The nurse is planning care for the client. Which of the following provider prescriptions should the nurse anticipate? Select All That Apply

Exhibits

Rationale:
A. Continuous passive motion device: This device is typically used following total knee arthroplasty to maintain joint mobility and prevent stiffness. It is not commonly indicated after total hip arthroplasty, where excessive hip movement is discouraged during early recovery.

B. Elevated toilet seat: An elevated toilet seat helps prevent excessive hip flexion, which reduces the risk of hip dislocation after surgery. It allows the client to sit and stand more safely without bending the hip beyond 90 degrees, which is a critical precaution following hip arthroplasty.

C. Trapeze bar: A trapeze bar may assist some clients in repositioning while in bed, but it is not a standard discharge requirement for hip arthroplasty. Its use is more common in inpatient rehabilitation or in clients with prolonged immobility.

D. Compression garment: While compression stockings may be used to reduce the risk of deep vein thrombosis (DVT), a compression garment is not a standard or essential piece of home equipment following hip replacement surgery unless specifically indicated by the healthcare provider.

Rationale:

Stop transfusion: The client is showing signs of a serious transfusion reaction such as fever, chills, back pain, and hypotension. Immediately stopping the transfusion prevents further infusion of incompatible blood, which could worsen hemolysis and lead to shock or kidney failure.

Flush blood transfusion tubing: Flushing the existing blood tubing with saline could push more incompatible blood cells into the circulation. This can intensify the reaction and increase the risk of complications. Instead, new IV tubing with normal saline should be used if further IV access is needed.

Notify blood bank: The blood bank must be informed to initiate an investigation, verify blood compatibility, and conduct testing to determine the cause of the reaction. This helps prevent further occurrences and ensures patient safety.

Notify primary physician: The physician needs to be informed promptly to provide additional orders, such as fluid resuscitation, lab tests, or medications to stabilize the client. Immediate collaboration is essential to manage the adverse event effectively.

Return blood and tubing to blood bank: Returning the blood product and used tubing allows the blood bank to analyze the unit for errors or contamination. This is necessary for confirming the transfusion reaction and documenting the incident.

Administer IV diphenhydramine: Diphenhydramine may be used to reduce symptoms such as itching or chills if an allergic component is suspected. It is often part of the initial response while further evaluation and treatment are underway.

Administer oxygen: The client’s oxygen saturation has dropped, and respirations are rapid and labored. Administering oxygen supports tissue oxygenation and addresses hypoxia during this acute reaction, which may compromise respiratory function.