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Review for NUR 427 Entry Exam > Blood component therapies > Flashcards

Blood component therapies Flashcards

1
Q

what are some common blood products

A

Packed red blood cells (PRBCs)
Platelets
Fresh frozen plasma (FFP)
Albumin

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2
Q

what are packed RBC (PRBC)

A

`ONLY THE BUSES!

Does NOT have plasma, platelets, or WBC components of blood

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3
Q

what does it mean to order a type and cross-match for PRBC?

A

type: determining a person’s blood type

cross-match: determining compatibility between the blood samples
- called an indirect Coombs test

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4
Q

universal blood donor

A

O-

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5
Q

universal blood recipient

A

AB+

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6
Q

what are the two components of blood types?

A

ABO and Rh

ABO is “blood types” “A genes” and “B genes”; Rh system – indicates presence vs. absence of rh antigen

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7
Q

what are the two most common blood types?

A

O Rh Positive (O+)

A Rh Positive (A+)

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8
Q

what are the labs you must monitor for transfusing blood?

A

H & H

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9
Q

What are the recommendations for hemodynamically stable patients w/o active bleeding:

A

Hgb <6 g/dL:
Transfusion recommended except in exceptional circumstances.

Hgb 6 to 7 g/dL:
Transfusion generally likely to be indicated.

Hgb 7 to 8 g/dL:
Transfusion may be appropriate in patients undergoing orthopedic surgery or cardiac surgery, and in those with stable cardiovascular disease, after evaluating the patient’s clinical status.

Hgb 8 to 10 g/dL:
Transfusion generally not indicated, but should be considered for some populations (eg, those with symptomatic anemia, ongoing bleeding, acute coronary syndrome with ischemia, and hematology/oncology patients with severe thrombocytopenia who are at risk of bleeding).

Hgb >10 g/dL:
Transfusion generally not indicated except in exceptional circumstances.

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10
Q

What are some pre-transfusion responsibilities?

A

Assess lab values
Verify order
Confirm type and cross-matching has been done (q 48 hrs)
Positive identification of patient; consent form
Pre-medicate as ordered
Anticipate PRBC = 250-350 ml
correct IV set-up
Be ready before the blood gets to the floor

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11
Q

how long do you have to begin the transfusion of blood once it arrives to the floor for transfusion?

A

30 minutes

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12
Q

how much time do you have to transfuse blood?

A

4 hours

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13
Q

what is the correct IV setup for blood transfusion?

A
  • Venous access (20 ga or larger; Lewis says 22 ga – not best practice!) 18 ga is ideal
  • “Y” tubing (one for blood; one for NS)
  • Filter
  • NS only (NO D5/LR!!!)
    • prime tubing with NS
  • prime and run the blood (250-350 ml)
  • run NS after blood is complete to get leftover blood in tubing
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14
Q

what are some transfusion responsibilities?

A
  • If blood not used right away, return to blood bank
  • Explain procedure/patient needs to report unusual sensations immediately:
    - Chills, SOB, itching, back pain
  • Take baseline V.S. (RN take initial set)
  • Begin infusion slowly (1-2 ml/min – 60-120 ml/hr) first 15 mins
  • Constant observation by RN first 15 – 30 minutes (per protocol)
  • Assess V.S. in 15 minutes
  • If no reaction, increase rate to infuse in about 2 hours (unless risk for FVE)
  • Take V.S. q hr & at end of transfusion
  • Post-infusion orders?
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15
Q

What is the maximum time of blood bag can hang and why?

A

4 hours maximum because there’s a risk for bacterial proliferation

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16
Q

why might the HCP order furosemide (Lasix) after a transfusion?

A

fluid volume overload (FVO)

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17
Q

How are platelets obtained?

A
  • Prepared from fresh whole blood
    ≈ 30-60 ml
  • Multiple units can be obtained from one donor
  • Must be kept at room temperature; good for 1 – 5 days
  • ABO compatibility not a factor
18
Q

What are the indications for platelet administration?

A

Bleeding caused by thrombocytopenia

Platelet count < 20,000/mm³

19
Q

is administering platelets give the patient clotting factors?

A

No, this is not the same thing as administering clotting factors (prothrombin admin for example)

20
Q

Why would you administer fresh frozen plasma (FFP)?

A

if the patient is having clotting factor issues

21
Q

What are some details about FFP administration and storage?

A
  • Liquid portion separated from whole blood and frozen ≈ 250 ml
  • Rich in clotting factors; contains no platelets
  • ABO compatibility is required
  • Stored for 1 year; use within 24 hrs of thawing
  • FFP should be administered at 200 mL/hr or slower if potential for overload.
22
Q

What are the indications for FFP?

A

Bleeding caused by a deficiency in clotting factors

Fluid volume expander (to lesser extent)

23
Q

Which blood product derivative is considered a colloid?

A

albumin

colloids keep fluid inside the intervascular space by oncotic pressure, also called pulling power

24
Q

does administering albumin require compatibility to the recipient?

