Every therapy in this chapter suppresses immunity, which means it also removes the signs you use to detect infection. Screen a drug before its first dose, classify a rejection by its timing, assign a shift on the delegation board, and then build the phone call that actually gets sepsis orders for a patient whose temperature is 37.9 and whose white count is normal.
1 · What are you about to start?
2 · What else is happening in the next two weeks?
The transplant patient in front of you
Your assignmentYou have a stable kidney transplant recipient, a patient starting her first infliximab infusion, and a rheumatoid arthritis patient on adalimumab who is looking unwell. You have an assistive personnel and a licensed practical nurse working with you. Assign each task, then check the board.
Mrs. Cole, room 412A 63-year-old woman on adalimumab and prednisone for rheumatoid arthritis, admitted two days ago with a cellulitic left leg. She took her biologic four days ago. In the last hour: temperature 37.9 degrees C, heart rate 118, respiratory rate 26, blood pressure 88/52 down from 126/74, and she is newly confused. Her white cell count was normal this morning. Build the call.
Tick everything that belongs in this call
Screen, monitor, teach
Which rejection, and what it means
The rule behind each answer
Assign every task, then checkThe registered nurse retains initial and ongoing assessment, all patient teaching, evaluation of response, first doses of biologics and infusion monitoring, blood product administration, and every unstable patient. Never delegate the first assessment of a patient with a suspected reaction or a suspected rejection episode.
The call you just made
Build it, then score itA good SBAR is short, specific, and ends with a request that has a number and a clock attached. Vague escalation is how deteriorating patients get a callback in an hour.