The Risks and Benefits of Transfusion Therapy

Potential complications of transfusions.

Photo © GARO / PHANIE / agefotostock

If your patient develops mild jaundice or thrombocytopenia two weeks after a blood transfusion, would you consider their transfusion history an important part of your assessment?

When I think of monitoring a patient who is receiving a blood transfusion, I think primarily about watching for a hemolytic transfusion reaction or circulatory overload. To me, that means keeping a close watch during the transfusion and for about 24 hours afterwards. Yet “classic” hemolytic reactions and volume overload are not the only potential complications of blood therapy. Delayed reactions can occur days or even weeks after you’ve run through your saline flush and disposed of the blood bag.

Update of current transfusion practices.

In this month’s AJN, Margaret Carman and colleagues provide readers with an update of current practices in transfusion therapy. In “A Review of Current Practice in Transfusion Therapy,” the authors survey the benefits and risks of fresh whole blood (used today primarily in military or disaster settings) and blood components—red blood cells, plasma, cryoprecipitate, and platelets. […]

2018-05-29T11:19:05-04:00May 29th, 2018|Nursing, patient safety, Patients|0 Comments
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What the Patient Knew: Communication and Patient Safety

Anticipating emergencies.

by rosmary/via Flickr

At the start of every shift after receiving report, I take a moment to consider what emergencies I might anticipate for my particular patient in our PICU. Monitor for excessive bleeding in a liver failure patient. Monitor for an altered neurological status in a patient with a head bleed. I try to envision how I would start CPR in the room if required. I try to be thorough in checking that all my emergency equipment is present and working. I try to keep patient safety at the forefront of my mind and priorities.

I came to work one day and received report about my 9-year-old patient who was post-operative day one from a planned craniofacial surgery. He would remain nasally intubated with eyes sutured shut for a few days until the swelling had reduced, and then would return to the OR to be extubated and to have the eye sutures removed. I’d had patients like him before and felt he would be very easy to keep safe, especially given that per handoff report, he was comfortably sedated and not overly agitated when he did briefly waken with nursing care.

A patient’s question.

As I got to know him through the first couple hours of my shift, I found that he was indeed comfortably sedated though easily […]

2018-05-24T10:08:09-04:00May 24th, 2018|Nursing, patient safety, Patients|0 Comments
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A Moment of Mindfulness: A Nurse’s Mosaic to Remember Patients

A Moment of Mindfulness © 2018 by Tilda Shalof

Noted author Tilda Shalof spent 28 years as an ICU nurse at Toronto General Hospital in Toronto. Over the years, she collected the discarded plastic medical packaging—including medicine caps, tube connectors, and vial lids, all of it sterile. At the suggestion of friend and artist Vanessa Herman-Landau, they used the plastic pieces to create this 4 ft. by 9 ft. mural, which is featured on AJN‘s May issue Art of Nursing page (click through to the PDF version for the best image).

[…]

2018-05-11T08:40:36-04:00May 11th, 2018|Nursing, Patients|0 Comments
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The Invisible Nature of Grief

Most nurses know the stages of grief by heart: denial, anger, bargaining, depression, and acceptance. We know the stages do not occur in an orderly, linear fashion. People flow in and out of each stage, circling back around to earlier stages as needed.

But I’m not aware of anyone discussing the invisible, insulating environment grief surrounds its survivors within. An acquaintance described it like this:

“We had just taken our son off of life-support, and sat with him as he passed. Our entire family had gathered to say goodbye. After leaving the hospital, we went to eat. I sat in the café, marveling at the world outside, that people were going about their daily lives, and I had just lost my son.”

When grieving periods were the norm.

collage by julianna paradisi/2018

A cultural understanding of this phenomena developed during the Victorian era, and still exists in period romance novels: People of means, after suffering the loss of a loved one or recovering from traumatic illness or injury, were sent to live with relatives in the country or at the seaside. There, they had no household responsibilities beyond taking long walks through the forest or along the shore, keeping journals, or sketching. In romance novels, the grieving heroine gets the added bonus of discovering a Fabio-like love to heal […]

2018-04-09T18:43:00-04:00April 9th, 2018|family, family experience, Nursing, Patients|0 Comments
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‘A Story Bigger Than Himself’: Easter on the Oncology Unit

“Kevin refused to make cancer the meaning of his days. . . . He showed me that the smallest gesture has the possibility to create expansive love. His kindness reminded many of the patients that they hadn’t lost value and worth, no matter how humbled they had been by cancer.”

That’s from the lovely Reflections essay in the new (April) issue of AJN and is written by nurse Barbara Adams. The article recounts a memorable Easter episode on the oncology unit in which a 26-year-old firefighter demonstrates a different kind of bravery and selflessness. […]

2018-03-30T08:34:03-04:00March 30th, 2018|Nursing, nursing stories, Patients|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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