction usually is caused by ABO incompatibility. The signs include flushing of the face, urticaria (hives), headache, pain in the lumbar area, chills, fever, chest pain, tachycardia, hypotension, and dyspnea. If any of these actions occur, the transfusion should be stopped immediately. Access to a vein should be maintained because it may be necessary to infuse IV solutions to ensure diuresis. Slowing the rate of the blood infusion will not correct this hemolytic reaction and will only worsen the patient's condition. Of course, documentation after the above interventions are performed is vital. Rechecking the blood type infusing will not stop the hemolytic reaction. After corrective actions/interventions are taken, the blood bag is returned to the blood bank for further testing.

Answer to Question 2

Ans:
D

Feedback:

Diseases such as myelogenous leukemia and other cases of primary thrombocytosis result in abnormalities in the thrombopoietin receptor and platelet binding. Cases of secondary thrombocytosis have an etiology rooted in increased thrombopoietin production. The common underlying causes of secondary thrombocytosis include tissue damage due to surgery, infection, cancer, and chronic inflammatory conditions such as rheumatoid arthritis and Crohn disease.

[nautica902]

TYSM

[chereeb]

Excellent