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blood ppts Flashcards

1
Q

what is the timeframe that blood components need to be used

what about blood products

A

Components need to be with 4 hours from blood bank (fridge) and products within 4 hours of spiking the bag.

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2
Q

What is the difference between a blood component and a blood product

A

Therapeutic component of blood intended for a transfusion and any therapeutic product derived from human blood or plasma and is produced by a manufacturing process

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3
Q

There are many checks that must occur with blood transfusions. What are the 2 most critical checks for blood compatibility

A

Blood type and Rh factor

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4
Q

What must be checked prior to administering any blood or blood product

A

Name of patient, DOB, MRN, blood type, Rh factor, expiry date and time, crossmatch results, product number

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5
Q

Which type of IV set can be used when giving a blood transfusion

A

Only straight filtered sets are used with no “Y’s

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6
Q

A new IV line must be used for each unit of blood to be transfused
t or f

A

true!

newest policy as filter works best with the first unit of blood

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7
Q

How often should VS be taken when giving a blood transfusion
rate that the line should run at to start
peds rate

A

Baseline, 5 mins, 15 mins and then q 1 h

Blood transfusions start slow at 50 ml/hr for adults. Peds 1ml/kg/hr.

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8
Q

A blood transfusion should be infused within a certain time frame once delivered from the blood bank

A

Within 4 hours once out of the blood bank fridge.

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9
Q

A transfusion reaction is most likely to occur during which time frame

A

Within 5-15 minutes

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10
Q

Your patient is complaining of chills and a fever. You suspect a transfusion reaction. What will be your actions

A

Stop the transfusion, start normal saline, VS’s and call the doctor.
. Be sure to mention disconnecting blood right at IV site so no more goes in – problem with nexiva catheters though! It mentions that with severe reactions with less than 10 mls of blood can occur! (“only a few mls”)

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11
Q

Your patient is having a severe transfusion reaction. What does this look like

A

Respiratory distress, fever, chills, nausea, chest tightness, back pain, anxiety

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12
Q

Fever, chills and muscle stiffness what is likely happening

A

febrile nonhemolytic reaction – begins about 2 hours after transfusion is started, non-life threatening but uncomfortable

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13
Q

pt is having Dyspnea, tachycardia, anxiety, orthopnea and cough
what is likelyt he problem
what can be done to prevent this

A

– circulatory overload – also can have JVD, increased BP and frothy pink sputum.
Need Lasix between units and units given slowly. If severe, d/c transfusion give O2 and call doctor, saline lock IV

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14
Q

cn you store blood products in the fridge until use

A

no! they must be kept at specific temp

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15
Q

what soln must IVIG be run with

A

d5W

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16
Q

What are the steps you would take after a transfusion reaction occurs and patient has been stabilized

A

You would recheck all the labelling, ID on patient etc., inform the blood bank, notify physician (should have already anyway!), keep the blood component/product to send to the blood bank for analysis, blood cultures if it’s a suspected infection and fill out all documentation forms per policy of the institution

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17
Q

what are blood components

what are blood products

A

PRBC’s
Plasma
Platelets
Cryoprecipitate (made from plasma)

Blood Products
Albumin
IVIG
Rhogam

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18
Q

who are cytomegalovirus negative given to & what is it

A

Indications- CMV negative blood is often given to premature infants, those infants under 4 weeks of age, and clients undergoing intrauterine transfusions. Other clients – bone marrow or organ transplant recipients, HIV or AIDS, spleenectomy, immunocompromised clients, pregnant women.

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19
Q

what type of blood therapy has highest risk of leading to septicemia

A

platelets as they are stored at rom temp

there are also fresh frozen platelets

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20
Q

pts who have ITP immune thrombocytopenia purpura should they get platelets

what blood product hsould they receive
who else might need this

A

patients with idiopathic thrombocytopenia purpura (ITP) should not receive platelet transfusions unless bleeding is significant or life threatening. Platelet transfusion given to clients with ITP will be rapidly removed from circulation by the client’s anti-platelet antibodies and thus will be, at most, only of transient benefit

IVIG - human immunoglobulins replacement for treatment of some auto immune diseases (chronic fatigue syndrome), treatment for Kawasaki’s in pediatrics, Guillian-Barre, idiopathic thrombocytopenia purpura.

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21
Q

do you need to keep ABO or Rh compatability in mind when giving plasma

A

must be ABO compatible. Rh factor need not be considered

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22
Q

what is fresh frozen plasma and how long can it be kept

indications for use FFP

A

Fresh Frozen Plasma is unconcentrated form of blood plasma containing all of the clotting factors except platelets.
Stored at minus 18 degrees Celsius or lower for up to one year.

