to give or not to give plasma

[Novanurse16]

Hi all!

I'm a new nurse. I recently completed the Versant residency program and this is has been my 5th night alone. I graduate in December and have been on my own since the beginning of July.

I have so many things spinning through my head and learning everyday!

During my shift at night, I had a pt who was admitted for fever that had a seizure at her facility. They believe that the seizure she had was probably febrile in origin because she came into the hospital with a fever of 105F. She suffers from mental retardation. Her source of infection has not been identified. Blood cultures not growing anything, neither urine. They are thinking maybe a CNS infection, possible meningitis. It is unclear at this point. Her main issue during her hospital stay has been spiking fevers. She was pending to have a lumbar puncture under conscious sedation today. Her coagulation studies were elevated so she was pending 2 units of plasma to be given on my shift.

For temp control, it was basically Tylenol rectal suppository, ice packs and bath. No NSAIDS since she was going to have the lumbar puncture today. I started the night with 101.2 and it eventually creeped up to 104F. Called the ARNP, order for cooling blankets and it went down thankfully by the beginning of shift.

My question is, I never transfused her the units of plasma because I did not feel comfortable giving it to her with a temperature throughout the whole night especially since it was having difficulty breaking. Was I wrong to hold it?

[Double-Helix, BSN, RN]

I think you should have handled it differently. When a patient has a medication ordered, the nurse cannot simply choose not to give that medication without discussing with the physician and documenting appropriately. It sounds like you were concerned that she may have a transfusion reaction that you wouldn't detect because of the fever, is that correct? If that was the case, you should have called the provider and discussed your concerns. They then could have given you further direction, ordered some pre-medication prior to the transfusion, or written an order to hold the plasma until the patient was afebrile. Simply not giving the medication without follow up or documentation of why would be considered a medication error.

[Rose_Queen, BSN, MSN, RN]

Simply not giving the medication without follow up or documentation of why would be considered a medication error.

Or practicing medicine without a license.

[Novanurse16]

Right. I completely understood that it would be considered a medication error. My resource nurse was aware of the situation. I passed it on to dayshift and she was going to be transfused the plasma and 1 unit of PRBC with premedication.

In hindsight, I should have contacted the attending to make them aware of the temperature early in the night and ask whether or not to still transfuse because a reaction was my biggest concern.

Ultimately, it was a good learning experience.