WEEK FOUR Flashcards
What is the Blood Transfusion Procedure?
( The collection ) IV access Administration set Infusion device Pre – transfusion checks Documentation Monitoring On completion Documentation
Blood transfusion adverse reactions?
Increased temperature of >1.5ºC Shivering Flushing Shortness of breath Pain (chest, loins, back, extremities) Burning/pain at drip site Drop in BP Rash or urticaria Haemaglobinuria Anaphylaxis Collapse Non-specific deterioration in pt’s condition, patients says they feel “odd”
What to do is there is a blood trasnfusion reaction?
If you observe any adverse symptoms
- STOP the transfusion and summon a Doctor immediately.
- Check observations
- Record & report promptly
- Re-check the identity of the patient and compare with the details on the blood pack and the cross-match form
- Keep blood giving set, bag of blood and all documents for return to the lab for review.
Glyceryl trinitrate (GTN)
Vasodilator
Increases blood flow from epicardial to endocardial regions
Coronary vasodilation
Peak plasma levels 4 minutes
Contraindications
Cerebral haemorrhage, Head injury, Hypersensitivity, Angina caused by obstructive cardiomyopathy
Reactions
Hypotension, Headache, Sedation, Nausea, Vomiting, Blurred vision, Syncope, Tachycardia
Dosage
600-900mcgs as soon after onset of symptoms
Elderly 300mcgs as starting dose
Buccal mucosa under tongue or in cheek
Aspirin
Inhibition of platelet aggregation
Used in patients with known cardiovascular/cerebrovascular disease
Prophylaxis for AMI, Unstable Angina, TIA, CVA
Therapy should cease 1/52 prior to surgery
Contraindications
Hepatic/renal disease, Bleeding disorders, Gastric/peptic ulcers, Hypersensitivity
Reactions
GI Distress, Nausea, Vomiting, Occult blood loss, Dizziness
Dosage
75-300mg PO OD
Heart failure is?
The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
Either (often biventricular)
- systolic failure (a problem with the contraction of the heart)
- diastolic failure (filling of the heart)
Heart failure characterised by?
A syndrome characterised by:
fluid overload
inadequate tissue perfusion
Some cases are reversible
Most HF is a progressive/ lifelong disorder managed with lifestyle changes and medications
Clinical manifestations of HF?
Right-sided failure/Diastolic (RV = right ventricle)
RV cannot eject sufficient amounts of blood and blood backs up in the venous system.
This results in peripheral oedema/hepatomegaly/ascites/anorexia, nausea/weakness & weight gain
Left-sided failure/Systolic (LV = left ventricle)
LV cannot pump blood effectively to the systemic circulation.
Pulmonary venous pressures increase and result in pulmonary congestion with dyspnoea/cough/crackles & impaired oxygen exchange
Chronic heart failure is frequently biventricular
Nursing care of a pt with HF
Subjective & objective health history Sleep and activity Physical exam Mental status Respiratory assessment Lung sounds: crackles and wheezes Cardiovascular assessment Heart sounds: S3 Fluid status/signs of fluid overload Daily weight/Input & Output Assess responses to medications Further medical investigations (CxR/ECG/bloods [BNP])
Medical management of HF
There are various classifications with treatment guidelines
Eliminate/reduce etiologic or contributory factors
Reduce the workload of the heart by reducing afterload and preload
Optimise all therapeutic regimens
Prevent exacerbations of heart failure
Medications routinely prescribed Angiotensin: converting enzyme inhibitors Angiotensin II receptor blockers Beta-blockers Diuretics(!) Digoxin
Nursing interventions of pt with HF
Promoting activity tolerance
- Cardiac rehabilitation program
- Encourage mobility (daily walking regimen)
- Spread out activities (over the day)
Monitor fluid volume
- Daily weights
- Fluid restriction/FBC (input & output)
- Respiratory assessment
- Nutritious (low sodium) diets
Oxygen therapy
Monitoring for complications (in brief)
- Hypokalaemia/ Hyperkalaemia (some diuretics/some ACE inhibitors)
- Hyponatraemia (prolonged diuretic therapy)
- Prevention of infection/thromboembolism/arrhythmias
Psychological support
- Restless/anxious/difficulty sleeping (PND)/fatigued/depressed
- Decrease anxiety = decrease heart workload
- Empowerment/educate/rehabilitate
- Individual management plans
- Advanced care directives
What is ACS?
Umbrella term
MI
Unstable Angina
- Associated with transient or permanent thrombotic occlusion
- Leads to ischemia or infarction
Initial assessment of ACS?
Acute CP or ACS symptoms:
12 Lead ECG recorded and assessed within 10 mins of presentation
Receive care based on the ACS Assessment Protocol
Cardiac specific Troponin
Oxygen Therapy
Only if SaO2 <93%
COPD Patients Maintain SaO2 88-92%
Aspirin
300mg PO administered to all Pts ASAP (unless contraindicated)
