Hematology in depth Flashcards
(195 cards)
1
Q
Go look at slide 1/45
A
types of anemia (morphology, examples, lab values expected)
2
Q
Classification of anemia: hypoproliferative
A
iron
vit b12 deficiency
cancer/inflammation
results from the inability of bone marrow to produce adequate numbers of red blood cells
3
Q
Classification of anemia: bleeding
A
GI, trauma, genitourinary, epistaxis
4
Q
Classification of anemia: hemolytic
A
Altered erythropoiesis Hypersplenism Drug-induced anemia Autoimmune anemia Mech health valve
Red blood cells are destroyed faster than they can be replaced
5
Q
Describe iron deficiency anemia:
A
Body’s iron stores are depleted an no iron available for hemoglobin synthesis.
6
Q
Describe microlytic anemia
A
transferrin saturation is below 20% and ferritin is below 30
happens when your red blood cells are smaller than usual because they don’t have enough hemoglobi
7
Q
What are general manifestations of anemia?
A
tachycardia SOB dyspnea chest pain muscle pain or cramping pallor
8
Q
What labs are evaluated when determining is someone has anemia?
A
Hbg/Hct Retiulocyte count RBC Iron studies – TIBC, % saturation, ferritin Vitamin B12 Folate Haptogloin – if hemolysis is suspected) Erythropoietin
9
Q
What are factors that can influence the development of anemia-associated symptoms?
A
- The rapididy with which anemia has developed
- The duration of the anemia
- The metabolic requirements of the patient
- Other concurrent disorders or disabilities (i.e., cardiopulmonary dx)
10
Q
Anemia assessment: general
A
Weakness, fatigue
Dizziness
Pica (craving unusual items including - ice, starch, or dirt)
11
Q
Anemia assessment: neurological
A
Numbness and tingling (paresthesias), irritability
Weakness
Headache
Poor coordination, confusion
Gait disturbances
Reflex abnormalities
Loss of position (proprioception) and vibration sense
Spasticity
Roaring, rushing, ringing, or pounding sensation in the ears
12
Q
Anemia assessment: respiratory
A
Dyspnea
Orthopnea
Tachypnea
13
Q
Anemia assessment: GI
A
Anorexia, nausea, vomiting Dysphagia Abdominal pain Flatulence Diarrhea Hepatomegaly Splenomegaly
14
Q
Anemia assessment: musculoskeletal
A
Muscle pain (claudication)
15
Q
Anemia assessment: integumentary
A
Pallor of the skin and mucous membranes
Jaundice (hemolytic anemia)
Brittle, ridged, concave nails
Impaired wound healing
Loss of elasticity
Early thinning and graying of hair
Dry skin
Painful mouth sores
Beefy red, sore tongue (megaloblastic anemia)
Smooth and red tongue (iron deficiency anemia)
Ulcerated corners of the mouth (angular cheilitis)
16
Q
Anemia assessment: cardiovascular
A
Palpitations Chest pain Tachycardia Hypotension Peripheral edema Murmurs
17
Q
Medical and nursing management for anemia
A
- Correct or control cause
- manage fatigue
- maintain adequate nutrition
- maintain adequate perfusion
18
Q
What can decrease the severity of fatigue in patients with anemia?
A
short periods of daily exercise can decrease the severity of fatigue
19
Q
What should clients with anemia keep in mind about their nutrition?
A
Iron, vitamin b12, folic acid are essential
- avoid alc
- culturally centered food and food preferences
- dietary supplements may be needed
20
Q
Iron deficiency anemia: causes
A
Blood low
Low iron in diet
Heavy menstruation
21
Q
Iron deficiency anemia: s/s
A
SOB Fatigue Increased workload of the heart Tachycardia Dizziness
22
Q
Iron deficiency anemia: dx
A
MCV < 90fL
Stool for occult blood
Colonoscopy
mean corpuscular volume. An MCV blood test measures the average size of your red blood cells
23
Q
Iron deficiency anemia: tx
A
Iron
Transfussion
24
Q
What are things to keep in mind about iron transfusions?
