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Blood component therapy Flashcards

1
Q

what are packed red blood cells and what do they contain

A

PRBC are RBCs with little plasma (hct 75%); some platelets & WBCs

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2
Q

how long can PRBC be stored

A

• PRBCs stored at 4 degrees safely up to 42 days

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3
Q

what would PRBC be indicated for

A

to Inc RBC mass
Symptomatic anemia
The platelets aren’t functional nor are the WBCs.
The WBCs might cause reaction

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4
Q

how are platelets stored & kept well-functioning

A

• Platelets at room temp last up to 5 days

o To prevent clumping they are gently agitated

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5
Q

platelets can be from single donor or random. Why would single be used

A

Repeated tx with random donors can lead to alloimmunization

If pt needs repeat Tx then they should be given single donor platelets

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6
Q

indications for platelets

A

Bleeding d/t dec platelets or to prevent bleed when pt has low platelets

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7
Q

cryoprecipitate is made of

A

Cryoprecipitate: fibrinogen, AHF (VIII:C), von Willebrand factor, fibrinonectin

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8
Q

indication for cryoprecipitate

A

Von Willebrand disease
Hypofibrinogenemia
Hemophilia A

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9
Q

what conc does albumin come in and what is it for

A

Albumin (5% or 25%)

Hypoproteinemia, burns, volume expansion by 5% to inc blood vol (in hypovolemic shock), give 25% albumin to dec hct

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10
Q

why give immunoglobulins

which globulins are you giving specifically

A

Hypogammaglobulinemia (in CLL or recurrent infects); idiopathic thrombocytopenia; primary immunodeficiency

gamma globulins. IgG

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11
Q

what is whole blood & why is it indicated

A

Whole blood that is composed of cells & plasma (hct 40%)

Volume replacement & 02 carrying capacity
Usually only for significant bleed >25% blood vol lost

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12
Q

which blood components can be heated to get rid of viral components

A

• Immune globulin is conc IgG & can be heated to 60* for 10hrs as can albumin to get rid of viruses

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13
Q

not sure if stuff about blood transfusion is important

what health hx is it nec to know for someone giving blood transfusion

A

• Donor is carefully interviewed for viral hep, STIs, stays in places with higher risks of other diseases, have they received transfusions, skin infect, hypersensitivity (as it can be passed on), pregnancy (shouldn’t give blood as they need it), immunization recently, CA, whole blood donation in past 56 days, aspirin affects platelets

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14
Q

what diseases can be passed on by blood transfusion

A

o Hep B & C (screening detects this)
o AIDS (blood screened for antibodies to HIV)
o Cytomegalovirus
o Graft vs host disease (only in severely immunocompromised recipients. Can irradiate blood for this)
o Creutzfeldt-Jakob disease (rare, fatal neurodegenerative disease that causes irreversible damage. It is a prion. Like mad cow disease)

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15
Q

physical requirements for blood donor

A

o Exceed 50kg for a standard donation of 450ml
o Older than 17
o Oral temp not exceed 37.5
o Pulse rate between 50-100
o Systolic 90-180 and diastolic 50-100
o Hg at least 1.94 for woman and 2.1 for men

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16
Q

what are the different kinds of blood donation

A 
directed donation
standard donation
autologous donation
intraoperative blood salvage
hemodilution
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17
Q

what is directed donation

A

blood to friend or family but not necessarily safer bc might not be willing to identify any history of risk factors ie) HIV

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18
Q

how much blood is taken during a standard donation

-how long does it take & what to do or tell them to do

A

phlebotomy consists of venipuncture and blood withdrawl. Withdrawal of 450 ml of blood usually takes up to 15 min Hold arm up after and apply firm pressure for 2-3 minutes. Donor remains recumbent until they feel able to sit up. Receives foods and fluid and stay for 15 minutes.

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19
Q

autologous donation

how many units can be taken & when are they not taken

A

patients own blood for future potential surgeries (orthopedic sx). Ideally collected 4-6 weeks early. Iron supplements given to prevent iron depletion. Typically 1 unit of blood/week. Phlebotomies are not performed within 72 hours of surgery

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20
Q

what is the advantage of autologous donation

should everyone do this to prevent risk?

