H&H Question

[LouisianaNurse2006]

This is probably a stupid question, but I am a new nurse, so here it goes anyway.........

I am working in the ortho unit (for 2 weeks now), and we have an order from one Dr that if H&H is falling to order a SOB (Stool for Occult Blood). Now I know that decreasing H&H could mean hemorrage from ortho surgery, and when they get below 10 & 30 we notify the Dr and he usually orders a couple units of blood. But what I am trying to understand is why the SOB? I thought Stool for Occult Blood would be a GI problem, not hip or knee surgery.

Thanks for any clarifications!

[decartes]

I'm only a nursing student but here goes my very raw thoughts in training: It may be possible that your pt. is on some anti-coag to prevent DVT's or emboli's from forming. Pt's on anti-coags are at obvious risk for bleeding with internal bleeds (such as GI) posing as BIG threats to the pt.

I hope this helps.

[EricJRN, MSN, RN]

This is a standing order and not referring to any one patient, right? The thinking could be that these ortho pts are more likely to have a long history of NSAID use. Combined with the stress on the body from surgery, that leaves you with a risk of GI bleeding.

[LouisianaNurse2006]

THANKS GUYS! That does make sense.

[psalm_55]

if the H&H are both falling, indicative of bleeding -- therefore, just testing a common site of bleeding among ortho patients

[P_RN, ADN, RN]

In addition to the other great answers, the stress of any kind of surgery could cause gastric irritation/bleeding.

[meownsmile, BSN, RN]

Louisiananurse if i might ask, how do your docs get by with giving transfusions at 10? Ours have to be below 7 if not symptomatic and if symptomatic the docs may give 1 unit but dont unless it is under 8 and symptomatic. Maybe a state thing?

Duh,, sorry we transfuse under 8.

[EricJRN, MSN, RN]

In my experience, it's more of a facility thing. Depends on the particulars of the institution. One big factor is how much blood the hospital can get vs the amount it transfuses. When I worked for a large cancer center, if we transfused people at 10 (or 8) we would have run out of blood. Now that I work at a general hospital where fewer pts have blood product needs, the rules there are more lax.

[NJNursing, ASN, RN]

Louisiananurse if i might ask, how do your docs get by with giving transfusions at 10? Ours have to be below 7 if not symptomatic and if symptomatic the docs may give 1 unit but dont unless it is under 8 and symptomatic. Maybe a state thing?

Duh,, sorry we transfuse under 8.

We almost always transfuse if under 8, depending on the H & P of the pt prior to surgery. Between 8-10 it's at the discretion of the doctor and their daily trend on the lab values.

Our hospital doesn't check stool for OB unless there's an indication to do such. Generally it's blood loss from a hip or knee and not a GI bleed, thus lowering the cost of care to not do unnecessary tests.