Delegation and Prioritization
The 5 rights of delegation
Circumstance
Task
Person
Direction/communication
Supervision
3 cell types
Erythrocyte (RBC)
Leukocyte (WBC)
Thrombocyte (platelets)
Symptoms
pallor
fatigue
dyspnea
CP
H/A, irritability
Palpitations
>1500 /uL
Absolute neutrophil count (ANC)
Low, critically low, and fatal vaules of thrombocytes
low= <150,000
critical= <30,000 (spontaneous bleeding)
fatal= <10,000 (fatal hemorrhage)
The 4 P's of Prioritization
Purpose- for care
Picture- of pt
Plan- preferred outcome
Part- roles
Primary site of hematopoiesis
Bone marrow
blood transfusion
<500 uL
Neutropenic- severe risk
warning signs of thrombocytopenia
bruising easily
nose bleeds/gums bleeding
petechiae
excessive bleeding at venipuncture site
Can chart information not requiring nursing judgement
UAP/tech
Locations where production of hematopoiesis occurs
Bone marrow
Liver
Lymph nodes
Spleen
Thymus gland
Tonsils
When does blood for transfusion have to be started upon receipt
within 30 mins
Nursing interventions for neutropenia
Private room
monitor visitors/no children
no fresh fruit or flowers
oral care
leave equipment in room (stethoscope)
Nursing interventions
soft bristle toothbrush
electric razor only
fall precautions
avoid large bore IV/unnecessary needle sticks
Suctioning can be delegated to this discipline
Blood products
wheezing, dyspnea, chest tightness, cyanosis, impending doom
Anaphylactic reaction to blood transfusion
How long after chemo is ANC lowest
7-10 days
Treatment
platelet transfusion
Feeding (without swallowing precautions)
UAP/tech
Lab will be increased when Hgb is decreased
Hematocrit
Blood transfusion reaction protocol
STOP the infusion and notify provider
Sign the body is not able to keep up with infection
How long to infuse platelets
30 min- 1hr