Possible Complications Resulting from Blood Transfusions

Intravascular hemolysis may occur (the destruction of blood inside the body). An allergic reaction may occur between the immune system and protein of the blood being transfused.

Special attention towards the patients’ vital signs is required. Complications from blood volume overload may occur. If the blood is incompatible between the patient and the donor, the patient may become febrile as a result of the body’s immune system. Hyperthermia may occur due to white bloods cells attacking foreign blood. If the body reacts to the foreign blood, we must take action to flush system if necessary. Hypothermia may also occur because of rapid infusion of blood into the body, especially in infants. If blood volume overload occurs, thrombosis may occur as well as hemorrhaging.

Young woman has Lacerations: which vital signs should be assessed?
Laceration: Tearing of skin and tissue with blunt or irregular instrument, tissue not aligned, with loose flaps of skin and tissue.
Lacerations to wrist: Radial pulse would be done on the other arm away from the laceration, apical pulse would also be appropriate to find a more accurate pulse rate
Blood pressure measure in popliteal to not increase bleeding of laceration
Blood pressure is needed to make sure the patient is not in shock.
LOC (level of consciousness) is needed in case patient has lost too much blood or
Suffered any type of head trauma
Orthostatic BP is needed if there was blood loss or weakness
Temp is needed as a precaution for infection
PERRLA is to see if patient is on narcotics, or has trauma
Cap refill is to see if the patient has adequate circulation to extremities
Pain is to see how much pain the patient is in due to the laceration scaled. 0-10
Elderly man, mowed lawn in 95 degree heat
“extremely hot weather causes dehydration, heat exhaustion and heat stroke. Risks increase when humidity is above 70% heat and humidity interfere with body’s natural cooling process. Exercise outside in hot and humid conditions can be hard on heart. Problem is worse because the heart is trying to deliver blood and oxygen to working muscles while body is trying to cool off. Decreases BV- heart has to pump even harder to get the smaller volume of blood to working muscles, skin and other body parts. When too much fluid is loss body temp rises, and NS doesn’t function properly. Extreme fluid loss can lead to brain and heart damage. All of which causes heat exhaustion which leads to heat stroke.”
s/s: warm dry skin with no sweating, strong and rapid pulse, confusion, unconsciousness, high fever (hyperpyrexia), throbbing HA, N/V
Tx: stop exercising, cooling down, cool water, seek medical attention
http://www.americanheart.org/presenter.jhtml?identifier=4660
Assessment:
Temp is needed to check the temperature of patient to see if they are at risk of hyperthermia or hypothermia
BP is needed to check if their heart is pumping enough oxygen to the body
Pulse is checked to see if their pulse is higher than average
Apical is used to get a more accurate pulse reading. Skin assessment, cold, clammy, sweating
Turgor is checked to see if patient is dehydrated
PERRLA is checked if the heat stroke caused any head trama. To see if patient is dehydrated
LOC is to see if the patient is conscious and aware of surroundings
Orthostatic BP is used in case their blood pressure drops due to lack of oxygen to the brain
O2 levels to see if oxygen is being pumped to extremities
Pain asses is the patient is in pain
Cap refill to see if the patient is getting blood to the extremities
Teenage girl faints
Wt to see if she has an eating disorder
Temp to see if the patient is febrile
BP to see if feinting was caused by hypo/hyper tension
Pulse is to see if feinting caused a high pulse and if it is back to normal
Turgor to see if the patient is dehydrated
PERRLA to check for head trauma and reactiveness
LOC to see if the patient is aware of her surroundings
Pain to asses if the patient is in pain
Cap refill to see if the patient is getting blood to the extremities
Look for other injuries related to the fall
Skin Color correct oxygen in body
Check sugar level for hypoglycemia
Temps for hyper and hypothermia

Objectives
Weight
Labs
Electrolyte balance
PERRLA
Viewing throat, nose
Height

Subjectives
Headache
discomfort

Team Aqua
Nutrition and Diets

Carbohydrate modified diets for diabetes mellitus
Diabetes Mellitus- is a syndrome of disordered metabolism, usually due to a combination of hereditary and environmental causes, resulting in abnormally high blood sugar levels (hyperglycemia). (Wikipedia.com)
- To improve metabolic control by achieving and maintaining optimal blood glucose.
- Provide adequate energy for a maintenance of a reasonable body weight
- Prevent acute and chronic complications of diabetes
- Improve overall health through optimal nutrition
Treatment and Management
Diabetes mellitus is a chronic disease. It is important for patient education involving dietetic support, exercise, self glucose monitoring, with the goal of keeping short-term and long term levels within acceptable bounds. Careful control is needed to reduce the risk of long term complications. (wikipedia.com)

Diet
- Mostly, grains, beans, and starchy vegetables
- Very few fats, sweets, and alcohol
- 6-11 servings of grains and starches a day
- 3-5 servings per day of vegetables
- 2-4 servings a fruit per day
- 2-3 servings of dairy per day
- 4-6 oz. of meat substitutes divided between meals
- make fats, sweets, and alcohol a special treat
(http://www.diabetes.org/food-nutrition-lifestyle/nutrition/meal-planning/diabetes-food-pyramid.jsp)

Signs and Symptoms
- frequent urination
- increased thirst
- increased fluid intake
- increased appetite
- rapid weight loss
- irreducible fatigue

