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medsurg 2 (: > Exam 3- endocrine, DM, hematology > Flashcards

Exam 3- endocrine, DM, hematology Flashcards

1
Q

Negative feedback mechanism

A

signals an endocrine gland to secrete a hormone in response to a body change to oppose the action of the change and restore homeostasis

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2
Q

Hypothalamus

A

Main boss- controls pituitary glands
Function is to produce regulatory hormones
Hormones:
Corticotropin-releasing hormone (CRH)
Thyrotropin-releasing hormone (TRH)
Gonadotropin-releasing hormone (GnRH)
Growth hormone releasing hormone (GHRH)
Growth hormone inhibiting hormone
Prolactin inhibiting hormone (PIH)

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3
Q

Pituitary gland

A

Divided into anterior and posterior lobes

Releases tropic hormones (hormones that stimulate other endocrine glands) in response to hypothalamus hormones

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4
Q

Anterior pituitary hormones and target organ

A

Thyroid stimulating hormone- thyroid
Adrenocorticotropic hormone- adrenal cortex
Luteinizing hormone- testes and ovaries
Follicle stimulating hormone- testes and ovaries
Prolactin- breast
Growth hormone- bone and soft tissues

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5
Q

Posterior pituitary hormones and target organs

A

Vasopressin (antidiuretic hormone)- kidneys

Oxytocin- uterus and breast

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6
Q

Adrenal gland

A

Tent shaped organs on the top of each kidney

Adrenal cortex and adrenal medulla

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7
Q

Adrenal cortex

A

Composes 90% of gland
Secretions regulated by adrenocorticotropic hormone (ACTH)
Hormones are called corticosteroids (adrenal steroids)
Aldosterone
promotes sodium and water reabsorption and potassium excretion
Regulated by RAAS, serum potassium level, ACTH
Cortisol
Released when you are stressed
Affects carbohydrate, protein and fat metabolism; emotional stability; immune
function; sodium and water balance
Regulated by levels of free cortisol, normal sleep-wake cycle, and stress
Release peaks in the morning

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8
Q

Adrenal medulla

A

1/10 of the gland
Stimulated by sympathetic nervous system (stimulates fight or flight response)
Norepinephrine and epinephrine

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9
Q

Thyroid gland

A

2 lobes on each side of the trachea- looks like a butterfly
Stimulated by TSH (thyroid stimulating hormone)
Iodine is needed to produce the hormones (salt)
Controls metabolism
Affects resp rate, HR and contractility of heart

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10
Q

Thyroid gland hormones

A

Thyroxine (T4)
Made first- converted to T3 with help of table salt (iodine)
Maintains body metabolism in steady state
Triiodothyronine (T3)
T4 converts to T3 in the cell
Increases metabolic rate
Decreases in older persons
Calcitonin (thyrocalcitonin)
Regulates serum calcium and phosphorus
Reduces bone resorption (breakdown)
Secreted when calcium is elevated
Pulls calcium from blood back into the bone

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11
Q

Parathyroid gland

A

4 small glands located close to or with in thyroid
Parathyroid hormone (PTH)
Regulates calcium and phosphorus metabolism
Acts on kidneys, bone, and GI tract
Takes calcium from bone to the blood
Activates vitamin D in kidneys to increase absorption of calcium

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12
Q

Pancreas

A 
Located behind stomach
Insulin from beta cells
     lowers blood glucose
Glucagon from alpha cells
     Increases blood glucose
Somatostatin from delta cells
     Inhibits secretion of glucagon and insulin
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13
Q

Important assessment with endocrine

A

Height, weight, and VS

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14
Q

Laboratory tests for endocrine

A 
Stimulation/suppression test
Assays- measure level of specific hormone in blood and other body fluids
Urine test
Tests for glucose
Imaging- MRI, US, CT
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15
Q

Anterior pituitary hormones

A

Growth hormone
Thyroid stimulating hormone
Adrenocortictropic hormone

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16
Q

Hypopituitarism

A

Deficiency of 1 or more anterior pituitary hormones
Decrease GH in adults- increase rate of bone destruction leading to thinner bones (osteoporosis) and increase risk for fractures

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17
Q

Hyperpituitarism

A 
Over secretion of anterior pituitary hormones
Increase GH in adults- acromegaly
     Thickened lips
     Coarse facial features
     Increase head size
     Lower jaw protrusion
     Enlarged hands and feet
     Joint pain
     Barrel chest
     Hyperglycemia
     Sleep apnea
     Enlarged heart, lungs, and liver
Some changes may be reversible but skeletal changes are permanent
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18
Q

