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Saunders NCLEX Review > Blood Products > Flashcards

Blood Products Flashcards

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1
Q

PRBC used for…

A

replacing erythrocytes

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2
Q

1 unit of PRBCs increases Hgb & HCT by…

A

Hgb: 1g/dL
HCT: 3%

**takes 4-6 hrs after transfusion completes

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3
Q

How do we assess effectiveness of PRBCs?

A
  • anemia resolved
  • increased erythrocytes
  • increased Hgb
  • increased HCT
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4
Q

“washed” RBCs

A
  • leukocyte-poor
  • leukocyte, proteins, plasma have been reduced

-usually prescribed for hx of allergic rxn or hematopoietic stem cell transplant

  • restore oxygen-carrying capacity of blood
  • restore intravascular volume
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5
Q

How fast do you infuse PRBCs?

A

2-4 hrs

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6
Q

Platelet Transfusion used to..

A

tx thrombocytopenia and platelet dysfx

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7
Q

patients that receive multiple units of platelets can become…

A

alloimmunized to different platelet antigens

-normal during pregnancy, but ADR for blood transfusion

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8
Q

What would patients benefit from who are alloimmunized?

A

platelets that match their specific HLA (human leukocyte antigen)

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9
Q

alloimmunized

A

immune response to foreign antigens after exposed to genetically different cells/tissues

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10
Q

Crossmatching for platelet transfusion

A

-no req’d, but usually done

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11
Q

how fast do you infuse platelets?

A

rapidly over 15-30 mins

-admin immediately after rec’d from blood bank

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12
Q

How do we measure effectiveness of platelet transfusion?

A
  • improved platelet count

- normally evaluated 1 hour and 18-24 hrs after infusion

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13
Q

For each unit of platelets, what is the expected increase in platelet count?

A

5k-10k per unit of platelet

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14
Q

FFP used for…

A

fresh-frozen plasma

  • used to provide clotting factors OR volume expansion
  • there are no platelets in FFP
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15
Q

How fast is FFP infused?

A
  • over 15-30 mins

- within 2 hours of thawing (clotting factors not viable after that)

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16
Q

Rh/ABO compatibility for FFP

A

REQUIRED

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17
Q

how do we monitor effectiveness for FFP?

A
  • monitoring coag studies, esp PT and PTT

- resolved hypovolemia

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18
Q

Prothrombin

A

Vitamin K-dependent glycoprotein produced by liver necessary for fibrin clot formation

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19
Q

PT

A

measures the amount of time it takes in seconds for the clot formation and is used to monitor warfarin therapy or to screen for dysfx of extrinsic clotting system

(such as liver dz, vit k deficiency, and DIC)

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20
Q

PT norm value

A

11 to 12.5 seconds

-within 2 seconds (+/-) of the control is considered normal

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21
Q

INR

A

international normalized ratio

  • test to measure the effects of some anticoags
  • standardizes the PT ratio
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22
Q

INR norm value

A
  1. 8 to 1.2

2. 0 to 3.5 for warfarin therapy

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23
Q

When collecting coag blood work….

A

direct pressure to venipuncture site for 3-5 minutes

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24
Q

What type of diet would shorten PT?

A
  • green leafy veges

- increases vit k absorption….therefore shortening clotting time

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25
Q

Vitamin K

A

clots

-antidote to warfarin

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26
Q

aPTT

A

measures effectiveness of heparin

-identifies which specific factor is causing the increased PT

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27
Q

Increased aPTT

A

deficiency of clotting factors, helpful to find which ones specifically to get to the cause of prolonged bleeding time

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28
Q

Critical values for aPTT

A

saunders: 87.5 seconds and greater are put on bleeding precautions for thrombocytopenia
nrsng: over 70 seconds is a critical value

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29
Q

When monitoring intermittent heparin therapy, what are the guidelines for blood draw?

A
  • 1 hr before next scheduled dose
  • do not draw from arm infusing heparin
  • direct pressure on VP site for 3-5 mins
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30
Q

aPTT norm value

A

25-39 seconds (saunders)

28-35 seconds (nrsng)

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31
Q

Cryoprecipitates used for..

A

replacing clotting factors, esp VIII and fibrinogen

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32
Q

What are cryoprecipitates prepared from?

A

FFP, stored frozen for up to 1 year

-after thawed, must be used

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33
Q

How are cryoprecipitates infused?

A

1 unit over 15-30 mins

34
Q

How do you measure effectiveness for Cryoprecipitates

A

-monitoring coag studies and fibrinogen levels

35
Q

Granulocytes used for…

A

tx patients with sepsis or neutropenic patients with infection unresponsive to ABX

36
Q

How do you measure effectiveness of granulocytes?

A

WBC and differential counts

37
Q

When documenting blood transfusions…

A
  • client’s tolerance
  • resp to transfusion
  • effectiveness of transfusion
38
Q

Autologous

A
  • patients own blood before sx
  • decreased risk of dz transmission and potential of complications
  • not an option for patients with leukemia and bacteremia
39
Q

How often can you donate for autologous before sx?

A
  • every 3 days as long as Hgb safe range

- within 5 weeks of transfusion date and end 3 days before tranfusion

40
Q

blood salvage

A
  • autologous involves suctioning blood from body cavities, joints, or other closed body sites
  • may need to be “washed” to remove tissue debris before reinfusion
41
Q

Designated donor

A
  • selecting your own compatible donor

- does not risk of infection transmission, but feel more comfortable

42
Q

How is compatibility done?

