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NCLEX-PN ExamPrep: Care of the Client with Hematological Disorders

Jun 21, 2011

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Transfusion Reactions

When clients lack blood or blood components, it might be necessary for these components to be replaced. Possible causes of the need for a transfusion include trauma, red blood cell destruction disorders, and bone marrow depression. Table 10.2 outlines types of reactions associated with blood transfusions. Study the symptoms extensively and expect to see items related to reactions on your nursing exams.

Table 10.2. Blood Transfusion Reactions

Type of Reaction	Symptoms	Treatment
Hemolytic (due to blood type or Rh incompatibility)	Headache, chest pain, anxiety, lower back pain, hypotension, tachycardia, tachypnea, hemoglobinemia, bronchospasm, vascular collapse	Stop blood transfusion. Send tubing and blood to laboratory. Maintain blood volume and renal perfusion.
Febrile reaction	Chills, tachycardia, fever, hypotension	Antipyretic administration; pretreat with future transfusions or give washed RBCs.
Allergic reaction (patient usually has a history of allergies)	Urticaria, itching, respiratory distress, anaphylaxis	Pretreat with antihistamine.
Bacterial reaction due to contaminated blood (not a common occurrence)	Tachycardia, hypotension, fever, chills, shock	Same treatment as septic shock.
Circulatory overload (more likely in elderly, children, and clients with multiple transfusions of whole blood)	Symptoms of congestive heart failure: hypertension, bounding pulse, distended neck veins	Monitor intake and output. Infuse blood slowly. Administer ordered diuretics.

Case Study

Joey is a 5-year-old boy admitted to the pediatric unit with a diagnosis of sickle cell anemia. He is in pain, and his parents reported that he had been running a temperature for three days due to bronchitis. The doctor diagnoses vaso-occlusive crisis. Joey's temperature is 101.8° F and you assess edema of the right knee.

What events could have triggered this crisis? Give a description of vaso-occlusive crisis, as well as signs and symptoms associated with the disorder.
Recommend three priority nursing diagnosis on admission of the child.
Which plans do you expect to be included in the physician's prescription?
This is Joey's first admission with this diagnosis. Name five teaching plans you will recommend to educate Joey's parents prior to discharge.

Answers to Case Study

Triggers of a crisis include low oxygen levels, stress, infection, and dehydration. A probable cause of Joey's crisis is the infection and fever noted in the client history.

Vaso-occlusive crisis occurs when sickling cells cause occlusion of vessels, decreasing the amount of oxygen to the localized site causing pain and necrosis. Signs and symptoms include fever, pain, and tissue engorgement.
Priority nursing diagnoses include
- Risk for injury
- Infection
- Pain
- Impaired tissue perfusion
The nurse would expect plans to include
- Hydration implementation PO or IV
- Oxygen orders and/or blood products to improve tissue perfusion and prevent further sickling
- Pain medication around the clock
- A heating pad to involved areas to improve comfort
Education needs are related to the disease process and include
- Preventing crisis (adequate hydration, avoiding altitudes and low oxygen levels, avoiding stress)
- Signs to observe that indicate a crisis episode
- Signs and symptoms of infection
- Resumption of age-appropriate activities that are no contact; for example, swimming
- Explanation of the disease process and genetic factors
- Explanation of the healthcare regimen prescribed by the physician

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