Hematology & Immunology: Assessment, Diagnostic Procedures, & Transfusions

Question 1

What MUST be addressed / asked when addressing the patient’s history for those with hematological & immunological disorders?

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Answer 1

OTC, herbal, & prescription medications!!!

• NSAIDs
• Aspirin or salicylates
• Corticosteroids
• Antibiotics
• Cytotoxic medications
• Hx of transfusions

Question 2

What diagnostic tests are commonly used for patients with hematology or immunology diagnoses?

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Answer 2

• CBC
• Coagulation Studies: PT, aPTT, INR

Question 3

What must be assessed before a blood transfusion?

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Answer 3

• 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

Question 4

It’s important to ask about what history when doing a pre blood transfusion assessment?

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Answer 4

Cardiac, Vascular, or Pulmonary history
* HTN
* CHF
* Pulmonary Edema
* COPD

Question 5

What other history should be asked before administering a blood transfusion?

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Answer 5

• Have you ever had a transfusion? (If so, how many)
• Have you ever had a reaction? (what kind, s/s, treatment)

Question 6

What are the signs & symptoms associated with a transfusion reaction that the patient should receive education about?

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Answer 6

• Rash
• Fever
• Chills
• Low Back Pain
• Nausea
• Pain at the IV site
• ANYTHING UNUSUAL

Question 7

What is a complication that is associated with receiving multiple units of blood?

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Answer 7

Hypocalcemia
* prolonged QT syndrome
* T-wave inversion
* ST segment prolongation

Question 8

What is the most severe / dangerous complication associated with blood transfusions?

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Answer 8

Acute Hemolytic Reaction

Question 9

What is acute hemolytic reaction?

Answer 9

When the donor blood is incompatible with the recipient’s blood

Question 10

Signs & Symptoms of Acute Hemolytic Reaction

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Answer 10

• Low back pain
• RBCs in urine
• Fever
• Chills
• Chest tightness
• Nausea
• Dyspnea
• Hypertention
• Anxiety
• Vascular collapse

Question 11

What can Acute Hemolytic Reaction lead to?

Answer 11

Multi-System Organ Failure

Question 12

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

Answer 12

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

Question 13

What is Febrile Non-Hemolytic Reaction?

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Answer 13

RBCs aren’t broken down causing a fever

S/S:
* Fever within 2 hours of starting a transfusion
* Chills
* Muscle stiffness

Question 14

What is circulatory overload (complication associated with blood transfuions) ?

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Answer 14

Too much blood is transfused too quickly which can lead to hypervolemia

Question 15

How can Circulatory Overload be prevented?

Answer 15

• Administer diuretics BEFORE transfusion
• Administer blood at a slower rate
• frequent assessment for S/S of fluid volume overload

Question 16

What are the signs & symptoms of Circulatory Overload?

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Answer 16

• Orthopnea
• JVD
• Tachycardia
• Dyspnea
• Anxiety
• Crackles
• Increased BP

Question 17

What can occur if circulatory overload is not recognized?

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Answer 17

Pulmonary Edema = Pink, frothy sputum

Question 18

What steps should the nurse take if they suspect a patient has circulatory overload?

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Answer 18

1.) Place patient in upright position

2.) Notify the doctor

3.) Administer oxygen, morphine, & diuretics as needed

Question 19

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?

Answer 19

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

Question 20

What is Transfusion Related Acute Lung Injury (TROLI)?

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Answer 20

Development of acute lung injury 6 hours after a transfusion

Question 21

What are signs and symptoms of Transfusion Related Acute Lung Injury (TROLI)?

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Answer 21

ABRUPT ONSET

• Acute SOB
• Hypoxia
• Pulmonary Edema (eventually)
• Hypotension
• Fever

Question 22

What is Transfusion Related Acute Lung Injury (TROLI) & what are the signs & symptoms of it?

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Answer 22

TROLI = development of acute lung injury 6 hours after a transfusion

S/S:
* Acute SOB
* Hypoxia
* Pulmonary Edema (eventual)
* Fever & hyptension

Question 23

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

Answer 23

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