Lactose Intolerance
 Intolerance occurs as a result of a lack of the digestive enzyme lactase.
 The GI tract is unable to break down lactose.
 Symptoms occur after the ingestion of milk products and include nausea, cramps, bloating, flatulence, and diarrhea.
 Diet for lactose intolerance excludes milk and milk products; foods with milk added may need to be avoided as well.
“Lactose is a larger sugar that is made up of two smaller sugars, glucose and galactose. In order for lactose to be absorbed from the intestine and into the body, it must first be split into glucose and galactose. The glucose and galactose then are absorbed by the cells lining the small intestine. The enzyme that splits lactose into glucose and galactose is called lactase, and it is located on the surface of the cells that line the small intestine.
Lactose intolerance is caused by reduced or absent activity of lactase that prevents the splitting of lactose (lactase deficiency). Lactase deficiency may occur for one of three reasons, congenital, secondary or developmental. “ “The common symptoms of lactose intolerance are gastrointestinal, primarily, abdominal pain, diarrhea , flatulence (passing gas), and, less commonly, abdominal bloating, abdominal distention, and nausea.”
http://www.medicinenet.com/lactose_intolerance/article.htm
Lactose Intolerant people should not consume milk or dairy products

DUMPING SYNDROME

Definition
Dumping syndrome is a group of symptoms most likely to develop most if you’ve had surgery to remove all or part of your stomach, or if your stomach has been surgically bypassed to help lose weight. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach are transported or “dumped” into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea.
Most people with dumping syndrome experience symptoms soon after eating. In others, they may occur one to three hours after eating, and can range from mild to severe.
Most often, you’ll find that dumping syndrome improves on its own without medical treatment or after adjusting your diet. In more-serious cases of dumping syndrome, you may need medications or surgery.
Symptoms
When symptoms of dumping syndrome occur during a meal or within 15 to 30 minutes following a meal, they may include:
 Nausea
 Vomiting
 Abdominal pain, cramps
 Diarrhea
 Dizziness, lightheadedness
 Bloating, belching
 Fatigue
 Heart palpitations, rapid heart rate
When signs and symptoms develop later, they may include:
 Sweating
 Weakness, fatigue
 Dizziness, lightheadedness
 Shakiness
 Feelings of anxiety, nervousness
 Heart palpitations, rapid heart rate
 Fainting
 Mental confusion
 Diarrhea
Treatments and drugs
Most cases of dumping syndrome improve with nutritional measures alone. However, if changing your diet doesn’t relieve your symptoms, your doctor may advise medications or surgery to slow the emptying of your stomach’s contents.
Dietary changes
Here are some dietary treatment strategies that your doctor may recommend:
 Eat smaller meals. Try consuming about six small meals a day rather than three larger ones.
 Avoid fluids with meals. Drink liquids only between meals.
 Change the makeup of your diet. Consume more low-carbohydrate foods. In particular, concentrate on a diet low in simple carbohydrates, such as sugar (found in sweets like candy, cookies and cakes). Read labels on packaged food before buying, with the goal of not only avoiding foods with sugar in their ingredients list, but also looking for (and staying away from) alternative names for sugar, such as glucose, sucrose, fructose, dextrose, honey and corn syrup. Artificial sweeteners are acceptable alternatives. Consume more protein in your diet and adopt a higher fiber diet.
 Increase pectin intake. Pectin is found in many fruits, such as peaches, apples and plums, as well as in some fiber supplements. It can delay the absorption of carbohydrates in the small intestine.
 Stay away from acidic foods. Tomatoes and citrus fruits are harder for some people to digest.
 Use low-fat cooking methods. Prepare meat and other foods by broiling, baking or grilling.
 Consume adequate vitamins, iron and calcium. These can sometimes become depleted in the aftermath of stomach surgery. Discuss this nutritional issue with a registered dietitian.
 Lie down after eating. This may slow down the movement of food into your intestines.
Even with dietary changes, you may continue to experience severe symptoms associated with dumping syndrome.
Medications
Your doctor may prescribe certain medications to slow the passage of food out of your stomach, and relieve the signs and symptoms associated with dumping syndrome. These drugs are most appropriate for people with severe signs and symptoms, and they don’t work for everyone.
The medications that doctors most frequently prescribe are:
 Acarbose (Precose). This medication delays the digestion of carbohydrates. Doctors prescribe it most often for the management of type 2 diabetes, and it has also been found to be effective in people with late-onset dumping syndrome. Side effects may include sweating, headaches, pallor, sudden hunger and weakness.
 Octreotide (Sandostatin). This anti-diarrheal drug can slow down the emptying of food into the intestine. You take this drug by injecting it under your skin (subcutaneously). Be sure to talk with your doctor about the proper way to self-administer the drug, including optimal choices for injection sites. Long-acting formulations of this medication are available. Because octreotide carries the risk of side effects (diarrhea, bulky stools, gallstones, flatulence, bloating) in some people, doctors recommend it only for people who haven’t responded to other treatments.
Surgery
Doctors use a number of surgical procedures to treat severe cases resistant to more-conservative approaches. Most of these operations are reconstructive techniques, such as reconstructing the pylorus, or they’re intended to reverse gastric bypass surgery.

Prevention
You can’t prevent dumping syndrome. However, measures such as dietary adjustments may prevent recurrences of your symptoms and minimize their severity.

Common Foods to Avoid
Some typical foods those suffering from dumping syndrome may need to avoid include:
• pancakes with syrup
• sweetened cereals
• fruit punch
• milkshakes
• sweet pickles
• ice cream
• candy
• cookies
• honey
Additional Dietary Changes
Eating smaller meals — about six a day — is typically helpful. Abstaining from drinking liquids during your meals is advised for all gastric bypass patients, but it is especially important to preventing the symptoms of dumping syndrome. You should always wait at least 30 minutes after a meal before drinking any liquids.
Some patients find avoiding foods that are either very hot or very cold may help prevent dumping syndrome. Consuming milk and dairy products has also been found to lead to symptoms. So it is a good idea to eliminate these foods and assess your symptoms after several days.

Reference website: http://www.mayoclinic.com/health/dumping-syndrome/DS00715