A

o Primary adv is prevention of viral infections from other blood also safe for ppl who have a history of transfusion reacitons, prevents alloimmunization and avoidance of complications to patients with alloAbs
o Needless autologous donation is disciouraged bc expensive, takes time, and uses resources inappropriately
o Might be inadequate-need more from random donors anyway

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21
Q

what is intraoperative blood salvage

A

• - provides replacement for patients who cannot donate blood before surgeru and for those underging vascular, orthopedic, or thoracic surgery
o During a surgical procedure, blood lose into a sterile cavity (hip joint0 is suctioned into a cell-saver macine. PRBCs or whole blood are washed with saline, filtered, and returned to patient as IV infusion

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22
Q

med surg ssecond section

A

e

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23
Q

what is the consideration with using older blood

A

• Caution with old blood cells cause continual destruction of RBC causes release of K out of cells into plasma. Lab test of K ordered before administering unit of blood

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24
Q

what are the 3 blood system types

A

ABO, RH, & human leukocyte antigen

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25
Q

how does ABO system work

what happens with incompatible RBCs

A
  • ABO uses presence or absence of specific antigens on surface of RBC
  • When type A antigen is present, blood group is type A
  • Antibodies that react against the A and B antigens are present in the plasma of people whose RBC do not carry the antigen. These antibodies (agglutinins) react against the foreign antigens (agglutongens).
  • Incompatible RBC agglutinate (clup together) and result in life-threatening hemolytic transfusion reaction
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26
Q

who is the universal recipient

A

type AB have neither antibody and can receive all blood types

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27
Q

what surface antigens does a person with O blood have and therefore what blood can they receive

A

have both A & B antibodies so they can only receive O blood

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28
Q

what is the RH system and which Rh antigen is most common and likely to cause reaction
if pt has this antigen are they positive or negative

A
  • Nearly 50 types of Rh antigen may be present on surface of RBC, D cell is widely prevalent and most likely to illict an IR.
  • Presence or absence of D that determines Rh type
  • With D makes you positive
  • No antibodies to D antigen (unlike ABO)
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29
Q

how is a pt sensitized and what makes them have a reaction

how long would this take

A
  • Person with Rh neg blood must first be exposed to Rh pos blood before Rh antibodies are found. If exposed to enough blood (200ml) then can cause severe reaction
  • These Abs take up to 2 weeks to form
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30
Q

must all blood that is given be matched to the pts Rh

A

• Rh pos blood may be used for a person with Rh neg without adverse effect if that person has not been previously exposed to Rh pos eg in trauma

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31
Q

implications of Rh negative mom who is having a baby

when would she get tx & what would this entail

A
  • Rh neg mom previously exposed to Rh antigen can transfer Rh antibodies across placenta resulting in fetal hemolysis (breakdown of RBC with resultant anemia and jaundice) often fatal to infant
  • To prevent current or future fetal hemolysis, Rh (D) immunoglobulin (RhoGam) given IM to mom to suppress or destroy the fetal Rh pos blood cells that passed on
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32
Q

what is HLA and what are they found on

what are complications of HLA

A
  • Highly immunogenic antigens can cause transfusion complications
  • HLA Ab are on surface of leukocytes
  • May be found on lymphocytes, granulocytes, monocytes, and platelets

complications:
o Febrile nonhemolytic reaction (FNH)
o Immune mediated platelet refractoriness
o Tranfusion-related acute lung injury (TRALI)
o Transfusion-associated graft-versus-host disease (tA- GVHD)

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33
Q

what is the most common reaction to blood therapy

why is it caused

and who does it gen occur in

A

Febrile Nonhemolytic Reaction

  • Caused by antibodies to donor leukocutes or platelets that remain in the unit of blood or blood component.
  • Often occurs in pt who had previous transfusions (exposure to multiple antigens from blood products) and in rh neg woman who have borne Rh positive children
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34
Q

onset of febrile nonhemolytic rxn

and how to prevent it

A

30min after initiation to 6hrs affter completion of transfusion

to prevent use leukocyte reduced products in pts who have experienced this complication before

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35
Q

mnfts of febrile nonhemolytic rxn

A

fever >1 degree above baseline, flushing, chills, headache, muscle pain; occurs most freq in immunosuppressed pts

