A female patient’s central venous access device (CVAD) becomes infecteD. Why would the physician order antibiotics to be given through the line rather than through a peripheral IV line?
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Solution
To attempt to sterilize the catheter and prevent having to remove it
Microorganisms that infect CVADs are often coagulase-negative staphylococci, which can be eliminated by antibiotic administration through the catheter. If unsuccessful in eliminating the microorganism, the CVAD must be removed. CVAD use lessens the need for peripheral IV lines and, thus, the risk of infiltration. In this case however, the antibiotics are given to eradicate microorganisms from the CVAD. CVAD use has this effect, but in this case, the antibiotics are given through the CVAD to eliminate the infective agent. The third option would not occur.
Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct advantage of using the CVAD for chemotherapeutic agent administration?
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Solution
Caustic agents in small veins can be avoided.
Many chemotherapeutic drugs are vesicants (highly active corrosive materials that can produce tissue damage even in low concentrations). Extravasations of a vesicant can result in significant tissue necrosis. Administration into a large vein is optimal. CVADs are more expensive than a peripheral IV. Dosing depends on the drug. IV chemotherapeutic agents are not administered at home. They are given in an outpatient or clinic setting if not given during hospitalization.
Dr. Smith orders a gram of human salt poor albumin product for a patient. The product is available in a 50 milliliter vial with a concentration of 25 percent. What dosage will the nurse administer?
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Solution
The nurse will administer 4 milliliters.
A 25 percent solution contains one quarter of a gram per milliliter. Thus, the nurse will administer 4 milliliters to provide a complete gram of albumin. The volume in option 1 would provide 12.5 grams of albumin. The nurse should determine the volume. It is unnecessary to seek the answer from the physician. A 25 percent solution is an acceptable product and can safely be used.
A male patient needs to receive a unit of whole blooD. What type of intravenous (IV) device should the nurse consider starting?
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Solution
A large bore catheter
Large bore catheters prevent damage to blood components and are less likely to develop clotting problems than a small bore catheter. The nurse should determine the correct device without asking the patient what type has been used before or asking the physician which type he prefers and start the IV.
A female patient needs a whole blood transfusion. In order for transfusion services (the blood bank) to prepare the correct product a sample of the patient’s blood must be obtained for:
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Solution
A blood type and crossmatch.
This is needed to utilize the correct type of donor blood and to match the donor product with the patient. Incompatible matches would result in severe adverse events and possible death. The tests in options 1 and 3 are unnecessary. The test in option 4 is utilized to determine the patient’s blood type and presence of antibodies to blood antigens. It does not determine donor blood compatibility with the patient.
Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient. This therapy is administered for treatment of:
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Solution
Anemia.
A red blood cell transfusion is used to correct anemia in patients in which the low red blood cell count must be rapidly corrected. RBC transfusion will not correct a low platelet count. RBC transfusion will not correct a low white blood cell count. Packed RBCs contain very little plasma and, thus, only a small amount of albumin. This amount will not correct low albumin levels.
A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that:
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Solution
This is a compatible match.
Type O, Rh negative blood has none of the major antigens and is safely administered to patients of all blood types. It is also known as the universal donor. Premedicating with these agents will not prevent a major transfusion reaction if the blood type and Rh factors of the donor blood are incompatible with the recipient’s blood.
Louie who is to receive a blood transfusion asks the nurse what is the most common type of infection he could receive from the transfusion. The nurse teaches him that approximately 1 in 250,000 patients contract:
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Solution
Hepatitis B infection.
Hepatitis B is the most common infection spread via blood transfusion. Donors are screened by a questionnaire that includes symptoms. The donated blood is also tested for infection. The risk of infection with the agents in options 2 and 3 has decreased to approximately 1 in 2 million secondary to donor questioning and donor blood testing. The incidence of West Nile viral transmission is unknown, but donor infection is still relatively rare.
A severely immunocompromised female patient requires a blood transfusion. To prevent GVHD, the physician will order:
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Solution
Irradiation of the donor blood.
This process eliminates white blood cell functioning, thus, preventing GVHD. Diphenhydramine HCl is an antihistamine. It’s use prior to a blood transfusion decreases the likelihood of a transfusion reaction. Option 2 will not prevent GVHD. Use of acetaminophen prevents and treats the common side effects of blood administration caused by the presence of white blood cells in the transfusion product: fever, headache, and chills.
A neighbor tells nurse Maureen he has to have surgery and is reluctant to have any blood product transfusions because of a fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person that the safest blood product is:
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Solution
An autologous product.
This process is the collection and reinfusion of the patient’s own blood. It is recommended by the American Medical Association’s Council on Scientific Affairs as the safest product since it eliminates recipient incompatibility and infection. The product in option 1 is collected from a blood donor other than the recipient. The process in option 2 is also collected from a blood donor other than the recipient, but the donor is known to the recipient and is usually a family member or friend. Cross-matching significantly enhances compatibility. It does not detect infection.