Which information obtained by the nurse in the clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

Choice A reason: Taking a daily multivitamin with iron is important for overall health, but it is not specifically related to preventing sickle cell crises. While maintaining proper nutrition is essential, it does not directly address the triggers or management of sickle cell crises.
Choice B reason: Restricting fluids to 2 liters per day is not appropriate for patients with sickle cell disease. In fact, maintaining adequate hydration is crucial to prevent sickling of red blood cells and reduce the risk of a sickle cell crisis. Restricting fluids could lead to dehydration, which can exacerbate the condition.
Choice C reason: Limiting exposure to crowds is an important instruction for patients with sickle cell disease. Crowded environments can increase the risk of infections, which can trigger a sickle cell crisis. By avoiding crowded places, patients can reduce their exposure to potential infections and help prevent crises.
Choice D reason: While avoiding caffeinated beverages is generally good advice for overall health, it is not specifically related to preventing sickle cell crises. Caffeine can cause dehydration, but the primary focus for preventing crises is maintaining proper hydration and avoiding infections.

1. Ensure MDHCP has discussed risks and benefits of blood transfusion. (a)
2. Educate patient on signs and symptoms of transfusion reaction. (d)
3. Obtain cross match and send it to blood bank. (b)
4. Gain blood from bank, confirm correct patient, correct product, correct cross match with 2 RNs. (e)
5. Initiate transfusion through a large gauge IV per hospital protocol. (c)
6. Start transfusion slowly for the first 15 minutes and stay with patient for the first 15 minutes. (f)
7. Increase rate of transfusion and monitor patient frequently. (g)
8. Ensure transfusion is complete within 4 hours of starting. (h)
9. Continue to monitor patient for transfusion reaction for 24 hours following transfusion. (i)

Rationale:

1. Ensure MDHCP has discussed risks and benefits of blood transfusion: It's essential that the healthcare provider discusses with the patient the potential risks and benefits of receiving a blood transfusion. This step is crucial for informed consent.
2. Educate patient on signs and symptoms of transfusion reaction: Before starting the transfusion, the patient should be educated on what signs and symptoms to watch out for that might indicate an adverse reaction, such as fever, chills, hives, or shortness of breath.
3. Obtain cross match and send it to blood bank: A blood sample is taken from the patient to determine their blood type and to perform a crossmatch, which ensures that the donor blood is compatible with the patient's blood.
4. Gain blood from bank, confirm correct patient, correct product, correct cross match with 2 RNs: Once the blood is ready, two registered nurses (RNs) will verify the patient's identity, the blood product, and the crossmatch results to ensure everything is correct before proceeding.
5. Initiate transfusion through a large gauge IV per hospital protocol: The blood transfusion is started using a large gauge intravenous (IV) line, as per hospital protocols to ensure proper flow and reduce complications.
6. Start transfusion slowly for the first 15 minutes and stay with patient for the first 15 minutes: The transfusion is started at a slow rate to monitor for any immediate adverse reactions. The healthcare provider stays with the patient during this time to closely observe them.
7. Increase rate of transfusion and monitor patient frequently: If no adverse reactions are noted in the first 15 minutes, the rate of transfusion can be increased. The patient is monitored frequently throughout the transfusion for any signs of a reaction.
8. Ensure transfusion is complete within 4 hours of starting: Blood products should be transfused within 4 hours to minimize the risk of bacterial growth and to ensure the effectiveness of the transfusion.
9. Continue to monitor patient for transfusion reaction for 24 hours following transfusion: After the transfusion is complete, the patient is monitored for at least 24 hours for any delayed transfusion reactions, such as fever, allergic reactions, or other complications.