Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MED SURGE WINTER CLINICAL > blood transfusion w3 > Flashcards

blood transfusion w3 Flashcards

1
Q

the hematological system includes

A
  • bone marrow
  • blood
  • spleen
  • lymph system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what does blood transfusion mean?

A

the administration of whole blood (ex. platelets, packed RBC, or plasma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

safety alert w/ blood transfusion

A
  • dextrose solutions or lactated ringer’s should never be used w/ blood bc they will cause RBC hemolysis
  • additives (including medication) must not be given via the same tubing as the blood unless the tubing is first cleared w/ saline solution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what gauge should the nurse use when administrating blood components?

A

using a 22-gauge IV needles or cannula, or catheter

  • larger needles (18 or 16-gauge) may be preferred if rapid transfusion are given or if the infusion is sluggish
  • smaller needles are used for platelets, albumin, and clotting factor replacements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

patient’s w/ a history of reaction to platelet transfusion may be premedicated w/ __ to decrease the possibility of reaction?

A

antihistamine and hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the nursing consideration when giving blood?

A

–always have a dual-checking system
-obtain vital signs before administration
-administer blood ASAP to pt when received
-never refrigerated on the nursing unit in food or drug fridge bc the temperature doesn’t meet the requirement for safe storage
-if blood is not used w/in 30 mins return to blood bank
-during the first 15min or 50ml of infused blood, the nurse must remain w/ the pt to monitor (reactions occur most often at this time)
-rate of infusion should be no more than 2mL/min
PRBCS should no be infused quickly unless an emergency
-after 15 mins retake viral signs
-observe pt periodically every 30 mins and up to 1 hour after transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how long should blood transfusion take to be administered?

A

usually not more than 4 hour bc of the increased risk for bacterial growth in the product once it is out of the refrigerator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is a blood transfusion reaction?

A

an adverse reaction to blood transfusion therapy can range in severity from milk, to life threatening conditions

  • must have judicious evaluation of the pt
  • reactions can be acute or delayed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is an acute hemolytic reaction?

A
  • most common cause of hemolytic reaction is transfusion of ABO incompatible blood
  • when occurs, antibodies in the recipient serum react w/ antigen on the donor’s RBCs. this reaction results in agglutination of cells, which can obstruct capillaries and block blood flow
  • may obstruct renal tubules, leading to kidney injury
  • death
  • usually develops w/in 15 mins of transfusion
  • DIC (disseminated intravascular coagulation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a febrile reaction?

A
  • most commonly caused by leukocyte incompatibility
  • common in individuals who receive 5 or more transfusions develop circulating antibodies to the small amount of WBCs in the blood product
  • is prevent by using additional filters in the tubing to leukocyte-deplete RBCs and platelets
  • may give acetaminophen or diphenhydramine 30 min before administration to reduce reactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

allergic reaction to blood transfusion?

A
  • may result d/t recipients sensitivity to plasma proteins of the donors blood
  • reactions are common in those who have a history of allergies
  • may administer antihistamines to help prevent reactions
  • epinephrine or corticosteroids can be used to treat severe reactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

circulatory overload and blood transfusion

A
  • pt w/ cardiac or renal insufficiency is at risk for developing circulatory overload, esp when large quantity of blood is infused in a short period of time (esp in elders)
  • nurse should do a fluid balance assessment, obtain baseline auscultation of the pts lung
  • complaints of SOB, and presence of adventitious breath sounds may indicate fluid overload in pt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

sepsis and blood transfusion

A
  • blood products can become infection from improper handling and storage
  • bacterial contamination of blood products can result in bacteremia, sepsis, or septic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is transfusion related acute lung injury? (TRALI)

A
  • characterized by the sudden development of noncardiogenic pulmonary edema (acute lung injury)
  • usually develops w/in hours of transfusion
  • leading cause of transfusion-related deaths (surpassing hemolytic reactions)
  • causes pulmonary capillary inflammation and increased permeability =respiratory distress and death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is massive blood transfusion reaction?

A
  • complications of transfusing large volumes of blood
  • occurs when RBCs or blood exceeds the total blood volume w/in 24hs =imbalance of normal blood elements results bc clotting factors, albumin, and platelets are not found in RBC transfusion
  • must monitor hemostatic lab values
  • can cause hypothermia (can cause dysrhythmias-warm blood using tool to prevent this), citrate toxicity, hypocalcemia, hyperkalemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is delayed transfusion reaction?

