Care for patient with hematologic condition

Question 1

key nursing intervention

Answer 1

provide close monitoring of at-risk patients to promote early recognition of DIC, assessing petechiae, bruising, or other signs of bleeding such as blood in the urine or stool

Question 2

Disseminated intravascular coagulation (DIC)

Answer 2

a potentially life threatening conditions in which there is potential for thrombosis and hemorrhage

can be acute (decompensated) or chronic (compensated) in nature and is systemic response to an underlying conditions associated with acute DIC include

sepsis
trauma (massive head injury; burns)
overwhelming inflammatory activation
intravascular hemolysis
obstetric complications
covid-19 (rare)

mostly associated with severe organ damage related to another condition (e.g. liver cirrhosis and malignancy

Question 3

primary treatment of DIC

Answer 3

addressing the underlying cause

related to sepsis, be prepared to administer aggressive broad-spectrum antibiotic treatment.

initiation or increase of oxygen, hemodynamic and/or ventilatory support as needed, RBC transfusion for severe bleeding, coagulation factor replacement therapy, plasma transfusion, and/or platelet transfusion

an indwelling catheter may be order to monitor output

Question 4

what to do after initial management is in place

Answer 4

closely monitor vital signs, skin and mucus membrane for evidence of bleeding and neurologic status for any change in cognition.

diminished pulses, chest pain, and/or a reduced oxygen saturation can be indication of clotting and deprivation of oxygen to tissue

if bleeding is noted (IV site), apply pressure and notify the provider

Monitor the complete blood count, fibrinogen, platelets, PT, aPTT, and D dimer

Report decreasing RBC, hemoglobin, hematocrit, fibrinogen, and/or platelets to the health care provider right away, as well as an increase in the D-dimer, and/or a prolonged PT or aPTT.

Question 5

Treatment for DIC associated with Covid-19

Answer 5

determined based on patient’s presentation

therapeutic dosing of low-molecular weight heparin for patient’s with covid-19 who are hospitalized yet not critically ill

Question 6

blood banking

Answer 6

process of collecting, processing, and storing blood, with the purpose of making sure it is safe to be used

Question 7

where is blood store in the hospital

Answer 7

agency’s blood bank stores the blood and distribute it to the appropriate location based on the orders of the health care provider

Question 8

Specialist in Blood Banking Technology (SBB)

Answer 8

can perform all operations within a blood bank from routine testing to leadership.

they can supervise staff, provide ongoing professional education, and work in research

Question 9

Blood Banking Technology (BB)

Answer 9

perform general operations within the blood bank

Question 10

Donor Phlebotomy Technician (DPT)

Answer 10

collecting blood from donors

Question 11

whole blood transfusion

Answer 11

not approved by the US food and drug administration for civilian use, due to the inability to complete infectious disease testing before product use

Question 12

what happens when whole blood is donated

Answer 12

centrifuged on arrival at blood banking facility and separated into various components

the components are transfused according to patient’s specific needs

Question 13

RBC transfusions

Answer 13

given to replace cells lost from trauma or surgery

patients with problem that destroy RBCs or impair RBC maturation also receive RBC transfusions

Packed RBC supplied in 250 mL bag are a concentrated source of RBCs and are the most common component given to RBC-deficient patients

Question 14

Compatibility of RBC transfusion

Answer 14

donor and recipient blood must be check carefully for compatibility to prevent lethal reactions

compatibility is determined by two antigen systems (cell surface proteins): the Rh factor (Rhesus factor) and the client’s blood group

Question 15

platelet transfusion

Answer 15

given when platelet counts fall below 10,000 mm3 and to patient with thrombocytopenia who are actively bleeding or are scheduled for an invasive procedure.

polled from as many as 10 donors and do not have to be the same blood type as the patient has.

for patient who are having hematopoietic stem cell transplantation (HSCT) or who need multiple platelet transfusions, platelets from a single done may be prescribed, which reduces the chances of allergic reaction

platelet infusion bags contain about 300 mL for pooled platelets and 200 mL for single donor platelets

platelets are fragile and must be infused immediately after being brought to the patient’s room, usually over a 15-30 minute period

a special transfusion set with a smaller filter and shorter tubing is used. Platelet filters help remove WBCs from the platelet for patients who have a history of febrile reactions or who need multiple platelet transfusions

Question 16

what to use to transfuse platelet

Answer 16

do not use standard blood administration set because the longer tubing increase platelet adherence to the lumen.

