ADMINISTRATION OF MEDICATION DEFINITION: To safely and accurately administer medication to a child, taking into account weight, surface area,

and the ability of the child to absorb, metabolize, and excrete the medication. PROPUSE: To prevent the disease. To cure the disease. To promote health. To give palliative treatment. To give as symptomatic treatment.

ROUTIES OF GIVING MEDICINES: Oral administration. Sublingual administration. Place the drug under the tongue which allows dissolution immediately. Inhalation. Systemic effect is produced immediately due to large surface area of the body and the rich supply of the blood vessels. Inunction. Apply drug to the skin by friction. Instillation. In a liquid form. Insertion. In a solid form. Parental administration. By needle. Irrigation. STANDARD OF CARE: To avoid medication errors, always follow these five steps in preparing and administrating medications to pediatric patients. Right child: Always check identification band of the child before administrating the medication. Right drug: Check the label on medication. Right dose: Always clarify the poorly writer orders. Right route: Some drugs are never given by certain routes because the route would hinder the action of the drug. Right time: Always mater a note of when the medication is to be given. Right documentation: The nurse documents medications given.

FOLLOW NINE RULES IN GUIDING YOUR MEDICATION ADMINISTRATION TO THE PEDITRIC PATIENT: Never give a child a choice of whether or not to receive medicine. The medication is ordered and is necessary for recovery; therefore, there is no choice to be made. However, do choices that allow the child some control over the situation, such as the kind of juice, the number of bandages, are the injection site. Never lie, do not till a child that a shot will not hurt. Keep explanations simple and brief. Use words that the child will comprehend. Assure the child that it is all right to be afraid and that it is okay to cry. Do not talk in front of the child as if the child were not these. Include the child in the conversation when talking to parents. Be positive approaching in the child. Be firm is assertive when explaining to the child what will happen. Keep the time between explanation and execution to a minimum. The younger the child, the shorter the time should be. Keep explanation simple. Obtain Parenteral co-operation , parents may be able to calm a frightened, child. ASSIGNMENT: 1. Assess the child or family for any previous experience with medications or hospitalizations. 2. Assess the childs level of consciousness, pulmonary, cardiovascular and gastrointestinal functions, muscle strength and mass. 3. Assess the childs developmental level and usual coping mechanisms. 4. Assess the child for allergies to medications. EQUIPMENT: Assemble the appropriate equipment PROCEDURE: ORAL MEDICATIONS: 1. Dropper: Wash hands, hold the infant in the cradle position and stabilize the head against your body. Hold infants arm with your free arm. Press on the infants chin to open mouth. Squirt the medication to the back and side of the mouth in small amounts. Medicine dropper. Syringe (with or without needle). Nipple. Medicine cup and spoon. Finger cot. Adhesive bandage. Lubricant.

2. Syringe: Hold the infant or toddler in the cradle position, supporting the head and holding the arms. Place the syringe to the back and side of the mouth and give the medication slowly, allowing the child to swallow. 3. Nipple: Hold the infant in the cradle position, squirting the medication from the syringe into the nipple. Allow the infant to suck the medication from the nipple. Follow the medication with 2-3 ml of water. 4. Medicine cup: A cup can be used for the older infant, toddler, preschooler school-age child and adolescent for the young patient, a parent or the child may hold the cup. Slay with the child until the entire close is swallowed. A spoon is an effective alternative to the medicine cup. Disguise a disagreeable taste in a small amount of food like applesauce. Syrup is also good for mixing medications that do not dissolve in water. Dilute alcohol based elixirs with water before administering. NOSE DROPS: Hold the infant in the cradle position, stabilizing the head with your arm, and filtering it back slightly. Squeeze the drops into each nostril as you try to comfort and hold the infant in this position for at least 1 minute. (Place the toddler head over a pillow). Squeeze the drops into each nostril. The school-age child and adolescent may give themselves their own medication since they can sniff the medication into the nasal passages. EAR DROPS: Position infants and toddles on their sides. This pinna of the ear is to be pulled down and back. Instill warm drops into the external canal and gently massage the area anterior to the ear. For children over 3 year, pull the pinna upwards and back. After the instillation , the child should maintain the position for 5-10 minutes. A cotton pledged placed into the ear canal can prevent the medication from leaking out, however it must be loose enough to allow discharge to drain from the ear canal. EYEDROPS OR OINTMENT: Place the child in a supine position, restraining him or her as necessary to safely instill the medication. (you may need help from another person). Pull the lower eyelid down and out to form a cup. Drop the solution into cup. The medicine will enter the conjunctive close the eye gently and attempt to keep it closed for a few movements. Ointments are applied along the inner can thus in an outward direction. Avoid touching the tip of the dropper or ointment tube to the body past. RECTAL MEDICATIONS: Place the child in a side-lying or prone positions. Lubricate the suppository into the rectum. Do not insert your finger more than inch. The buttocks should be held tightly together 5-10 minutes.