FFP is indicated for:
 massive transfusion (replacement of the patient’s blood volume in < 24 hours) with deficiency of Factor VIII and V, otherwise frozen plasma is adequate. 
-exchange transfusion in neonates.
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23
Q

when not to use fresh frozen plasma

A
  • dont use when coagulopathy can be corrected with more specific therapy eg cryoprecipitate or a factor
  • dont use when can inc blood vol w NS or other solns
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24
Q

what is cryoprecipitate and when is it indicated

A

Cryoprecipitate – is a low purity concentrate of 3 hemostatic proteins prepared from donated whole blood. A single bag of Cryo contains an average of 100units of factor VIII and von Willebrand factor, and 150-200mg of fibrinogen with some factor XIII and fibronectin. Made from plasma, fibrinogen and factors 8 and 13

for patients bleeding with low fibrinogen levels.

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25
what is the only fibrinogen conc available for IV use
Cyro is the only fibrinogen concentrate available for IV use.
26
what pt would need factor VIII factor IX
VIII is from human plasma to treat clients with Hemophilia A or von Willebrand’s disease. IX – is from human plasma to treat clients with Hemophilia B (factor IX deficiency). It may be of value to clients with congenital factors X or II (prothrombin) deficiency.
27
what might these pts need Kawasaki’s in pediatrics, Guillian-Barre, idiopathic thrombocytopenia purpura.
IVIG
28
what are packed RBCS and who are they indiated for
RBCs that have been filtered and WBCs removed Component of choice for virtually all patients with a deficit of oxygen carrying capacity, e.g. blood loss or anemia
29
why are packed RBCs a good choice for bone marrow or organ transplant pts
The majority of the WBC are removed thereby decreasing the risk of cytomegalovirus (CMV) infection (CMV virus is carried in the WBC.) also reduces the risk of the patient forming antibodies against WBC (HLA) antigens
30
what properties does plasma have
oncotic and volume expanding
31
functions of albumin
Maintains plasma colloid osmotic pressure and serves as carrier of intermediate metabolites in transport and exchange of tissue products.
32
indications of albumin
Symptomatic relief and supportive treatment in management of shock, burns, hypoprothrombinemia, adult respiratory distress syndrome, cardiopulmonary bypass, acute liver failure, acute nephrosis, sequestration of protein-rich fluids, erythrocyte resuspension, hypotension or shock during renal dialysis, hyperbilirubinemia and erythroblastosis fetalis.
33
are platelets generally cross matched
only if the platelet bag contains a lot of RBCs the bag will contain all the same ABO type blood but wont nec be the same ABO as the recipient
34
how long do platelets take before they expire
4hrs
35
how are platelets and cryoprecipitate different which to use if fluid vol restrictions
cryoprecipitate has some of the *prenatant platelets* removed so it is smaller vol and better for heart failure etc
36
who is the universal recipient universal donor
Type AB means both antigens are present- Neither antibody so * Universal recipient- can receive all blood types Type 0 means neither antigen is present- Both A & B antibodies present: Can only receive type O Blood
37
which of the following blood products MUST have ABO compatability PRBC Cryoprecipitate AHF (anti-hemophilic factor) Platelets Albumin (however, RH compatibility preferred) IVIG Rhogam whole blood
PRBC and whole blood are the only two that require ABO compatibility.
38
when would there be risk of hemolytic disease of the newborn would it be with the first pregnancy
Rh neg mom and Rh pos baby. The moms Abs can get into the babies blood and cause hemolytsis not problematic for first baby but each subsequent pregnancy the risk and dose of antibodies increases and so therefore does the (risk and severity of) hemolytic disease
39
if baby is Rh positive and mum is Rh neg will she need rhogam when would she get it
Mother needs Rhogam shot at 28 weeks gestation then within 72 hrs of the delivery.
40
indications for rhogam
* Pregnancy/delivery of an Rh-positive baby irrespective of the ABO groups of the mother and baby * Abortion/threatened abortion at any stage of gestation * Ectopic pregnancy * Antepartum fetal-maternal hemorrhage (suspected or proven) resulting from antepartum hemorrhage (e.g., placenta previa), amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g., version) or abdominal trauma * Transfusion of Rh incompatible blood or blood products
41
can you hang blood alone
no. two RNS necessary
42
what kind of pt ID do you need
name pt medical ID DOB one unique identifier
43
when you are hanging the blood what do you need to know about it other than that it matches the pts name, that the bag looks good
Check blood group and Rh factor, blood lot/serial number,
44