A
  • includes hemolytic reactions (24-14 days)
  • infections
  • iron overload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

infection and blood transfusions

A

-Infectious agents transmitted by blood transfusion include hepatitis B and C viruses, HIV, human herpesvirus type 6 (HSV-6), EBV, HTLV-1, cytomegalovirus (CMV), and malaria. Hepatitis is still the most common viral infection transmitted but is decreasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is autotransfusion? /autologous transfusion

A
  • removing whole blood from a person and transfusion that blood back into the SAME person
  • problems of incompatibility, allergic reactions, and transmission of disease are avoided
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

autologous donation

A
  • person donates their blood before a planned surgical procedure
  • can be frozen and stored for 10 yrs
  • great for pts that have rare blood types
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

autotransfusion donation

A
  • involves safely and aseptically collecting, filtering, and returning the pt’s own blood that is lost during a major surgery or traumatic injury
  • replaces volume and stabilize the condition of bleeding pt
  • collection devices most often used during surgeries
  • some system allow blood to be automatically and continuously reinfused
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

S/S of febrile, nonhemolytic reaction

A
  • sudden chills and fever
  • headache
  • flushing
  • anxiety
  • vomiting
  • muscle pain
22
Q

S/S of mild allergic reaction to transfusion

A
  • flushing
  • itching
  • pruritus
  • urticaria (hives)
23
Q

S/S of severe allergic reaction of transfusion

A
  • anxiety
  • urticaria
  • dyspnea
  • wheezing
  • progressing to cyanosis
  • bronocospams
  • cardiac arrest
24
Q

S/S of circulatory overload blood transfusion reaction

A
  • cough
  • dyspena
  • pulmonary congestion
  • adventitious breath
  • headache
  • HTN
  • tachycardia
  • distended neck viens
25
Q

S/S of sepsis blood reaction

A
  • rapid onset of chills
  • high fever
  • vomiting
  • diarrhea
  • hypotension
  • shock
26
Q

S/S of transfusion-related acute lung injury (TRALI) reaction

A

-fever
-chills
-hypotension
-tachypnea
-frothy sputum
-dyspnea
-hypoxemia
-respiratory failure
-noncardiogenic pulmonary edema
(occurs w/in 1-6 hrs of transfusion)

27
Q

S/S of massive blood transfusion reaction

A
  • Hypothermia and cardiac dysrhythmias (from massive infusion of large quantities of cold blood).
  • Citrate toxicity and hypocalcemia (from the use of citrate as a storage solution).
  • Hyperkalemia (from potassium leaking from stored RBCs).
28
Q

nursing management of acute hemolytic reaction

A
  • treat shock and DIC (disseminated intravascular coagulation)
  • draw blood and urine sample
  • maintain BP w/ IV colloid solutions
  • give diuretics to maintain urine flow
  • insert-in-dwelling urinary catheter to measured voided amounts to monitor hourly urine output
  • dialysis may be required if renal failure occurs
  • stop transfusion
29
Q

management of febrile nonhemolytic reaction

A
  • give antipyretics
  • avoid ASA in pt with thrombocytopenia
  • stop transfusion (don’t restart w/out physical orders)
30
Q

management of mild allergic blood transfusion reaction

A
  • give antihistamine, corticosteroid, epinephrine
  • if symptoms are mild transfusion may be restarted slowly w/ an order
  • never restart transfusion if fever or pulmonary symptoms develop
31
Q

management of severe allergic reaction

A
  • CPR
  • administer O2
  • epinephrine (injection)
  • antihistamine
  • corticosteroids b2 agonists
  • DO NOT RESTART TRANSFUSION
32
Q

nursing management for circulatory overload reaction

A
  • place pt upright w/ feet in dependent position
  • obtain chest radiograph
  • administer diuretics, O2, and/or morphine
  • phlebotomy may be indicated
33
Q

management of sepsis transfusion reaction

A
  • obtain culture of patient’s blood and send bag with remaining blood and tubing to blood bank for further study.
  • treat septicemia as directed— administration of antibiotics, IV fluids, and/or vasopressors.
34
Q

management of transfusion-related acute lung injury reaction

A
  • send bag w/ remaining blood and tubing to blood bank
  • analyze ABG’s and HLA (human leukocyte antigen)
  • provide O2
  • administer corticosteroids, diuretics
  • CPR
  • provide ventilatory and blood pressure support if needed
35
Q

management of massive blood transfusion reactions

A

-monitor clotting status and electrolyte levels

36
Q

what is the purpose of blood transfusions?