INTERA MUSCULAR INJECTIONS: CHOOSING THE SITE: Factors that must be considered: 1. Amount of muscle mass. 2. Type of medication to be given. 3. Amount and character of the medications. The volume of solution should be no more than 1.0 ml for infants and small children, 2.0 ml in the older child . 4. Number of injections to be given during the course of treatment. 5. Ability of the child to assume the necessary position. PROCEDURE: 1. VASTUS LATERALIS: This main muscle in the thigh is used most often for 1M injections in all age groups, but especially in infants. Locate the trochanter of the femur and the knee, and divide the area into thirds. Give the injection into the middle third, grasping the thigh and compressing the muscle. Direct the needle perpendicular the muscle or at a 45 degree angle toward the knee. VENTROGLUTEAL: Place the index finger on the anterior superior iliac spine and your second finger at the iliac crest inject the medication below the iliac crest at a 90 degree angle inside the triangle formed by these landmarks. Limit the amount of medication Injected into one site: Infant - ml. Toddler 1 ml. School aged or adolescent 1 - 3 ml. Avoid giving injections is to children in their beds or in the playroom. Since they should consider these safe places if possible, take the child to the treatment room for painful procedures. Cover the puncture site with an adhesive bandage to prevent leaking out. GLUTEAL REGION: The posterior gluteal muscle is not recommended as an injection site until the child has been walking for at least 1 year. Place the child supine and encourage toe-in position. Palpate the posterior superior iliac spine and the head of the great trochanter of the femur. Give the injection superior and lateral to an imaginary line between there landmarks. Direct the needle in a straight back-to front course. DELTOLD:

The deltoid muscle is shallow and can only accommodate a small amount of fluid (1.0 ml) position the child in any position that is convenient for the child and the person who will help hold the child. The childs entire arm and shoulder be exposed. Give the injection in the den sent past of the muscle, above the armpit and below the acromion. INTRADERMAL INJECTIONS: The medial surface of the forearm is the most common site for administration. These injections are made into the upper layers of the skin (as in TB skin tests and allergy tests). A needle should be inserted bevel-up at a 15 degree angle. A 25 gauge 5/8 inch needle should be used. No more than 0.1 ml should be injected. A small belb should form. SUBCUTANEOUS INJECTIONS: Subcutaneous injections are made just below the skin. All 1M injections sites can be used, as well as inter capsular abdominal wall, and sub scapular areas. Drugs given this way (for ex: epinephrine, insulin) are absorbed slowly. Hold the tissue to form a cushion insert the needle in a daut-like fashion, and release the tissue. Aspirate and then inject the medicine. Withdraw the needle quickly and apply dry gauge. A gauge is 26, 3/8 inch needle or 25 gauge 5/8 inch needle should be used. NO more than 0.5 ml of medication should be given to a small child or 1.0 ml to the pre schooler and adolescent. Z TRACK: After drawing up the ordered medication and 0.2 ml to 0.3 ml of air replace the needle with a new one. Pull the skin laterally away from the intended injected site. After cleaning the site insert the needle and inject the medication slowly wait 10min before you withdraw the needle. Withdraw the needle and allow the retracted skin to resume its normal position. Dont massage the site. PATIENT AND FAMILY EDUCATION: The parent or child will be informed of the name of the medication given to the child and why it is necessary to the medical treatment. The parent will know how to provide comfort measures for the distressed infant or child. Provide human contact. Provide vestibular stimulation rocking in supine position or being held upright over the shoulder. Provide a pacifier especially for the infant who is NPO. Recording and reporting

BLOOD TRANSFUSION INTRODUCTION: Blood transfusions typically use two sources of blood: one's own (autologous transfusion), or someone else's (allogeneic transfusion). The latter is much more common than the former. Using another's blood must first start with donation of blood. Blood is most commonly donated as whole blood intravenously and collecting it with an anticoagulant. In developed countries, donations are usually anonymous to the recipient, but products in a blood bank are always individually traceable through the whole cycle of donation, testing, separation into components, storage, and administration to the recipient. This enables management and investigation of any suspected transfusion related disease transmission or transfusion reaction. In developing countries the donor is sometimes specifically recruited by or for the recipient, typically a family member, and the donation occurs immediately before the transfusion. DEFINITION: Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease. People suffering from hemophilia or sickle-cell disease may require frequent blood transfusions. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood. INDICATIONS: Many people who have surgery need blood transfusions because they lose blood during their operations. For example, about one-third of all heart surgery patients have a transfusion. Some people who have serious injuries - such as from car crashes, war, or natural disasters need blood transfusions to replace blood lost during the injury. Some people need blood or parts of blood because of illnesses. You may need a blood transfusion if you have:

A severe infection or liver disease that stops your body from properly making blood or some parts of blood. An illness that causes anemia, such as kidney disease or cancer. Medicines or radiation used to treat a medical condition also can cause anemia. There are many types of anemia, including aplastic, Fanconi, hemolytic, iron-deficiency, pernicious, and sickle cell anemias and thalassemia . A bleeding disorder, such as hemophilia or thrombocytopenia

PROCESSING AND TESTING OF BLOOD AFTER DONATION: Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Collected blood is then separated into blood components by centrifugation: red blood cells, plasma, platelets, albumin protein, clotting factor concentrates, cryoprecipitate, fibrinogen concentrate, and immunoglobulins (antibodies). Red cells, plasma and platelets can also be donated individually via a more complex process called apheresis.

All donated blood is tested for infections. The current protocol tests donated blood for HIV-1, HIV-2, HTLV-1, HTLV-2, Hepatitis B, Hepatitis C, Syphilis (T pallidum), Chagas disease (T cruzi), and West Nile Virus. In addition, platelet products are also tested for bacterial infections due to its higher inclination for contamination due to storage at room temperature. Presence of Cytomegalovirus (CMV) is also tested because of risk to certain immunocompromised recipients if given, such as those with organ transplant or HIV. However, not all blood is tested for CMV because only a certain amount of CMV-negative blood needs to be available to supply patient needs. Other than positivity for CMV, any products tested positive for infections are not used. All donated blood is also tested for ABO and Rh groups, along with the presence of any red blood cell antibodies. Leukoreduction is the removal of white blood cells by filtration. Leukoreduced blood products are less likely to cause HLA alloimmunization (development of antibodies against specific blood types), febrile non-hemolytic transfusion reactions, cytomegalovirus infections, and platelet-transfuion refractoriness. Pathogen Reduction treatment that involves, for example, the addition of riboflavin with subsequent exposure to UV light has been shown to be effective in inactivating pathogens (viruses, bacteria, parasites and white blood cells) in blood products. By inactivating white blood cells in donated blood products, riboflavin and UV light treatment can also replace gamma-irradiation as a method to prevent graft-versus-host disease (TA-GVHD).

