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* PLEASE INCLUDE COMPLETE PATHOPHYSIOLOGY IF ASKED IN THE QUESTION * Lloyd Bennett is a 76-year-old male who was admitted through the Emergency Department 2 days ago with a femoral head fracture sustained in a fall outdoors and underwent left hip arthroplasty. All drains have been removed. Provider changed the dressing this morning, and the dressing is currently clean, dry, and intact. Patient has complained of fatigue with physical therapy and does not tolerate changes in position without dizziness. Complete blood count this morning identified hemoglobin of 7 g/dL. The provider has ordered two units of packed red blood cells to be given. The lab has called and the first unit is ready. 1. Name three (3) immediate priorities for a patient having a transfusion reaction. Explain why you identified them as priorities. 2. What follow-up blood work would you collect and send for this patient? Explain your rationale. 3. Identify and explain three (3) different methods or interventions to help Mr. Bennett prevent deep vein thrombosis (DVT). Explain the pathophysiology of each. 4. Mr. Bennett’s hemoglobin was 7 g/dL (70 g/L), which is what triggered the order for blood transfusion. The result of Mr. Bennett’s Type & Screen test comes back, and his blood type is B Neg. Which type of Pack Red Blood Cells (PRBC) will be compatible for Mr. Bennett? Explain the pathophysiology behind your answer. 5. Mr. Bennett has received 2 units of Pack Red Blood Cells (PRBC) on your shift so far. He is also getting 0.9% Normal Saline at 100ml/hr. You are doing a 12-hours shift and your shifts started at 07:30hr. It is now 16:30hr. Mr. Bennett seemed fine during both units of blood transfusion. Suddenly, he is telling you that he has difficulty breathing. What do you think it’s happening? What would be your nursing interventions? Please explain. 6. What treatments would you provide a patient with low hemoglobin who cannot received any blood products due to religious beliefs or personal choices? Identify three (3) interventions and the rationale behind each one. 7. The physician orders a third (3rd) unit of PRBC for Mr. Bennett. You check the blood and set up the blood transfusion as you have with the previous 2 transfusions. This time, Mr. Bennett tells you that he is having back pain, but otherwise he looks fine. On his cardiac monitor you notice new arrythmias, which he did not have before. Explain what is happening? What is the pathophysiology of these new arrythmias in relation to Mr. Bennett’s treatment? 8. Mr. Bennett surgical site starts to bleed. You notified the team and changed the dressing twice already. Both times, the dressings had large amounts of sanguineous discharge. Identify three (3) factors that exacerbates bleeding. Explain the pathophysiology of each factor. 9 . Mr. Bennett’s bleeding has stopped for almost 24hrs. The most recent bloodwork results are as follow: WBC = 9 (4-10) Hemoglobin = 100 (120-170) *males Platelets = 29 (130-380) aPTT = 25 (22-30) INR = 1.0 (0.9-1.2) Question: Would you administer or hold the ordered dose of Enoxaparin 40mg S/c (Lovenox). Please explain your answer.
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