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NURS 3532 - Skills 4 > Lab 1 > Flashcards

Lab 1 Flashcards

1
Q

informed consent is required…

A
  • for every pt prior to receiving blood or blood products
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2
Q

what must be included in informed consent for blood or blood products (5)

A
  • provide both verbal & written info that is understood by the pt or substitute decision maker
  • be voluntary
  • discuss risks, benefits, and alternatives (including doing nothing)
  • understand the pt has the right to refuse
  • include opportunity for the pt to ask questions
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3
Q

who can consent or refuse medical treatment in manitoba?

A
  • competent persons 16 years or older can legally give or refuse consent
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4
Q

who can give consent if the pt is not competent and/or older than 16 years old (4)

A
  • proxy
  • guardian
  • authorized prescriber
  • substitute decision maker
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5
Q

who can obtain informed consent (4)

A
  • medical resident
  • physician
  • NP
  • registered nurse extended practice
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6
Q

when should the informed consent process begin

A
  • upon initial admission to allow pt time to make an informed decision and time for consideration of alternatives
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7
Q

how long is consent valid for

A
  • a consent from signed by the pt is valid for 1 year from the date of the pt’s signature if the same authorized practioner is performing the procedure
  • significant changes in the pts condition require new consent
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8
Q

describe informed consent in the event of an emergency (4)

A

authorized practitioners can defer consent at their discretion if the following apply:

  • pt lacks decision making capacity and subtitute decision maker not available
  • urgent transfusion to save life, limb, or vital organ
  • reasonable person would consent in the circumstance
  • no evidence that the pt objects to the transfusion
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9
Q

describe consent by phone; what is required? (3)

A

is acceptable when not able to be done in person, it requires:

  • witness throughout the convo
  • signature of authorized practitioner who obtained consent
  • signature of witness on consent form
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10
Q

what do you do if no consent is documented

A
  • no blood given until resolved
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11
Q

what should you do if treatment is refused

A
  • ensure if it documented in the health record
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12
Q

what are the most common transfusion associated risks

A
  • non-infectious risks
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13
Q

describe infectious risk associated w transfusion (2)

A
  • very low, but cannot be absolutely guaranteed

- donated blood is a biological product that cannot be risk free of germs

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14
Q

what are common non-infectious risks associated w transfusions (9)

A
  • transfusion associated circulatory overload
  • transfusion associated dyspnea
  • transfusion related acute lung injury
  • hemolytic reaction
  • incompatible transfusion
  • hypotensive reaction
  • aseptic meningitis
  • IVIg headache
  • others
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15
Q

describe mild allergic reaction r/t transfusions: onset, symptoms, mngmt, can transfusion continue?

A
  • begins within 1-45 mins after start of transfusion
  • mild hives, rash
  • managed w diphenhydramine
  • transfusion can continue
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16
Q

describe transfusion associated circulatory overload: onset, symptoms, treatment, transfusion proceedings

A
  • begins w 1-45 mins after start
  • dyspnea, orthopnea, cyanosis, tachycardia, HTN, increased venous pressure
  • Tx: O2, diuretics, chest xray
  • consider restarting transfusion at reduced rate if clinical status allows
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17
Q

describe febrile non-hemolytic reaxction: symptoms, Tx, can transfusion continue?

A
  • fever present during or up to 4 hours after transfusion
  • Tx: acetaminophen
  • transfusion can continue
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18
Q

describe anaphylactic reaction r/t transfusions: onset, symptoms, treatment, can transfusion continue

A
  • onset: 1-45 mins after start of transfusion
  • Sx: severe rash, upper or lower airway obstruction, hypotension
  • stop transfusion, do not restart
  • Tx: supportive ventilatory support as indicated
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19
Q

describe bacterial contamination r/t transfusions: symptoms, treatment

A
  • Sx: rigors, fever, tachycardia, hypotension, dyspnea, NV, DIC
  • Tx: stop transfusion, notify blood bank, return residual product, collect blood cultures, supportive therapy, abx
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20
Q

describe acute hemolytic transfusion rxn: why does it occur, symptoms

A
  • occurs when wrong ABO blood is transfused

- Sx: fever, chills, hemoglobinuria, pain, hypotension, NV, dyspnea, renal failure, DIC

