Surgical Case: Lloyd Bennett Guided Reflection Questions 1. How did the scenario make you feel? I felt confident in my response with this scenario. I decided to do it a second time to achieve the highest grade possible. 2. Prior to blood administration, what assessments of the blood product and the patient are required to promote safe delivery and lessen potential complications? Patient’s IV must be assessed for redness, swelling, pain, and infiltration. Assess to make sure the IV dressing is dry and intact. Informed consent must be obtained from the patient. The patient’s name and date of birth must be verified. The patient’s vital signs must be taken before the administration. Two nurses must verify the blood, patient ID, and type and crossmatch. 3. What signs and symptoms first indicated the patient was having a transfusion reaction? The patient stated he was having back pain, he became anxious, and he started to shiver from having chills. 4. Review the immediate priorities when a transfusion reaction occurs and the rationale for each. Stop the transfusion immediately to prevent worsening condition in patient. Change the IV tubing to prevent further infusion of the blood. Notify the provider so they can add additional orders. Initiate a saline infusion to dilute the transfusion and minimize its effect. Vital signs must be monitored to prevent further complications and deterioration in the patient’s condition. The IV tubing and blood should be sent to the blood bank for analysis. 5. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. L.B. is a 76-year-old male who was admitted through the emergency department two days ago with a femoral head fracture sustained in a fall outdoors. He is postop from a left hip arthroplasty and had an order for a PRBC transfusion related to Hgb of 7 g/dL the patient developed a blood transfusion reaction almost immediately. Protocol was initiated and the patient remains stable. The patient has normal saline running at 100 mL/hr. His vitals read HR:93, BP:105/68, RR:16, SpO2:94%, T:99 F. I recommend monitoring the patient for delayed reactions from this transfusion. Provider’s orders should continue to be followed. Vital signs should be closely monitored. 6. What follow-up blood work may be required? RBC, WBC, erythropoietin, Hgb, serum creatinine, BUN, and urine test. 7. What follow-up disclosure is required with Lloyd Bennett and his family? Lloyd and his family must be made aware of the transfusion reaction. 8. What would you do differently if you were to repeat this scenario? How would your patient care change? The first time I completed this scenario I did not call the blood bank until a while after the transfusion reaction had occurred. If I were to complete the scenario again, I would be sure to call the blood bank in a timely manner.

Surgical Case Lloyd Bennett

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