The nurse is managing the care for a client with hyperparathyroidism, and is reviewing the client's list of prescribed and over-the-counter medications. Which medication(s) on the client's current medication record should the nurse discuss further with the healthcare provider? Select all that apply.

Potential condition:

TACO is a complication that can occur during or shortly after a blood transfusion, particularly in children. It happens when the volume of blood infused exceeds the circulatory system's ability to handle it, leading to fluid overload. In this case, the child is receiving 250 mL of packed red blood cells (PRBCs), and there are signs that the child may be experiencing fluid overload, such as tachycardia, hypotension, headache, and flushing. The elevated heart rate (115 beats/minute) and low blood pressure (88/44 mm Hg) after the transfusion started suggest that the child may be at risk for circulatory overload. These symptoms, combined with the increased temperature (100.9°F, 38.3°C), further support the likelihood of TACO.

Actions to Take:

Stop the blood transfusion: This is the first and most important step when transfusion-related complications, such as TACO, are suspected. Stopping the transfusion immediately helps to prevent further exacerbation of the fluid overload, which could lead to worsening respiratory distress and circulatory compromise.

Administer an antipyretic: The child has developed a fever (100.9°F), which could be a response to the transfusion. Administering an antipyretic such as acetaminophen or ibuprofen can help manage the fever, provide comfort, and prevent further complications. Fever management is important, especially in transfusion reactions, as it helps reduce the risk of complications such as febrile non-hemolytic transfusion reactions (FNHTR).

Parameters to Monitor:

Blood pressure: Monitoring the blood pressure is critical in assessing the child’s circulatory status. A low blood pressure (88/44 mm Hg), especially in the context of tachycardia, indicates that the child is experiencing hypotension, which is often associated with circulatory overload. Close monitoring of blood pressure will help guide the decision to start appropriate treatments, such as diuretics, to manage the overload.

Hematocrit: The hematocrit value provides information about the oxygen-carrying capacity of the blood. Given that the child’s hemoglobin was 6.5 g/dL (65 g/L) prior to the transfusion, it’s important to continue monitoring the hematocrit to assess the effectiveness of the PRBC transfusion. If the hematocrit remains low despite transfusion, it could indicate an ongoing issue with blood volume or oxygen delivery to tissues.

A. Monitor the client's white blood cell count. WBC count is a key indicator of infection and helps monitor the severity of the infection.

B. Institute contact precautions for staff and visitors. MRSA is highly contagious and can be spread through direct contact, so contact precautions are necessary to prevent transmission.

C. Send wound drainage for culture and sensitivity. This is essential to identify the specific pathogen and determine the appropriate antibiotic treatment.

D. Explain the purpose of a low bacteria diet. While a low-bacteria diet is often recommended for immunocompromised patients, it is not a priority in this scenario, where infection management and isolation precautions are more urgent.

E. Use standard precautions and wear a mask. Standard precautions should always be used, but a mask is not necessary unless the client has respiratory symptoms, which is not indicated in this case.