National American University School of Nursing



NATIONAL AMERICAN UNIVERSITY

BLOOMINGTON CAMPUS

BSN PROGRAM

Nursing 3360: Holistic Nursing Care in Acute Illness I

Spring 2014

Learning Plan 4

Introduction to Hematology and Lab Interpretation

Blood Transfusions

Objective of the Course/Competency:

1. Demonstrate theoretical principles and ability to perform safe, effective and efficient psychomotor skills.

Knowledge and skills leading to mastery of this competency

a. Explain the interrelationships among theory, practice, and research.

b. Integrate theories and concepts from liberal education into nursing practice.

c. Determine the application of psychomotor skills for the efficient, safe, and compassionate delivery of client care.

e. Promote respiratory, circulatory, cardiopulmonary, gastrointestinal, genitourinary, integument, and musculoskeletal functioning.

2. Acquire knowledge that promotes the safe delivery of prescribed medications.

Knowledge and skills leading to mastery of this competency

a. Establish a foundational understanding of the medication administration process.

b. Identify sources of information necessary to administer prescribed medication, including compatibility and interactions among prescribed medications and complementary substances.

c. Determine the safe range of the dosage prescribed.

d. Calculate dosage necessary to administer prescribed medications.

e. Determine the appropriateness of the route for dministration of prescribed medication.

f. Demonstrate the ability to prepare and administer prescribed medication.

g. Determine the effectiveness of the prescribed medication.

h. Demonstrate the ability to follow procedure for working with controlled substances.

3. Explain the purposes, rationales, and indications for various nursing actions.

Knowledge and skills leading to mastery of this competency

a. Incorporate a model of critical thinking when making clinical judgments and decisions.

b. Cite nursing and associated literature that supports the nursing action.

c. Deliver compassionate, client-centered, evidence-based care that respects client and family preferences.

d. Explore phenomena in nursing that relates to the human response to illness.

4. Acquire knowledge from the behavioral, biological and physical sciences necessary to provide simple to intermediate level nursing actions.

Knowledge and skills leading to mastery of this competency

a. Synthesize theories and concepts from liberal education to build an understanding of the human experience

b. Identify sources of information necessary to deliver nursing actions to clients and families who are experiencing illness.

c. Incorporate theories of aging when providing care for gerontological clients.

d. Explore the Patterns of Knowing.

5. Document pertinent, accurate and complete client care information.

Knowledge and skills leading to mastery of this competency

a. Incorporate a standardized terminology in a care environment that reflects nursing’s unique contribution to patient outcomes.

b. Examine information and electronic medical record systems used to document client information.

c. Explain the use of CIS systems to document interventions related to achieving nurse sensitive outcomes.

6. Demonstrate advancing knowledge and skill in implementing the nursing process in client care and critical thinking activities.

Knowledge and skills leading to mastery of this competency

a. Articulate the components of the nursing process: Assessment, diagnosis, outcome identification, planning, implementation, and evaluation.

b. Relate the six components of the nursing process to the nurse’s clinical reasoning.

c. Discuss the significance of nursing diagnosis for nursing practice.

d. Differentiate between a medical and nursing diagnosis.

e. Discuss the categorization of nursing diagnosis by functional health patterns.

f. Explore the four types of diagnostic statements: Actual, risk, possible, and wellness.

g. Explain the purposes of outcome identification and planning.

h. Explore Nursing Outcomes Classifications and Nursing Intervention Classification.

i. Explain the purposes of implementation and evaluation.

j. Explain activities the nurse carries out to effectively use the nursing process.

7. Explore the stress, anxiety, coping and adaptation of the client and family.

Knowledge and skills leading to mastery of this competency

a. Investigate the concepts of stress, anxiety, coping and adaptation.

b. Evaluate person environment factors that contribute to the experience of stress and anxiety.

c. Examine the importance of cognitive appraisal in experiencing stress.

d. Determine strategies to manage stress and illness.

e. Determine when problem-focused and emotion-focused coping should be used.

Overview:

Blood administration is frequently used following many therapeutic and surgical procedures. However, it only is a temporary means of support until the underlying problem has been resolved. Blood transfusions refer to platelets, packed red blood cells (PRBCs), or plasma. Blood transfusions have many potential hazards; therefore, they should only be used if necessary. The nurse must ensure that the risks, benefits, and alternatives of blood component therapy has been thoroughly discussed and a written consent form signed and placed in the patient’s medical record prior to administration of blood components.

Learning Activities:

Lewis:

• Chapter 30 Hematological System

ATI Adult Medical- Surgical Nursing:

• Chapter 43 Hematologic Diagnostic Procedures

Review:

Come to Class Prepared to Discuss:

• Hematology and Lab Interpretation

o Blood components

o Clotting

o Laboratory studies:

▪ CBC

▪ ESR

▪ Blood typing and Rh factor

▪ System specific labs:

• Cardiac markers

• Liver function tests

• Renal tests

• Thyroid

• Blood transfusions

o Indications

o Types of transfusions

o Monitoring before, during, and after transfusion

o Complications

Post-class:

• Blood Transfusion Worksheet (attached)

Learning Objectives:

1. Differentiate between the different types of blood cells and their functions.

2. Describe the subjective and objective assessment data related to the hematologic system that should be obtained from a patient.

3. Describe the components of a physical assessment of the hematologic system.

4. Differentiate normal from common abnormal findings of a physical assessment of the hematologic system.

5. Describe the purpose, significance of results and nursing responsibilities related to diagnostic studies of the hematologic system.

6. Blood transfusions

a. Indications

b. Types of transfusions

c. Monitoring before, during, and after transfusion

d. Complications

7. Describe the nursing management of the patient receiving transfusions of blood and blood components.

BLOOD REPLACEMENT

1. List 3 objectives for blood transfusion.

2. Define the following terms

a. Agglutinin

b. Antigen

c. Autologous donor

d. ABO

e. Rh

3. The universal donor has the blood group ____________________.

4. The blood group of the universal recipient is __________________.

5. The nurse must check which of the following with another nurse before initiating the transfusion?

a. ABO and Rh

b. Patient name.

c. Unit number on compatibility tag.

d. Expiration date.

e. All of the above.

6. The recommended rate of infusion for a unit of whole blood or packed RBC’s is _______ hrs, but not longer than __________hrs.

7. Clients particularly at risk for circulatory overload are (name three) _______________.

8. Needle size for blood transfusion is #________ to #____________ gauge.

9. Infusion for blood must always have _____________ and a ___________ administration set.

10. The client is particularly at risk for a transfusion reaction during the first 15 minutes. List nursing action you will do to monitor the client for signs/symptoms of a reaction.

11. List 5 signs and symptoms most commonly associated with transfusion reaction.

12. IV tubing should always be primed with which IV solution?___________.

Why?

13. Nursing actions for blood transfusion reaction:

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