Hyperpituitarism

Treatment

A

Bromocriptine

Hypophysectomy

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19
Q

Bromocriptine

A

dopamine agonists
Stimulates dopamine receptors and inhibits release of GH
Side effects- orthostatic hypotension, headache, nausea, abdominal cramps, constipation
Take with food
If pregnancy occurs stop immediately

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20
Q

Hypophysectomy

A

Surgical removal of pituitary gland
Nasal packing present for 2-3 days after surgery- necessary to mouth breath
Mustache dressing will be placed under the nose
Do not brush teeth, cough, sneeze, blow nose or bend forward after surgery
Monitor neurologic response
Post nasal drip or increase swallowing- cerebrospinal fluid leakage
Keep HOB elevated
Assess nasal drainage
Halo sign indicates CSF- light yellow color at the edge of clear drainage on dressing
Most CSF leaks resolve with bedrest
Deep breathing hourly
Rinse mouth frequently
Apply lubricating jelly to dry lips
Assess for meningitis- headache, fever, neck rigidity!!!!!!!!

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21
Q

Posterior pituitary disease

A

Vasopressin (ADH)
Low- Diabetes insipidus (DI)
High- SIADH

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22
Q

Diabetes insipidus

A

Water loss caused by ADH deficiency or inability of the kidneys to respond to ADH

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23
Q

Diabetes insipidus

Symptoms

A

Polyuria
Dehydration
Increase plasma osmolarity and sodium- stimulates sensation of thirst
Urine is diluted- low specific gravity <1.005
4-30 L of urine/day

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24
Q

Diabetes insipidus

Interventions/treatment

A 
Can't be NPO for more than 4 hours
Daily weight
24 hour urine
Desmopressin- synthetic vasopressin
Maintain adequate hydration
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25
Q

SIADH

A

ADH continues to be secreted when not needed- water retention
Decrease sodium can lead to seizures

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26
Q

SIADH

symptoms

A 
Decrease urine volume; Increase urine osmolarity
Weight gain
Changes in LOC
VS changes
Bounding pulse
Increase BP
Decrease DTR
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27
Q

SIADH

interventions/treatments

A

Fluid restriction- frequent mouth rinsing
Monitor for fluid overload- I&Os; daily weights
Flushes tubes with NS instead of water (for the sodium)
Sodium tablets
Tolvaptan (PO) or Conivaptan (IV)- vasopressin antagonists
Pull out water- Do not touch sodium- Do not use longer than 30 days
When sodium levels are near normal can use normal diuretic

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28
Q

Adrenal cortex disease

A

Aldosterone- Na and H2O retention; K Excretion
Cortisol- Cholesterol, protein, and fat metabolism; Glucose
Low- Addisons
High- Cushings

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29
Q

Addisons disease

A 
Caused by inadequate secretion of ACTH, dysfunction of hypothalamic-pituitary control mechanism, or dysfunction of adrenal tissue
Hyponatremia
Hypovolemia
Hyperkalemia
Hypoglycemia
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30
Q

Addisons disease

symptoms

A

Neuromuscular- fatigue, lethargy, joint/muscle pain
GI- abdominal pain, N/V, diarrhea, anorexia
Salt craving
Skin- primary insufficiency; increased pigmentation
primary autoimmune; vitiligo (decreased pigmentation)
secondary insufficiency; no skin color changes
Hypoglycemia- sweating, headache, tachycardia, tremors
Hyperkalemia- dysrhythmias, irregular HR
Hyponatremia- decreased cognition and BP; often 1st indicator

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31
Q

Addisons disease

interventions/treatment

A 
Initiate H2 histamine blocker IV for ulcer prevention
Administer insulin with dextrose to shift K+ into cells
Loop or thiazide diuretics
Monitor HR, rhythm, and ECG
IV glucose
Hourly blood glucose
Cortisone
Hydrocortisone
Prednisone
Fludrocortisone
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32
Q

Cortisone

A

Take with meal or snack

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33
Q

Hydrocortisone

A

Report s/s of excessive drug therapy (cushing syndrome)