COMPATIBILITY TESTING: Before a recipient receives a transfusion, compatibility testing between donor and recipient blood must be done. The first step before a transfusion is given is to Type and Screen the recipient's blood. Typing of recipient's blood determines the ABO and Rh status. The sample is then Screened for any alloantibodies that may react with donor blood. It takes about 45 minutes to complete (depending on the method used). The blood bank technologist also checks for special requirements of the patient (e.g. need for washed, irradiated or CMV negative blood) and the history of the patient to see if they have a previously identified antibody. A positive screen warrants an antibody panel/investigation to determine if it is clinically significant. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for commonly encountered and clinically significant alloantibodies. Donor cells may have homozygous (e.g. K+k-), heterozygous (K+k+) expression or no expression of various antigens (K-k+). The phenotypes of all the donor cells being tested are shown in a chart. The patient's serum is tested against the various donor cells using an enhancement method, e.g. Gel or LISS. Based on the reactions of the patient's serum against the

donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (i.e. cause transfusion reactions, HDN, etc.). Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen negative phenotyped red blood cells to prevent future transfusion reactions. A direct antiglobulin test (Coombs test) is also performed as part of the antibody investigation. If there is no antibody present, an immediate spin crossmatch or computer assisted crossmatch is performed where the recipient serum and donor serum are incubated. In the immediate spin method, two drops of patient serum are tested against a drop of 3-5% suspension of donor cells in a test tube and spun in a serofuge. Agglutination or hemolysis (i.e., positive Coombs test) in the test tube is a positive reaction and the unit should not be transfused. If an antibody is suspected, potential donor units must first be screened for the corresponding antigen by phenotyping them. Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read. In urgent cases where crossmatching cannot be completed, and the risk of dropping hemoglobin outweighs the risk transfusing uncrossmatched blood, O-negative blood is used, followed by crossmatch as soon as possible. O-negative is also used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies. NEONATAL TRANSFUSION: To ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for Cytomegalovirus. Most guidelines recommend the provision of CMVnegative blood components and not simply leukoreduced components for newborns or low birthweight infants in whom the immune system is not fully developed. These specific requirements place additional restrictions on blood donors who can donate for neonatal use. Neonatal transfusions typically fall into one of two categories:

"Top-up" transfusions, to replace losses due to investigational losses and correction of anemia. Exchange (or partial exchange) transfusions are done for removal of bilirubin, removal of antibodies and replacement of red cells (e.g., for anemia secondary to thalassemias and other hemoglobinopathies).

ADVERSE EFFECTS: Transfusions of blood products are associated with several complications, many of which can be grouped as immunological or infectious. There is also increasing focus (and controversy) on complications arising directly or indirectly from potential quality degradation during storage. Overall, adverse events from transfusions in the US account for about $17Billion - and in effect

add more to the cost of each transfusion than acquisition and procedure costs combined. While some complication risks depend on patient status or specific transfusion quantity involved, a baseline risk of complications simply increases in direct proportion to the frequency and volume of transfusion.

Immunologic

Acute hemolytic reactions occur with transfusion of red blood cells, and occurs in about 0.016 percent of transfusions, with about 0.003 percent being fatal.[citation needed] This is due to destruction of donor erythrocytes by preformed recipient antibodies. Most often this occurs due to clerical errors or improper typing and crossmatching. Symptoms include fever, chills, chest pain, back pain, hemorrhage, increased heart rate, shortness of breath, and rapid drop in blood pressure. When suspected, transfusion should be stopped immediately, and blood sent for tests to evaluate for presence of hemolysis. Treatment is supportive. Kidney injury may occur due to the effects of the hemolytic reaction (pigment nephropathy). Delayed hemolytic reactions occur more frequently (about 0.025 percent of transfusions) and are due to the same mechanism as in acute hemolytic reactions. However, the consequences are generally mild and a great proportion of patients may not have symptoms. However, evidence of hemolysis and falling hemoglobin levels may still occur. Treatment is generally not needed, but due to the presence of recipient antibodies, future compatibility may be affected. Febrile nonhemolytic reactions are due to recipient antibodies to donor white blood cells, and occurs in about 7% of transfusions. This may occur after exposure from previous transfusions. Fever is generally short lived and is treated with antipyretics, and transfusions may be finished as long as an acute hemolytic reaction is excluded. This is a reason for the now-widespread use of leukoreduction - the filtration of donor white cells from red cell product units. Allergic reactions may occur when the recipient has preformed antibodies to certain chemicals in the donor blood, and does not require prior exposure to transfusions. Symptoms include urticaria, pruritus, and may proceed to anaphylactic shock. Treatment is the same as for any other type 1 hypersensitivity reactions. A small population (0.13%) of patients are deficient in the immunoglobin IgA, and upon exposure to IgA-containing blood, may develop an anaphylactic reaction. Posttransfusion purpura is a rare complication that occurs after transfusion containing platelets that express a surface protein HPA-1a. Recipients who lack this protein develop sensitization to this protein from prior transfusions, and develop thrombocytopenia about 710 days after subsequent transfusions. Treatment is with intravenous immunoglobulin, and recipients should only receive future transfusions with washed cells or HPA-1a negative cells.