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21
Q

describe transfusion associated acute lung injury: onset, symptoms, treatment

A
  • onset: within 1-2n hours after start, can be delayed up to 6 hrs
  • Sx: dyspnea, hypoxemia, fever, hypotension, no evidence of circulatory overload
  • Tx: supportive care, mechanical ventilation if needed
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22
Q

what are 2 rules r/t transfusion safety

A
  • dont transfuse blood if other non-transfusion therapies or observation would be just as effective and safe
  • if pt does require blood transfusion, do not transfuse more than 1 red cell unit at a time when transfusion is required in stable, non-bleeding pts –> 1 unit of blood is usually adequate if non-bleeding & stable
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23
Q

what are indications for a 2nd unit of blood (2)

A
  • active blood loss

- ongoing symptoms of anemia

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23
Q

what are indications for a 2nd unit of blood (2)

A
  • active blood loss

- ongoing symptoms of anemia

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24
Q

according to best practice, orders for blood components and/or plasma protein products should include: (7)

A
  • pts name and unique identifier
  • date & time order written & signed legibily
  • type of blood to be admin
  • rate at which transfusion to be admin
  • duration of transfusion
  • any special requirements (ex. warmer, irradiated)
  • any pre-meds if required
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25
Q

the healthcare professional drawing blood must positively id the pt by confirming with the id band…. (2)

A
  • first and last name

- unique identifier (PHIN)

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26
Q

once a blood sample is collected, the tube is labelling in the presence of the pt and includes… (6)

A
  • first and last name
  • PHIN
  • date
  • time
  • facility name
  • phlebotomist initials
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27
Q

when must positive pt ID be established (2)

A
  • time of pre-transfusion blood testing

- admin of any/all blood, blood components, and/or plasma protein products

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28
Q

what must be done if discrepanies are discovered during positive pt identification at the bedside and at the lab

A
  • at the bedside: blood samples must not be collected

- in the lab: sample rejected and request new blood draw from the unit

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29
Q

what is a transfusion medicine results report (TMRR)

A

report generated by Canadian Blood Services that indicates:

  • indicates pt ABO group, Rh and antibody status
  • expiry date and time
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30
Q

the TMRR is received in the pt care area within….. how long is it valid for?

A
  • received within 1-24 hrs depending on priority

- valid for 72 hrs

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30
Q

the TMRR is received in the pt care area within….. how long is it valid for?

A
  • received within 1-24 hrs depending on priority

- valid for 72 hrs

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31
Q

what is the most common cause of transfusion reactions

A
  • mis-identificiation of pts
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32
Q

what is the second sample protocol

A
  • ensures that no pt receives group specific blood until at least 2 samples are received w the same ABO group results
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33
Q

what are 2 types of pts r/t second sample protocol

A
  1. never had a type and screen

2. previous type and screen on file

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34
Q

describe what is done for pts who have never had a type and screen (2)

A
  • receive group O red cells until a second type and screen is completed
  • second sample requested by blood bank after issue of 2 units O group red cells
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35
Q

describe what is done for pts w a previous type and screen on file r/t second sample protocol (2)

A
  • issues group specific blood immediately

- no need for second sample to be sent

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36
Q

what is to be included in the Request for Release of Blood/Blood Derivative form to Blood Bank (4)

A
  • unit where blood is needed
  • unit phone number
  • when its required
  • first and last name of ordering practioner
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37
Q

when is the Request for Release of Blood/Blood Component/Deriviate form used by the blood bank: (4)

A

when you need to:

  • order plts (stored at CBS)
  • request blood products for a pt with an antibody
  • request irradiated plts or red cells
  • request a copy of a pts result report
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38
Q

describe the admin of emergency blood (5)

A
  • pre-transfusion sample must be drawn prior to admin of emergency red cells
  • note on request of release form that emergency units are being requested
  • phone the blood bank to notify themm
  • complete tag w pt demographic info
  • authorized practitioner to sign ROT
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39
Q

female pts under 45 years require the use of ??? for emergency situation

A
  • group O- red cells
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40
Q

all clinical orders for blood products should include: (6)

A
  • first and last name of pt
  • PHIN
  • DOB
  • physician who ordered the product
  • product requested what and how much
  • where is it going (location)
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41
Q

the transporter must present w ??? at the hospital blood bank to pick up a blood product

A
  • documentation (verbal orders not acceptable)
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41
Q

the transporter must present w ??? at the hospital blood bank to pick up a blood product

A
  • documentation (verbal orders not acceptable)
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42
Q

at what point can blood products be returned to the blood bank

A
  • if they have not been out of a controlled enviro for no more than 60 mins from the time of issue
    ex. if blood no longer required, IV no longer patent and needs to be restarted
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43
Q

once the blood product arrives in the transfusion area, a complete visual insepction is completed to look for:

