HNN227: Blood Transfusion + Immune Conditions Flashcards
Stages of wound healing
INITIAL PHASE
Lasts 3-5 days.
1. Haemostasis = cessation of bleeding via clotting a. Vasoconstriction of large blood vessels b. Platelets aggregate to form a platelet plug and stop the bleeding c. Activation of the clotting cascade results in the eventual formation of fibrin and a fibrinous meshwork 2. Inflammation
GRANULATION PHASE
Lasts 5 days - 4 weeks.
1. Collagen deposition: fibroblasts migrate to the wound to synthesis and secrete collagen 2. Angiogenesis: formation of new blood vessels by endothelial cells 3. Granulation tissue development: new tissue grows inwards from surrounding connective tissue 4. Epithelialisation: as granulation begins, so does growth of new epithelial tissue 5. Wound contraction: the edges of the wound are drawn together by myofibroblasts, specialised cells that contain bundles of parallel fibres in their cytoplasm.
MATURATION PHASE
Up to 6 weeks
Scar tissue is remodelled (reshaped or reconstructed by collagen deposition and lysis and debridement of wound edges)
Secondary intention healing
Wounds that occur from trauma, ulceration, and infection.
Have large amounts of exudate and wide, irregular wound margins with extensive tissue loss.
Wound edges cannot be approximated.
Heal by primary intention.
Types of Blood Transfusion
Whole Blood: Alleviate signs and symptoms of anaemia due to blood loss, disease or treatment
Platelets: Treat, or prevent, bleeding in patients who have thrombocytopenia or abnormal platelet function.
Plasma: Contains proteins, clotting factors and antibodies and is separated or processed into a number of products.
Plasma
Fresh frozen plasma (FFP) contains coagulation factors and plasma proteins and is used to treat bleeding or to reduce the likelihood of bleeding
Cryoprecipitate contains a number of clotting proteins and is most commonly used to treat bleeding or to reduce the likelihood of bleeding where fibrinogen is low
Albumin is a blood protein used to increase oncotic pressure in the intravascular space, causing fluid shift from the interstitial to intravascular space
Indications for blood transfusion
Severe anaemia (Hb<70g/L)
Blood loss
Cardiac dysfunction
Bone marrow suppression
Atherosclerotic disease
Blood transfusion nursing considerations
3 P’s
1. Patient: ask the pt to ID themselves and check wrist band against pack and prescription
2. Prescription: check against pack
3. Pack: donation no., patient compatibility label, donor group, expiry date
Duration
· If urgent can be transfused as fast as tolerated
· If non-urgent, typically 1 unit over 1-3 hours but within 4
· Slower rate if risk of circulatory overload
· Once removed from the fridge, transfusion to begin within 30 mins
Compatible Fluids
· Normal saline (0.9% sodium chloride)
· 4% albumin
· Gelofusine
· ABO compatible plasma
Monitoring
1. Before Transfusion: set of baseline vitals
2. During Transfusion: frequent visual observation; vitals at commencement, 15 mins, stipulated interval
3. Post Transfusion: set of vitals
Blood transfusion reactions
Temperature
Rise to ≥ 38 °C or ≥ 1 °C above baseline. Chills, rigors.
CNS
Anxiety, sense of unease or something going wrong, general feeling of being unwell
Skin
Urticaria, rash, pruritus (itching)
Cardiac
Tachycardia, hypertension, hypotension
Respiratory
Shortness of breath, wheeze, decreased O2 saturation, stridor
GIT
Nausea, vomiting
Urinary
Haematuria, oliguria (output <400mL/day)
Pain
Pain along IV site, chest/back pain
Uncontrolled bleeding or generalised oozing from IV sites or wounds
5 Signs of Inflammation
- Redness – secondary to vasodilatation and increased blood flow
- Heat – localised increase in temperature, also due to increased blood flow
- Swelling – results from increased vessel permeability, allowing fluid loss into the interstitial space
- Pain – caused by stimulation of the local nerve endings, from mechanical and chemical mediators
- Loss of function
Exudate – contains plasma proteins (primarily albumin)
Stages of Inflammation
Vascular Phase
Cellular Phase
Vascular Phase
- Damaged tissues release histamines; increasing blood flow to the area
- Arterioles and venioles vasodilate to promote blood flow to tissues
- Histamines increase capillary permeability allowing for phagocytes and clotting factors to enter the wound
- Fluid balance shifts causing an accumulation of interstitial fluid = leave wound as exudate
- Exudate transports cells and plasma components that participate in healing and dilutes toxins
- Increase tissue perfusion causes redness and warmth
- Pain is caused by the direct action of chemical agents released during inflammation and pressure from swelling on nerve endings
a. Bradykinin and prostaglandin increase the transmission of pain to the brain
Cellular Phase
- Initiated by the movement of monocytes and neutrophils into the inflamed tissue
- Leucocytes move through the tissue via chemotaxis
a. Margination – cells line up against the endothelium
b. Rolling – close contact with and roll along the endothelium
c. Adhesion – connecting to the endothelial wall
d. Emigration – cells move through the vessel wall to the affected area
Leucocytes engulf and degrade bacteria and cellular debris = exudate
- Leucocytes move through the tissue via chemotaxis
Cell Derived Mediators
Histamine: found in high concentrations in the mast cells of tissues; cause vasodilation and increase capillary permeability.
Serotonin: performs similar actions to histamine; stimulates smooth muscle contraction.
Prostaglandin: potent vasodilator; can inhibit platelet aggregation; stimulates pain receptors.
Plasma Derived Mediators
Bradykinin: increases capillary permeability and stimulates pain receptors.
Clotting system: traps exudate, microorganisms, fibrin strands, foreign bodies
Complement cascade: vasodilation; promotes leucocyte chemotaxis; augments phagocyte action
Nursing Management of Inflammation
Pharmacological
- NSAIDS
- Aspirin
- Paracetamol
- Corticoid steroids
Non-Pharmacological
- Rest
- Ice
- Compression
- Elevation
- Health promotion
- Diet
Inflammatory Conditions
Non-immune diseases that start with the inflammatory response: cancer, atherosclerosis, ischaemic heart disease.
Inflammatory diseases: asthma, auto-immune diseases, coeliac disease, inflammatory bowel disease, rheumatoid arthritis.
