CENTRAL PHILIPPINE UNIVERSITY
COLLEGE OF NURSING
Jaro, Iloilo City, Philippines
BT: Case Scenario 1 (Group 1)
Blood Transfusion Case Scenario
Mrs. Jenny Lin, a 55-year-old fell while walking on the stairs. She was brought to the
Emergency Department for an initial examination and the doctor advised for admission.
Advanced Osteoarthritis was diagnosed and the X-ray revealed a Complete Fracture in
Left Femur. She was scheduled for Open Reduction Internal Fixation.
After surgery, Mrs. Lin had a hemoglobin count of 75g/L and was experiencing
shortness of breath and chest pain.
The doctor’s orders for the following:
Transfuse one (1) unit of packed RBC, blood type "O" positive after proper
crossmatching
Give furosemide(Lasix) 40mg IVTT after transfusion.
Submitted By:
GARBOSA, REJE MAE F.
GARZON, ALIYAH KRIS P.
GASCON, BENEDICTO JR. M.
Submitted To:
PROF. ADELFA D. DUSARAN
Answer the questions and post them on the reply button. ( 10 points)
1. What are the nursing considerations before starting a blood
transfusion?
When transfusing blood, the following must be remembered to help ensure safe and
effective care for patients is maintained and provided:
● Ensure that the correct preparation of the patient and the care procedure is done.
○ Double-check the order for transfusion and correlate this with the clinical
diagnosis and care plan of the patient.
○ Verify the blood type of the patient on the chart. If needed, obtain a request
for blood typing.
○ Once blood is transfused or a donor is available, request for crossmatching to
be done. A sample will be obtained from the patient and from the donor/blood
pack and tested.
○ After crossmatching is done, a request for the number of units to be
transfused should be made.
○ NOTE: Universal donor is blood type O-, while type AB+ is the universal
recipient.
● Obtain consent. Consent must be obtained prior to starting any invasive procedure
or therapy. NOTE: The physician is the one explaining the procedure and asks the
patient to sign the form. The role of the nurse is to witness the signing.
○ Assess for any allergies the client may have.
○ Ask the client about any previous blood transfusion and their reaction to it.
i. If the patient has had a BT before, the physician may need to
prescribe premedication to prevent a febrile non-hemolytic reaction,
common with patients who have had several blood transfusions done.
ii. The usual premedication given is Benadryl (diphenhydramine) and
acetaminophen, 30 minutes to 1 hour before transfusion.
● Verify the BT order. Check the patient record and the order of the physician. The
following are verified:
iii. Patient identification and the information about the patient from the
blood bank;
iv. Results of typing and crossmatching;
v. The expiration date of the blood product to be administered.
● Warm the blood products.
● Determine the correct gauges for the IV needle. Usual IV needles from a blood
transfusion are gauge 18 0r 16. Larger bore needles are needed for BT because it
allows the passage of RBCs.
● Ensure proper IV tubing and access site. Y-tubing with an in-line filter is typically
used for BT. If the patient needs any other IV fluids, this is administered on another
line.
● Prime the line. The BT line is primed prior to the administration of BT. 0.9% NaCl is
used to prime the line and is the only compatible IV fluid with blood transfusions.
NOTE: Once the line is primed, the BT can be started.
● Obtain vital signs. These vital signs are taken prior to the start of the BT and
several times during the BT. Blood pressure, temperature, and pulse rate can be
used as indicators of potential adverse reactions to transfusion.
● Start the transfusion. Ensure that the patient is positioned comfortably since the BT
may last for anytime between 30 minutes to 4 hours.
● Monitor patient response to the therapy. Apart from vital signs, the patient may be
assessed for the following:
i. Rashes. This is an indication of an allergic reaction either to the blood
type or the additives in the blood products.
ii. Chills. A sign of a pyrogenic reaction, especially when this is seen in
the patient with an increase in temperature.
iii. Shortness of breath. This is a sign of hemolytic reaction and
necessitates the stopping of the transfusion.
iv. Headache, back pain, nausea, and vomiting.
○ NOTE: If using an infusion pump, set the pump at 2mL/min for the first 15 to
30 minutes of transfusion and monitor the patient’s response. Vital signs must
be monitored as per the following schedule:
i. In the first 5 minutes after starting the transfusion;
ii. 15 minutes after transfusion started;
iii. On the 30th minute;
iv. Every hour until the transfusion is done;
v. 1 hour after the transfusion is over.
○ Once transfusion is done, the line should be flushed with normal saline
solution. If there are no more succeeding transfusions, the line is
discontinued, and the BT set is disposed of properly.
2. Why is furosemide given after a blood transfusion? (Ben and Ali)
Furosemide has been frequently administered by physicians in newborns
and various age groups during and after blood transfusions. The rationale behind
this common practice is to reduce vascular overload caused by the extra blood
volume delivered during transfusion.
References:
https://rnspeak.com/blood-transfusion-nursing-responsibilities/
https://www.clinicaltrials.gov/ct2/show/NCT00618852
