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Clients with Health Challenges - N3600 > Blood transfusions > Flashcards

Blood transfusions Flashcards

1
Q

Where does blood come from?

What cannot be completely removed from donated blood?

A

Canadian Blood services

There will be a small trace of WBCs left over

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2
Q

What are indications for a tranfusion?

A

Blood loss (e.g. surgery, MVA)
Replacement of blood components
Improve oxygen carrying capacity

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3
Q

What are the risk of blood transfusions?

A

Risks are low, but may transmit disease/infection and their is a possible of transfusion reactions

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4
Q

When we administer one unit of PRBCs, how much does Hb go up by?

A

10 units within an hour or two

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5
Q

What does pheresis mean?

A

Indicates what was removed from plasma
e.g. leukopheresis - removed white blood cells
(in her context = separation of blood contents)

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6
Q

The majority of blood is _______, 55%; then ____ make up 40-45%
What is the last ~1%?

A

plasma - 55%
RBCs - 45%
1% - platelets and WBCs

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7
Q

Process of separation of blood components is called ______ - practical and economical - causes less reactions

A

Pheresis

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8
Q

Where are blood cells generated?

How long does it take to regenerated blood cells

A

Mostly from the vertebrae (bone marrow)
Takes 2 months to regenerated blood cells

Note: in-utero - blood cell generation is from the liver

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9
Q

Marrow generates these blood cells/

A

RBCs, WBCs, platelets

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10
Q

What are the different donation types?

A

Autologous - donate your own blood
Direct donation - from a family member with the same blood type
Standard blood donation - donated through blood services from the general population

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11
Q

At what frequency can we donate blood?
How long is autologous blood stored for?
Does autologous decrease the chance of reactions?

A

q2 months - as that is how long it takes to replace RBCs

Autologous blood is stored for 10 years

It doesn’t decrease the risk by an appreciable amount

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12
Q

Who’s role is it to obtain informed consent for a blood transfusion.

A

Doctor’s

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13
Q

Used for RBC’s and volume (acute massive blood loss).

A

Whole blood

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14
Q

For symptomatic anemia.

A

PRBCs

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15
Q

For deficiency of clotting factors in bleeding patients.

A

FFP - fresh frozen plasma

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16
Q

For active hemorrhage, DIC (disseminated intravascular coagulation)

A

Platelets

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17
Q

Whenever you go to the lab, we do not trust a ______ to go and get the blood. we get it ourselves.

A

porter

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18
Q

What is the volume of a single unit of whole blood?

A

450mL + 50 mL of anti-coagulant

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19
Q

One unit of PRBCs will increas HB approximately __g/L in a non-bleeding ___kg man.

A

10g/L

70

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20
Q

If a person has ulcerative colitis, what blood product would they receive?

A

PRBCs - only losing a bit of blood every day - low Hb

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21
Q

What are the important physical assessments before a transfusion?
What other information do we want to know/share?

A 
vitals - T°; respiratory assessment
Hx of transfusion rxn
Pregnancy number
Health status - esp. heart status
Teach patient what to report, and be there to provide reassurance
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22
Q

Why is the number of pregnancies important to know before a transfusion?

A

High number of pregnancies can increase reaction risk due to exposure to fetal circulation.

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23
Q

`Why do we want to know about heart health before a transfusion?

A

Because we are giving fluid –> increase blood volume –> makes heart work harder

24
Q

What is the difference between blood typing and cross-matching?

A

Blood typing - test for type (ABO) and Rh factor

Cross-matching = test for other minor antigens

25
Q

What is the most common blood type?
What is the least?

Which is the universal donor?
Acceptor?

A

O+ - most common
AB- - least common

universal donor - O-
Universal acceptor - AB+

26
Q

If your blood sticks together when anti-Rh serum is added, you are Rh__.
If you blood does not clump when anti-Rh serum is added, you are Rh__.

A

+

-

27
Q

Why is the Rh factor particularly important regarding births?

A

If the mother is Rh-, and the child is Rh+ - will get a reaction - this increases in risk for every pregnancy

28
Q

How do we get around the issue of an Rh- mother and an Rh+ baby?

A

Give gamma globulin at 28 weeks and then a few hours (72) before birth
(tested baby’s blood during the first trimester)

29
Q

Will there be a reaction from an Rh- mother to the birth of her first baby?

A

No, only the second birth

30
Q

What is the gamma globulin given?

A

RhoGAM

31
Q

What solution will not cause RBC lysis?

A

normal saline

32
Q

What is the most important baseline vital?