It reduces the number of platelets the patient receives.

Question 17

when to take vital signs during infusion

Answer 17

taken before infusion, 15 minutes after infusion starts and at its completion.

Question 18

what is given to someone who has had an allergic reaction to a transfusion

Answer 18

diphenhydramine and acetaminophen before the transfusion to reduce fever and severe chills (rigors) that occurs during the platelet transfusions

Question 19

plasma transfusion

Answer 19

may be given fresh to replace blood volume and clotting factors.

more often, plasma is frozen immediately after donation, forming fresh frozen plasma (FFP)

infused FFP immediately after thawing while the clotting factors are still active

ABO compatibility is required for transfusion of plasma products because the plasma contains the donor’s ABO antibodies, which could react with the recipient’s RBC antigens.

infusion bag contains 250 mL and infused rapidly as the patient can tolerate, generally 30-60 minute period through a regular Y set or straight filtered tubing

Question 20

granulocyte (WBC) transfusion

Answer 20

rarely patients with neutropenia who have infection receive WBC replacement infusions

WBC have many antigens that can cause severe reactions when infused into a patient’s whose immune system recognizes donor antigens as non-self

WBCs are suspended in 400 mL of plasma and are infused slowly, usually over 45-60 minute period, depending on the concentration of cells being infused

agency required stricter monitoring of WBC infusions because reactions are more common. A healthy care provider may need to be present in the hospital unit, and vital signs may need to be taken every 15 minutes throughout the transfusion

Amphotericin B infusion should be separated from WBC transfusion by 4-6 hours because this drug an hemolyze the blood cells, and mask a transfusion reaction.

Question 21

massive transfusion protocol

Answer 21

although packed RBC transfusion are the therapy choice when hematocrit and hemoglobin levels are low, this transfusion type does not contain clotting factors or platelets that may be need when continuing heavy blood loss and hemorrhage are present.

In massive transfusion protocol (MTPs) in which large amount of blood products are need to counteract hemorrhage, all blood components are used to restore volume, clotting ability, and oxygen carry capacity

often the protocols calls for balanced delivery of components, with packed RBC, plasma, and platelets infused in an order and proportion that mimic whole blood

Question 22

pretransfusion responsibility

Answer 22

preparation of the patient for transfusion is critical and blood product administration procedure must be followed carefully

review agency policies and procedures as well

be certain the prescribing HCP has discussed the benefit and risks of transfusion therapy with the patient

prescription is need to administer blood components

specifies the type of components to be given, the volume ordered, and any special conditions that must be observed

In hospitals consent for is obtained from the patient is performed

a blood specimen is obtained for type and crossmatch; this involves testing of the donor’s blood and the recipient’s blood for compatibility

Question 23

what type of tubing is used for blood component transfusion

Answer 23

both Y tubing and straight tubing is used

a blood filter to remove sediment from the stored blood products is included with blood administration sets and must be used to transfuse most but not all, blood products

Question 24

what solution is used with blood product transfusion

Answer 24

normal saline is used in the administration of blood product

ringer lactate and dextrose in water are not used for infusion because they may cause clotting or hemolysis of blood cells

do not infuse other drugs with blood; they may clot the blood during transfusion and cause complication

Question 25

what is checked during type and compatibility

Answer 25

blood component with appropriate patient identification, health record number, and date of birth examine blood bag label, the attached tag and requisition slip to ensure the ABO and Rh types are compatible with those of the patient expiration date and inspect product for discoloration, gas bubbles, or cloudiness, which can be indication of bacterial growth or hemolysis

Question 26

what size needle is used for blood tranfusion

Answer 26

18-20 gauge needle or catheter to prevent catheter occlusion or damage to RBC

Question 27

how long does the nurse have to stay with the patient after infusion

Answer 27

first 15-30 minutes of the infusion this is when hemolytic transfusion reactions usually occur after 15-30 min, monitor vital signs at least as often as agency policy and the patient's condition indicate to identify early indication of adverse transfusion reactions.