A

RBC’s are combined with recipient’s serum and Coombs serum

-if compatible, no RBC agglutination occurs

43
Q

Universal donor

A

O-

44
Q

Universal recipient

A

AB+

45
Q

Rh+ can receive….

A

can receive from +/-

46
Q

Rh- can receive…

A

can receive from - only

47
Q

Infusion pumps for blood transfusions

A
  • special IV tubing to prevent hemolysis of RBC
  • IV pump used if designed for opaque solutions
  • special manual cuffs made for blood products may be used to increase flow rate
48
Q

special cuffs for blood products should not exceed

A

300 mm Hg

49
Q

do not use standard BP cuffs because…

A

do not exert equal pressure

50
Q

Blood warmers

A

prevent hypothermia and ADR when multiple units of blood are administered

-do not microwave or hot water

51
Q

S/S of immediate blood transfusion rxns

A
  • chills/sweating
  • muscle aches, back, chest pain
  • rashes, hives, itching, swelling
  • rapid, thready pulse
  • dyspnea, cough, wheezing
  • pallor, cyanotic
  • apprehension
  • tingle/numb
  • HA
  • N/V/D
  • abdominal cramps
52
Q

S/S of transfusion rxn in unconscious pt

A
  • weak pulse
  • fever
  • tachy/bradycardic
  • hypotensive
  • visible hemoglobinuria
  • oliguria/anuria
53
Q

delayed tranfusion rxn

A
  • days to years
  • fever
  • mild jaundice
  • decreased HCT
54
Q

What do you do as the nurse if you are giving a transfusion?

A
  • stay with the patient for first 15 mins of infusion
  • monitor for S/S of rxn
  • first 15 is most critical
  • V/S q30 mins-1 hr per hospital protocol
55
Q

What do you do as the nurse if you suspect a transfusion rxn?

A
  1. stop infusion immediately
  2. remove tubing down to IV site, KVO with NS
  3. Notify HCP and BB
  4. stay with pt and observe S/S, V/S q5 mins
  5. prepare to admin emergency drugs per protocol
  6. obtain urine sample and/or other labs as ordered
  7. send all tubing, labels, blood product to BB
  8. document
56
Q

TACO

A

Transfusion-associated Circulatory Overload

-too rapid transfusion, patient can’t tolerate

57
Q

S/S of TACO

A
  • cough, dyspnea, wheezing
  • HA
  • HTN
  • tachycardic, bounding pulse
  • JVD
58
Q

What do you when TACO suspected?

A
  • slow infusion
  • pt upright, feet dependent
  • notify HCP
  • admin O2, diuretics, morphine as ordered
  • monitor for dysrhythmias
  • phlebotomy in severe cases
59
Q

Septicemia

A

-transfusion contaminated with microorganisms

60
Q

S/S of Septicemia

A
  • rapid onset of chills and high fever
  • V/D
  • hypotensive
  • shock
61
Q

What do you do if you suspect septicemia?

A
  • notify HCP
  • obtain blood cultures and cultures of blood bag
  • admin O2, IVF, ABX, vasopressors, corticosteroids as ordered
62
Q

Iron overload

A

-delayed transfusion rxn that occurs with multiple transfusions (anemia, thrombocytopenia)

63
Q

S/S of iron overload

A
  • V/D
  • hypotensive
  • altered hematological values
64
Q

What do you do if you suspect iron overload?

A

-deferoxamine admin IV or subQ

65
Q

deferoxamine

A

removes accumulated iron via kidneys

  • urine turns red as iron is excreted
  • d/c after iron returns to normal
66
Q

Dz transmission from transfusion

A
  • hep C most common
  • HIV
  • Herpes virus type 6
  • Epstein-Barr virus
  • human T-cell leukemia
  • CMV
  • Malaria

**testing has decreased risk of these significantly

67
Q

Hypocalcemia

A
  • Citrate/Calcium love each other
  • Citrate in transfused blood binds with calcium and is excreted
  • Serum calcium is assessed before and after transfusion
68
Q

S/S of Hypocalcemia

A
  • hyperactive reflexes
  • paresthesia
  • tetany
  • muscle cramps
  • positive Trousseau’s sign
  • positive Chvostek’s sign
69
Q

Trousseau’s sign

A

“Throw the hand back”

-carpal spasm produced by occlusion with BP cuff

70
Q

Chvostek’s sign

A

tapping on facial nerve, twitching of eyes, mouth, or nose

71
Q

Hyperkalemia

A
  • older the blood, greater the risk
  • pt’s already at risk shoudl receive fresh blood

-assess date of blood and K levels before and after transfusion

72
Q

S/S of hyperkalemia

A
  • paresthesia
  • weakness
  • abd cramps
  • diarrhea
  • dysrhythmias
73
Q

What do you do if you suspect hyperkalemia?

A
  • slow infusion

- notify HCP

74
Q

What do you do if you suspect hypocalcemia?

A
  • slow infusion

- notify HCP

75
Q

Citrate Toxicity

A

rapid admin of multiple units of stored blood may cause hypocalcemia and hypomagnesemia

-leads to myocardial depression and coagulopathy

76
Q

Citrate

A

anticoag used in blood products that are metabolized by the liver

77
Q

Most at risk for citrate toxicity

A

liver dysfx

neonates with immature liver

78
Q

What do you do if you suspect Citrate Toxicity

A
  • slow/stop infusion to allow citrate to be metabolized

- hypocalcemia and hypomagnesemia tx’d with replacement therapy

79
Q

Hgb norm value

A

12-16.5

80
Q

HCT norm value

A

male: 42-52%
female: 35-47%

Saunders NCLEX Review (1 decks)

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