Hematologic System

Question 1

67 - Blood transfusion reactions
+ Nursing Care of transfusion reactions (general)
+ Symptoms of reactions: Acute hemolytic, Febrile, Mild allergic, Anaphylactic, Circulatory overload

Answer 1

NURSING CARE: STOP TRANSFUSION, INFUSE 0.9% NACL THROUGH SEPARATE LINE. SEND BLOOD BAG TO LAB.

ACUTE HEMOLYTIC: Low back pain, fever/chills tachycardia, hypotension, tachypnea.

FEBRILE: Fever/chills, hypotension, tachycardia.
+ Administer antipyretics

MILD ALLERGIC: Itching flushing, hives (urticaria).
+ Administer diphenhydramine.

ANAPHYLACTIC: Wheezing, dyspnea, cyanosis, hypotension.

CIRCULATORY OVERLOAD: Dyspnea, tachycardia, tachypnea, crackles, hypertension, juglar vein distension.
+ Slow infusion rate, administer diuretics.

Question 2

88 - Anemia: Causes

Answer 2

BLOOD LOSS: Trauma, GI bleed, menorrhagia.

SICKLE CELL ANEMIA: Defective Hgb, malformed RBCx.

IRON DEFICIENT ANEMIA: Most common type of anemia in children and pregnant women, Provide iron supplements: ferrous sulfate, iron dextran.

PERNICIOUS ANEMIA: Lack of intrinsic factor in gastric mucosa, which prevents absorption of B12. Administer cyanocobalamin (B12) parenterally or intranasally.

FOLIC ACID DEFICIENCY: Provide folic acid orally or parenterally. Note: large doses of folic acid can mask B12 deficiency.

Bone marrow suppression

Question 3

85 - Expected ranges of: RBC, WBC, platelets, Hgb, Hct, PT, aPTT, INR

Answer 3

RBC: 4-6 million/uL (approximately)
WBC: 5,000 - 10,000/mm3
PLATELETS: 150,000 - 400,000 mm3
Hgb: 12-18 g/dL (approximately)
Hct: 37-52% (approximately 3 times the Hgb)
PT: 11 - 12.5 seconds
aPTT: 30 - 40 seconds (therapeutic range is 1.5-2.5 times the amount while on heparin).
INR: 0.8 - 1.1 (therapeutic range is 2-3 while on warfarin).

Question 4

86 - Blood transfusions
+ What type of blood can a patient receive with type A, B, AB, O
+ Rh compatibility?
+ Nursing care for transfusions

Answer 4

TYPE A: Can receive type A and O

TYPE B: Can receive type B and O

TYPE AB: Can receive type A, B, AB, and O

TYPE O: Can receive Type O

Rh compatibility: If a Rh-negative person receives Rh-positive blood, it will cause hemolysis.

BLOOD TRANSFUSIONS:
+ Use 20 gauge or bigger IV catheter.
+ Confirm patient ID, blood compatibility, expiration time with another RN.
+ PRIME ADMINISTRATION SET WITH 0.9% NACL ONLY.