Question 28

after infusion

Answer 28

discontinue infusion and dispose of the bag and tubing according to agency and blood bank policy to prevent the spread of blood borne pathogens obtain vital signs and compare with patient's base line document all aspect of transfusion type of product, product number, volume infused, duration of infusion, vital signs and assessment collected throughout the infusion, any adverse reactions and associated intervention and the patient's tolerance and response

Question 29

what is recommended by TJC before administering blood

Answer 29

correctly identify the patient check health providers order for blood, the blood itself, with another registered nurse. compare with patient's id band by using two methods patient's room is not an acceptable form of ID

Question 30

responsibility during transfusion

Answer 30

any severe reactions usually occur within the first 50 mL of blood patient should report any sensation such as chills, SOB, hives, itching, or back pain. assess vital signs every 15 minutes after starting infusion then hourly if not reaction rate can be increased 1 unit in 2-4 hours depending on the patient's cardiac status and agency policy for rate of infusion blood components without large amount of RBC can be infused more quickly infusion rate is slower for older patients electrolyte imbalance may occur during transfusion especially when packed RBC is given; during transfusion some cells are damaged, releasing potassium, which can result in hyperkalemia. This occur when the blood is frozen or several weeks old

Question 31

transfusion reaction signs

Answer 31

rapid bounding pulses hypertension swollen superficial veins transfusion reaction hypotension rapid thready pulse increased pallor/ash gray appearance cyanosis

Question 32

how should blood be infused

Answer 32

infused slowly, taking 2-4 hours for each unit of whole blood, packed RBC, or plasma. Should not exceed 4 hours due to bacterial growth avoid concurrent fluid admin into other IV site; if possible allow 2 full hours after infusing 1 unit of blood before infusing the next unit change blood tubing after every 2 unit transfused to reduce the risk for possible bacterial growth

Question 33

when does acute transfusion reaction occur

Answer 33

within 24 hours of transfusion delayed transfusion reaction can take place after 24 hours and can be observed up to 30 days.

Question 34

what are signs and symptoms of acute transfusion reaction

Answer 34

febrile hemolytic allergic or bacterial reaction circulatory overload transfusion associated graft-vs host disease report changes in physical or emotional status such as new onset of joint, back, chest or abd pain; chills; nausea, feeling unwell; or feeling uneasy

Question 35

what happens to hemolytic or bacterial reaction blood bags

Answer 35

they are returned to the blood or laboratory initiate rapid response team if no other IV sites, keep access and flush with normal saline but do not flush tubing oxygen is applied and diphenhydramine is given IV push if shock is present, fluid resuscitation and hemodynamic monitoring are needed blood pressure support with vasopressors may be needed. other drug therapy is supportive in nature such as antipyretics for fever, antibiotic for bacterial contamination, and meperidine for rigors.

Question 36

Transfusion related acute lung injury (TRALI) and Transfusion-associated circulatory overload (TACO)

Answer 36

increased when the donor and recipient are from different ethnicities, even when ABO and Rh compatibility are matched. Occurs 24 hours to 21 days after transfusion. arise from differences in other RBC antigens that are not usually part of screening antigens vary considerable among ethnicities a more diverse donor population could help to reduce teh incidence of severe transfusion reactions.

Question 37

autologous blood transfusion

Answer 37

collection and infusion of the patient's own blood. eliminate compatibility problems and reduces the risk of transmitting bloodborne diseases.

Question 38

the four types of autologous blood transfusion

Answer 38

preoperative autologous blood donation acute normovolemia hemodilution intraoperative autologous transfusion postoperative blood salvage

Question 39

acute hemolytic transfusion reaction

Answer 39

incompatibility of ABO blood type or Rh factor usuall occurs within the first 15 minutes of transfusion

Question 40

signs and symptoms of acute hemolytic transfusion reaction

Answer 40

chills dyspnea fever flushing infusion site pain low back pain shock tachcardia tachypnea

Question 41

what to do when acute hemolytic transfusion reaction occur

Answer 41

immediately stop infusion administer diuretic infuse IV normal saline to maintain urine output of at least 1 mg/kg/hr insert urinary cath if needed prepare to treat shock and DIC if needed

