Brittany Long
Septic Reaction
- Rigors - Chills - Fever - Shock
Nonhemolytic febrile reaction
- fever - chills
Allergic reaction
- urticaria - flushing - wheezing - laryngeal edema
Splenomegaly
-D/t blood sequestered @ spleen -If report pain @ L side, do not deeply palpate d/t rupture/trauma of spleen. S/S: 1. Splenomegaly 2. Reduced hgb 3. tachycardia ASSESSING ABD: 1. Lie @ supine 2. Inspect 3. Auscultate 4. Percuss 5. Palpate LABS: 1. Elevated reticulocyte count 2. Erythrocyte sedimentation rate 3. Bilirubin 4. Platelet count
Hypovolemic shock
1. Delayed cap refill 2. Pale extremities w/ weak peripheral pulses 3. Decr. UO w/ dark amber urine 4. Tachycardia & irritability
Exacerbation of vaso-occlusive crisis & acute splenic sequestion
1. Elevated T = pain = stress 2. Lack of fluid intake 3. Distress over family leaving = stress 4. Abd. pain & tenderness = stress
Obtaining health hx of
1. Frequency of vaso-occlusive crises 2. Precipitating events 3. Past hospitalizations 4. Immunization Hx
Post Quiz
1. Hypovolemic = give fluids 2. Putting foley @ 5 y/o > tiny tube, pee pee 8. Encourage w/ decorated cup, several options, and small fluids frequently
Ketorolac (NSAID for pain that can't be managed with usual NSAIDs)
1. Incr. bleeding time & risk for thrombotic events (along w/ MI & stroke) w/ prolonged use 2. Mask s/s of infection d/t masking antipyretic & anti-inflammatory actions 3. Incompatible w/ morphine thru IV 4. Shouldn't be given w/ other NSAIDs 5. Incr. risk for gastrointestinal events
Birttany Long (complex)
1. Pain lvl w/ faces scale 2. Breathing & resp. assessment 3. Auscultate everything 4. Education. 5. Give morphine 6. Check for blood in safety measures 7. Give blood. 8. Reassess breathing afterwards
Blood transfusion
1. Use 2-step verification process (pt & blood component) 2. Follow institution protocol for blood transfusion admin & management 3. Initiate w/i 30 mins! 4. Infuse slowly for first 15 mins & remain @ bedside to monitor pt. 5. Reassess breathing
5 y/o patient
1. Uses FACES scale 2. Allow to squirt own medicine into mouth 3. Given job during assessment process
Sickle Cell Anemia
Both parents have trait, 25% chance of child having it w/ q pregnancy Teach about good nutrition -Foods high in folic acid: liver, oranges, whole wheat grains, broccoli, brussel sprouts
Chest Syndrome
Complication of vaso-occlusive crisis Clumping of sickle cells @ lungs = decr. gas exchange = hypoxia = further sickling
Splenectomy
Risk for infection & sepsis! 1. Medical alert bracelet 2. Prophylactic antibiotics 3. Immunizations
Blood Transfusion Rxn (Acute hemolytic rxn )
S/S 1. Anxious, chest tightness & HA 2. Low BP, high T, UO blood tinged 3. Chills, shaking, fever, N/V, flank pain, & pain @ insertion site Can progress to RF & shock INTERVENTIONS: 1. Stop infusion 2. Start secondary line for fluids
Vaso-occlusive pain crisis d/t sickle cell anemia
Sickle cells clump = impede blood flow = tissue hypoxia= ischemia = pain (like CAD) S/S 1. Acute pain 2. Dactylitis: swelling of fingers/toes PLAN OF CARE: 1. Admin O2 if pulse ox < 92% 2. Assess pain frequently & admin rx routinely -if morphine= itching> req. order for medication for itching; watch for resp. depression 3. Admin hypotonic IV fluids>> hemodilution 4. Non pharmacological methods: offer toy, distract w/ questions, encourage deep breathing for bubbles, place heating pad w/ mom reading. LABS 1. Decr. hemoglobin 2. Incr. platelet count 3. Elevated reticulocyte count