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34
Q

Prednisone

A

Report illness- daily dose not adequate during illness or stress

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35
Q

Fludrocortisone

A

Monitor BP

Report weight gain and edema

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36
Q

Cushing syndrome

A

Increase Na
Increase fluid
Increase glucose

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37
Q

Cushing disease

symptoms

A 
Buffalo hump
Enlarged trunk with thin arms and legs
Round face- moon face
Muscle wasting and weakness
Thin/translucent skin
Full bounding pulse 
Increase BP
Edema
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38
Q

Cushing disease

intervention/treatment

A

Focus on pt safety
Ketoconazole- decrease cortisol production
Fluid and sodium restriction
Monitor I&Os- daily weights
Hypophysectomy- removal of pituitary gland
Adrenalectomy- Removal of adrenal gland

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38
Q

Hypothyroidism

A

Decrease metabolism
Water and mucous deposits in the body- myxedema
Myxedema come- thyroid crisis

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38
Q

Hypothyroidism

symptoms

A 
Muscle movement slows
Cold intolerance
Decreased libido
Facial puffiness
Goiter (enlarged thyroid)
Thick tongue
Weight gain
Impaired memory
Nonpitting edema
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39
Q

Hypothyroidism

Treatment

A

Levothyroxine- synthetic hormone replacement
Start with low dose and gradually increase
Given IV with myxedema coma
Final dose determined by levels of TSH
Taken in the AM on empty stomach
4 hours before or after meal

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40
Q

Hyperthyroidism

A

Excessive hormone secretion from thyroid
Increased metabolism
Can be temporary or permanent
Graves disease- most common

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41
Q

Hyperthyroidism

symptoms

A 
Palpitations
Photophobia (sensitive to light)
Weight loss; increased appetite 
Heat intolerance
Increased libido
Low grade fever
Manic
Exophthalmos- wide eyed/startled look
Hyperglycemia
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42
Q

Hyperthyroidism

treatment

A 
Reduce stimulation
Promote comfort
Drug therapy
     Beta blockers- treats symptoms
     Antithyroid drugs- methimazole/propylthiouracil
     Iodine preparations- Lugol solution
Radioactive iodine (RAI) therapy
Total or subtotal thyroidectomy
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43
Q

Methimazole/Propylthiouracil

A

Avoid crowds and people who are ill
Watch for indications of hypothyroidism
Do not take when pregnant- birth defects
Propylthiouracil- watch for liver failure

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44
Q

Lugol solution

A

Initially can increase production of thyroid hormones

Check for fever, rash, metallic taste, mouth sores, sore throat, GI distress

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45
Q

Radioactive iodine (RAI) therapy

A

Use toilet not used by others for at least 2 weeks
Flush toilet 3 times
Use a laxative on second or third day
Avoid contact with pregnant women, infants, and young children for first week

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46
Q

Total or subtotal thyroidectomy

A

VS every 15 minutes till stable then every 30 minutes
Use pillows to support head and neck
Avoid neck extension
Deep breathing every 30 minutes to 1 hour
Keep emergency tracheostomy equipment in room
Monitor for thyroid crisis- fever, tachycardia, systolic HTN

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47
Q

Hypoparathyroidism

A

Decrease function of parathyroid

Hypocalcemia; Hyperphosphatemia

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48
Q

Hypoparathyroidism

symptoms

A

tingling and numbness
muscle contractions
positive chvostek and trousseau sign

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49
Q

Hypoparathyroidism

interventions/treatment

A

Correcting hypocalcemia, vitamin D deficiency, hypomagnesemia
High calcium Low phosphorus diet
Avoid milk, yogurt, processed cheese

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50
Q

Hyperparathyroidism

A

Increase function of parathyroid

Hypercalcemia; Hypophosphatemia

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51
Q

Hyperparathyroidism

interventions/treatment

A

Diuretics and hydration therapy

Parathyroidectomy

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52
Q

Euglycemia

A

Normal blood glucose

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53
Q

Type 1 DM

A

Insulin dependent- produce no insulin

Insulin given subQ everyday

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54
Q

Type 2 DM

A

Non insulin dependent- produces insulin just not enough

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55
Q

Absence of insulin

A 
Hyperglycemia
Polyuria
Polydipsia- excessive thirst
Polyphagia 
Ketone bodies
56
Q

Ketone bodies

A

Acidic breakdown product that collect in the blood when insulin is not available
Lead to ketoacidosis
Result in kussmal respiration- Increase in rate and depth of respirations to “blow off” carbon dioxide and acids. “rotting citrus fruit” odor.

