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10 Cards in this Set
- Front
- Back
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What are signs of hypoglycemia Blood glucose <70 mg/dl
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Shaking
tachycardia sweating anxious dizziness hunger impaired vision weakness fatigue headache irritability |
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What are the signs of hyperglycemia
Blood glucose >200 mg/dl |
Extreme thirst
frequent urination dry skin hunger blurred vision drowsiness nausea |
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What are the signs of a stroke?
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Sudden neurological deficits such as muscle weakness (hemiplegia) of face, arm, or leg (especially if confined to one side of the body); confusion or trouble speaking or understanding speech; trouble seeing in one or both eyes; trouble walking; dizziness; loss of balance or coordination; and severe headache
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What are nursing interventions for patient with a seizure?
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Turn to left side; note time seizure starts and stops, note incontinence
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What are the signs of a blood transfusion reaction?
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abnormal bleeding, chest or back pain, coughing, cyanosis, dyspnea, facial flushing
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Interventions for transfusion reaction
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STOP THE BLOOD infusion immediately and infuse normal saline to keep the vein open. Then, notify the MD and blood bank with signs and symptoms of the reaction; take vitals every 15 min. until patient is stable; be prepared to begin resuscitative measures if needed; draw an EDTA (lavender top) tube and label appropriately; send the sample along with the complete transfusion reaction form and the remainder of the blood with the entire administration set still attached to the blood bank; collect the first voided or obtain a catheter urine sample immediately afterward; send to the lab for urinalysis record on transfusion record in reaction and comments columns
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Blood products must be infused within...
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within 30 min from the time the component left the blood bank.
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Rate of infusion should be set at...
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Begin infusion slowly for first 15 min to observe for any sign of reaction. If no reaction, increase infusion rate to couple within 2-4 hours.
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What do you need to verify before beginning blood transfusion?
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Patient name and number on hospital bracelet; name and number on unit requisition; patients own verbal response when asked to give name and date of birth
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How do you treat a pt who is not NPO and has a glucose between 50-70?
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Treat with 15 grams of fast acting carbs; recheck 15 min after carbs given; then again in 1 hour
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