Implementation of Nursing Care 

Prepare the Patient for Diagnostic Evaluation

Your role as a nurse is to provide continuing support to the child and family during diagnostic studies and prepare the child both physically as well as psychologically  for such studies. 

Administration  of Transfusion Therapy

Children who cannot maintain a haemoglobin level of about 7 mg/dl receive regular transfusion tharapy to prevent chronic hypoxemia and  to suppress ineffective erythropoisis. Frozen RBC packed cells less than a week old should be used. Prevent and watch for transfusion reactions. Regulate the rate so as to prevent volume over  load or cardiac failure. 

Nursing Care During Blood Transfusion 

1. Your first responsibility is to identify donor and recipient blood types and groups on lables and patient's charts. Ensure that blood is administered slowly. 
2. Check the intravenous site frequently for infiltration. Observe the patient for transfusion reactions which include, chills, itching, rash, fever, headache and pain in the back or other parts or body. 
3. Clamp off the tubing immediately if such rection occurs in the patient and report to your senior. You should not remove the needle unless you are specifically instructed to do the same. 
4. Maintain the patency of  tube by opening the saline line if blood has been stopped. This will ensure administration of neccessary medications and preservation of vein for further infusions. 
5. Always use infusion pump to regulate flow of blood or fluid to prevent the danger of circulatory over load in children. 
6. Watch for complication which include, dyspnoea precordial pain and distended neck veins. There can also be a danger of air emboli or electrolyte disturbance. So you need to be alert particularly in case of a child who needs repeated transfusion. 
7. You should save the blood bag and  tubing if  the transfusion reaction occurs and return the same to blood bank depending upon the policy and routine of  your hospital. Mostly the reaction occurs within first 10 minutes of administration, but you should carefully watch the child  thoughout the treatment. 
8. You  have to administer drugs such as Benadryl for allergic reaction, and aminophylline for wheezing if  they are prescribed by concerned physician. 
9. Always prewarm the blood to be administered to prevent cardiac arrhythmias. 
10. You should always monitor vital signs, temperature, pulse, respiration and blood pressure before transfusion and monitor changes.