Outcome 2,8,11,12 and 13 - Essay Example

On examination, his pulse rate was 120 per minute and his blood pressure was 80/50mmHg. I immediately made a diagnosis of anaphylactic reaction and stopped the iron drip. I started oxygen and initiated plain saline drip. I gave 10ml per kg bolus. I then called the house officer who was appreciative of my immediate response to the reaction that saved the patient. Intravenous iron therapy is associated with risk of anaphylactic reactions that can be fatal. hence it is important to closely monitor any patient on intravenous iron therapy.

The patient was worried and asked me as to what was the problem. I told him that he reacted to the drug that was administered to him. he then asked me as to what would be the other means of increasing his hemoglobin and I told him that the next option would be blood transfusion. Outcome 8 12 year old Annah, a known case of acute lymphatic leukemia was brought to the emergency department with complaints of fever. She has been on chemotherapy for the past 3 months. She has no other complaints except for feeling of weakness.

On examination, her pulse rate was 120 per minute and the pulses were bounding. She was febrile and even respiratory rate was high. Her blood pressures were11/90mmHg. She appeared toxic. She also looked pale. Examination of the systems revelaaed no abnormality. I suspected neutropenia in this patient secondary to chemotherapy. I send blood samples for complete blood picture including neutrophil count, blood culture and urine culture. In view of rise in respiratory rate, I checked her saturations which were normal.

I asked for an X-ray. The reports revealed neutropenia. I made a diagnosis of febrile neutropneia and called the oncologist who ordered to initiate broad spectrum anitbiotics ceftazidime and gentamycin, while awaiting culture results. The parents were worried and asked me about the cause of fever. I told them that due to cancer treatment, the defense mechanisms were lost which contributed to increased risk of infections. It is very important for a nurse taking care of hematological cancer patients to be aware of the most significant and disastrous complication, febrile nuetropenia which needs admission and management in the hospital.

Febrile neutropenia can lead to sepsis (Bedbie et al, 2000). If untreated, it can lead to severe sepsis and shock. Annah's parents were worried that she might go into shock. I understood the concerns of the patient and directed them to the physician's chamber to meet the physician who was more qualified to address the needs of the parents. Outcome 11 In our out-patient department, we often would encounter patients with iron deficiency anemia who would be started on oral iron supplements. Iron supplements are very nasty because they can cause many side effects like abdominal pain, nausea, vomiting and constipation, because of which compliance is very poor.

There was one particular 55 year old gentle man who had persistent low hemoglobin levels despite iron therapy. Infact, we were planning to evaluate for other causes of hemoglobin when his wife told us that he was not taking his medication regularly because of side effects. I then told the patient into confidence and educated him about the important and benefits of iron therapy. I told him to take iron medication about one hour after meals to minimise side effects and also to have the best absorption possible.

I told the patient to drink some orange juice after taking iron