A
  • increase (circulating blood volume (hemorrhage, trauma, surgery, hypovolemic shock, burns)
  • correct (RBC deficiency and improve oxygen carrying capacity of the blood)
  • maintain (blood’s clotting ability ex. pt w/ bone marrow suppression)
  • provide (selected blood components as replacement therapy (clotting factors, platelets)
37
Q

what are the 4 main components of blood?

A
  • plasma
  • RBC
  • WBC
  • platelets
38
Q

whole blood/packed red blood cells (PRBCs)

A

whole blood or packed RBC are transfused where major blood loss occurred

  • most commonly used
  • once plasma has been removed from whole blood, additives are used to resuspend red cells (maintain red cells in optimum condition during storage)
39
Q

what are the indicates for whole blood or PRBCs?

A
  • RBCs improve oxygen-carrying capacity
  • useful as a volume expander after acute blood loss
  • symptomatic anemia
40
Q

what are platelets?

A

responsible for clotting (coagulation), change fibrinogen into fibrin =creating a mesh onto which red cells collect and clot

41
Q

indications when we would administer platelets?

A

-severe micro-vascular bleeding occurs (DIC- disseminated intravascular coagulation)
-for pt with platelet count of less than 10,000 to 20,000/mm3
-pt w/ platelet count of less than 50,000/mm3 who are bleeding
(N=150-400,000/mm3)

42
Q

what is albumin?

A

dynamic protein in plasma responsible for maintaining the plasma colloid osmotic pressure thereby regulating intravascular blood volume

43
Q

indications for albumin

A
  • 5% solution, used for volume expander, hypovolemic shock and hyporoteinemia
  • 25% solution used for severe burns and low albumin levels
44
Q

indications for fresh frozen plasma (FFP)

A

active bleeding- replacement of plasma coagulation factors when simultaneously blood volume expansion is required
-contains all clotting factors expect platelets and is frozen to preserve factor 5 and 8

45
Q

indications for cryoprecipitate?

A

obtained from FFP (fresh frozen plasma) after slow thawing

  • indications
  • given to increase fibrinogen levels (pt who have developed DIC- by defusing bleeding that results from depletion of platelets and clotting factors)
  • for bleeding or immediately prior to an invasive procedure in pts w/ significant hypo-fibrinogenemia
  • advantages- can replace these factors w/out the hypervolemia risk w/ FFP
46
Q

what is intravenous immunoglobulins (IVIG)

A

IVIG is a protein replacement therapy for pts which have decrease or abolished antibody production capabilities

  • it is extracted from donor plasma
  • IVIG effect last between 2 weeks and 3 months
47
Q

what are the indications for IVIG (intravenous immunoglobulins)

A
  • immune deficiencies
  • inflammatory and autoimmune disease
  • acute infections
  • IVIG is administered to maintain adequate antibodies levels to prevent infections and confers a passive immunity
48
Q

what are the pre transfusion nursing assessments?

A

-neuro-confusion, decrease energy/LOC, hypoxemia
-respiratory- increase RR, effort, cyanosis, SOB
-cardiac- low B/P (indicates low circulating volume) increase HR
-active bleeding (hemorrhage d/t trauma, surgery, hemorrhagic shock and/or inability to clot effectively)
current treatments-chemo alters a person RBC, WBC and platelets
-factor deficiencies
-lab values (CBC, RBC, HGB HCT, WBC, PLATELETS, ALBUMIN

49
Q

what blood do we use in emergency situations?

A

O- blood

50
Q

what should the nurse do when preparing blood transfusions?

A
  • understand why the pt is receiving the blood
  • CONSENT- usually valid up to 1 yr
  • take baseline vital signs and auscultate chest
  • do not pick up blood until pt is ready, consent is signed and IV is in the pt (correct gauge 22) connected to flushed blood tubing
  • larger needles like 18-16 are preferred if raid transfusion are given or if the infusion is sluggish (smaller needles are for platelets, albumin, and clotting factors)
  • bedside have 2 RN’s verify
  • start transfusion slowly (50ml/hr)x15 mins
  • stay w/ pt first 15 mins
  • check on pt and repeat vital signs (i.e q15 min for 1st hour, q30 mins)
  • doc set of VS on transfusion record
  • if not complications after 15 mins INCREASE RATE to infuse as ordered
  • IV Furosemide may be ordered between units (client at risk for fluid overload)
51
Q

why do some pts have reactions to blood products?

A
  • incompatible product-identification errors
  • donor WBC and cytokines
  • donor antibodies
  • bacteria
  • allergens
  • donor viruses or parasites

MED SURGE WINTER CLINICAL (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions