Assessment and Nursing Interventions for Blessing Owusu in the Emergency Department

QUESTION

You are the nurse working in the emergency department of Sheridan College Hospital. Your
patient is Blessing Owusu, a 53-year-old individual, who presented to triage via ambulance
following a syncopal episode at home. Conscious on arrival, Blessing indicates that they have
had their period for “2 weeks straight; I don’t know how there is any blood left in my body.”
Their daughter, Nneka, informs you that she heard a loud thud and found Blessing lying on the
floor of the bathroom. Past Medical history is significant for Anemia, Diabetes Mellitus Type 2,
managed with Metformin and a history of heavy menstrual bleeding. Blessing states that she
“can’t seem to catch her breath”. Nneka notes that Blessing has been dizzy a lot recently, and
seems very weak, and “looks grey”.
Upon assessment, you observe Blessing to be diaphoretic and pale. VS are as follows
BP 90/48
Resp 26
Pulse 130
SpO2 92% on RA
Temp 36.8 C orally

Blessing’s blood type is O-. What blood type(s) can they receive? What steps should the
nurse take if the wrong blood type was sent?
Explain what Anaphylactic reaction is, and what it’s associated signs and symptoms are.
What steps should the nurse take if Blessing is suspected of having an anaphylactic
reaction?
Assume the hospital’s policy is to run blood at 75ml/hr for the first 15 minutes. Calculate
the starting gtt/min if the drop factor of the tubing is 10gtt/ml. Please show your work.

ANSWER

Assessment and Nursing Interventions for Blessing Owusu in the Emergency Department

Introduction

This essay focuses on the case of Blessing Owusu, a 53-year-old individual who presented to the emergency department following a syncopal episode and experiencing prolonged menstrual bleeding. The essay will address two critical aspects of nursing care: blood compatibility and anaphylactic reactions. Additionally, it will provide calculations for the starting gtt/min based on the hospital’s blood administration policy.

Blood Compatibility and Nursing Interventions

Blessing’s blood type is O-. Individuals with O- blood type are considered universal donors, as their blood lacks A, B, and Rh antigens. Therefore, they can only receive O- blood. In case the wrong blood type was sent, the nurse should immediately stop the transfusion, assess the patient for any signs of adverse reactions, and inform the healthcare team about the error. The patient’s vital signs and symptoms should be closely monitored, and appropriate interventions should be implemented based on the specific reaction or complications observed.

Anaphylactic Reaction and Nursing Interventions

An anaphylactic reaction is a severe and potentially life-threatening allergic response triggered by an allergen. It involves a rapid release of histamine and other chemical mediators, leading to a systemic inflammatory response. Signs and symptoms of anaphylaxis may include difficulty breathing, wheezing, swelling of the face or throat, hives or skin rash, rapid heartbeat, decreased blood pressure, dizziness, and loss of consciousness. If Blessing is suspected of having an anaphylactic reaction, the nurse should activate the emergency response system, ensure a patent airway, administer oxygen, initiate cardiopulmonary resuscitation (CPR) if necessary, and administer epinephrine as prescribed. Intravenous fluids and other medications may be required to stabilize the patient’s condition. Close monitoring of vital signs and continuous assessment of the patient’s response to interventions are crucial.

Calculating the Starting gtt/min

If the hospital’s policy is to run blood at 75ml/hr for the first 15 minutes and the drop factor of the tubing is 10gtt/ml, the starting gtt/min can be calculated using the following formula:

Gtt/min = (Volume to be infused × Drop factor) ÷ Time in minutes

Assuming the blood administration time is 15 minutes and the drop factor is 10gtt/ml, the calculation would be:

Gtt/min = (75 ml × 10 gtt/ml) ÷ 15 min
Gtt/min = 50 gtt/min

Therefore, the nurse should set the infusion rate to 50 gtt/min to ensure the appropriate flow rate during the initial 15 minutes of blood administration.

Conclusion

Providing safe and effective nursing care in the emergency department requires knowledge and attention to critical aspects such as blood compatibility and anaphylactic reactions. Understanding the blood type compatibility and taking prompt action in case of an incorrect blood type are vital to prevent adverse reactions. Similarly, recognizing and responding promptly to signs of an anaphylactic reaction is essential to mitigate potential life-threatening complications. Furthermore, accurate calculations of infusion rates ensure the appropriate administration of blood products, ensuring patient safety and optimal care.