adult 1: blood component therapy + transfusion reaction

Question 1

When is a blood transfusion usually ordered?

Answer 1

When a patient’s hemoglobin is below 7–8 g/dL.

Question 2

What types of blood components might be ordered?

Answer 2

Packed RBCs, plasma, platelets, or whole blood.

Question 3

What supplies are needed for a blood transfusion?

Answer 3

18–20 gauge IV catheter, Y tubing, normal saline, blood product, type and crossmatch, consent form, second RN verification, infusion pump, vitals machine.

Question 4

What gauge IV catheter is used for blood transfusions?

Answer 4

18–20 gauge.

Question 5

How soon must a blood product be administered after it arrives on the unit?

Answer 5

Within 30 minutes.

Question 6

What is the maximum time a blood transfusion can take?

Answer 6

Must be completed within 4 hours.

Question 7

What is the typical infusion rate for a blood transfusion?

Answer 7

No faster than 120 mL/hr.

Question 8

What are the steps for administering a blood transfusion?

Answer 8

Identify patient (2 identifiers), get baseline vitals, verify blood with 2nd RN, prime Y tubing with NS, start transfusion via pump, stay for 15 mins, monitor vitals hourly and post-transfusion.

Question 9

How often are vitals taken during a transfusion?

Answer 9

Before transfusion, at 15 minutes, then every hour, and one hour after completion.

Question 10

What is the first thing you do if a patient has a transfusion reaction?

Answer 10

Stop the transfusion immediately.

Question 11

After stopping the transfusion, what do you do next?

Answer 11

Maintain a patent IV line with NS.

Question 12

Who should be notified after a transfusion reaction?

Answer 12

The blood bank and healthcare provider.

Question 13

What should you verify after a transfusion reaction?

Answer 13

Recheck patient ID tags and blood product numbers.

Question 14

What patient assessments should be done during a reaction?

Answer 14

Monitor vital signs and urine output.

Question 15

What medication is given for pruritus and skin warmth during a reaction?

Answer 15

Diphenhydramine.

Question 16

What happens to the used blood bag and tubing after a reaction?

Answer 16

Save and send to the blood bank.

Question 17

What specimens need to be collected after a transfusion reaction?

Answer 17

Blood samples and other specimens as ordered for evaluation.

Question 18

Should you document a transfusion reaction?

Answer 18

Yes, document according to facility policy.

Question 19

When can a transfusion be restarted after a reaction?

Answer 19

Only with an HCP order, after symptoms subside.

Question 20

When should you not restart a transfusion?

Answer 20

If fever or pulmonary symptoms occur.

Question 21

How should the patient be monitored after a reaction?

Answer 21

Closely and frequently.

Question 22

What causes a febrile nonhemolytic transfusion reaction?

Answer 22

Sensitization to donor WBCs, platelets, or plasma proteins.

Question 23

What are the S/S of a febrile nonhemolytic reaction?

Answer 23

Sudden chills, rise in temp by 1°C, rigors, headache, vomiting.

Question 24

What are the nursing interventions for febrile nonhemolytic reaction?

Answer 24

Administer antipyretic; do not restart transfusion unless HCP orders.

Question 25

How can febrile nonhemolytic reactions be prevented?

Answer 25

Use leukocyte-reduced blood; premedicate with acetaminophen/diphenhydramine 30 mins before transfusion.

Question 26

What causes an acute hemolytic transfusion reaction?

Answer 26

Infusion of ABO incompatible blood leading to immune attack on RBCs.

Question 27

What are the S/S of acute hemolytic reaction?

Answer 27

Fever (± chills), back/flank/abdominal pain, site pain, tachycardia, dyspnea, hypotension, dark urine, bleeding, AKI, shock, cardiac arrest.

Question 28

What are the nursing interventions for acute hemolytic reaction?

Answer 28

Maintain BP with IV fluids, treat shock, draw blood slowly, give diuretics, insert IUC, assist with dialysis, hold transfusion until new match provided.

Question 29

How can acute hemolytic reactions be prevented?

Answer 29

Double RN verification before transfusion.

Question 30

What causes transfusion-associated circulatory overload (TACO)?

Answer 30

Blood transfused faster than the circulation can handle.

Question 31

What are the S/S of TACO?

Answer 31

Cough, dyspnea, pulmonary congestion, crackles, hypertension, tachycardia, JVD.

Question 32

What are the nursing interventions for TACO?

Answer 32

Monitor vitals, place in high Fowler’s, obtain chest X-ray, administer diuretics and oxygen.

Question 33

How can TACO be prevented?

Answer 33

Slow infusion rate (<120 mL/hr), ask blood bank for split units.

Question 34

What causes transfusion-related acute lung injury (TRALI)?

Answer 34

Reaction between transfused antileukocyte antibodies and recipient leukocytes → pulmonary inflammation and capillary leakage.

Question 35

What are the S/S of TRALI?

Answer 35

Fever, chills, hypotension, tachypnea, frothy sputum, dyspnea, hypoxemia, respiratory failure.

Question 36

What are the nursing interventions for TRALI?

Answer 36

Monitor vitals, give O2 and corticosteroids, start CPR, support BP and breathing, get ABGs and chest X-ray.

Question 37

How can TRALI be prevented?

Answer 37

Use leukocyte-reduced blood products.