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Difficulty: HardReligious and Spiritual Influences on Health

A nurse is developing a plan of care for a client who is a devout Jehovah's Witness and is experiencing active gastrointestinal bleeding with a hemoglobin level of 6.2 g/dL (62 g/L). The client has signed an advance directive explicitly refusing blood products. Which of the following nursing interventions are appropriate for this client? Select all that apply.

  1. Administer intravenous volume expanders such as lactated Ringer's solution or 0.9% sodium chloride.Answer
  2. Administer prescribed subcutaneous epoetin alfa and intravenous iron preparations.Answer
  3. Explore the client's personal willingness to accept minor blood fractions such as albumin or immunoglobulins.Answer
  4. D
    Transfuse packed red blood cells (PRBCs) under implied consent if the client becomes hemodynamically unstable and loses consciousness.
  5. E
    Prepare to infuse fresh frozen plasma (FFP) because it is considered an acceptable non-cellular fluid replacement.
  6. F
    Delegate the task of discussing alternative bloodless treatment options with the client to the unlicensed assistive personnel (UAP).

Answer

The appropriate interventions include administering intravenous volume expanders (like lactated Ringer's), administering epoetin alfa with iron, and exploring the client's willingness to accept minor blood fractions such as albumin.
Jehovah's Witnesses refuse whole blood and its four primary components: red blood cells, white blood cells, platelets, and plasma. Therefore, PRBCs and FFP are strictly prohibited. However, non-blood volume expanders (such as lactated Ringer's or 0.9% sodium chloride) and medications that stimulate red blood cell production (such as epoetin alfa and iron) are acceptable and crucial for managing severe anemia. Additionally, the acceptance of minor blood fractions (such as albumin, cryoprecipitate, or immunoglobulins) is considered a matter of personal conscience, making it essential for the nurse to explore the client's individual willingness to accept them.

Step-by-Step Solution

1
Identify the client's religious affiliation and associated medical restrictions.
The client is a Jehovah's Witness and strictly prohibits the transfusion of whole blood and its major components.
Understanding religious doctrine is essential for providing culturally competent care and respecting patient autonomy.
2
Determine which therapies are universally acceptable within the faith.
Non-blood volume expanders and hematopoietic agents (such as epoetin alfa and iron) are fully acceptable.
These interventions help manage hypovolemia and stimulate red blood cell production without violating religious tenets.
3
Identify treatments that require individual consultation based on personal conscience.
Minor blood fractions, such as albumin or immunoglobulins, may be accepted by some individuals within the faith and refused by others.
Clarifying the client's personal stance on fractions ensures care aligns precisely with their specific beliefs.
4
Evaluate the incorrect interventions against ethical, legal, and safety standards.
Administering FFP, transfusing PRBCs during unconsciousness, and delegating treatment discussions to a UAP are recognized as violations.
A competent adult's advance directive remains valid even if incapacitated, plasma is a prohibited major component, and UAPs cannot perform medical teaching or complex assessments.

Key Concept

Culturally competent care and ethical principles for clients of the Jehovah's Witness faith who refuse blood transfusions.
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Topics

Religious and Spiritual Influences on Health

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