57
Q

Chronic complications of diabetes

A

Cardiovascular disease
Cerebrovascular disease
Reduced immunity- high sugar lowers WBC
Retinopathy- should get yearly eye checks
Nephropathy- kidneys get damaged due to perfusion problems
Neuropathy- become less sensitive to things
Sexual dysfunction
Cognitive dysfunction

58
Q

Blood test

A

Glycosylated hemoglobin (A1C)
Fasting blood glucose
Glucose tolerance test
Autoantibody testing

59
Q

Glycosylated hemoglobin (A1C)

A

Measures how much glucose binds to hemoglobin in last 120 days
4-6% Normal range

60
Q

Fasting blood glucose test

A

100 mg/dL Normal range

>126 on 2 test indicates DM

61
Q

Glucose tolerance test

A

Used during pregnancy

<140 mg/dL Normal range

62
Q

Autoantibody testing

A

Shows if its Type 1 or Type 2

63
Q

Type 2 DM

treatment

A

Start off with diet and exercise
Then med if needed
Then insulin if needed

64
Q

Type 1 DM

treatment

A

Diet and exercise, but still need insulin

65
Q

Oral anti-diabetic agents

A

Reduce glucose or increase sensitivity to insulin
Do not work for type 1
Used when type 2 DM can not be treated with diet and exercise alone
Major side effect- hypoglycemia
Monitor blood glucose and assess for hypoglycemia
Not substitute for diet and exercise

66
Q

Glimepiride

A

Insulin stimulator
Increases insulin production from pancreas
Teach pts s/s of hypoglycemia
Take with or just before meals
Check with HCP before taking any herbs or OTC

67
Q

Metformin/Glucophage

A

Biguanides
Decrease glucose production by the liver
Avoid alcohol
Stop before imaging testing using contrast and dont start again for 48 hours

68
Q

Acarbose

A

Alpha-glucosidase inhibitor
Slow down absorption of carbs in small intestines
Take only with a meal
Abdominal discomfort and bloating are common

69
Q

Insulin Aspart

A

rapid acting

0.25 hour onset

70
Q

Human lispro

A

Rapid acting

0.25 hour onset

71
Q

Regular human

A

Short acting

0.5 hour onset

72
Q

Insulin Glargine

A

Long acting

2-4 hour onset

73
Q

Insulin Detemir

A

Long acting

1 hour onset

74
Q

units of rapid acting/grams of carbs

A

1 unit of rapid acting for 15 g of carbs

75
Q

Hypoglycemia

A

Abnormally low glucose level <70 mg/dL

76
Q

Hypoglycemia

causes

A

Too much insulin/ oral hypoglycemic agent
Too little food
Excessive physical activity

77
Q

Hypoglycemia

adrenergic symptoms

A 
sweating
tremors
tachycardia
nervousness
hunger
78
Q

Hypoglycemia

CNS symptoms

A 
inability to concentrate
confusion
double vision
irrational behavior
memory lapse
slurred speech
79
Q

Hypoglycemia

management

A

Treatment must be immediate
15 g fast-acting carbs (3-4 glucose tabs, 4-6 oz juice/soda, 6-10 hard candies, 1 TBS of honey)
Retest glucose after 15 minutes
Retreat if still <70 mg/dL
Provide snack with protein and carbs if next meal is not within 1 hour

80
Q

Bone Marrow

A

Functional site of blood formation in adults and produces RBC, WBC, and platelets

81
Q

Blood comonents

A

Plasma proteins (albumin, globulins, fibrinogen)
RBC/erythrocytes
WBC
Platelets

82
Q

Accessory organs of blood formation

A

Spleen- destroys old or imperfect RBCs, breaks down hemoglobin released from these destroyed cells for recycling, stores platelets, and filters antigens
Liver- produces prothrombin and other clotting factors, stores whole blood and blood cells

83
Q

Hematologic changes associated with aging

A 
Decrease in blood volume with lower levels of plasma proteins
Bone marrow produces fewer blood cells
RBC,WBC counts lower
Decreased immunity
Hemoglobin levels fall after middle-age
84
Q

Reticulocytes

A

Immature RBCs
Shoot up with decreased oxygen because body thinks its a RBC problem
To make into adult cell we need folic acid, vitamin B12, iron, cobalt, nickle
If any of these components are missing we become anemic

