Blood transfusion and Vital signs Situation

Joann Caruana, a 33-year-old mother of four, has just returned to the surgical ward following a laparoscopic cholecystectomy performed under general anaesthesia. The surgery was successful, and no immediate complications were noted intraoperatively. 

• What assessments and interventions should the nurse perform to manage and monitor Joann’s pain after laparoscopic cholecystectomy? 
• Which signs and symptoms will the nurse monitor for that may indicate postoperative complications? 
• What postoperative respiratory exercises should Joann be encouraged to perform, and why are these particularly important following surgery under general anesthesia? 
• What advice should the nurse provide to Joann regarding physical activity, wound care, and diet during the first few days after discharge following a laparoscopic cholecystectomy? Explain why each of these recommendations is important for her recovery 

Cholecystectomy – Postoperative Situation

3.1 Pain Assessment & Management 

I would evaluate the pain of Joann with the help of a validated scale and monitor her facial expressions, vital signs, and the incision site. I would give scheduled or as-required analgesics like IV opioids or NSAIDs and re-assess pain after 30 minutes to see what works. Non-pharmacological measures like positioning a small pillow over her abdomen for comfort, guided relaxation, and distraction techniques (music or conversation) would complement medications. All assessments and interventions would be documented to guide ongoing care (da Silva Schulz et al., 2020).

3.2 Monitoring for Postoperative Complications 

I’d monitor her vital signs hourly, watching for fever, tachycardia, hypotension, or tachypnea that might signal bleeding, infection, or sepsis. I’d inspect her abdomen and trocar sites for increasing redness, swelling, warmth, or purulent drainage. I’d watch for escalating pain, abdominal distension, nausea, or vomiting, which could imply ileus or bile leak. I’d also observe for right-shoulder pain or jaundice, suggesting a bile duct issue, and check lower limbs for warmth, redness, or swelling, indicating possible DVT (Di Santo, 2019).

3.3 Respiratory Exercises having Postoperative 

Joann should do deep-breathing exercises an hour slowly, filling the lungs completely through the nose and exhaling through pursed lips to reopen collapsed alveoli. Using an incentive spirometer three to five times per session helps maintain lung expansion and prevents atelectasis. Controlled coughing with the abdomen supported by a pillow helps clear secretions safely and effectively. Early ambulation and gentle thoracic expansion movements further promote ventilation and reduce the risk of pneumonia, a common concern after general anesthesia (Kunadharaju et al., 2023).

3.4 Discharge Advice: Activity, Wound Care, Diet 

Joann should begin gentle walking as soon as she feels able, gradually increasing time to prevent deconditioning and lower DVT risk. Lifting or engaging in any strenuous activity should be avoided for two weeks to ensure she does not strain her healing tissues. I advise her to keep the incisions clean and dry, examine the area daily, check for signs of redness or discharge, and notify me of any suspicious symptoms of infection. Initially, she should follow a low-fat diet to prevent digestive upset, then progress to balanced meals rich in protein and vitamins to support recovery (Cao et al., 2017).

Part 4: Blood Transfusion

Ms. Rita Spiteri, a 52-year-old woman, has been admitted to the hospital with a diagnosis of gastrointestinal bleeding. Her hemoglobin level is 8 g/dL.

She has been type- and cross-matched and is scheduled to receive two units of packed red blood cells (PRBCs). The nurse is preparing to administer the first unit 

• The nurse is conducting a pre-transfusion What information must be obtained before administering the blood transfusion? (1.25 marks; 75 words).
• Before administering the first unit of packed red blood cells, what assessments and safety checks must the nurse perform? 
• What documentation is required following the administration of blood products, and why is accurate record-keeping essential in transfusion therapy? 
• Fifteen minutes after the transfusion begins, Ms. Spiteri reports itching all over. How should the nurse respond, and what immediate actions should be taken? 

Blood Transfusion

4.1 Pre-Transfusion Assessment

Before starting the transfusion, I would verify her Name and Date of birth with blood product label and check that her informed consent is documented. I’d review her transfusion history for prior reactions or antibodies, confirm her current hemoglobin and coagulation profile, and note any allergies or comorbidities. I would also review her baseline data on vital signs, including temperature, blood pressure, pulse, and respiratory rate, and examine her IV site to determine its patency and suitability for receiving a blood transfusion (Gammon et al., 2022).

4.2 Pre-Administration Safety Checks 

With another qualified nurse, I’d perform a bedside “two-person check,” matching the patient’s ID band with the blood bag’s unit number, blood type, Rh factor, and expiration date. I’d inspect the PRBC unit for discoloration, clots, or leaks. I’d ensure the IV cannula is at least 20-gauge, flush it with normal saline, and attach a blood filter set. Finally, I’d reconfirm the physician’s order, verify that the bag contains the prescribed volume, and prepare to monitor vitals closely during the transfusion (Bediako et al., 2021).

4.3 Post-Administration Documentation 

After completing the transfusion, I’d record the blood unit number, blood type, start and finish times, total volume infused, and Ms. Spiteri’s pre-transfusion, intra-transfusion, and post-transfusion vital signs. I’d note any reactions or interventions and sign the transfusion record. Exact certification safeguards the traceability of the blood product, enables the early detection and investigation of adverse events, and fulfills legal and regulatory requirements, thereby contributing to overall patient safety and quality hemovigilance (Chebii Kipkulei, 2019).

4.4 Response to Itching 15 Minutes In 

Noting Ms. Spiteri’s itching, I would also discontinue the transfusion instantly and preserve intravenous access with an infusion of normal saline. I would examine her vital signs and skin for any signs of hives or rash, and I would inform the physician or the rapid-response team. According to the protocol, I would clean and give prescribed antihistamines and observe whether it develops into severe reactions. I’d document the event, save the blood bag and tubing for inspection, and report the reaction to the blood bank for further evaluation.