A nurse is monitoring a client 15 minutes after the initiation of a blood transfusion. The client reports feeling chilled, and their temperature has risen slightly from 98.6°F (37°C) to 100.2°F (37.9°C). What is the most appropriate immediate action?
Provide the client with a warm blanket and assess their condition in 10 minutes.
Reduce the transfusion rate and observe the client for additional reactions.
Discontinue the transfusion and assess the client's symptoms.
Administer a prescribed fever medication and continue the transfusion.
The correct action is to stop the transfusion to prevent further exposure to a potentially harmful reaction. Chills and an elevated temperature after a transfusion is started can indicate a febrile non-hemolytic transfusion reaction or another serious reaction. While notifying the healthcare provider and assessing the client are essential follow-ups, those actions do not address the immediate need to halt the transfusion, which is required to prevent worsening symptoms. Additionally, administering a fever medication without intervening to stop the transfusion could mask critical symptoms and delay treatment of the reaction.
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Physiological Integrity
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