85
Q

What does hemoglobin need to hold on to oxygen

A

Iron

which is why we see pallor with iron deficiency anemia

86
Q

How do we lose Iron

A

bleeding only

87
Q

RBC life span

A

120 days
die in the spleen
some go to the liver
byproduct of dead RBCs is bilirubin

88
Q

What does bilirubin do

A

Colors stool and urine

89
Q

Who is at most risk for anemia

A

Vegetarians

90
Q

RBC normal range

A

Female: 4.2-5.4
Male: 4.7-6.1

91
Q

Hemoglobin Normal range

A

females; 12-16

males; 14-18

92
Q

Hematocrit normal range

A

females; 37-47

males; 42-52

93
Q

WBC normal range

A

5,000-10,000

94
Q

Reticulocyte count normal range

A

0.5-2.0

95
Q

Iron normal range

A

females; 60-160

males; 80-180

96
Q

Platelet count normal range

A

150,000-400,000

97
Q

Bone marrow aspiration and biopsy

A

Let patient know we are going into hip bone- iliac crest
Given a local anesthesia
Side lying position, knees closer to chest, like a C shape
Pts needs to stay still during this procedure
Last 5-15 minutes
Post-op; no aspirin, no contact sports right after procedure, avoid activity for first 48 hours

98
Q

Sickle cell anemia

A

formation of abnormal Hgb chains that easily clump and stick together
Genetic condition
African Americans at greater risk
Can have the trait (carrier) or active disease
Usually diagnosed in childhood

99
Q

Sickle cell anemia

RBC

A

Sticky- they stick together
Do not have good oxygen carrying capacity
Fragile break easily
Less life span than healthy RBC

100
Q

Sickle call anemia

Diagnostic

A 
Hematocrit decreased
Bilirubin elevated
WBC elevated
Reticulocyte elevated
X-ray with bone changes
CT with soft tissue damage
Electrophoresis shows sickled hemoglobin
101
Q

Sickle call anemia

Diagnostic

A 
Hematocrit decreased
Bilirubin elevated
WBC elevated
Reticulocyte elevated
X-ray with bone changes
CT with soft tissue damage
Electrophoresis shows sickled hemoglobin
102
Q

Sickle cell anemia

clinical manifestations

A 
inadequate oxygen supply
PAIN, especially in joints with edema
cyanosis, open sores, darkened areas
fatigue, SOB, cool extremities
spleen and liver damage
respiratory distress
episodes are intermittent
103
Q

Sickle cell anemia

prevention of crisis

A 
drink at least 3-4 liters everyday
avoid alcohol and smoking
flu shot 
avoid hot and cold temperature extremes
Avoid areas of high altitudes
milk, low-impact exercise three times a week
104
Q

Sickle cell anemia

treatment

A 
pain management- IV analgesics
Hydration
Oxygen therapy
Hydroxyurea
Prophylactic antibiotics- penicillin
105
Q

Hydroxyurea

A

reduces sickling episodes and pain by increasing production of HbF
Can be given to stop a crisis but can not be used life long or long-term
Monitor for toxicity- reduces bone marrow function

106
Q

Anemias caused by decreased RBC production

A

iron deficiency
vitamin b12 deficiency
folic acid deficiency

107
Q

Iron deficiency anemia

A

Occurs when the intake of dietary iron is inadequate for hemoglobin synthesis

108
Q

Iron deficiency anemia

causes

A

inadequate diet
blood loss
poor GI absorption

109
Q

Iron deficiency anemia

diagnosis

A

serum Ferritin <10 ng/mL

low H&H

110
Q

Iron deficiency anemia

clinical manifestations

A

weakness and pallor
brittle, thin, spoon shaped nails
angular cheilosis- reddened areas on the corner of lips
fatigue and reduced exercise tolerance
Pica- desire to eat substances not meant for nutrition (common in pregnant women and children)

111
Q

Iron deficiency anemia

treatment

A

PO iron supplements- Ferrous sulfate, Feosol
IM- Iron Dextran
IV- Venofer
Monitor for side effects- dyspepsia, constipation, diarrhea, tarry stools, stained teeth

112
Q

Iron deficiency anemia

client teaching

A

Vitamin C enhances absorption of iron

113
Q

Dietary sources of iron

A 
Red and organ meat
Raisins
Beans
Egg yolks
Leafy green vegetables
114
Q

Vitamin B-12 deficiency

clinical manifestations

A 
Big RBCs
paresthesia and poor balance
Glossitis- beefy red tongue
Pallor
Fatigue and weight loss
Jaundice
115
Q

