Case Presentation -Assignment 1 Chief complaint "I'm getting tired easily and I am passing black stools". History of present illness Mr Ha is a 45 year old motor mechanic admitted for a gastroscopy....

Case Presentation -Assignment 1 Chief complaint "I'm getting tired easily and I am passing black stools". History of present illness Mr Ha is a 45 year old motor mechanic admitted for a gastroscopy. He has been fatiguing easily and passing black stools for the past three days. Of recent he has been having burning epigastric pain. Medical History Gastric Ulcers Chronic Back pain on NSAIDS Hypertension Social History 2-3 bottles of beer a day. Smokes two packs of cigarettes per day Medications One aspirin per day for cardiac prophylaxis. Physical examination He appears anxious and somewhat restless. Blood Pressure 90/60 mmHg, Heart Rate 110/min – HR Thready - Standing (Patient complains of dizziness upon standing). Respiratory Rate - 22 /minute; Temperature 38 Laboratory tests Hemoglobin 89mmol/L, Hematocrit 27%, WBC Normal PT/PTT - normal. chest x-ray - normal. X-ray of abdomen (kidney, ureter, bladder - KUB) is unremarkable. The patient was tested as O Rh positive. A type and screen was done, 2 units of packed red blood cells (PRBC) were cross matched. Transfusion - PRBC #1 The first unit was started at 10:55 am. Vital signs were recorded: Blood pressure: 90/60 Oxygen saturation: 95% Temperature: 36.9 C Pulse: 109/min. Transfusion - PRBC #2 The second unit was started by the same nurse at 15:15pm. Vital signs were taken with no untoward results. No further vital signs were taken until 16:30pm. when the patient started shaking and stiffness was noted. The transfusion was stopped and the doctor was contacted. Vital signs were Temperature: 40.9 C Pulse: 220/min. Blood pressure: 110/70 Oxygen saturation: 98% on rebreather The patient presented as confused and losing consciousness. Questions 1. Describe the pathophysiology of an acute haemolytic transfusion reaction. Hint: Pathophysiology consists of the (Aetiology/Causes, Risk Factors, Pathogenesis (mechanism of disease) and Clinical Manifestation. Support your answer with current health care related literature (i.e. Peer-reviewed Journal articles less than 7 years old). (300 words) 2.Develop a nursing care plan for patient experiencing an acute transfusion reaction transfusion reaction. Hint: A care plan can use the nursing process as a guide or the clinical reasoning cycle. Generally it should have an assessment, at least three priority diagnosis, plan, interventions (including commonly used medications) and evaluation outcomes. Support your answer with current health care related literature (i.e. Peer-reviewed Journal articles less than 7 years old). (700 words)