Blood Administration & Coagulation Disorders Flashcards
Autoimmune Thrombocytopenia Purpura(ITP)
An autoimmune disorder,
normal platelet production but the number of circulating platelets have decreased because the patient makes an antibody against the surface of their own platelets which then makes it possible for macrophages to eat up their own platelets, destruction of the antibody-coded platelets in the spleen.
When the platelet destruction exceeds the production, we have impaired clotting.
Possibly a virus cause
Signs and symptoms
mucous membranes-bleeding in the teeth during brushing or flossing,
large bruises, petechaie/rash on upper arms, legs and chest,
anemia(bleeding or blood loss), hemorrhagic stroke(monitor neurological and mental status).
Diagnosed by
low platelet count and megakaryocytes in their bone marrow.
Megakaryocytes are precursors to thrombocytes
Antiplatelet antibody detected in their blood and H&H will decrease.
Once the platelet count becomes less than 50,000-engage in thrombocytopenic precaution.
Medications
Immunosuppressants, corticosteroids
Platelets become less than 10,000
Transfuse them with platelets
You may transfuse them with platelets but
the spleen is going to eat them just as you transfuse them platelets.
Monitor them
Bleeding Precautions
Avoiding IM injections Use a lift sheet Instruct the patient not to blow their nose Use the smallest needle for the task when they bump into a furniture, apply ice for an hour Test urine and stool for occult blood Look at IV sites for blood trickling Nothing by rectum Measure the abdominal girth daily Use electric shaver No flossing of the teeth Place patient on fall precaution Patients must wear firm shoes Furniture should be padded
Surgical intervention
Splenectomy
Post-op Splenectomy
Roll them over to check for bleeding
Dressing becomes saturated, reinforce dressings
If they are bleeding, get vital signs first before calling the surgeon.
Anybody that has had splenectomy is at risk for infections hence annual vaccination
Thrombocytopenia Purpura
Autoimmune disease, causes tissue ischemia, they can end up with MI, AKI, stroke, if untreated, fatal within 3 months,
They undergo platelet removal, infuse FFP to reduce the clumping, thin the plasma
Medications
Do not administer Aspirin, flecamycin and immunosuppressants
Hemophilia
hereditary disorder, Sex-linked, passed from mothers to son, 50% of passing it to daughters making them carriers and sons will have the disease
Two forms of hemophilia: Hemophilia A-factor VIII deficiency(accounts 80% of cases)and hemophilia B-factor IX deficiency(accounts 20% of cases) also know as Christmas disease.
they can produce platelet plugs but the clotting deficiency impairs the formation of the clots.
Signs and Symptoms of Hemophilia
Bleeding for minor cuts, bruises or abrasions
worry about bleeding into the joints-disabling arthritis,
tendency to bruise, prolonged hemorrhages after surgery, prolonged apTT, normal bleeding time and normal PT
Management
Hemophilia A- managed by Regular infusion of factor VIII PRN(administer before bleeding).
Anybody at risk for bleeding, look for swelling. It indicates they are bleeding(internally), look for tachycardia and other signs of shock
Hemophilia B is managed by infusion of factor IX(recombinant)
Heparin-induced thrombocytopenia
results from receiving unfractionated heparin or heparin product.
Higher incidence in females and also people who are exposed to heparin for more than a week
Ask people if they have been to the hospital for more than 100 days
ask symptoms of VTE
Look for thrombocytopenia after heparin exposure(hallmark sign)
Treatment
Administer anticoagulants -Direct thrombin inhibitors.
Once you bleed, you start clotting and clotting
Transfusion therapy
Patients can receive whole blood or components.
You can give packed red blood cells, FFP that has clotting factors in it, albumin(people who have low albumin or need to pull fluid back into the vascular space),
burn patients(administer ONLY during acute stage), do not give during emergent.
Don’t give to people who have leaky capillaries.
Indications for getting packed red blood cells
excessive blood loss hemoglobin less than 6 Kidney failure patients Hemophilia(Factor 8, FFP, cryoprecipitate) Low platelet patients Preprocedure patients with low platelets
Blood products-type and crossmatch
Nursing Care
Ensure there is a consent
Verify prescription with another RN
There are two nurses hanging blood
Examine the blood bag label-attach the tag and requisition slip for the ABO compatibility to the blood bag
Inspect blood for any type of discoloration, gas bubbles, clotting. Send it back to the lab. Hang with NS only. Specialized tubing for RBC
administer within 30 mins.
For older adults deliver with nothing more than 19 gauge needle
The blood should not be older than a week because it releases potassium into the system.
Delivery of lots of blood lowers calcium level due to citrate(a preservative in the blood) in blood
Monitor vital signs Q15mins)
Monitor for fluid overload
Blood is delivered over 2-4 hours
Avoid concurrent IV fluid administration
Blood is typed based on
antigens and Rh factor
Blood groups
Group O is a universal donor
Group AB is a universal recipient
Rh negative people can only receive Rh negative blood
Rh positive people can receive both from Rh negative and Rh positive.
You can receive and get blood from you blood group and group O example
AB can get blood from A, B AB or O
A can give A and AB
B can give B and AB
AB can give AB only
Transfusion Responsibilities
Provide patient education Take vital signs Q15mins Begin the transfusion Stay with the patient first 15 -30mins. The timing starts when the blood gets to the blood Instruct patient to report chills, SOB Assess for hyperkalemia
Platelet and RBC transfusion
Packed red blood cells are 250ml
May premedicate with acetaminophen and benadryl to prevent reaction.
For platelets, you do not administer with Y tubing.
Deliver platelets quickly say 15-30mins
Do not premedicate
FFP
Administer right away because it disintegrates at room temperature.
It is usually 200ml bag
Deliver in 30-60mins with Y tubing
Types of reactions
Febrile reaction
happens within 2 hours
results from development of anti-WBC antibodies (usually people undergoing mulitiple transfusions)
S/S
Chills, 1 degree temp or greater from the pre-transfusion temp, hypotension and Tachycardia
Intervention
Stop the transfusion
Initiate NS with new tubing
Administer next time WBC filter and antipyretics
Hemolytic reaction
happens when 10ml is transfused or it can manifest later in subsequent transfusion
results from blood not compatible to patient’s blood type or Rh factor
S/S
Chills, fever, low back pain, tachycardia, flushing,hypotension, chest pain or tightness, tachypnea, nausea, anxiety, hemoglobinuria, sense of impending doom.
Intervention Stop the transfusion Remove the tubing Hang new NS with new tubing Check vital signs Send blood to blood bank for testing. Double check patient's blood type and Rh Call physician
Allergic reaction
starts 24 hours after the transfusion
s/s
itcing, hives, flushing, anaphylactic reaction, bronchospasm, laryngeal edema or shock
Intervention Stop the transfusion Start NS Administer antihistamine If restarting, start slow
Bacterial Reaction
Occurs over several hours
S/S
Wheezing, dyspnea, chest tightness, cyanosis, hypotension and shock
Intervention Stop the transfusion Send the blood culture to the lab Administer ABT and IV infusion Position patient with feet lower than the heart
Circulatory Overload
Especially seen in older people.
When the transfusion was done too rapidly
Assess for fluid overload
Intervention
Slow or stop transfusion
Position client upright
Administer O2, diuretics, morphine and nitroglycerin to decrease the preload.
