Random
What are the 3 workup tests for a bone marrow transplant
PFT/ 24hr urine/ heart echo
What does Neutropenic mean?
ANC less than 1.00
When do you transfuse RBC for BMT
Hct equal or less than 24
BMT threhold for Plt
equal or less than 15
Management of Rituxan infusion. What do you watch for?
Vitals/ reaction
When/why do you draw blood cultures. When can you draw concurrent blood cultures?
1st fever of 100.6
Concurrent fever over 24hr period from previous drawn blood cultures
In regards to neutropenia, if someone on the floor is going off the floor to a procedure/test and has an ANC of 0.5, what do you make sure the Pt has before they leave the floor
Ticket to ride
Put mask on
When do you transfuse for RBCs for hem/teaching
Hgb equal or less than 7
Hem/teaching plt threshold
10 or less
Signs and symptoms of a rituxan reaction
Fever/chills/rigors- flu like symptoms, SOB/hypoxia
When do you not draw blood cultures?
no fever, and within 24hr of previous blood cultures
What is count recovery
When someone's counts are recovering from getting chemo
Pt has a hct of 25/hgb8, Pt is SOB and low BP and has a high heart rate, no fever, what should you ask for from the physician
a RBC transfusion, Pt is symptomatic
Pt has a plt of 25k, starts having nose bleed and hematuria. What do you need to ask the physician?
I need a plt transfusion
Ask for Coags. (DIC panel, PT INT, APTT)
Calculation of rituxan
500mg in 800mls. Run at rate of 50mg/hr and bump up every 30 minutes until you reach a max rate of 400mg/hr
Will calculate at that time
how to draw blood cultures
new cap, do not waste blood, 2 10 mls syringes
What would a patient get that is in count recovery
blood/ platelets/ Neupogen
What are signs and symptoms of a transfusion reaction?
Rash/hives/ SOB/ New low back pain/ fever/ hematuria
When to transfuse K and Mag for BMT/hem and
less than 3.8 and when ordered/ and Mag less than 1.7
What do you do during a reaction?
Stop infusion, call for assistance, stay with the patient, page the doctor initiate PRN meds at bottom of admin. sheet (this is different per order and per patient), if the Pt is tanking go ahead and call an RRT
When to notify rrt and how
Whenever you want, especially if your Pt is declining, Call "0" or 2-8872. (give your charge a heads up, not that you need permission, just a heads up so the charge knows what is going on)
What does it mean to not be in count recovery, also known as Pt has "achieved count recovery"
Stable h&h/ Plt/ ANC. Not needing blood transfusions and no longer needing neupogen shots
Process of ordering blood transfusion reaction
stop transfusion, click "yes" on transfusion reaction, Allscripts will pop a box up, disconnect blood from Pt, keep all tubing intact, draw two pink tops and but into tan biohazard back and take to blood bank.
Before you disconnect the Pt you must call the doctor and ask if they would like to order the blood transfusion reaction order set. it is ultimately up to the physician.
Signs and symptoms of sepsis
Fever,low temp. (less than 96), low BP. high HR. increased RR, AMS, decreased LOC,
What are the PRN meds. for a rituxan reaction?
Tylenol 650mg/ steriods (hydrocortison 100mg)/ demeral 12.5mg) benadryl 50mg