A

Temperature

33
Q

PRBC volume?

Whole blood volume?

A

231mL

450mL

34
Q

We prime the blood tubing with what solution? Why?
The greatest chance of transfusion reactions occurs when?
What is the initial rate?

A

Saline - doesn’t lyse RBCs

Greatest chance for reactions within first 15 minutes

Initial rate is 50mL/hour - or 8 drops/minute

35
Q

When inspecting blood bag, gas bubbles indicate what?

What does abnormal colour or cloudiness indicate?

A

Bacterial growth - bubbles

Hemolysis - off-colour, cloudy

36
Q

We must start the blood transfusion within what time frame?

How long can blood be transfused for?

A

30 minutes

4 hours

37
Q

How is blood tubing different from regular tubing?

A

Has a filter that screens out fibrin clots and other particles

38
Q

What labels to we verify before giving blood?

A

Label attached to unit of blood
Separate chart label
Canadian blood services (CBS) blood product label

39
Q

What is the most serious blood transfusion reactoin?

What is the most common?

A

Acute Hemolytic reaction

Febrile non-hemolytic

40
Q

What are the risks to the nurse from blood tranfsusion?

A

Coming into contact with a bodily fluid and contracting a disease

41
Q

Documentation:

  • Document ____ and _____ transfusion began and ended
  • Amount and type of blood products infused
  • ______ ____ pre, intra and post procedure’
  • any ________ information or unusual signs and symptoms
  • Results of _____, if known
A

date, time
vital signs
reaction
therapy

42
Q

How often do we take vitals during the transfusion?

A

q15 for the first hour

q30 post the first hour

43
Q

What are the 6 types of transfusion reactions?

A 
Febrile, non-hemolytic
acute hemolytic
Allergic reaction
circulatory overload
Transfusion related acute lung injury (TRALI)
Delayed hemolytic reaction
44
Q 
Most common transfusion reaction.
cause?
More common with this blood product.
Prevention?
Treatment?
A

Febrile, non-hemolytic
Caused by WBCs from donor
Most common in platelet transfusions
Prevention - WBC reduction in blood processing
Treatment:
- slow transfusion, give acetaminophen and closely monitor

45
Q 
Most dangerous transfusion reaction.
Cause?
What is the most important response?
What is the treatment?
Delay?
A

Acute hemolytic
Cause is wrong blood type given
Most important to stop transfusion immediately
Treatment - Given low dose dopamine to maintain BP and improve renal blood flow

Delayed hemolytic reactions can occur >14 days post op

46
Q

Results from sensitivity to plasma protein within blood component being tranfused

Should you stop the transfusion?

A

Allergic reaction

Stop transfusion right away
- if mild, may recontinue with anti-histamine (diphenhydramine = benedryl)
if severe - benedryl and epinephrine given and closely monitored; maintain intravascular volume

47
Q

Circulatory overload transfusion reaction:

Who is at risk?

How can it be prevented?

Should you stop the infusion?

Can you continue the infusion?

Medication post-transfusion?

A

CHF/heart problems, kidney failure

Prevent - do a good assessment beforehand

Depending on vitals:
- if laboured breathing - stop, give diuretic, then continue

if they have a lot of fluid - will ask physician for diuretic (Lasix/furosemide)

48
Q

Describe TRALI.

A

WBCs form and occlude the microvasculature of the lungs.

49
Q

Most common transfusion realted cause of death.

A

TRALI

50
Q

TRALI is most common with what transfusions?

TRALI can occur within __ ____ of transfusion

A

plasma

2 hours

51
Q

TRALI treatment?

A

oxygen, intubation, diuretics and fluid support by IV

52
Q

How is TRALI diagnosed?

A

Chest X-ray - will see bilateral pulmonary infiltrates

53
Q

Where physiological homeostasis is challenged by injuries or disease process, causing hypoxia & impaired exchange of nutrients at the cellular level

A

shock

54
Q

Which types of transfusion reactions could lead to shock?

A

Acute hemolytic, anphylactic

55
Q

What are the nurses responsibilites post-transfusion? (4)

A

1 - Document

2 - Dispose of equipment in biohazard receptacles

3 - Ongoing monitoring of client throughout rest of shift to ensure no delayed reactions

4 - Flush with saline (Once blood tubing removed, new continuous tubing flushed with normal saline and attached to previous IV
- if no IV line before, flush IV tubing with saline, or run a bag of saline if already in place)

Clients with Health Challenges - N3600 (22 decks)

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