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36
Q

intervention if febrile nonhemolytic rxn

A

stop transfusion
antipyretic
monitor temp q4h

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37
Q

what is acute hemolytic rxn and how quickly would it occur

A

• Antibodies already present in the recipients plasma rapidly combine with antigens on donors erythrocytes and the erythrocytes are destroyed in circulation. There is either an ABO or Rh incompatability

ocurs within 15mins of transfusion initiation. ABO incompability is faster

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38
Q

mnfts of acute hemolytic rxn

A
  • Symp: fever up to 41*, chills, severe low back pain and chest pain, nausea, chest tightness, dyspnea, and anxiety, tachycardia, sensation of heat and pain along vein receiving blood, chills,bronchospasm , HoTN, DIC, vascular collapse, possible death
  • As erythrocytes are destroyed, th Hg is released from the cells and excreted by the kidneys, therefore hg appears in the urine (hemoglobinuria) hypotension, bronchospasm, and vascular collapse may result
  • Dimished renal perfusion results in ACF and DIC
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39
Q

how much blood is nec for acute hemolytic rxn

A

• Can occur in as little as 10ml of PRBCs

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40
Q

interventions for acute hemolytic rxn

A

stop transfusion and remove blood tubin and product.
notfy
VS q15
correct arterial P and coagulopathy according to orders
catheter
I/O hourly
assess for shock
dialysis may be nec
blood and urine samplessent to lab along with the blood that caused rxn

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41
Q

delayed hemolytic transfusion rxn onset

how does it work

A

• Occurs within 2- 14 days when level of antibody has been increased to the extent that a reaction can occur
there is immune response against non-ABO donor Ags. gen the result of destr of transfused RBCs by alloAbs not detected during cross match

• The hemolysis of the erythrocutes is extravascular via the RES and occurs gradually

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42
Q

how to prevent delayed hemolytic transfusion rxn

mnfts

A

careful cross match
can be missed as it occurs so late

unexplained fever,
unexplained dec in Hgb/Hct
inc biliruin levels
jundice

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43
Q

nurs intervention for delayed hemolytic trnsfusion rxn

A

monitor lab values for anemia (next time could be full acute hemolytic rxn)

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44
Q

allergic rxn (mild to moderate)
onset in
mnfts

A

• Thought to be from sensitivity to plasma protein within blood component being transfused

onset during transfusion to 1hr after transfusion
• Symp: itching, urticarial, and flushing, local erythema

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45
Q

prevention & interventions

A
  • If severe- epinephrine, corticosteroids, and vasopressor support
  • can Give pt antihistamines before as preventative meas
stop transfusion
notifu
give antihistamines
VS q15
transfusion can be restarted if fever, dyspnea, wheezing not present
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46
Q

what happens in severe allergic rxn

is it faster than mild to mod allergic rxn

A

caused by recipient allergy to donor antigen usually IgA
agglutination of RBCs obstr caps & blocks blood flow causing issues w all organ systems

onset withing 5-15mins of initiation of transfusion

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47
Q

mnfts of severe allergic rxn

A 
coughing
nausea
V
dyspnes
resp distress
wheezing
HoTN
l/o consciousness
possible cardiac arrest
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48
Q

interventions for severe allergi rxn

how to prevent

A 
life threatening!
stop transfusion
keep IV acess
Notify and notify blood bank too
antihistamines, corticosteroids, epinephrine and antipyretics as ordered
VS until stable
CPR?

to prevent: transfusion of saline washed or leukocyte depleted RBCs

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49
Q

graft vs host disease:
what is it
when does it occur

A

what is it: donor lymphocytes destroyed by recipients IS. If pt is immunocompromized the donor lymphocytes are seen as foreign but the pts IS cant destroy them and in turn the pts lymphocytes are destroyed
when does it occur: days to weeks

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50
Q

mnfts of graft vs host disease

interventions

A

skin rash
fever
jaundice d/t liver dysfx
bone marrow suppression

give methotrexate and corticosteroids as ordered

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51
Q

what is often the max rate for transfusion ml/kg/hr

A

2-4ml/kg/hr

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52
Q

iron overload when might this occur and whats is happening

A

might occur w multiple transfusion or hronic transfusion therapy
the iron from the donated blood binds to the protein and isnt eliminated

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53
Q

mnfts of iron overload

nursing intervention

A 
cardiac dysfx
SOB
arrythmias
heart failure
inc serum transferring
inc liver enzymes
jaundice

monitor for above issues

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54
Q

what is TRALI

is it common

A

Transfusion-Related Acute Lung Injury
• Potentially fatal, idiosyncratic reaction
• Most common transfusion related cause of death
• Thought to involve antibodies in plasma of donor to the leukocutes in the recipients blood. Sometimes reverse happes- abs in recipient agglutinates to anitgens on the few remaining leukocutes in blood component being transfused
• Another theory- initial insult to patients vascular endothelium causes neutrophils to aggregate at the injured endothelium
• Various substances within the transfused plasma (lipids, cytokines) then activate the netutrophils
• End result of this process is interstitial and intra-alveolar edema, as well as extensive sequesteration of WBCs withn the pulm capillaries