A
  • leakage
  • discoloration
  • clots
  • expiry date
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44
Q

what is done if the blood product does not pass visual inspection

A
  • send back to the blood bank immediately
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45
Q

prior to admin of blood & blood products, what needs to be completed? (4)

A

2 person verification to verify:

  • complete order from authorized practicioner
  • intended recipient’s ABO group, Rh status, and any antibodies
  • donation ID number, donor ABO group, and Rh status
  • positive ID of the intended recipient
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46
Q

describe rules r/t transfusion of blood or blood products (3)

A
  • ensure correct tubing for product being administered
  • never add med to infusion
  • refer to site specific policy & procedures for pediatric considerations
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47
Q

describe the infusion rate & duration of blood (3)

A
  • infusion of one unit of RBC must not exceed 4 hrs
  • initiate at slower rate and remain w pt for first 15 min
  • increase rate as ordered after initial 15 min if no signs of adverse reaction
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48
Q

describe the removal of the manilla tag w blood transfusions

A
  • do not remove until the transfusion is complete

- after transfusion is complete, remove and place tag in confidential waste

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49
Q

when should admin sets for blood & blood products be changed? (5)

A

after:

  • four consecutive units
  • more than 30 mins between units
  • do not use same set for diff products
  • set becomes occluded
  • max of 4 hours
50
Q

where is documentation of the blood transfusions be done on

A
  • cumulative blood product record
51
Q

what is included on the cumulative blood product record (5)

A
  • product name
  • donation lot and sequence number
  • date & time
  • initials of 2 prescribers that checked product
  • vital signs
52
Q

what is done after the record of transfusion is completed

A
  • returned to the blood bank to complete vein to vein standards
53
Q

describe VS monitoring w admin of transfusion (5)

A

VS:

  • before transfusion begins
  • after first 15 min
  • every hour during
  • at the end
  • one hour post transfusion
54
Q

describe monitoring r/t transfusions

A
  • remain w pt for the first 15 min

- increase freq based on pts clinical presentation

55
Q

what should you observe for during the first 15 min of every transfusion: (15)

A

new onset of:

  • temp rise >1*C
  • SOB
  • HTN
  • hypotension
  • hypoxemia
  • chills
  • rigors
  • rash
  • uritcaria
  • pruritis
  • jaundice
  • hemoglobinuria
  • bleeding @ IV site
  • pain (back, chest, bone, abdomen)
  • tachycardia
56
Q

what should you do if at any time during the transfusion you suspect a transfusion rxn (8)

A
  • stop transfusion immediately
  • refer to transfusion reaction algorithim
  • maintain IV w NS using a new IV set
  • assess VS and monitor minimum q15 min
  • contact physician or autorized practicioner for medical assessment and treatment
  • perform visual inspection of product
  • repeat 2 nurse check for clerical discrepancies
  • notify blood bank
57
Q

what are the objectives for blood transfusion (3)

A
  • increase circulating blood volume after surgery, trauma, or hemorrhage
  • increase # of RBCs & maintain hgb in people w severe anemia
  • provide selected cellular components as replacement therapy (clotting factors, plts, albumin)
58
Q

what is the determination of blood groups based off

A
  • presence or absence of A and B RBC antigens
59
Q

what are the four types of blood types

A
  • A
  • B
  • AB
  • O
60
Q

what antigen is present w type A? who can they donate to? who can they receieve from? what serum antibodies?

A
  • A antigen
  • anti-B antibodies
  • donate: A, AB
  • receive from: A, O
61
Q

type b blood: what antigens? what antibodies? can donate to? can receive from?

A
  • B antigen
  • anti-A antibodies
  • donate: B, AB
  • receive from: B, O
62
Q

type O blood: antigens? antibodies? donate to? receive from?

A
  • absence of antigens
  • anti-A and anti-B antibodies
  • donate to all
  • receive from O
63
Q

type AB blood: antigens? antibodies? receive from? donate to?

A
  • presence of A and B antigens
  • no serum antibodies
  • donate to: AB
  • receive from: all
64
Q

individuals w typw A blood naturally produce….. type B?

A
  • type A = naturally produce anti-B antibodies

- type B = naturally produce anti-A antibodies

65
Q

what is the universal blood donor? why?

A
  • type O

- has neither A or B antigens

66
Q

what is the universal recipient and why

A
  • type AB

- produce neither antibody

67
Q

what causes a transfusion reaction

A
  • if blood that is mismatched w the pt’s blood is transfused
  • it is an antigen-antibody reaction
68
Q

what is another consideration when matching for blood transfusions

A
  • Rh factor
69
Q

what is Rh factor

A
  • antigenic substance in the erythrocytes
70
Q

describe the influence that Rh + vs Rh- has on blood transfusions

A
  • Rh+ = can receive from Rh - or + blood

- Rh- = can only receive Rh-

71
Q

what is an autologous transfusion

A
  • collection of a pt’s own blood which is then reinfused during surgery
72
Q

what is the benefit to an autologous transfusion

A
  • decreased risk of complications such as mismatched blood and exposure to bloodborne infectious agents
73
Q

how much blood can be collected autologously

A

1-5 units

74
Q

when is assessment completed when transfusing blood or blood components

A
  • before, during, and after the transfusion
75
Q

what documentation should be done/checked pre-transfusion (3)

A
  • check for pt consent (and expiry)
  • obtain cross match sample
  • confirm physician order
76
Q

what should be included on the physician order for a transfusion (6)

A
  • blood product
  • pt name
  • product amt (how many units)
  • clinical indication
  • rate of infusion
  • duration
77
Q

what assessments should be done pre-transfusion

A
  • baseline VS

- ensure IV patent, signs of infection or infiltration

78
Q

what size of IV is recommended for transfusions and why

A
  • 18-20 G

- bc blood is thicker and stickier than IV fluids

79
Q

what is included in pre-transfusion admin set prep (3)

A
  • prime blood tubing w 0.9% NS
  • obtain a baxter pump
  • prime a separate primary line w NS and hang at bedside for emergency use only (in case of reaction)
80
Q

why is NS used to prime blood admin tubing

A
  • prevent hemolysis or breakdown of RBCs
81
Q

what comes from the blood bank after faxing the request to the blood bank (3)

A
  • blood component bag
  • blood component tag
  • record of transfusion (ROT)
82
Q

what is done once the blood has arrived to the unit

A
  • grab the chart & RN to complete your checks
83
Q

what is done during the first check and where

A
  • pt identification at the nursing sent
84
Q

what does nurse 1 vs nurse 2 do during the 1st check

A
  • nurse 1: read from ROT first & last name (letter by letter) & PHIN or unique identifier
  • nurse 2: compare and verifiy info on both with admission sheet
85
Q

what does nurse 1 vs nurse 2 do during the second check

A
  • nurse 1: read from ROT first and last name (letter by letter), PHIN, donation unit # or lot #, ABO/Rh blood type (donor), compatability status
  • nurse 2: compare and verify w component tag
86
Q

what is checked during the 3rd check

A
  • component verification
87
Q

what does nurse 1 vs nurse 2 do during the 3rd check

A
  • nurse 1: read from blood component tag product type, donor ABO/Rh, donor unit # or lot #, crossmatch expiry date (on tag), unit expirary date (on bag), modifiers (ex. irradiated)
  • nurse 2: compare and verify the info on component bag
88
Q

what else is checked during the component verification (3rd check) (3)

A
  • verbally inspect blood product
  • make sure to check volume in the bag
  • document the 2-person verification process on the cumulative blood product record (CBPR)
89
Q

what is done during the 4th check

A
  • pt ID and verification at the bedside
90
Q

describe what is done during the 4th check

A
  • check pts last & first name and PHIN on pt ID armband with the component/PPP tag attached to donor unit
  • ask pt to state/spell their last & first name and DOB (if capable)
  • if pt cannot give verbal id, a nurse must confirm identity by stating letter by letter and number by number from the ID armband to the corresponding info on the component/PPP tag attached to the donor unit
  • same 2 individiuals must sign CBPR
91
Q

what should be worn when setting up blood transfusions

A
  • gloves
92
Q

describe how to set up your blood transfusion (4)

A
  • spike blood component bag
  • make sure clamp NS to prevent backflow into the saline bag
  • prime the line w blood
  • insert into baxter pump
93
Q

describe the infusion rate of a blood transfusion

A
  • start infusion rate slow: 30-50 mL/h for first 15 min (timer starts once blood hits the vein)
  • then set to ordered rate
94
Q

what is done after setting up the infusion and setting the infusion rate

A
  • label the line

- attach to pt

95
Q

describe VS assessment r/t blood transfusions (5)

