Blood and IV therapy

Question 1

packed RBCs given for

Answer 1

surgery pts or anemic

Question 2

platelets given to

Answer 2

cancer pts

Question 3

plasma given to

Answer 3

burn pts

Question 4

albumin is

Answer 4

a volume expander

therefore can cause circulatory overload

Question 5

prothrombin given to

Answer 5

increase clotting time

Question 6

factor VIII given for

Answer 6

hemophilia

Question 7

universal donor

Answer 7

O

Question 8

universal recipient

Answer 8

AB

Question 9

only IV fluid that can be used with blood

Answer 9

normal saline (0.9% NaCl)

Question 10

If transfusion reaction occurs with blood then

Answer 10

1. Stop the infusion
2. restart NS
3. Save blood containers and tubing to return to lab
4. draw blood sample for plasma, hemoglobin, culture, retyping
5. collect urine sample for hemoglobin
6. monitor voiding for hematuria

check airway,
can give antihistamines, Benadryl, steroids, and aspirin

Question 11

autologous transfusion

Answer 11

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

Question 12

Allergic reaction to blood

Answer 12

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

Question 13

hemolytic reaction to blood

Answer 13

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

Question 14

Febrile nonhemolytic reaction to blood

Answer 14

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

Question 15

sepsis related to blood transfusion

Answer 15

tachycardia, hypotension, high fever, chills, shock
stop blood
obtain blood culture
antibiotics 
IV fluids
vasopressors
steroids

Question 16

circulatory overload from blood

Answer 16

dyspnea, crackles, increased respiratory rate, tachycardia
slow/discontinue transfusion

high risk - elderly, heart disease, transfusion

Question 17

primary purpose of IV therapy

Answer 17

to maintain or restore fluid and electrolyte balance

Question 18

isotonic fluids

Answer 18

same concentration as body fluids so no shifting of fluids

Question 19

hypertonic fluids

Answer 19

solute concentration greater than body fluids

pull fluids into the vessels

Question 20

hypotonic fluids

Answer 20

solute concentration less than that of body fluids

pull fluids into the tissues

Question 21

0.45% NaCl

Answer 21

hypotonic

Question 22

0.9% NaCl

Answer 22

isotonic

Question 23

10-15% dextrose in water

Answer 23

hypertonic

Question 24

3% NaCl

Answer 24

hypertonic

Question 25

lactated ringer's

Answer 25

isotonic

Question 26

sodium bicarbonate 5%

Answer 26

hypertonic

Question 27

5% dextrose in water

Answer 27

isotonic but becomes hypotonic when glucose metabolized

Question 28

ml per hr

Answer 28

total solution/hours to run

Question 29

drops per min

Answer 29

total volume x drop factor / time in mins

Question 30

change tubing every

Answer 30

72 hours

Question 31

change bags every

Answer 31

24 hours

Question 32

circulatory overload

Answer 32

assessment: crackles, dyspnea, confusion, seizures nursing care: reduce IV rate, assess VS, assess lab values, notify MD

Question 33

infiltration

Answer 33

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

Question 34

extravasation

Answer 34

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

Question 35

vesicants

Answer 35

gentamycin penicillin, vanco, dilantin, antinepletics, calcium, potassium, epi

Question 36

phlebitis

Answer 36

irritation assess: reddened, warm area around insertion site, tenderness, swelling nursing care: discontinue IV, warm/moist compress, restart new IV

Question 37

thrombophlebitis

Answer 37

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

Question 38

hematoma

Answer 38

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

Question 39

clotting

Answer 39

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

Question 40

PICC complications

Answer 40

malposition, pneumothorax, dysrythmias, nerve or tendon damage, respiratory distress, catheter embolism, thrombophlebitis

Question 41

PICC nursing care

Answer 41

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

Question 42

tunneled central catheter

Answer 42

hickman, groshong, permacath long term increases in size complications - thrombosis, phlebitis, air embolism, infection, bleeding, vascular perforation

Question 43

triple lumen central catheter

Answer 43

distal lumen - draw blood middle lumen - TPN proximal - infuse blood and admin meds