A
Hemoglobin rise after 1 week – full 1-2g/dL 4-8 weeks
25
What are sfx of iron?
nausea, epigastric discomfort can take with meals but then decrease absorption
26
Iron supplement education
Take iron on empty stomach (1 hour before, or 2 hours after a meal) - absorption is reduced with food, especially diary products and antacids
To prevent gastrointestinal distress, the following schedule may work better if more than one tablet a day is prescribed: Start with only one tablet per day for a few days, then increase to two tablets per day, and then three tablets per day. This method permits the body to adjust gradually to the iron.
Increase the intake of vitamin C, to enhance iron absorption.
Eat foods high in fiber to minimize problems with constipation.
Remember that stools will become dark in color.
To prevent staining the teeth with a liquid preparation, use a straw or place a spoon at the back of the mouth to take the supplement. Rinse the mouth thoroughly afterward.
27
What foods are high in vitamin C?
citrus fruits and juices, strawberries, tomatoes, broccoli
28
Anemia and kidney disease
Creatinine level > 3
Decreased production of erythropoietin
Can cause HTN d/t rapid production
29
What are s/s of having anemia with kidney disease?
Fatigue, decreased activity tolerance
30
Anemia with chronic disease
Rheumatoid arthritis
| Cancers
31
What deficiencies are present with megoblastic anemia?
Folic acid and vitamin b12
a type of anemia characterized by very large red blood cells.
32
Megoblastic anemia: cause
Autoimmune condition
33
Megaloblastic anemia: s/s
```
Fatigue
Mood changes
Memory difficulty
Weakness
Vitiligo (patchy loss of skin pigmentation)
Premature graying of hair
Tongue is smooth, red, and sore
```
34
Megaloblastic anemia: dx
MCV < 90 fL
35
Megaloblastic anemia: tx
IM injections of b12 or folic acid orally
36
Where is folate found?
green leafy vegetables, legumes, egg yolks, fortified foods like cereal, and liver
37
Why are folic acid and vb12 needed?
To have DNA maturation and RBC
38
Someone with newly diagnosed megaloblastic anemia will need what?
endoscopy
39
B12 deficiency comes from what?
absorption - examples include Crohns, gastric bypass or gastrectomy
40
What is happening in hemolytic anemias?
The erythrocytes have a shortened lifespan; thus, their number in circulation is reduced.
41
What happens when there are too few erythrocytes with hemolytic anemia?
result in decreased available oxygen, causing hypoxia, which, in turn, stimulates an increase in erythropoietin release from the kidney. The erythropoietin stimulates the bone marrow to compensate by producing new erythrocytes and releasing some of them into the circulation somewhat prematurely as reticulocytes
42
What are the 2 types of hemolytic anemias that we talked about in class?
Thalassemia
| Autoimmune hemolytic anemia (AIHA)
43
Thalassemia: cause
hereditary
44
Thalassemia: highest population
Mediterranean, African, and Southeast Asian ancestry
45
Thalassemia: alpha
occurs without s/s
| milder than beta
46
Thalassemia: beta
fatal within the 1st few years of life
47
Thalassemia: tx
Tranfusion of PRBC
| -- can develop anti-RBC antibodies, transfusion-associated infections and iron overload
48
What are treatments of iron overload?
Deferoxamine, Deferasirox, and deferiprone
49
Deferoxamine, Deferasirox, and deferiprone: side effects
Bone marrow suppression, liver function abnormalities, annual eye and hearing exams, n/v, diarrhea, abdominal pain
50
Deferoxamine, Deferasirox, and deferiprone: issues
adherence
51
Autoimmune Hemolytic Anemia (AIHA): patho
own immune system hemolyzes RBCs
52
Autoimmune Hemolytic Anemia (AIHA): causes
unknown 50%, chronic lymphocytic leukemia, lupus, or infections
53
Autoimmune Hemolytic Anemia (AIHA): tx for mild
Monitoring
corticosteroids
try other immunosuppressive agents
54
Autoimmune Hemolytic Anemia (AIHA): tx for severe
blood transfussions
55
Autoimmune Hemolytic Anemia (AIHA): nursing considerations
If splenectomy - get vaccinations
| Corticosteroids - monitor BP and BG
56
Jaundice is a s/s of hemolytic anemia; what are nursing considerations and/or teaching points about this?
caused by a build-up of bilirubin in the body. This causes severe itching, but the client should avoid scratching because this can worsen the condition and cause breaks in the skin. The client should not use soap when bathing and bathe in tepid water to avoid pruritis
57
What is the primary cause of death of AIHA?
iron overload
58
Thrombocytopenia: what is it?
Low platelet count.
59
Thrombocytopenia: causes
Malignancy, infections, medications, autoimmunity (ITP), and DIC
60
Thrombocytopenia: clinical manifestations
Less than 50,000/mm3 - bleed occurs following surgery or trauma
Less than 20,000/mm3, – petechiae, spontaneous nasal and gingival bleeding, menstrual bleeding, bleeding after dental procedures
Less than 10,000/mm3 – fatal CNS or GI hemorrhage can occur
61
Thrombocytopenia: medical management
Medications associated with the cause (abx., cardio meds, etc)
Platelet transfusion
62
Chemo patients must maintain their platelets above what
10,000
63
What is normal platelet count?
150,000-450,000 (150-450)
64
Thrombocytopenia: nursing management / education
caution with activity d/t increased bleeding risk
65
Heparin induced Thrombocytopenia (HIT)
Formation of antibodies against the heparin-platelet complex.
66
HIT risk factors:
```
Type of heparin used
Duration of heparin therapy (>4 days)
Surgery (esp. if required cardiopulmonary bypass)
Women
Dose (SQ/IV) is not risk factor
```
67
HIT characteristics
Decline in platelet count (5-10 days after heparin therapy)
Drop 50% below baseline over 1-3 days
Risk for thrombosis (DVT, CVA, ACS, ischemic damage to extremity)
68
HIT: tx
Stop heparin
use alternative means of anticoagulations
If thrombosis occurs, 3-6 months of anticoagulation therapy will be needed
69
What is the alternative anticoagulation therapy is someone gets HIT?
argatroban - thrombin inhibitor
| NOT COUMADIN -- promotes thrombosis in the microvasculature by depleting protein C
70
HIT nursing interventions
Discuss the need to not have Heparin for 3-4 months
71
Immune Thrombocytopenia Purpura (ITP): what is it?
Platelet count is decreased by destruction and impaired production
Low amounts of thrombopoietin
72
Immune Thrombocytopenia Purpura (ITP): s/s
incidental finding
bruising vs bleeding from mucous membrances
less than 10,000 platelets
73
Immune thrombocytopenia purpura (ITP): risk factors
uncontrolled HTN and peptic ulcer disease
74
Immune Thrombocytopenia Purpura (ITP): medical management
need to keep safe platelet levels (30-50,000)
lifestyle (caution with activities)
transfusons are not common
less than 5,000 --> high dose IVIG and corticosteroids
75
Immune Thrombocytopenia Purpura (ITP): nursing management
lifestyle
report HA or visual disturbances - could show intracranial bleeding
avoid IM and rectal meds - stimulate bleeding
avoid constipation
electric razors
soft bristled toothbrush
no intercourse until greater than 50,000
76
Immune Thrombocytopenia Purpura (ITP): Incidence in children
acute - children 1-6 weeks after a viral illness
77
Platelet defects: functional platelet disorder cause
induced by aspirin
78
Functional Platelet Disorder: clinical manifesations
Ecchymoses
| Risk for bleeding with trauma or surgery
79
Functional Platelet Disorder: medical management
stop medication prior to surgery - typically days prior
80
Functional Platelet Disorder: nursing management
caution with OTC meds
81
Von-Willebrand disease
Inherited bleeding disorder.
| Necessary for factor VIII and platelet adhesion at site of vascular injury
82
Von-Willebrand disease: diagnostic
Question after procedures (dental), nosebleeds and large bruises, heavy menses
Lab – normal platelet but prolonged bleeding time (PTT)
83
Von Willebrand Disease (vWD): management
Minimize postprocedural bleeding (vasopressin)
| Avoid Aspirin and other NSAIDs
84
What are sfx of vasopressin?
HA, Facial flushing, tachycardia, hyponatremia, rarely –seizures
85
Why might women be encouraged to get on birth control with vWB disease?
increases the # of vWB factors they have in their blood
86
Acquired Coagulation Disorders: Liver disease (cirrhosis, tumor or hepatitis)
Coagulation factors are synthesized in liver
Significant bleeding risk
Transfusion of FFP
Esophageal varices or peptic ulcers
87
Acquired Coagulation Disorders: Vitamin K deficiency
occurs in malnourished patients
88
Acquired Coagulation Disorders: complications of antocoagulant therapy
Antidote to heparin = protamin sulfate
| antidote to warfarin = VK
89
Acquired Coagulation Disorders: Disseminated Intravascular Coagulation (DIC) -- what is it triggered by
sepsis, trauma, cancer, shock, allergic reaction
90
DIC: s/s
bleeding from mm., venipuncture sites and GI/urinary tract
91
DIC: tx
```
Treat underlying cause
Improve o2
replace fluids
correct electrolyes imbalances
vasopressor meds
```
92
Who is the most common patient at risk for developing DIC?
Sepsis and acute promyelocytic leukemia
93
DIC can lead to what organs to fail
kidney, lung, brain, skin
94
What are examples of Malignant Hematologic Condictions
Polycythemia Vera
Essential Thrombocytopenia
Chronic Myeloid Leukemia (CML)
*they are myeloproliferative neoplasms*
95
Polycythemia Vera: what is it?
Myeloid stem cells are too high in number
| -- elevated erythrocyte, leukocyte and platelet counts
96
Polycythemia Vera: s/s
Hallmark signs: splenomegaly, severe and painful itching triggered by water
Ruddy complexion
LUQ pain
blood volume complaints (HA, dizzy, fatigue, blurred vision)
increase blood viscosity
increase uric acid (potential kidney stones)
pruritus d/t increased basophils
97
What is essential thrombocytopenia
Result of elevated platelet on CBC
Can cause vaso-occlusion in the microvasculature
Asymptomatic
98
What is Chronic Myeloid Leukemia
Over production of myeloid WBC; platelets can also be elevated
99
Chronic myeloid leukemia: s/s
Bone Pain, enlargement of liver and spleen
Fatigue, night sweats, abd pain, early satiety and weight loss
High WBC – confusion, vision changes, SOB, chest pain
100
Chronic myeloid leukemia: nursing considerations
Durg interactions, fluid retention, GI sfx
101
How to decrease pruritus
bathing in cool water with mild soap
102
What is the therapeutic management of polycythemia vera?
therapeutic phlebotomy
103
What is secondary polycythemia?
excessive production of erythropoietin
104
Secondary polycythemia: cause
smoking, OSA, COPD, cyanotic heart disease, living at high altitude
105
Secondary Thrombocytosis: causes
infection, chronic inflammatory disease, acute hemorrhage, and splenectomy
--- Increased production of platelets, but not over 1 million/mm3
106
Secondary Thrombocytosis: tx
should return to normal
107
What are examples of bone marrow failure syndromes
```
Aplastic anemia (AA)
Myelodysplastic syndromes (MDSS)
```
108
What is aplastic anemia
Damage to bone marrow stem cells
109
Aplastic anemia: cause
acquired or congential - idiopathic
| -- insideous manifestions
110
Aplastic anemia: s/s
show similar as anemia
111
Aplastic anemia: tx
if severe -- Treat quickly (transfusion of blood and platelets) or anx with fever
or
stem cell transplant
112
Nursing considerations with Aplastic anemia:
monitor for decrease RBC, WBC, platelet
113
What is the end result of Aplastic anemia:
cytopenias (reduction in # RBC)
114
Aplastic anemia - death is often caused by what?
hemorrhage or infection
115
Myelodysplastic syndrome (MDSS) - what
ineffective hematopoiesis
116
Myelodysplastic syndrome (MDSS) - risk factor of what
leukemia
117
Myelodysplastic syndrome (MDSS): s/s
Fatigue, dyspnea, activity intolerance, unexplained bruising or bleeding or recurrent infections
118
Myelodysplastic syndrome (MDSS) - what should nurse monitor patient for
report s/s of anemia, thrombocytopenia and infection
119
What is acute myeloid leukemia
result of genetic mutations that occur during hematopoiesis and ultimately reflect the type, quality and quantity of cells produced.
The bone marrow becomes packed with abnormal cells and ultimately begins to release these cells into the circulation prematurely
120
What is the stongest risk factors for acute myeloid leukemia?
The strongest risk factors for resistant disease, early relapse, and decreased survival include advanced age, poor functional status, and complex cytogenetic abnormalities
121
Acute Myeloid Leukemia: onset
Abrupt - 1 week to a month
122
What is a sign of acute myeloid leukemia?
fever and infection
123
Acute myeloid leukemia: what happens to blood cells
Decrease in erythrocytes and platelets, leukocyte count can be low, normal or high, decreased neutrophil count
124
Acute Myeloid Leukemia: thrombocytopenia
increased risk of bleeding
125
Acute Myeloid Leukemia: medical management
stem cell transplant
126
Acute myeloid leukemia: nursing management
prevent infection and bleeding, promote comfort and patient education
127
What are other types of malignant hematologic disorders?
```
Acute Promyelocytic Leukemia (subtype of acute myeloid leukemia)
Acute lymphocytic leukemia
Hodgkin lymphoma
Non-Hodgkin Lymphoma
Chronic Lymphocytic Leukemia (CKK)
Multiple myeloma
```
128
Who is at risk for developing chronic lymphocytic leukemia?
vietnam war veterans
129
Acute lymphocytic leukemia: what is it?
controlled proliferation of immature lymphoid cells – decreased leukocytes, erythrocyte, and platelets
130
Acute lymphocytic leukemia: signs and symptoms
Testes and CNS – s/s testicular swelling, HA, visual changes, vomiting, and neurologic deficits
131
How are malignant hematologic disorders typically treated?
All of these will typically be treated with some type of chemo, no raw veggies or fruits, no plants, no flowers, avoid crowds, private room
132
Why would someone need a splenectomy?
1. Emergency removal d/t trauma or rupture
2. Elective - treating selected hematologic disorder
3. severe hemorrhage
133
What is Sickle Cell Disease?
Inheritance of HgS (sickle hemaglobin) gene
134
Sickle Cell Disease: patho
Hgb forms sickle shape when exposed to low oxygen levels
Hgb loses its round, pliable, biconcave disc shape and becomes dehydrated, rigid, and sickle shaped
Rigid RBCs can adhere to vessel walls, predisposing for clot formation
If HgS is exposed to enough oxygen before becoming too rigid, it can revert back to normal shape
135
What can trigger HgS to sickle?
Normal o2 levels in venous blood
136
What are the types of sickle cell crises?
Vaso-occlusive crisis
Aplastic crisis
Sequestration crisi
137
Sickle cell crisis: Vaso-occlusive crisis
Very painful
Results in entrapment of RBCs and WBCs in microcirculation, leading to tissue hypoxia
Oxidative damage to vessel causes dysfunction in vessel wall causing vasculopathy
138
Sickle cell crisis: Aplastic crisis
Develops from human parvovirus infection
Hgb levels fall rapidly, bone marrow can't compensate, no reticulocytes produced
139
Sickle cell crisis: Sequestration crisis
Pooling of sickled cells in various organs
Spleen most common in children
Liver and lungs most common in adults
140
Acute Chest Syndrome:
Type of vaso-occlusive crisis
most common cause of death in young adults with sickle cell disease
141
Acute Chest Syndrome: what triggers it
Often triggered by infection
Fat embolism
PE
pulmonary infarction
142
Acute Chest Syndrome: s/s
fever, respiratory distress, new infiltrates in CXR ``
143
Acute Chest Syndrome: tx
RBC transfusion, abx, brochodilators, nitric oxide
144
Acute Chest Syndrome: how can someone decrease their risk?
use of incentive spirometer & RBC transfusions during vaso-occlusive crisis
145
What is a common sequelae of SCD?
pulmonary htn
146
Why can pulmonary HTN be hard to diagnose until late stages?
due to little or no s/s in early stages
147
pulmonary HTN s/s
Fatigue, dyspnea on exertion, dizziness, chest pain
SpO2 remains normal, BSCTA (?)
148
What type of strokes are common in children and older adults vs young adults who have sickle cell disease
Ischemic strokes: children and older adults
| Hemorrhagic strokes: young adults
149
What do strokes result from with sickle cell disease?
decrease cerebral perfusion d/t anemia, hemolysis or increase hypoxic stress
150
What are reproductive complications that men can experience with SCD?
25% men develop hypogonadism
Low testosterone levels, low libido, erectile dysfunction, infertility
Frequent episodes of priapism can contribute to significant pain, decreased libido, and impotence
151
What are reproductive complications that women can suffer from if they have SCD?
Menarche can be delayed
Pain episodes may increase during menstruation
Need for reliable birth control when treated with hydroxyurea d/t teratogenic defects
152
Treatment for SCD?
```
Hydroxyurea
Folic acid replacements
Incenitive spiro
abx
corticosteroids
hydration
PRBC transfucion
PFT
```
153
What does hydroxyurea do for SCD tx?
increases fetal hemoglobin (high affinity for o2)
154
What are sfx of hydroyurea?
chronic suppression of leukocyte formation, teratogenic, potential for development of cancer
155
Why might someone with SCD require daily folic acid replacements?
to maintain the supply requires for increased erythropoiesis from hemolysis
156
Why might someone need abx if they have SCD?
for acute chest syndrome
157
What is important about hydration with someone who has SCD?
fluid overload can develop quickly
158
Why might someone benefit from PRBC transfusions if they have SCD
treats hypoxia
159
Why might someone need PFTs regularily if they have SCD?
to detect early pulmonary HTN
160
What are adequate pharm therapies, especially during vaso-occlusive crises?
Aspring for mild pain - decreases inflammation and reduced risk of thrombosis
NSAIDs - may have ceiling effect, watch for renal disease/damage
IV opioids and PCA for pain crisis
161
what are non-pharm therapies to decrease the pain someone has with SCD?
Treatment for neuropathic pain
adequate hydration
supplemental o2
162
What is hemophilia A
Deficient Factor VIII
163
What is hemophilia B
deficient or defective factor IX
164
What happens with hemophila?
Increased propensity to bleed, hemorrhage even from minor trauma
165
Hemophila: what does the extent of the hemorrhage depend on
level of factor deficiency and force of trauma
166
Hemophilia: where does 75% of bleeding occur?
joints - can cause permanent joint damage with recurrent bleeds of same joint
167
Hemophila: bleeding into muscles can do what
compress nerves
168
Hemophilia: tx
Factor VIII and X concentrates
Less ofte, FFT
Children can receive factor prophylactically 3-4 times per week
Can develop neutralizing antibodies (inhibitors) to factor concentrates, decreasing effectiveness
Desmopressin - transient increase in Factor VII, mechanism not fully understood
169
Hemophilia: nursing considerations
Education on necessary physical restrictions, when to seek care
Coping with disease-related restrictions on lifestyle
Fall prevention– especially with older adults
Home administration of factor at first sign of bleeding
Education on importance of compliance with prophylactic treatments
Education on medications and foods that interfere with platelet aggregation– aspirin, NSAIDs, alcohol
Avoid heat during acute bleeding episodes
170
Why would someone receive blood
low blood d/t surgery, trauma, anemia (low production), renal failure, cancer
171
What is the importance of RBC
```
Body can’t function well without them
Carries hemoglobin (delivers O2 and removes CO2)
```
172
s/s that someone is low on RBC
fatigue; SOB; increased HR
173
What are examples of blood products
```
Whole Blood
Packed Red Blood Cells (PRBC)
Platelets
Fresh Frozen Plasma (FFP)
Albumin
```
174
What must be set in place in order to prevent transfusion reactions
Facility protocol
| RN to transfuse the blood
175
blood transfusion: client safety
Patient needs to be typed and cross matched
| labeling, blood brand
176
know ABO compatability and Rh factor
book and slide 38 ppt
177
What should a nurse obtain along with informed consent
allergies
previous transfusions
- pre-medicate (benedryl, tylenol)
178
Blood transfusions - what do you need in regard to IV access
18g or larger because RBC can lyse
| 2 IV access because you can not transfuse anything with blood, and the patient may need other medications hung
179
How long does blood transfusion take on avg
2 hr
180
Where is blood stored
blood bank in fridge
181
how many units of blood can be given at a time
1 unit
182
When should the nurse start the blood transfusion
Start within 30 minutes of receiving blood and needs to be done within 24 hours
- needs to be IN BODY to reduce risk of bacteria growth
183
What do you verify with a blood transfusion
```
Order
Pt. identifications
Blood bank info
Blood type and donor type, RH factor
Expiration date
Look at blood and make sure no
```
184
What do you monitor during blood transfusion
baseline vitals
185
What supplies will you need for a blood transfusion
```
Alcohol pads
Gloves
Biohazard bag
Blood tubing “Y tubing with filter”
Blood product
500 mL bag of 0.9% NS—NOTHING ELSE!
10 mL flush
```
186
Blood transfusion rate
TRANSFUSE SLOWLY!
| Approx. 2mL/min for first 15 minutes
187
What does the nurse do for the first 15 min of blood trans
Stay with patient
| minimize amount of blood to patient incase of trans rx
188
When do most transfusion rx occur
1st 15 min
189
When does the nurse get vitals after the start of the infusion
after 5 min
190
when do the second set of vital get taken after the 1st 5 min
15 minutes, another vital set and then you can increase the IV rate
191
What are s/s of blood trans rx
```
Hemolytic
Febrile
Allergic
Circulatory overload
Rash (hives)
Aching (back, head, chest)
Chills
Tachycardia
Increased RR
Oliguric (low UOP)
Nausea
```
192
The blood trans procedure
Assure patency of IV line
Hang normal saline flush bag
Spike normal saline bag and prime tubing (including the filling blood tubing filter completely)
Close saline roller clamp BEFORE proceeding to next step.
-- Keep line clamped. Will open when flushing blood through line after blood bag is empty.
Spike blood bag and prime tubing
-- Be sure to prime entire line
Connect tubing to IV access
-- 20g or larger should be used
Set pump
Monitor for adverse reactions & STAY with patient!
Measure vital signs after 5 minutes & 15 minutes
Increase infusion rate after 15 minutes per order/policy
Measure vitals during & after infusion complete
193
What should nurse do if the patient has a rx to the blood trans
STOP transfusion!! *note the time
Disconnect blood tubing and replace with new tubing primed with 0.9% NS
Notify the doctor and blood bank
STAY WITH PATIENT
Monitor VS every 5 minutes
Send tubing, blood to blood bank
DOCUMENT!
194
Medications for blood trans rx:
corticosteroids, fluids, antihistamines, antipyretics, vasopressors, diuretics (dependent on reaction type and patient)
195
Labs to obtain when pt has blood trans rx
clotting? DIC? Electrolytes, blood levels, Urine- free hemoglobin