55
Q

TRALI onset and mnfts

what kind of blood product is it more likley to occur with

A

• Onset abtupt- within 6hours
mnfts: SOB, hypoxia (arterial o2 sat), less than 90%, hypotensin, fever and pulm edema
• Diagnostic criteria include hypoxemia, bilateral pulm infiltrates and no evidence of cardiac cause for the pulm edema

more likely with plasma

56
Q

what are people who receive long-term blood therapy at risk of

A
  • Long term are at a greater risk for infection and more sensitive to donor antigens, bc exposed to more donors
  • Iron overlaod is a complication for long term. One unit is 250 mg of iron
57
Q

what does excess iron damage

A

• Excess iron can cause organ damage particularily in liver, heart, testes and pancreas

58
Q

to dec febrile reactions what should happen to the blood during processing

A

use WBC filtered products

59
Q

how can you prevent iron overload and how does it manifest (prob not important)

A

mnfts: heart failure, endocrine failure

- -prevent by chelation therapy

60
Q

how to manage risk of cytomegalovirus

A

WBC filters

61
Q

P&p

A

P

62
Q

FOR PREop blood donation how soon before sx does the pt donate. how long does it last

A
  • Preop is the most common type of autologous donation. Last donation may occur 72 hour before surgery
  • Donated blood stored at 1-6 degrees for 35-42 days
63
Q

what lasts longest CPD or CPDA-1 or CPDA-1 additive system
what are they
which are more common

A

all types of blood preservatives
CPD–citrate phosphate and dextrose has a shelf life of 21 days
CPDA-1–CPD plus adenine has shelf life of 35 days
the above two are more common

CPDA-1 add. sys. has CPD plus various preservative combinations

64
Q

what is the concern with using older blood

A

continual destruction of RBC causes release of K out of cells into plasma. Lab test of K ordered before administering unit of blood

65
Q

what are the 3 blood system types

A

ABO
Rh
HLA

66
Q

if pt has type A blood what antigens do they have and what antibodies

A

A antigens

B antibodies

67
Q

what antigens and antibodies does O blood have

A

A and B antigens

68
Q

who is th universal donor and who is the universal recipient

A

O- is universal donor

AB+ is universal recipient

69
Q

what kind of blood could a AB- pt receive

A

A-
B-
O-

70
Q

who has more transfusion options (can receive more)? pt with neg or pos blood

A

positive can receive more

71
Q

are there antibodies if you are Rh neg?

how does this relate to pregnant moms?

A
  • No antibodies to D antigen (unlike ABO)
  • Person with Rh neg blood must first be exposed to Rh pos blood before Rh antibodies are found. If exposed to enough blood (200ml) then can cause severe reaction
72
Q

t or f. you should never give blood that is incompatible with osmeones Rh group

A

sort of false. obviously give compatible if it is possible but…Rh pos blood may be used for a person with Rh neg without adverse effect if that person has not been previously exposed to Rh pos eg in trauma

73
Q

what might happen with rapid transfusion of cold blood

what might be used

A

dyshtymias and dec in core temp

can use blood warmer if lg transfusion

74
Q

what do you need to confirm before giving blood (lab related)

A

type and cross match in past 72hrs

hct, coagulation, platelet…I also think K?? and other things too?

75
Q

if pt has had transfusion sensitivity to blood in the past what might they be given before their blood

A

anithistamine s or antipyretics

76
Q

what do you need in relation to pts IV access

how is this different for peds

A
  1. Verify IV cannula is patent
    a. Administer blood to adult using 14-24 guage short peripheral
    b. Transfuse a neonate or ped with a 22-24 gauge
    c. A 1.9 fr is the smallest CVAD that can be used
77
Q

what to assess before giving blood

A
  1. Verify order of specific blood, date time to begin, duration and pre or posttransfusion meds
  2. Health hx and known allergies. Type and cross match 72 hours before
  3. Verify IV cannula is patent
    Administer blood to adult using 14-24 guage short peripheral
  4. Assess lab values- Hct, platelets,etc.
  5. Pt signed consent
  6. Know why getting it
  7. pretransfusion vitals
  8. Assess need for IV fluids or meds while transfusing
  9. Assess understanding
78
Q

after the blood is released from blood bank how long do you have before you need to hang it