A

no, compatibility is not necessary

25
Q

What are some acute transfusion reactions?

A
  1. Acute Hemolytic (AHTR) - incompatibility of blood product
  2. Febrile, Non-hemolytic (FNHTR) - fever develops during infusion
  3. Mild Allergic - sensitization to donor WBCs (most common), platelets, or plasma proteins (more common in people with h/o allergies)
  4. Anaphylactic and Severe Allergic - sensitization to donor plasma proteins
  5. Bacterial/Sepsis - bacteria present in blood
  6. Circulatory Overload (TACO = transfusion-associated circulatory overload) - too much blood volume administered
26
Q

What is the purpose of storing blood products as “leukocyte-reduced”?

A
  • considered a contaminant of other cellular blood components (RBC’s & platelets) – and can cause a number of adverse consequences:
    - Including immunologically mediated effects (AEB FNHTRs)
  • Pre-storage leukoreduction = 85% of blood in US now
27
Q

What are some S/S of Acute Hemolytic Transfusion Reaction - (AHTR)?

A 
Immediate onset
Facial flushing
Fever w/ or w/o chills
Headache
Low back pain (also abdominal, chest, flank pain)
Hemoglobinuria
Dyspnea, tachypnea
Hypotension
Cardiac arrest/Death
28
Q

what are some rn considerations/responses and prevention for a Acute Hemolytic Transfusion Reaction - (AHTR)?

A

Nursing Response:
Treat shock; maintain BP with IV colloids
Obtain blood samples from site
Obtain first voided urine; insert foley to monitor U/O
Send unit, tubing & filter to lab

Prevention:
Meticulous verification

29
Q

what are some s/s for Febrile Non-hemolytic Transfusion Reaction(FNHTR)- (most common)

A 
Sudden chills & fever
Headache
Flushing
Anxiety 
Vomiting
Muscle pain

note– there is no respiratory emergency situation

30
Q

what are some rn responses and prevention for Febrile Non-hemolytic Transfusion Reaction(FNHTR)- (most common)?

A

Nursing Response:
Administer antipyretic
Restart only if HCP orders

Prevention: Ensure receiving leukocyte-reduced products; give Tylenol prophylactically

31
Q

what are some s/s for Transfusion Reactions:Mild Allergic Transfusion Reaction?

A

Signs & Symptoms:
Flushing
Itching
Urticaria (hives)

32
Q

what are some rn responses and prevention for Mild Allergic Transfusion Reaction?

A

Nursing Response:
Administer antihistamine, corticosteroid as ordered
If s/s mild/transient, may be restarted slowly with HCP order

Prevention: Treat prophylactically with antihistamines & steroids; consider washed RBC’s & platelets

33
Q

what does washed PRBC mean?

A

Washed with isotonic saline to leukocytes and residual plasma (which prevents allergic reactions caused by prior sensitization to donor plasma proteins).

Washing of red cells removes unwanted plasma proteins, including antibodies

34
Q

what are some s/s for Anaphylactic & Severe Allergic Transfusion Reaction?

A

Anxiety
Urticaria
Dyspnea/wheezing
Progressing to cyanosis, bronchospasm, hypotension, shock & cardiac arrest

**note: presence of cardiac and respiratory compromise

35
Q

what are some rn responses and prevention for Anaphylactic & Severe Allergic Transfusion Reaction?

A

Nursing Response:
Initiate CPR; start O₂
Administer epinephrine – also antihistamines, corticosteroids, ß2 agonists

Prevention:
Extensively washed RBCs only; autologous components

36
Q

what are some s/s for Bacterial/Sepsis Reaction?

A

Rapid onset of chills, high fever
Vomiting & diarrhea
Marked hypotension

37
Q

what are some rn responses and prevention for Bacterial/Sepsis Reaction?

A

Nursing Response:
Obtain culture of blood & return blood bag to lab
Treat septicemia:
Antibiotics, IVFs & vasopressors

Prevention: Follow blood banking standards (collect, store, process) & infuse within 4 hours of start time

38
Q

what are some s/s for Transfusion-associated Circulatory Overload (TACO)?

A 
Cough & dyspnea
Pulmonary congestion
Headache
Increased V.S.
Distended neck vein
39
Q

what are some rn responses and prevention for Transfusion-associated Circulatory Overload (TACO)?

A

Nursing Response:
Slow or stop infusion
Administer diuretics, O2, morphine
CXR stat

Prevention: Recognize whose at risk

40
Q

what does autologous transfusion (autotransfusion) include?

A

Autologous donation – before planned procedure
- donate own blood so no potential bad reaction
- this is very expensive so not typically done
Frozen/stored years
Not frozen/used in a few weeks (more common)
Less popular than in past – expensive; insurance often won’t pay; & often wasted

Autotransfusion
Collection device used during surgery

Review for NUR 427 Entry Exam (27 decks)

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