Transfusion-associated acute lung injury (TRALI) is an increasingly recognized adverse event associated with blood transfusion. TRALI is a syndrome of acute respiratory distress, often associated with fever, non-cardiogenic pulmonary edema, and hypotension, which may occur as often as 1 in 2000 transfusions.[16] Symptoms can range from mild to life-threatening, but most patients recover fully within 96 hours, and the mortality rate from this condition is less than 10%. Although the cause of TRALI is not clear, it has been consistently associated with anti-HLA antibodies. Because these types of antibodies are commonly formed during pregnancy, several transfusion organisations have decided to use only plasma from men for transfusion. TRALI is typically associated with plasma components rather than packed red blood cells (RBCs), though there is some residual plasma in RBC units.

Infectious

Rarely, blood products are contaminated with bacteria. This can result in life-threatening infection, also known as transfusion-transmitted bacterial infection. The risk of severe bacterial infection is estimated, as of 2002, at about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions. It is important to note that blood product contamination, while rare, is still more common than actual infection. The reason platelets are more often contaminated than other blood products is that they are stored at room temperature for short periods of time. Contamination is also more common with longer duration of storage, especially when exceeding 5 days. Sources of contaminants include the donor's blood, donor's skin, phlebotomist's skin, and from containers. Contaminating organisms vary greatly, and include skin flora, gut flora, or environmental organisms. There are many strategies in place at blood donation centers and laboratories to reduce the risk of contamination. A definite diagnosis of transfusion-transmitted bacterial infection includes the identification of a positive culture in the recipient (without an alternative diagnosis) as well as the identification of the same organism in the donor blood. Since the advent of HIV testing of donor blood in the 1980s the transmission of HIV during transfusion has dropped dramatically. Prior testing of donor blood only included testing for antibodies to HIV. However, due to latent infection (the "window period" in which an individual is infectious, but has not had time to develop antibodies), many cases of HIV seropositive blood were missed. The development of a nucleic acid test for the HIV-1 RNA has dramatically lowered the rate of donor blood seropositivity to about 1 in 3 million units. As transmittance of HIV does not necessarily mean HIV infection, the latter could still occur, at an even lower rate. The transmission of hepatitis C via transfusion currently stands at a rate of about 1 in 2 million units. As with HIV, this low rate has been attributed to the ability to screen for both antibodies as well as viral RNA nucleic acid testing in donor blood. Other rare transmissible infections include hepatitis B, syphilis, Chagas disease, cytomegalovirus infections (in immunocompromised recipients), HTLV, and Babesia.