A

30mins

79
Q

what do you need to identify when you have the blood

A
  1. Verbally compare and correctly verify patient, blood product and type.
    a. 2 ID and
    b. transfusion record number and pt id number match
    c. name and bday on all documents
    d. unit number on blood bag with blood bank form are same
    e. blood type matches on tranfsion record and blood bag. Right bag
    f. check expiration date
    g. just before initiating, check pt ID, info with blood unit label information, do nt give without id bracelet
    h. both individuals verify pt and unti ID
80
Q

what do you ask pt to do before initiating infusion. or empty?

A
  1. Empty urine drainage bag or have pt void
81
Q

how do you prepare the blood bag before hanging it

A

f. Prepare blood- gently agitate blood unit bag, turning back and forth, upside down, remove protective covering from access port. Spike w other Y connection. Close normal saline clamp above filter, open clamp above filter to blood unit and prime tubing

82
Q

what kind of tubing do you use to give blood

A

y tubing (with giant drip chamber) and in line filter.

83
Q

which VS do you notify the dr of if it is high

A

temp if pt is febrile

84
Q

if youre giving blood through a 24 gauge what needs to be done

A

blood bank might have to divide the unit (as the infusion rate will be slower and you need it to infuse in 4hrs)

85
Q

what is the only thing that blood is compatible with therefore what to do if pt needs med at the same time

how does dextrose affect blod

A

0.9 NS

they should get second line for meds

dextrose–>coagulation

86
Q

you go to admin blood but something happens and you cant hang it in the 30mins. what to do?

A

immed return it to blood bank and get it when you can give the blood

87
Q

rate for initial 15mins

what should you do during this time

A

2ml/min or 20gtt/min

stay with pt during first 15

88
Q

according to VIHA freq of VS monitoring

what to do at the same time

A

at 5min, 15, 1hr?
check their IV site and infusion status
check for signs of transfusion rxn eg chills, flushing, itching, dyspnea

89
Q

t or f your pt is having a reaction to blood. you run the NS through the pts existing tubing

A

F. change the tubing as youd ont want the blood in the tubing to run into the pt

90
Q

you have run one unit of blood and need to do another one. what will youc hange

A

tubing and set. d/t 4hr time limit and danger of bacteria

91
Q

your blood has infused what to do

now you have another bag to give what o

A

clear line with NS and discard bag appropriately

TKVO with NS and get the other bag

92
Q

which blood products do you not need ABO testing

A

cryo

albumin

93
Q

which blood product do you need ABO but not Rh compatibility

A

fresh frozen plasma that is single donor

94
Q

which blood products do you not eed Rh compatibility

A

fr frozen plasma
cryo
colloid components (albumin

95
Q

which blood components cant transmit HBV or HIV

A

colloid components. everything else can

96
Q

what to document after transfusion

A
  • pretransufion meds, VS, location and condition of IV site, pt education
  • type and vol of blood component, blood unit/donor/reciipient ID, compatability, expiration date, pt response.
97
Q

onitoring for adverse rxn

TRALI onset

A

6hrs generally

98
Q

what might fever indicate

A

acute hemolytic rxn
febrile nonhemolytic
bact sepsis

99
Q

what might tachy indicate and or tachypne, dyspnea

A

acute hemolytic rxn

cic overload

100
Q

what might drop in BP indicate

A

infectious disease transmission
acute hemoytic rxn
anaphylaxis

101
Q

what might hives, skin rash (including on trunk and on back indicate

A

early singns of allergic rxn, anaphylaxis, GVHD (which occurs after transfusion)

102
Q

observe pt for wheezing chest pain, possible cardiac arrest..this indicates?