what is the leading cause of death from transfusion what kind of transfusion is this more likely to occur with
TRALI (transfusion related acute lung injury) now the leading cause of death (5-14% CFR) often seen with plasma components not RBC’s.
45
what is TRALI how does it manifest
TRALI is a syndrome of acute respiratory distress. potentially fatal, idiosyncratic reaction. Plasma antibodies from donor’s plasma, that are present in the blood component stimulate the recipients WBCS; aggregates of WBCs form and occlude the microvasculature within the lungs. Manifested as pulmonary edema that can occur 4 hrs+ post transfusion → fever, chills, acute resp distress, s/s of acute left sided heart failure. Signs and Symptoms: Fever, pulmonary edema, hypotension, chills occurring 4-6 hours after transfusion.
46
other than TRALI what is another very serious complication of transfusions that can lead to death and why does it occur
ABO incompatibility is one of the most serious usually causing death Most attributed to Human Error – Patient misidentified, sample error, wrong blood, transcription/admin error, storage problem
47
why might a febrile nonhemolytic reaction occur
Febrile non-hemolytic – reaction to cytokines, leukocytes, plasma antibodies, bacteria
48
what is TACO what are the manifestations
TACO (Transfusion Associated Circulatory Overload) – hypervolemia can develop = dyspnea, orthopnea, tachycardia, sudden anxiety, JVD, crackles at base of lungs, increased BP, possibly leading to pulmonary edema.
49
who is at risk of transfusion assoc circulatory overload
Note…caution when transfusion given to client with CVD/Heart Failure/COPD.
50
what would cause acute hemolysis
Acute hemolysis – wrong ABO group given to recipient.
51
what IV gauges can you run blood through. why? | what can be done if the pt is pediatric or elderly and you cant get those gauges in
18 or 20 because of the rate of infusion But you can infuse into a 22 g. For pediatric patients or elderly when only a smaller gauge will work, you can contact the lab and get the unit split into two so that it doesn’t need to infuse so fast.
52
when infusing blood what other eqpt do you need? | what is the exception to this?
a primed bag of NS ready to go in case of reaction
53
how do the rates for infusion of blood typically go
Rate of transfusion- not too fast for first 15 minutes as most likely time for reaction- 2ml/min or 20 gtt/min (10 drop factor for blood giving set) or @ 50ml/hr for the first 15 minutes for adults [PEDS: 1 mL/kg/hr x 15 min, then as ordered, probably 2-5 mL/kg]
54
what are most blood products compatable with | what is the exception
NS in gen IVIG only compatible with D5w
55
when to do VS when giving blood
baseline, immediately prior, then at 5 minutes, 15 minutes and hourly until blood transfusion finished.
56
what is the time limit that blood must infuse within and why
Blood needs to infuse within 4 hrs because it’s very good medium for bacterial growth.
57
your pt has blood infusing but must go for a diagnostic what do you do
the pt cannot leave the unit with blood infusiing. postpone the diagnostic
58
t or f flush with NS after giving blood
f
59
after hangin blood and starting it is it ok to leave and attend to other pts?
no. most major reactions are more likely to occur in the first 15 minutes therefore nurse should stay and observe patient for at least 5 mins
60
what VS should be reported if taking baseline vitals
if pt is febrile
61
assessments to do before blood admin
Thorough head-to-toe assessment Thorough medical history including transfusion history Baseline lab work Baseline vitals then Q5, Q15, q1h & monitor carefully Report if patient febrile Prior to transfusion
62
what lab work to do before blood admin what lytes and why
Lab work – Hgb, Hematocrit, K, Cl, CBC, platelet count, INR possibly, PTT and other clotting factors if this is an issue. when blood is stored destroys RBCs releasing K from cells into plasma so if blood transfused too fast transient hyperkalemia occurs before K is reabsorbed. Ca is diminished transiently - especially in young kids and the elderly.
63
acronym for wht to do during blood transfusion | TRAN
TRANSFUSION TIMING of blood – initiate within 30 min, complete within 4 hr RATE of transfusion: Adult 50 ml/hr first 15 min); Peds 1mg/kg/hr ASSESSMENT of patient, medical Hx, prior transfusions & IV site NEVER infuse without INFORMED CONSENT
64
acronym for what to do during blood transfusion | SFUS
SIGNS & symptoms of transfusion reaction (↑HR & TEMP first signs FLUID overload – Respiratory assessment, Ins & outs UNDERSTAND – reasons/goals of transfusion: Teach patient SERUM ELECTROLYES: K and Ca
65
acronym for what to do during blood transfusion | ION
ID X 2 nurses - Patient, DOB, Unique #, Bld grp, RH factor, Bld serial #, exp date, observe blood for color, consistency, leakages OBSERVE patient carefully - vital signs before, @ 5 min, @15, hrly NORMAL Saline @ bedside for emergencies

234342 (11 decks)

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