Other

Transfusion inefficacy, while not itself a "complication," can lead to various complications due in part to the need to repeat transfusions; inefficacy can be especially serious for critical-care patients requiring rapid restoration of oxygen delivery. Insufficient efficacy can result from blood product units damaged by storage lesion - a set of biochemical and biomechanical changes which occur during storage. With red cells, this can decrease viability and ability for tissue oxygenation. (Note that upon transfusion, cells have exhibited some degree of ability to reverse their storage lesion, ability not entirely - and often too slowly to benefit urgent-care patients.) Transfusion-associated volume overload is a common complication simply due to the fact that blood products have a certain amount of volume. This is especially the case in recipients with underlying cardiac or kidney disease. Red cell transfusions can lead to volume overload when they must be repeated due to insufficient efficacy. Plasma transfusion is especially prone to causing volume overload due to its hypertonicity. Hypothermia can occur with transfusions with large quantities of blood products which normally are stored at cold temperatures. Core body temperature can go down as low as 32 C and can produce physiologic disturbances. Prevention should be done with warming the blood to ambient temperature prior to transfusions. Transfusions with large amounts of red blood cells, whether due to severe hemorrhaging and/or transfusion inefficacy, can lead to an inclination for bleeding. The mechanism is thought to be due to disseminated intravascular coagulation, along with dilution of recipient platelets and coagulation factors. Close monitoring and transfusions with platelets and plasma is indicated when necessary. Metabolic alkalosis can occur with massive blood transfusions due to the breakdown of citrate stored in blood into bicarbonate Hypocalcemia can also occur with massive blood transfusions due to the complex of citrate with serum calcium Blood doping is often used by athletes, drug addicts or military personnel for reasons such as to increase physical stamina, to fake a drug detection test or simply to remain active and alert during the duty-times respectively. However a lack of knowledge and insufficient experience can turn a blood transfusion into a sudden death. For ex. when individuals run the frozen blood sample directly in their veins this cold blood rapidly reaches the heart, where it disturbs the heart's original pace leading to cardiac arrest and sudden death.

COMPLICATIONS OF BLOOD TRANSFUSION: Viruses and Infectious Diseases

Some infectious agents, such as HIV, can survive in blood and infect the person receiving the blood transfusion. To keep blood safe, blood banks carefully screen donated blood. The risk of catching a virus from a blood transfusion is very low.

HIV. Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient. Hepatitis B and C. The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million. If you receive blood during a transfusion that contains hepatitis, you'll likely develop the virus. Variant Creutzfeldt-Jakob disease (vCJD). This disease is the human version of Mad Cow Disease. It's a very rare, yet fatal brain disorder. There is a possible risk of getting vCJD from a blood transfusion, although the risk is very low. Because of this, people who may have been exposed to vCJD aren't eligible blood donors.

Fever You may get a sudden fever during or within a day of your blood transfusion. This is usually your body's normal response to white blood cells in the donated blood. Over-the-counter fever medicine usually will treat the fever. Some blood banks remove white blood cells from whole blood or different parts of the blood. This makes it less likely that you will have a reaction after the transfusion. Iron Overload Getting many blood transfusions can cause too much iron to build up in your blood (iron overload). People who have a blood disorder like thalassemia, which requires multiple transfusions, are at risk for iron overload. Iron overload can damage your liver, heart, and other parts of your body. If you have iron overload, you may need iron chelation (ke-LAY-shun) therapy. For this therapy, medicine is given through an injection or as a pill to remove the extra iron from your body. Lung Injury Although it's unlikely, blood transfusions can damage your lungs, making it hard to breathe. This usually occurs within about 6 hours of the procedure. Most patients recover. However, 5 to 25 percent of patients who develop lung injuries die from the injuries. These people usually were very ill before the transfusion. Doctors aren't completely sure why blood transfusions damage the lungs. Antibodies (proteins) that are more likely to be found in the plasma of women who have been pregnant may

disrupt the normal way that lung cells work. Because of this risk, hospitals are starting to use men's and women's plasma differently. Acute Immune Hemolytic Reaction Acute immune hemolytic reaction is very serious, but also very rare. It occurs if the blood type you get during a transfusion doesn't match or work with your blood type. Your body attacks the new red blood cells, which then produce substances that harm your kidneys. The symptoms include chills, fever, nausea, pain in the chest or back, and dark urine. The doctor will stop the transfusion at the first sign of this reaction. Delayed Hemolytic Reaction This is a much slower version of acute immune hemolytic reaction. Your body destroys red blood cells so slowly that the problem can go unnoticed until your red blood cell level is very low. Both acute and delayed hemolytic reactions are most common in patients who have had a previous transfusion. Graft-Versus-Host Disease Graft-versus-host disease (GVHD) is a condition in which white blood cells in the new blood attack your tissues. GVHD usually is fatal. People who have weakened immune systems are the most likely to get GVHD. Symptoms start within a month of the blood transfusion. They include fever, rash, and diarrhea. To protect against GVHD, people who have weakened immune systems should receive blood that has been treated so the white blood cells can't cause GVHD. NURSING CARE:

Nursing care plan assessment and examination

Individuals who report a history of numerous allergies or previous transfusions should be monitored more carefully since they are at higher risk for reaction. A history of cardiovascular disease should be noted because those patients need to be monitored more carefully for fluid overload. Note also if a patient has a history of Raynauds disease or a cold agglutinin problem, because, before being administered and with physician approval, blood needs to be warmed. Once the transfusion is in process, the patient may report any of the following signs of transfusion reaction: heat or pain at the site of transfusion, fever, chills, chest tightness, lower back pain, abdominal pain, nausea, difficulty breathing, itching, and a feeling of impending doom. A change in any vital sign can indicate the beginning of a transfusion reaction. Note if the urine becomes cloudy or reddish (hemolysis). Observe any change in skin color or the appearance of hives. Be alert for signs of edema, especially in the oropharynx and face. Auscultate the lungs before beginning the transfusion, and note any baseline adventitious sounds. Blood bank protocols have lowered the risk of human immunodeficiency virus (HIV) transmission from more than 25,000 cases before 1985 to a risk of 1 in 50,000 to approximately 1 in 150,000 currently. In spite of the decreased risk, many patients worry about contracting HIV when they need blood products. In reality, the risk of hepatitis B and C is much higher. If a blood transfusion reaction occurs, the fears and anxieties are compounded and may warrant specific

interventions. Nursing care plan primary nursing diagnosis:Risk for ineffective airway clearance

Nursing care plan intervention and treatment

Adhere strictly to the policies regarding typing, cross-matching, and administering blood. Make sure that the recipients blood sample is correctly labeled when it is sent to the laboratory. Check each unit before administration to make sure that it is not outdated, that the unit has been designated for the correct recipient, that the patients medical records number matches the number on the blood component, and that the blood type is appropriate for the patient. All patients should have their identification band checked by two people before the transfusion is begun. Notify the blood bank, and withhold the transfusion for even the smallest discrepancy when checking the blood with the patient identification. Maintain universal precautions when handling all blood products to protect yourself, and dispose of used containers appropriately. Begin the transfusion at a rate of 75 mL or less per hour. Remain with the patient for the first 15 minutes of the transfusion to monitor for signs of a hemolytic reaction. If the patient develops a reaction, stop the transfusion immediately; evaluate the adequacy of the patients airway, breathing, and circulation; take the patients vital signs; notify the physician and blood bank; and return the unused portion of the blood to the blood bank for analysis. If the patient develops chills, monitor the patients temperature, and cover him or her with a blanket unless the temperature is above 102F. Remain with the patient and explain that a reaction has occurred from the transfusion. Nursing care plan discharge home health care guidelines

Teach the patient to report any signs and symptoms of a delayed reaction, such as fever, jaundice, pallor, or fatigue. Explain that these reactions can occur anytime from 3 days after the transfusion to several months later. Explain that the patient should notify the primary healthcare provider if she or he develops any discomfort in the first few months after transfusion. Attributing these signs to specific diseases may make the patient unnecessarily anxious, but the patient should know to notify the healthcare provider for anorexia, malaise, nausea, vomiting, concentrated urine, and jaundice within 4 to 6 weeks after transfusion (hepatitis B); jaundice, lethargy, and irritability with a milder intensity than that of hepatitis B (hepatitis C); or flulike symptoms (HIV infection).

