Problem
Scenario
Mrs. Jones is a 30 year-old patient who was riding a motorcycle when she was involved in an accident with a car. Paramedics caring for her at the scene made the following observations:
a) Skin cyanotic; cool and clammy
b) Blood pressure 100/60 and falling, pulse 100
c) Trauma to the lumbar region of the back
Paramedics start an IV to rapidly infuse a 0.9% sodium chloride solution (normal saline). They transport her to a small rural hospital where Mrs. Jones' blood pressure continues to fall and her cyanosis worsens. The physician begins infusing O negative packed red blood cells (PRBCs) and arranges transport by helicopter to a trauma center. He sends additional PRBC units in the helicopter for transfusion en route. After arrival at the trauma center, the following notes were added to Mrs. Jones chart:
a) Hematocrit 30%
b) Blood drawn for typing and cross matching; packed B positive blood cells infused
• Question I: What is hematocrit? What does Mrs. Jones' value indicate?
• Question II: Why was the physician able to use O negative blood before the results of the blood type tests were obtained? Explain your answer.
• Question III: Mrs. Jones blood type was determined to be B positive. What plasma antibodies (agglutinins) does she have and what type of blood can she receive?
After the first unit of PRBCs was administered the physician ordered for another unit to be infused. During the infusion of the second unit, the nurse noticed Mrs. Jones was shivering and there were rashes all over her body.
• Question IV: What would be the likely explanation for Mrs. Jones' symptoms and the priority nursing action?
While continuing to stabilize, Mrs. Jones started experiencing further symptoms. She showed signs of confusion, her blood pressure continued to fall, her blood sugar level decreased, she was complaining of pain in her lower back. Her physicians recognize the acuity and the seriousness of this situation. They suspect her symptoms are a result of an endocrine imbalance as a result of the accident.
• Question V: What endocrine imbalance is Mrs. Jones experiencing? Describe how you reached this conclusion and the treatment for this imbalance.