Hematology and Immunology Assessment, Diagnostic Procedures, and Transfusions (Online Lecture)

Question 1

history includes

Answer 1

nutritional history
OTC, herbal, and prescription

Question 2

why do we want to know about nutritional history

Answer 2

iron, alcoholism (anemia

Question 3

what are some medications we want to look out for

Answer 3

NSAIDS
ASA/salicylates
corticosteroids
antibiotic
cytotoxic medications
history of tranfusions

Question 4

NSAIDS and ASA/salicylates increases what

Answer 4

bleeding (esp in GI)

Question 5

why is history of transfusions important

Answer 5

more exposure = more likely to experience a reaction

Question 6

what does onset of symptoms tell us

Answer 6

severity

Question 7

what does CBC tell you

Answer 7

total number of blood cells (Hemoglobin, hematocrit, leukocytes, erythrocytes, platelets)

Question 8

what does CBC with Dif tell us

Answer 8

size/shape/morphology

Question 9

coagulation studies include

Answer 9

PT aPTT INR

Question 10

when is bone marrow aspiration and biopsy done

Answer 10

done when more detailed information is needed to assess the quality and quantity of each type of cell produced by the bone marrow

Question 11

what is included in patient preparation for a bone marrow aspiration and biopsy

Answer 11

careful explaaintion
premedication (pain and anxiety)

Question 12

what to expect with a bone marrow aspiration

Answer 12

pressure
pain (sharp but brief)

Question 13

complications of bone marrow aspiration

Answer 13

bleeding and infection

Question 14

what meds should post bone marrow aspiration patient avoid

Answer 14

avoid asa products (increased bleeding)

Question 15

pre transfusion assessment includes

Answer 15

history of previous transfusions
history of previous reactions

Question 16

why do we want to know about previous transfusions

Answer 16

multiple transfusions will increase the risk of reactions

Question 17

if a patient discloses that they have had a previous reaction what should we ask

Answer 17

type
mainifesations
treatment
preventative strategies

Question 18

what are some preventative strategies we can use

Answer 18

premeditate with benydrll or steroids

Question 19

how do we prevent febrile reactions

Answer 19

Tylenol and removing WBC from PRBC so the blood will be washed and reduces the risk of reaction

Question 20

why do we want to know about pregnancy before a transfusion

Answer 20

increase number of pregnancies will increase risk of infection due to fetal circulation exposure

Question 21

why do we want to know cardiac, vascular, or pulmonary disease state before transfusion

Answer 21

highest risk of FVO

Question 22

what should our physical assessment pre transfusion look like

Answer 22

baseline VS, HR, RR, Sat, temp, lung sounds, JVD, and edema
skin assesment

Question 23

what do we look for when doing our pre transfusion skin assessment

Answer 23

observe for petechiae rash

Question 24

why do we want to observe for petechiae rash before transfusion

Answer 24

make note before to determine if there is a change

Question 25

what is a complication of transfusion

Answer 25

fluid volume overload

Question 26

what should our patient education be about transfusions

Answer 26

S/S of reactions

Question 27

what are s/s of transfusion reactions

Answer 27

rash fever chills low back pain nausea pain at IV site shortness of breath anything unusual

Question 28

complications - febrile non hemolytic reaction - caused by

Answer 28

antibodies to donor leukocytes in blood

Question 29

complications - febrile non hemolytic reaction - who might this occur on

Answer 29

a patient who has had transfusions before

Question 30

complications - febrile non hemolytic reaction - s/s, fever how many hours after start

Answer 30

2

Question 31

complications - febrile non hemolytic reaction - s/s

Answer 31

fever within 2 hours chills muscle stiffness

Question 32

complications - febrile non hemolytic reaction - life threatening

Answer 32

non life threenting

Question 33

complications - febrile non hemolytic reaction - prevention

Answer 33

leukocyte poor or reduced products and antipyretic agents

Question 34

complications - acute hemolytic reaction - dangerous?

Answer 34

yes, potentially life threatening

Question 35

complications - acute hemolytic reaction - why happen

Answer 35

donor blood is incompatible

Question 36

complications - acute hemolytic reaction - s/s

Answer 36

fever chills low back pain nausea chest tightness dyspnea anxiety hypotension bronchospasm vascular collapse

Question 37

complications - acute hemolytic reaction - what happens

Answer 37

RBC is destroyed and hemoglobin is released into blood stream

Question 38

complications - acute hemolytic reaction - when hemoglobin is released into blood stream this can cause

Answer 38

kidney failure

Question 39

complications - acute hemolytic reaction - what is key

Answer 39

prompt recognition

Question 40

complications - allergic reaction - s/s

Answer 40

hives itching flushing

Question 41

complications - allergic reaction - usually severe or mild

Answer 41

mild

Question 42

complications - allergic reaction - mild Treatment

Answer 42

antihistamines

Question 43

complications - allergic reaction - if severe what s/s

Answer 43

laryngeal edema and shock

Question 44

complications - allergic reaction - prevention

Answer 44

steroids or antihistamines prior

Question 45

complications - circulatory overload - prevention is key, administer slowly to high risk patients, who is that

Answer 45

heart failure child elderly

Question 46

complications - circulatory overload - what type of assessment is needed

Answer 46

frequent ongoing

Question 47

complications - circulatory overload - s/s

Answer 47

orthopedic JVD tachycardia dyspnea sudden anxiety crackles in lungs increase BP pulmonary edema

Question 48

complications - circulatory overload - pulmonary edema sputum

Answer 48

pink frothy

Question 49

complications - circulatory overload - interventions

Answer 49

upright postion notify MD oxygen diuretics

Question 50

complications - circulatory overload - kidney failure patients are at high risk, when might we do a transfusion

Answer 50

during dialysis

Question 51

complications - delayed hemolytic reaction - time period

Answer 51

14 days

Question 52

- delayed hemolytic reaction - abrupt or gradually

Answer 52

gradually

Question 53

- delayed hemolytic reaction - s/s

Answer 53

fever anemia increased bilirubin jaundice

Question 54

complications - delayed hemolytic reaction - life threatening

Answer 54

no

Question 55

complications - delayed hemolytic reaction - intervention

Answer 55

not required

Question 56

complications - transfusion related acute lung injury - cause

Answer 56

unknown idiosyncratic

Question 57

complications - transfusion related acute lung injury - time period

Answer 57

6 hours after

Question 58

complications - transfusion related acute lung injury - s/s

Answer 58

shortness of breath hypoxemia hypotension fever pulmonary edema

Question 59

complications - transfusion related acute lung injury - onset

Answer 59

abrupt

Question 60

complications - transfusion related acute lung injury - treatment

Answer 60

aggressive supportive therapy - intubation - ICU - fluids - pressors

Question 61

if transfusion reaction is suspected what is your actions (7)

Answer 61

stop transfusion maintain IV line *change tubing and bag assess patient carefully notify MD notify blood bank send blood bank tubing and blood if hemolytic reaction is suspected, obtain blood and urine samples

Question 62

steps if transfusion reaction is suspected

Answer 62

1. stop transfusion 2. maintain IV line, change tubing and bag 3. assess patient carfully 4. notify MD 5. notify blood bank 6. send blood and tubing to blood bank

Question 63

what if a hemolytic reaction is suspected, what other things will we need to collect

Answer 63

blood and urine