Adventure's N Nursing

nurse-b:

OSCE Skills: Blood Transfusion

I’m basing this process on the time from when the blood sampling has been done, sent to the lab, and the appropriate products have arrived on the ward. Click through for the RCN Guidelines on blood transfusion for a more detailed guide to the whole shebang. Once blood products have arrived on the ward, they must be given as quickly as possible. 

1. Introduce yourself to the patient, check their identity and explain the procedure to them, including all risks, ensuring they give consent.
2. Check that the decision to administer a blood transfusion has been documented in the patient’s notes and the product has been prescribed appropriately.
3. Conduct a baseline set of observations on the patient including pulse rate, temperature, blood pressure, respiration rate and oxygen saturation (note: this must be repeated before each unit of blood is given, if applicable).
4. Check the blood product’s expiry date, and for signs of clumping, discolouration and leakage. Also check if the patient has any special requirements for blood products such as iradiated blood or any concomitant drugs.
5. Ask the patient to tell you their full name and date of birth to positively identify them, then verify this information using their wristband and check they match the information on the blood product.
6. Check that the compatibility label is identical to the label on the blood product (same blood group and donation number). If you are interrupted carrying out any checks, you must start again from the beginning. If there are any discrepancies with the checks DO NOT administer the products until they have been resolved.
7. Wash and dry your hands and put on a pair of gloves and an apron.
8. Obtain venous access if necessary. If an appropriate port is available, it may be necessary to flush the line with saline.
9. Attach the bag of blood product to an appropriate giving set (see my prev post on fluid administration if you’re interested!) and set the infusion rate. All blood products should be administered within 4 hours. Begin the infusion, ensuring you know the correct time.
10. Check your patient’s vital signs after 15 minutes. THIS IS CRUCIAL as most adverse reactions to blood products will occur during the first 15 minutes. Symptoms of minor reactions include: a temperature increase of up to 1.5 degrees centigrade, increased heart rate without hypotension and a mild rash. It should also be noted that an increase in agitation, anxiety, pain around the transfusion site, pain in the loins, backache, fever, skin flushing or rash (urticaria) can also be signs of serious transfusion reaction. In the case of any reactions, the transfusion should be stopped immediately and urgent medical review must be carried out. Carry out routine observations regularly throughout the transfusion.
11. Complete appropriate documentation in the patient’s notes as stated by your Trust’s policy. Don’t forget your fluid balance chart! 
12. Once completed, record the patient’s vitals again.
13. Also according to your Trust’s policy, send information regarding the final fate of the blood products (transfused ok? Stopped halfway through? Discarded? Why? etc.) to the lab for their records.

bloopz:

Signs and symptoms of Mononucleosis also known as the ‘kissing disease’

(via dorasnursing)

lalainern:

Emphysema

(Source: nursetinkerbell)

lalainern:

Asthma

(Source: nursetinkerbell)

lalainern:

MYOCARDIAL INFARCTION

(Source: nursetinkerbell)

Signs of Increased Intracranial Pressure are opposite those of Shock [hemorrhage]. That’s a pretty easy way to remember it.

(Source: rightatrium, via nursetinkerbell)

Miotic vs Mydriatic. Another helpful way to remember this - is to think of the D as Dilate. Mydriatic meds make your pupils dilate. These meds are contraindicated in patients that have increased intra-ocular pressure.

(Source: rightatrium, via nursetinkerbell)