Hello everyone, long time reader, thanks in advance for your input! I had two situations this week that I'd like some feedback on.
First, was administering two units of platelets to a cancer patient. First one was infused and shortly after, before I hung the second, patient stated that she felt a nasal congestion all of a sudden, with a slight sinus type of headache. Her vitals were unchanged, temp remained in the 36 C range, no shortness of breath or other symptoms. I asked another nurse what she thought and she didn't think it was a reaction. I researched blood transfusion reactions in our policies, and headache was listed as a possible reaction, but I didn't think on its own it was truly a reaction without VS change, or other symptom. However with the stuffy nose? At any rate, the second units of platelets was infused and her symptoms remained the same. I reported off to the next RN and went home, end of story. Also, she had been premedicated with tylenol and benadryl.
Second situation, working in the ED and patient definitely did have an allergic reaction to IV contrast following return from CT scan with profound angioedema. No SOB, difficulty swallowing, VSS, patient seeming ok. MD notified and rec'd orders for solumedrol 125, benadryl 50 and zantac 150 - IV for all 3 of course. Shortly after I gave solumedrol and benadryl (was waiting on zantac from pharm but that's another story...) patient became very agitated, tachy up to 148, yelling she can't breathe, diaphoretic. We put her on a nonrebreather, no other meds given, her heart rate returned to NSR and her anxiety lessened after a couple of minutes. No stridor or wheezing, SaO2 never less than 95%. Do you think this was an escalation of sorts of the allergic reaction? It seemed to happen RIGHT AFTER I gave benadryl and solumedrol. Perhaps a reaction to either of these medications?
Also, this ED situation was happening concurrently while I had a crying baby in another room (who was fine but still, the crying...), another patient needing to go to OR.... my coworkers were helping me obviously but I could feel my stress level shooting through the roof. Any suggestions on how to physically calm myself, any techniques you may utilize to stay focused and not feel like it is all on you? I know it can't be good for me to get so wound up and stressed out, nor is it good for my patients!
Thanks so much!
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Hello everyone, long time reader, thanks in advance for your input! I had two situations this week that I'd like some feedback on.
First, was administering two units of platelets to a cancer patient. First one was infused and shortly after, before I hung the second, patient stated that she felt a nasal congestion all of a sudden, with a slight sinus type of headache. Her vitals were unchanged, temp remained in the 36 C range, no shortness of breath or other symptoms. I asked another nurse what she thought and she didn't think it was a reaction. I researched blood transfusion reactions in our policies, and headache was listed as a possible reaction, but I didn't think on its own it was truly a reaction without VS change, or other symptom. However with the stuffy nose? At any rate, the second units of platelets was infused and her symptoms remained the same. I reported off to the next RN and went home, end of story. Also, she had been premedicated with tylenol and benadryl.
Second situation, working in the ED and patient definitely did have an allergic reaction to IV contrast following return from CT scan with profound angioedema. No SOB, difficulty swallowing, VSS, patient seeming ok. MD notified and rec'd orders for solumedrol 125, benadryl 50 and zantac 150 - IV for all 3 of course. Shortly after I gave solumedrol and benadryl (was waiting on zantac from pharm but that's another story...) patient became very agitated, tachy up to 148, yelling she can't breathe, diaphoretic. We put her on a nonrebreather, no other meds given, her heart rate returned to NSR and her anxiety lessened after a couple of minutes. No stridor or wheezing, SaO2 never less than 95%. Do you think this was an escalation of sorts of the allergic reaction? It seemed to happen RIGHT AFTER I gave benadryl and solumedrol. Perhaps a reaction to either of these medications?
Also, this ED situation was happening concurrently while I had a crying baby in another room (who was fine but still, the crying...), another patient needing to go to OR.... my coworkers were helping me obviously but I could feel my stress level shooting through the roof. Any suggestions on how to physically calm myself, any techniques you may utilize to stay focused and not feel like it is all on you? I know it can't be good for me to get so wound up and stressed out, nor is it good for my patients!
Thanks so much!