Question 42

Acute pain transfusion reaction

Answer 42

Some degree of hemolysis occurs during or shortly after transfusion but is not widespread

Question 43

signs and symptoms of Acute pain transfusion reaction

Answer 43

back pain chest pain hyptension joint pain

Question 44

nursing intervention for Acute pain transfusion reaction symptoms

Answer 44

administer med to manage pain

Question 45

Allergic transfusion reaction (mucocutaneous)

Answer 45

plasma protein sensitivity

Question 46

signs and symptoms of Allergic transfusion reaction (mucocutaneous)

Answer 46

flushing periorbital edema pruritus rash urticaria

Question 47

nursing intervention for Allergic transfusion reaction (mucocutaneous)

Answer 47

administer antihistamine prepare to administer bronchodilators, steroid, and epinepherine if symptoms progress to bronchospasm, wheezing, and anaphylaxis (very rare)

Question 48

Allergic transfusion reaction (anaphylactic transfusion reaction)

Answer 48

plasma protein sensitivity

Question 49

signs and symptoms of Allergic transfusion reaction (anaphylactic transfusion reaction)

Answer 49

anxiety angioedema bronchospasm cyanosis dyspnea stridor shock urticaria

Question 50

nursing intervention for Allergic transfusion reaction (anaphylactic transfusion reaction)

Answer 50

administer epi as the priority be prepared to administer antihistamines, bronchodilators, steroids, and epi if needed prepare to perform CPR and treat shock if needed

Question 51

Febrile reaction (nonhemolytic)

Answer 51

occurs most often in patient's with anit-WBC antibodies

Question 52

signs and symptoms of Febrile reaction (nonhemolytic)

Answer 52

chills fever headache rigors tachycardia tachypnea

Question 53

nursing intervention for Febrile reaction (nonhemolytic)

Answer 53

administer acetaminophen administer dihphenhydromine if indicaated administer meperidine for rigors, if indicated recognize that transfusion may begin (based on healthcare provider's order) at a reduced rate of infusion; acetaminophen and diphenhydromine may be ordered prior to next transfusion

Question 54

Transfusion-associated circulatory overload (TACO)

Answer 54

can occur when a blood product is infused too quickly, especially in older adult pulmonary reaction that may be difficult at first to differentiate from transfusion-related acute lung injury (TRALI)

Question 55

signs and symptoms of Transfusion-associated circulatory overload (TACO)

Answer 55

bounding pulse cardiogenic fluid overload cough cyanosis decrease oxygen saturation (<90%) dyspnea hypertension neck vein distention pulmonary edema respiratory distress tachycardia

Question 56

nursing intervention for Transfusion-associated circulatory overload (TACO)

Answer 56

apply oxygen administer diuretics collab with HCP regarding number of transfusion, timing of admin and admin diuretic before or inbetween transfusion elevate head of bed to facilitate gas exchange monitor intake and output recognize that symptoms can occur 6-12 hours after transfusion

Question 57

Transfusion-associated graft-versus-host disease

Answer 57

occurs most often in immunocompromised patient when donor T lymphocytes attack host tissue usually occurs 1-2 week after transfusion Donor T lymphocytes attack host tissue

Question 58

signs and symptoms of Transfusion-associated graft-versus-host disease

Answer 58

anorexia hepatitis chronic infection thrombocytopenia vomiting weight loss

Question 59

nursing intervention for Transfusion-associated graft-versus-host disease

Answer 59

administer irradiating blood products to destroy most T cells and their cytokine products

Question 60

Transfusion-related acute lung injury

Answer 60

occurs most often when donor blood contains antibodies agianst the recipient's neutrophin, antigens, HLA or both

Question 61

signs and symptoms Transfusion-related acute lung injury

Answer 61

acute hypoxemic respiratory distress chest x-ray with diffuse patchy infiltrates cyanosis hypotension decreased oxygen saturation (<90%) pulmonary edema

Question 62

nursing intervention for Transfusion-related acute lung injury

Answer 62

*Apply oxygen * Elevate head of bed to facilitate gas exchange * Initiate supportive care to facilitate gas exchange; most cases resolve within 96 hours * Prepare for intubation and mechanical ventilation * Recognize that symptoms can occur 2–4 hours after transfusion