Hematological Assessment, Disorders, & Blood Transfusion

Question 1

What are some cues of anemia from physical assessment?

Answer 1

• Observing for pallor or cyanosis or fissures at the corners of the mouth
• A red, swollen, smooth, shiny, and tender tongue (glossitis)
• Palpate lymph nodes for swelling and tenderness
• Palpate for skin temperature, capillary refill, and edema
• Inspect oral mucosa and skin for erythema, red streaks, petechiae, bruising, or purpura

Question 2

Iron-Deficiency Anemia clinical manifestations?

Answer 2

• Hypoxia
• Fatigue
• Pallor
• Tachycardia
• Tachypnea
• Glossitis
• Koilonychia

Question 3

Vitamin B12 Anemia patient education?

Answer 3

• Dietary sources of vitamin B12
• Need for vitamin B12 supplementation
• Prenatal teaching
• Radiation for advanced cancers can prevent absorption
• Actions of acid-reducing medications

Question 4

Sickle Cell Crisis nursing intervention?

Answer 4

• Administer supplemental oxygen
• Provide aggressive hydration
• Administer analgesics
• Administer antipyretics
• Provide supportive measures

Question 5

Sickle Cell Anemia patient education?

Answer 5

• Avoid cold temperatures
• Avoid high altitude
• Avoid dehydration
• Avoid overexertion
• Maintain ADLs
• Risk of crisis during pregnancy
• Fetal complications
• Genetic counseling

Question 6

Describe blood donation and acceptance.

Answer 6

[O]
- receives from O
- gives to AB, A, B, O

[A]
- receives from A, O
- gives to A, AB

[B]
- receives from B, O
- gives to B, AB

[AB]
- receives from AB, A, B, O
- gives to AB

Question 7

Can blood transfusions be delegated to LVN/LPN and UAP?

Answer 7

• LVN/LPN CANNOT initiate blood transfusions
• Blood transfusion therapy CANNOT be delegated to UAP

Question 8

What are some nursing responsibilities when administering blood (pRBCs)?

Answer 8

• Check the patient’s identity (2 identifiers) and verify with another licensed nurse before administering a blood product
• Check the prescriber’s prescription
• Make sure the patient has an appropriate venous access site, crossmatch procedures have been completed and informed consent has been obtained

Question 9

What are some general precautions for administering blood (pRBCs)?

Answer 9

• No solution other than normal saline should be added to blood components
• No medications should be added or piggybacked
• Blood MUST be administered ASAP (w/in 20-30 mins) after receiving it from the blood bank; if it can’t be, return it
• Inspect the blood for leaks, abnormal color, clots, and bubbles
• Assess VS and lung sounds before the infusion, then after the first 15 mins, and q 30-60 mins (per policy) until 1 hour after tranfusion
• To avoid the risk of septicemia, infusions should run between 2-4 hours for pRBCs; only 1 unit should be given at at time
• Blood tubing should be changed between each unit of blood

Question 10

What do you do in the event of a blood transfusion reaction?

Answer 10

• Change the IV tubing down to the IV site and keep the IV line open w/ normal saline
• Notify the provider & the blood bank
• Stay w/ the patient, observing cues and monitoring VS q5 mins
• Prepare to administer emergency medications as prescribed
• Obtain a urine specimen and any other specimen ordered
• Return blood bag, tubing, attached labs, and transfusion record to the blood bank
• Document the occurrence and the patient’s response