Hematology and Immunology Assessment, Diagnostic Procedures, and Transfusions (Online Lecture) Flashcards
history includes
nutritional history
OTC, herbal, and prescription
why do we want to know about nutritional history
iron, alcoholism (anemia
what are some medications we want to look out for
NSAIDS
ASA/salicylates
corticosteroids
antibiotic
cytotoxic medications
history of tranfusions
NSAIDS and ASA/salicylates increases what
bleeding (esp in GI)
why is history of transfusions important
more exposure = more likely to experience a reaction
what does onset of symptoms tell us
severity
what does CBC tell you
total number of blood cells (Hemoglobin, hematocrit, leukocytes, erythrocytes, platelets)
what does CBC with Dif tell us
size/shape/morphology
coagulation studies include
PT aPTT INR
when is bone marrow aspiration and biopsy done
done when more detailed information is needed to assess the quality and quantity of each type of cell produced by the bone marrow
what is included in patient preparation for a bone marrow aspiration and biopsy
careful explaaintion
premedication (pain and anxiety)
what to expect with a bone marrow aspiration
pressure
pain (sharp but brief)
complications of bone marrow aspiration
bleeding and infection
what meds should post bone marrow aspiration patient avoid
avoid asa products (increased bleeding)
pre transfusion assessment includes
history of previous transfusions
history of previous reactions
why do we want to know about previous transfusions
multiple transfusions will increase the risk of reactions
if a patient discloses that they have had a previous reaction what should we ask
type
mainifesations
treatment
preventative strategies
what are some preventative strategies we can use
premeditate with benydrll or steroids
how do we prevent febrile reactions
Tylenol and removing WBC from PRBC so the blood will be washed and reduces the risk of reaction
why do we want to know about pregnancy before a transfusion
increase number of pregnancies will increase risk of infection due to fetal circulation exposure
why do we want to know cardiac, vascular, or pulmonary disease state before transfusion
highest risk of FVO
what should our physical assessment pre transfusion look like
baseline VS, HR, RR, Sat, temp, lung sounds, JVD, and edema
skin assesment
what do we look for when doing our pre transfusion skin assessment
observe for petechiae rash
why do we want to observe for petechiae rash before transfusion
make note before to determine if there is a change
what is a complication of transfusion
fluid volume overload
what should our patient education be about transfusions
S/S of reactions
what are s/s of transfusion reactions
rash
fever
chills
low back pain
nausea
pain at IV site
shortness of breath
anything unusual
complications
- febrile non hemolytic reaction
- caused by
antibodies to donor leukocytes in blood
complications
- febrile non hemolytic reaction
- who might this occur on
a patient who has had transfusions before
complications
- febrile non hemolytic reaction
- s/s, fever how many hours after start
2
complications
- febrile non hemolytic reaction
- s/s
fever within 2 hours
chills
muscle stiffness
complications
- febrile non hemolytic reaction
- life threatening
non life threenting
complications
- febrile non hemolytic reaction
- prevention
leukocyte poor or reduced products and antipyretic agents
complications
- acute hemolytic reaction
- dangerous?
yes, potentially life threatening
complications
- acute hemolytic reaction
- why happen
donor blood is incompatible
complications
- acute hemolytic reaction
- s/s
fever
chills
low back pain
nausea
chest tightness
dyspnea
anxiety
hypotension
bronchospasm
vascular collapse
complications
- acute hemolytic reaction
- what happens
RBC is destroyed and hemoglobin is released into blood stream
complications
- acute hemolytic reaction
- when hemoglobin is released into blood stream this can cause
kidney failure
complications
- acute hemolytic reaction
- what is key
prompt recognition
complications
- allergic reaction
- s/s
hives
itching
flushing
complications
- allergic reaction
- usually severe or mild
mild
complications
- allergic reaction
- mild Treatment
antihistamines
complications
- allergic reaction
- if severe what s/s
laryngeal edema and shock
complications
- allergic reaction
- prevention
steroids or antihistamines prior
complications
- circulatory overload
- prevention is key, administer slowly to high risk patients, who is that
heart failure
child
elderly
complications
- circulatory overload
- what type of assessment is needed
frequent ongoing
complications
- circulatory overload
- s/s
orthopedic
JVD
tachycardia
dyspnea
sudden anxiety
crackles in lungs
increase BP
pulmonary edema
complications
- circulatory overload
- pulmonary edema sputum
pink frothy
complications
- circulatory overload
- interventions
upright postion
notify MD
oxygen
diuretics
complications
- circulatory overload
- kidney failure patients are at high risk, when might we do a transfusion
during dialysis
complications
- delayed hemolytic reaction
- time period
14 days
- delayed hemolytic reaction
- abrupt or gradually
gradually
- delayed hemolytic reaction
- s/s
fever
anemia
increased bilirubin
jaundice
complications
- delayed hemolytic reaction
- life threatening
no
complications
- delayed hemolytic reaction
- intervention
not required
complications
- transfusion related acute lung injury
- cause
unknown
idiosyncratic
complications
- transfusion related acute lung injury
- time period
6 hours after
complications
- transfusion related acute lung injury
- s/s
shortness of breath
hypoxemia
hypotension
fever
pulmonary edema
complications
- transfusion related acute lung injury
- onset
abrupt
complications
- transfusion related acute lung injury
- treatment
aggressive supportive therapy
- intubation
- ICU
- fluids
- pressors
if transfusion reaction is suspected what is your actions (7)
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
steps if transfusion reaction is suspected
- stop transfusion
- maintain IV line, change tubing and bag
- assess patient carfully
- notify MD
- notify blood bank
- send blood and tubing to blood bank
what if a hemolytic reaction is suspected, what other things will we need to collect
blood and urine
