3.6 Learning Activities

Case Study #1

Helen, age 80, has a history of myelodysplastic syndrome, anemia, and chronic heart failure. She is scheduled to receive a blood transfusion today for a Hgb of 6.5 g/dL this morning. She arrived at the clinic to see her primary care provider for follow-up appointment with her daughter Grace. “I feel so tired this morning,” Helen groans, “It was really hard getting out of bed to get here. Grace had to help me into my wheelchair and helped get my hair fixed and get me dressed today too. I’m so exhausted now.”

Grace nods as Helen talks, and adds, “I also think she looks really pale. She definitely needs a transfusion today. I’m worried about her.”

As you complete your assessment prior to the transfusion, Helen begins coughing and has audible crackles when breathing. Additionally, her BP is elevated from baseline and rhonchi are auscultated bilaterally in the bases of her lungs.

The MD provides the following orders:

• • Administer 2U PRBCs today
  • Type and screen now
  • Administer furosemide 20 mg IV now and between units of blood

1. What are the indications for a blood transfusion for Helen?

2. Are there any considerations you need to make regarding starting an IV for the blood transfusion?

3. What steps will you take to prepare for the administration of blood for Helen?

4. What precautions or nursing considerations need to be made?

5. What assessments will you complete prior to the blood transfusion? During the blood transfusion?

6. Helen has blood type O-. What types of blood are compatible with this type?

7. You are notified that the blood has been prepared in the lab and is ready for administration. What steps do you take to ensure safety for the client?

8. Explain the remaining steps for the procedure of administering the blood transfusion.