A

anaphylaxis

103
Q

headache or muscle pain in presence of fever indicates

A

febrile nonhemolytic rxn

104
Q

N or V might indicate

A

acute hemolytic
anaphylactic
infectious disease transmission

105
Q

DIC, renal failure, anemia. hemoglobinuria (shown by CBC, hct, hgb)

A

late signs of acute hemolytic rxn

106
Q

pt has jaundice, inc livr Es, liver damage, bone marrow suppression

A

graftvs host disease. would occur followig transfusion

107
Q

what might tingling, dysrhtyhmi, HoTN indicate

A

hypocalcemia. from citrate combining with calcium

108
Q

WHERE TO GET BLOOD SAMPLE (if nec) if pt is having transusion rxn

A

from arm opposite IV

109
Q

which conditions might you give antipyretics or analgesics for

A

relieve fever and discomfort in acute hemolytic rxn, febrile nonhemolytic rxn, GVHD, bact sepsis

110
Q

when to give corticosteroids for transfusion rxn

A

for severe allergic rx

111
Q

other than blood what kind of sample miht you send to lab after transfusion rxn

A

first voided urine sample
Hgbinuria indicates acute hemolyti rxn. degree f damage to kidneys is influenced by ph of urine and rate of urine excretion

112
Q

procedure of pt has transusion rxn

A
  1. If you think transfusion reaction- stop IV immediately
  2. Remove blood component and tubing containing blood product and replce with saline
    a. Unless mild allergic reaction, stop transfusion, give antihistamines, restart or dc transfusion per protocol
  3. Maintain with NS
  4. Vitals
  5. Notify HCP and blood bank
  6. Obtain blood samples if needed
  7. Return back to blood bank
  8. Monitor vitals q15min
  9. Administer meds according to severity:
    Epi
    Antihistamine
    Abx
    Antipyretics/analgesics
    Diuretics/morhine
    Corticosteroids
    IV fludis
  10. Obtain first voided urine sample and send to lab
113
Q

what is the problem that can occursto babies with Rh neg mom and Rh pos baby in 2nd preg called

A

hemolytic disease of the newborn

erythroblastosis fetalis

114
Q

what might allow fetal blood to cross into mom

A

amniocentesis

percutaneous blood sampling

115
Q

what should Rh neg mom get at first visit when preg when will this test be repeated
exception to this

A

anti D ab titre
repeat at 28wks
will occur more freq if high titre first assessment (q2wk) and may have to deliver v early if high risk

116
Q

when is the first RhIG given

when is the next dose

A

28wks
72hrs after give another dose

the rhogam will destroy the abs

117
Q

if baby is losing blood in utero what can be done

A

intraueterine transfusion-O neg or fetus’ blood type

118
Q

when is ABO compatibility a concern in preg

A

when placenta is loosened. gen ABO compability isnt a concern

119
Q

hw to detect Rh issue

A

rising anti Rh titer or inc level of Abs

120
Q

how might baby present if Rh issue

A

might not be pale at birth as red cell production. if anemic will get hypoglycemic
not jaundiced at birth as maternal circ evacuates bilirubin keeps up in utero. liver and spleen might be enlarged

121
Q

how are babies treated for blood issues

A

early feeding to remove bilirubin from BMs
phototherapy triggers liver to fx
exchange transfusion

122
Q

consideration when spiking a blood bag

A

spike it at chest height

123
Q

when getting post blood blood work what is ideal timing

A

6hrs after

124
Q

how many mls of NS do you need on hand

A

500ml

125
Q

if giving more than 2 units blood what is often done between

A

diuretic

126
Q

can you send pt to procedure if they have blood going

A

no. go with them or order portable

127
Q

should you use the tape f the lot number for chartig

A

no

128
Q

from handout VIHA

if pt has mild allergic rxn do you need blood or urine spec

A

no

129
Q

before ordering blood from transfusion services what needs to be prepared

A

informed consent on chart
bag of 500ml NS and IV tubing at bedside
IV (20gague or larger)
transfusion admin set at bedside

130
Q

what 3 items are you checking at bedside and what are you checking them for

A

check issuing requisitiion
label on blood product
attahed product tag

check for
pt surname, given name, initials
unique # or PHN for outpts
DOB
blood group and Rh factor or lot #
blood serial number
date of donation/expiry date
131
Q

how to id the pt

A

check label on blood product and the attached product tag with pts name band and have pt spell their last name and give DOB if possible

132
Q

after IDing the pt whatto dowhen hanign blood

A

sign and date the issuing req and then immed hang it

133
Q

is it 4hrs after hanign or 4hrs after issuance that it must infuse

A

after issuance

134
Q

nurses role in informed consent for blood

A

we can witness signature

we cant tell them about it eg why theyre getting it, what theyll get etc before the dr speaks to them

234342 (11 decks)

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