Blood and IV therapy Flashcards
packed RBCs given for
surgery pts or anemic
platelets given to
cancer pts
plasma given to
burn pts
albumin is
a volume expander
therefore can cause circulatory overload
prothrombin given to
increase clotting time
factor VIII given for
hemophilia
universal donor
O
universal recipient
AB
only IV fluid that can be used with blood
normal saline (0.9% NaCl)
If transfusion reaction occurs with blood then
- Stop the infusion
- restart NS
- Save blood containers and tubing to return to lab
- draw blood sample for plasma, hemoglobin, culture, retyping
- collect urine sample for hemoglobin
- monitor voiding for hematuria
check airway,
can give antihistamines, Benadryl, steroids, and aspirin
autologous transfusion
give blood to yourself
collected 4-6 weeks before surgery
iron supplements may be ordered
benefits - prevention of infection from donated blood, used for pts with hx of reaction, rare blood types
contraindications - acute infection, chronic disease, hemoglobin
Allergic reaction to blood
hypersensitivity to antibodies in blood
occurs immediately or within 24 hours
mild - urticaria, itching, flushing
anaphylaxis - hypotension, dyspnea, decrease O2 sat, flushing
can prevent by premedication with antihistamines
stop blood
restart NS
notify MD
Benadryl, oxygen, corticosteriods
hemolytic reaction to blood
incompatibility occurs within mins - 24 hrs nausea, vomiting, pain in lower back, hypotension, increased pulse, decrease in urinary output, hematuria stop blood oxygen, benadryl, airway management
Febrile nonhemolytic reaction to blood
most common, antibodies to donor platelets or leukocytes
fever, hills, nausea, headache, flushing, tachycardia, palpitations
stop blood
antipyretics (avoid aspirin if pt thrombocytopenic)
seen after multiple transfers
sepsis related to blood transfusion
tachycardia, hypotension, high fever, chills, shock stop blood obtain blood culture antibiotics IV fluids vasopressors steroids
circulatory overload from blood
dyspnea, crackles, increased respiratory rate, tachycardia
slow/discontinue transfusion
high risk - elderly, heart disease, transfusion
primary purpose of IV therapy
to maintain or restore fluid and electrolyte balance
isotonic fluids
same concentration as body fluids so no shifting of fluids
hypertonic fluids
solute concentration greater than body fluids
pull fluids into the vessels
hypotonic fluids
solute concentration less than that of body fluids
pull fluids into the tissues
0.45% NaCl
hypotonic
0.9% NaCl
isotonic
10-15% dextrose in water
hypertonic
3% NaCl
hypertonic
lactated ringer’s
isotonic
sodium bicarbonate 5%
hypertonic
5% dextrose in water
isotonic but becomes hypotonic when glucose metabolized
ml per hr
total solution/hours to run
drops per min
total volume x drop factor / time in mins
change tubing every
72 hours
change bags every
24 hours
circulatory overload
assessment:
crackles, dyspnea, confusion, seizures
nursing care:
reduce IV rate, assess VS, assess lab values, notify MD
infiltration
assessment:
edema, pain, coolness in area, significant decrease in flow rate, apply tourniquet above infusion site and if continues to drip then infiltrated
nursing care:
discontinue IV, apply warm compress, sterile dressing, elevate arm, start new IV proximal
extravasation
infiltration of vesicant
vesicant - medication that causes blisters and tissue sloughy
gentamycin penicillin, vanco, dilantin, antinepletics, calcium, potassium, epi
pain, burning, edema, blanching at site
tx: prevention - place meds in larger vein
stop IV, aspirate then notify MD
vesicants
gentamycin penicillin, vanco, dilantin, antinepletics, calcium, potassium, epi
phlebitis
irritation
assess:
reddened, warm area around insertion site, tenderness, swelling
nursing care:
discontinue IV, warm/moist compress, restart new IV
thrombophlebitis
irritation
assess:
pain, swelling, redness and warmth around insertion or along path of vein, fever, leukocytosis
nursing care:
discontinue IV, apply warm compress, elevate extremity, restart IV in opposite extremity
hematoma
assess:
ecchymosis, immediate swelling at site, leakage of blood at site
nursing care:
discontinue IV, apply pressure with sterile dressing, cool compress for 24 hrs followed by warm compress, restart iv in opposite extremity
clotting
assessment:
decreased IV flow rate, back flow of blood into IV tubing
nursing care:
dc IV, do NOT irrigate or milk tubing, do NOT increase IV flow rate or hang solution higher, do NOT aspirate clot form cannula, urokinase may be injected to clear occlusion
PICC complications
malposition, pneumothorax, dysrythmias, nerve or tendon damage, respiratory distress, catheter embolism, thrombophlebitis
PICC nursing care
change dressing 2-3 times a week
flush with NS alone or with NS followed by heparinized saline
do not take bp or draw blood on extremity
tunneled central catheter
hickman, groshong, permacath
long term
increases in size
complications - thrombosis, phlebitis, air embolism, infection, bleeding, vascular perforation
triple lumen central catheter
distal lumen - draw blood
middle lumen - TPN
proximal - infuse blood and admin meds
