Reflective Journal #2

Name: Tatyana Boytsan Date: February 25th, 2017

Noticing

Subjective and objective data:

o The female patient in her early twenties presented to the facility as a transfer from

a nearby hospital, related to her new-found tumor near the heart. After a round of

chemotherapy, she becomes neutropenic. As we wait for her ANC to rise, she

begins to become tachycardic consistently staying anywhere from 120 to 160 and

she comes weak, almost fainting. Her hemoglobin also falls to 7.1 g/dL. The

doctors initially believed that she was dehydrated and a fluid bolus was given,

which did not affect the tachycardia. The nurse suggested a blood transfusion, in

hopes that raising the hemoglobin level would help the tachycardia and overall

fatigue of the patient.

How did you know there was a problem? Abnormal presentation or your gut feeling?
o It was obvious there was a problem due to the patients abnormal presentation. It

all first began when the patient became very weak, and almost fainted. She was on

telemetry, therefore my nurse and I saw that she had become increasingly

tachycardic. And it was her labs that showed us the low hemoglobin level.

Interpreting

What other information do I need to make a decision? Is there anyone else I need to

involve or notify? What could be happening and how critical is this situation?
o A blood cross and type would be necessary before transfusion, if chosen to do so.

The doctor would be the one to order it, so he or she would need to be notified

along with the patient (and her family) because consent would also be needed.
 The patient may be tachycardic due to the low hemoglobin level, however the

situation is not severely critical.

Responding

Should I do something now or wait and watch? How will I know if I am making the best

decision? What interventions can I delegate to other members of the healthcare team?
o Considering the physicians already tried fluid resuscitation, it would be suggested

to do something now instead of wait and watch, even though the tachycardia is

asymptomatic. Interpersonal communication, alongside research to support the

decision, would help us know that we are making the best decision. It is suggested

that a transfusion of a single unit of blood can help patients who develop

symptoms of anemia, i.e. tachycardia unresponsive to fluid resuscitation or

when the hemoglobin level falls below 8 g/dL (Carson et al., 2012). Which is

exactly what was ordered! Taking vitals before beginning the transfusion of blood

products can be delegated to an UAP.

Reflecting

Did I make the right decision? Did I achieve the desired outcome? What did I do really

well? What could I have done better?

o Yes, a unit of blood was ordered and it helped the hemoglobin rise above 8 g/dL

and the tachycardia to decrease! The desired outcome was indeed achieved. I did

well when it came to monitoring the patients clinical manifestations and

situation, however I was not the one that suggested that a blood transfusion could

be helpful. If I gain more knowledge in that department, I can be prepared to offer

better solutions in the future.

Resource:

Carson,J.L.,Grossman,B.J.,Kleinman,S.,Tinmouth,A.T.,Marques,M.B.,Fung,M.K.,

Djulbegovic,B.(2012)RedBloodCellTransfusion:AClinicalPracticeGuideline

fromthe AABB.AnnInternMed.2012;157:4958.doi:10.7326/000348191571

20120619000429