OXYGEN INHALATION

Administration of oxygen is a process of providing the oxygen supply to the child treatment of low concentration of oxygen in the blood. Children with respiratory dysfunctions are treated with oxygen inhalation to relieve anoxaemia (deficiency of oxygen in the blood). The normal amount of oxygen in the arterial blood should be in the range of 80 to 100 mm of Hg. If it falls below 60 mm of Hg; irreversible physiologic effects of oxygen deficiency but it does not correct the underlying causes. Purpose of Oxygen Inhalation To manage the condition of hypoxia. To maintain the oxygen tension in blood plasma. To increase the oxyhemoglobin in red blood cells. To maintain the ability of cells to carry out the normal metabolic function. To reduce the risk of complications.

Common indications for oxygen administration Cyanosis : Bluish discolouration of skin, nail buds, mucus membranes, resulting from a decreased amount of oxygen in the hemoglobin of the blood. Breathlessness or labored breathing : By some diseases such as emphysema, pulmonary embolism, coronary thrombosis etc. Anaemia. Diseasis such as pulmonary oedema, pnenumonia, chest trauma etc. Environment with low oxygen content e.g. high attitudes. Poisoning with chemicals that alter the tissues ability to utilize oxygen e.g. cyanide poisoning. Haemorrhage. Shock and circulatory failure. Children who are under anaesthesia and critically ill. Asphyxia Lack of oxygen by blocking the air passage such as drowning, foreign bodies, electrical shock, strangulations etc. Articles needed for oxygen administration: Oxygen source oxygen cylinder, central supply. Oxygen instrument according to methods like oxygen mask, oxygen hood, nasal prongs, nasal catheter, oxygen tent or canopy. Humidifier. Flow meter. Gauze pieces. Adhesive tape.

 No smoking signs. Spinner to open the main value of oxygen cylinder. Bowel with water to check the patency of the tube. Methods of oxygen administration: Oxygen administration depends upon the condition of child, age, concentration desired, facilities available and the preference of the doctor. Oxygen administration can be given continuously or intermittently. It depends on the requirement of the child. It is given in 40 to 60 percent concentration. There are following methods of oxygen administration. 1. Administration of oxygen by nasal catheter : This is very common method of oxygen administration in hospital settings. A catheter is inserted into the nostril reaching up to the uvala and is held in place by adhesive tapes. This catheter does not interfere with the child freedom to eat, to talk and to move on the bed. Catheter no. 4 to 6 is used and it should be 7.5 to 10 cm inserted in the nasopharynx. The catheter should be removed every 8 hourly, and new catheter should be inserted by using other nostril alternatively. Catheter method is used for the older children. The amount of oxygen should be 4 litre per minute. 2. Administration of oxygen by the mask : Today, there are various face masks available that cover the childs mouth and nose for oxygen administration. The mask size should be according to the childs size. It should be properly fited and if it does not fit properly, oxygen will be lost from the mask. It should be removed after every four hours and wipe the face. The masks are advantageous for those patients who are unable to breathe through nose. The flow of oxygen should be about 2-3 litre for young children and 1-2 litre/minute for the infants. 3. Administration of oxygen by the tent method : The oxygen tent method consists of a canopy over the patients bed, that cover the patient fully or partially. Oxygen tent is made up of plastic material , transparent and prevent absorption of oxygen. The lower part of the canopy is tucked under the bed to prevent the escape of oxygen. These are certain advantages and disadvantages for using a oxygen tent method. Oxygen tent provides the environment for the patient with controlled oxygen concentration, temperature regulation and humidity control. It allows freedom for free movement in bed. Disadvantages It creates a feeling of isolation. It requires high volume of oxygen which is not easily available. When tent is opened, there is loss of oxygen concentration. It has more chances to fire. It requires more time and cleanliness to maintain a tent.

Complications of oxygen administration : Infection : By using the contaminated equipments, the causative organisms can be present in such places as tracheostomy or Endotracheal tubes, catheters, humidifying water and masks etc. Drying of mucus membrane of the respiratory tract : It can occur when oxygen is administered without sufficient humidity. It can cause irritation and trying of the mucus membrane. Combustion (fire) : Oxygen itself does not burn, but it supports combustion. Oxygen toxicity :