Vitamin B-12 deficiency

treatment

A

Strict vegans need to supplement with vitamin B12
IM injections weekly, then monthly
Oral, nasal spray, or sublingual B12 may be given after initial correction with injection methods

116
Q

Foods rich in B12

A

meat
eggs
cheese
milk

117
Q

Folic acid deficiency anemia

A

Inadequate absorption of folic acid
GI disease/surgery may alter absorption
Alcohol increases folate deficiency
Folic acid and vitamin B12 deficiencies can mask each other- when one is messed up so is the other

118
Q

Folic acid deficiency anemia

causes

A

poor nutrition
malabsorption (crohn’s disease)
drugs

119
Q

Folic acid deficiency anemia

clinical manifestations

A

Same as vitamin B12 without nervous system involvement

Neural tube defects in infants can be seen if mom deficient during pregnancy (spinal bifida)

120
Q

Folic acid deficiency anemia

treatment

A

Folic acid supplements

Dietary intake- liver, yeast, legumes, leafy green vegetables, oranges

121
Q

Who needs a transfusion?

A 
Blood loss due to trauma or surgery
Thrombocytopenia
Active bleeding
Neutropenic oncology patients
Sickle cell disease
122
Q

Nursing considerations for blood transfusion

A 
Verify order
Patient education
Make sure consent is signed
Has patient had a previous reaction?
Assess vital signs
Inspect blood product prior to administration
Another nurse must co-sign
Blood must be transfused within 4 hours of receiving
Use normal saline for priming and flushing tubing
Dispose of properly
Document
19 gauge or bigger
123
Q

What can we do if pt has had reaction to blood transfusion before

A

Give a steroid prior to transfusion

124
Q

What fluid can run with blood

A

Normal saline

125
Q

What tubing is used for blood transfusion

A

Y-tubing

126
Q

Universal blood donor

A

O neg

127
Q

Universal blood recipient

A

AB neg

128
Q

Types of transfusions

A

RBC
Platelet
Plasma
WBC

129
Q

RBC transfusion

A

Often given after surgery, trauma, or anemia
Patient with Rh positive blood can receive blood from Rh negative; Rh negative cannot receive Rh positive blood
Infuse within 4 hours per unit
VS every 30 minutes during infusion

130
Q

Platelet transfusion

A

Given when platelets are below 10,000 or patient with thrombocytopenia and active bleeding
Infused within 15-30 minutes per unit
Do not have to be donor matched
Comes up frozen; let it thaw

131
Q

Plasma transfusion

A

Given to replace blood volume and clotting factors
Infused over 30-60 minutes per unit
Do not have to be donor matched
Comes up frozen

132
Q

WBC transfusion

A

Given to neutropenic patient
High risk of reaction- VS every 15 minutes
Given over 45-60 minutes
Not that common unless absolutely needed

133
Q

Types of transfusion reactions

A

Febrile
Hemolytic
Allergic
Bacterial

134
Q

Febrile reaction

blood transfusion

A

Most often occur after multiple transfusions

s/s- chills, tachycardia, fever, hypotension, tachypnea

135
Q

Hemolytic reaction

blood transfusion

A

Caused by blood type or Rh incompatibility
s/s- fever, chills, headache, chest pain, low back pain, tachycardia, tachypnea, hypotension, sense of impending doom
Can happen within 15-30 minutes of infusion beginning

136
Q

Allergic reaction

blood transfusion

A

Most common if patient has other allergies
Reaction may not occur until 24 hours after infusion
s/s- urticaria, bronchospasm, itching, anaphlaxis

137
Q

Bacterial reaction

blood transfusion

A

Contaminated blood product
Rapid onset
s/s- tachycardia, hypotension, fever, chills, shock

138
Q

Circulatory overload

blood transfusion

A

Occurs when blood is transfused too quickly

s/s- HTN, bounding pulse, JVD, dyspnea, restlessness, confusion

139
Q

If suspect a reaction….

blood transfusion

A 
Stop infusion immediately
Check vital signs
Oxygen
Benadryl if needed
Notify physician
Document
Send every piece of tubing equipment to the lab to be tested

medsurg 2 (: (1 decks)

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