Hematology & Immunology: Assessment, Diagnostic Procedures, & Transfusions Flashcards
What MUST be addressed / asked when addressing the patient’s history for those with hematological & immunological disorders?
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OTC, herbal, & prescription medications!!!
- NSAIDs
- Aspirin or salicylates
- Corticosteroids
- Antibiotics
- Cytotoxic medications
- Hx of transfusions
What diagnostic tests are commonly used for patients with hematology or immunology diagnoses?
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- CBC
- Coagulation Studies: PT, aPTT, INR
What must be assessed before a blood transfusion?
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- Baseline vitals
- HR
- RR
- Saturation
- Temperature
- Edema (Fluid Volume Overload can easily occur with transfusions, especially in patients with cardiac history like CHF)
- Skin assessment
It’s important to ask about what history when doing a pre blood transfusion assessment?
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Cardiac, Vascular, or Pulmonary history
* HTN
* CHF
* Pulmonary Edema
* COPD
What other history should be asked before administering a blood transfusion?
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- Have you ever had a transfusion? (If so, how many)
- Have you ever had a reaction? (what kind, s/s, treatment)
What are the signs & symptoms associated with a transfusion reaction that the patient should receive education about?
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- Rash
- Fever
- Chills
- Low Back Pain
- Nausea
- Pain at the IV site
- ANYTHING UNUSUAL
What is a complication that is associated with receiving multiple units of blood?
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Hypocalcemia
* prolonged QT syndrome
* T-wave inversion
* ST segment prolongation
What is the most severe / dangerous complication associated with blood transfusions?
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Acute Hemolytic Reaction
What is acute hemolytic reaction?
When the donor blood is incompatible with the recipient’s blood
Signs & Symptoms of Acute Hemolytic Reaction
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- Low back pain
- RBCs in urine
- Fever
- Chills
- Chest tightness
- Nausea
- Dyspnea
- Hypertention
- Anxiety
- Vascular collapse
What can Acute Hemolytic Reaction lead to?
Multi-System Organ Failure
Acute Hemolytic Reaction
1.) What is it?
2.) What can it lead to?
What are the common signs & symptoms?
RED INFORMATION FROM SLIDES IS IN BOLD
1.) Donor blood is incompatible with recipient blood
2.) Can cause Multi-System Organ Failure
3.) Signs & Symptoms
* Low back pain
* RBCs in urine
* Fever
* Chills
* Chest tightness
* Nausea
* Dyspnea
* Anxiety
* Hypertension
* Vascular collapse
What is Febrile Non-Hemolytic Reaction?
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RBCs aren’t broken down causing a fever
S/S:
* Fever within 2 hours of starting a transfusion
* Chills
* Muscle stiffness
What is circulatory overload (complication associated with blood transfuions) ?
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Too much blood is transfused too quickly which can lead to hypervolemia
How can Circulatory Overload be prevented?
- Administer diuretics BEFORE transfusion
- Administer blood at a slower rate
- frequent assessment for S/S of fluid volume overload
What are the signs & symptoms of Circulatory Overload?
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- Orthopnea
- JVD
- Tachycardia
- Dyspnea
- Anxiety
- Crackles
- Increased BP
What can occur if circulatory overload is not recognized?
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Pulmonary Edema = Pink, frothy sputum
What steps should the nurse take if they suspect a patient has circulatory overload?
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1.) Place patient in upright position
2.) Notify the doctor
3.) Administer oxygen, morphine, & diuretics as needed
Circulatory Overload
1.) What is it?
2.) What are the common signs and symptoms?
3.) What can occur if it goes unrecognized?
4.) How can it be prevented?
1.) Hypervolemia can occur when too much blood is administerd too quickly
2.) Orthopnea, JVD, tachycardia, dyspnea, anxiety, crackles, increased BP
3.) If unrecognized then pulmonary edema (pink frothy sputum) can occur
4.) Prevention: administer diuretics, administer blood at slower rate, frequently assess for s/s of fluid volume overload
What is Transfusion Related Acute Lung Injury (TROLI)?
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Development of acute lung injury 6 hours after a transfusion
What are signs and symptoms of Transfusion Related Acute Lung Injury (TROLI)?
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ABRUPT ONSET
- Acute SOB
- Hypoxia
- Pulmonary Edema (eventually)
- Hypotension
- Fever
What is Transfusion Related Acute Lung Injury (TROLI) & what are the signs & symptoms of it?
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TROLI = development of acute lung injury 6 hours after a transfusion
S/S:
* Acute SOB
* Hypoxia
* Pulmonary Edema (eventual)
* Fever & hyptension
Transfusion Nursing Management:
What steps should the nurse should take when a patient has a transfusion reaction?
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EXAM QUESTION (WRITTEN) PER HALEY
1.) Stop transfuion
2.) Notify the doctor
3.) Assess the patient (Compare pre & post assessment)
4.) Maintain IV - change tubing & bag
5.) Notify the blood bank
6.) Send all used blood & tubing to the blood bank
7.) Get blood & urine samples from the patient