A
  • prior to transfusion
  • after first 15 (and stay w the pt during first 15)
  • hourly during transfusion
  • end of transfusion
  • 1-hr post transfusion
96
Q

what must be documented r/t transfusions? where is it documented

A
  • type of blood, blood component or PPP
  • donor unit # (including check digit and center code) or lot #
  • time infusion starts and ends
  • VS
  • pt education and response during and after transfusion
  • total volume infused (fluid bal record)

document on cumulative blood product record

97
Q

what is done w the ROT after initiating the blood transfusion

A
  • complete & return it to the blood bank as soon as the pt’s blood mixes w the blood/blood component (after 15 min of constant observation)
98
Q

what is the purpose of the ROT

A
  • ensure traceability from the donor’s veins to the recipient’s veins
  • provides evidence for the pt & CBS in the event that many years later it is discovered that the current blood supply is tainted
99
Q

what pt education should be completed r/t transfusions (6)

A
  • explain they are getting blood
  • ask if pt knows reason why they are getting the transfusion
  • ask if they have had a previous transfusion or rxn
  • explain the procedure
  • educate on the importance of letting you know if they are feeling any different & signs of a transfusion rxn
  • ensure they have given consent & signed the consent form
100
Q

what is done once the transfusion is complete (2)

A
  • discard tubing & blood bag in the biohazard waste bin

- place blood component tag in confidential waste

101
Q

what is a transfusion rxn

A
  • systemic response by the body to incompatible blood
102
Q

what are some causes of a transfusion rxn (3)

A
  • RBC incompatibility
  • allergic senstivity to the components of the blood
  • allergic sensitivity to the potassium or citrate preservative in the blood
103
Q

what is a second category of transfusion rxns?

A
  • diseases transmitted by infected blood donors who are asymptomatic
104
Q

what are examples of diseases transmitted thru transfusions

A
  • malaria
  • hepatitis
  • AIDs
105
Q

describe what to do if a blood reaction is suspected (10)

A
  • stop the transfusion immediately
  • keep the IV line open by piggybacking NS directly into the IV line (do not turn off the blood and simply turn on the NS connected to the y-tubing set, this would cause the blood remaining in the tubing to be infused)
  • notify the physician & blood bank immediately
  • recheck identifying tags & numbers
  • remain w the pt, observe S&S, monitor VS & U/O, as often as q5min
  • treat symptoms as per physicians order (emergency drugs, prep for CPR, etc.)
  • obtain urine specimen & send to lab to determine the presence of hgb as a result of RBC hemolysis
  • obtain blood sample as indiciated
  • save the blood container, tubing, attached labels, and transfusion record, and return to the lab
  • document the incident
106
Q

what fluids cannot be used w blood transfusions and why

A
  • dextrose or LR = RBC hemolysis

- no meds via the same tubing as well

107
Q

most pts not in danger of fluid overload can tolerate the infusion of 1 unit of PRBCs over ____ h, the transfusion should not take longer than n4 hr

A
  • can usually tolerate over 2 hr

- should not take longer than 4 h –> risk of bacterial growth in the product once it is out of refrigeration

108
Q

what is the most common cause of hemolytic transfusions

A
  • ABO-incompatible blood
109
Q

what is an acute hemolytic rxn

A
  • when antibodies in the recipients serum react w antigens on the donor’s RBCs
    = agglutination of cells –> obstruct capillaries and blood floiw
    = hemolysis of RBCs= release of free hgb into plasma = AKI
110
Q

why do nurses stay w the pt during the first 15 min of a transfusion

A
  • the clinical manifestations of an acute hemolytic rxn usually develop within the first 15 min
111
Q

what is a delayed transfusion rxn

A
  • transfusion rxn that occurs 24 hr to 14 days after admin
112
Q

what causes a febrile reaction?

A
  • reaction due to leukocyte incompatability —> when individuals receive 5 or more transfusions they develop circulating antibodies to the WBCs in the blood product
113
Q

how are febrile reactions prevented

A
  • admin of acetaminophen and diphenhydramin 30 min before transfusion
114
Q

what is used to prevent allergic rxn r/t transfusion? what can treat a severe reaction?

A
  • prevent: antihistamines

- treat: epi or corticosteroids

115
Q

who is at higher risk of developing circulatory overload r/t transfusions

A

individual w renal or cardiac insufficiency

116
Q

what is transfusion-related acute lung injury

A
  • sudden development of noncardiogenic pulmonary edema
117
Q

what is a massive blood transfusion rxn

A
  • an acute complication of transfusing lrg volumes of blood products or when replacement of RBCs or blood exceeds the total blood vol within 24 hrs
    = imbalance of normal blood elements bc clotting factors, albumin, and plts are not found in RBC transfusions
118
Q

what other problems may occur w massive blood transfusions (3)

A
  • hypothermia (if cold blood)
  • dysrhythmias (if cold blood)
  • hyperkalemia (if K leaks from RBCs)
119
Q

what medication is commonly prescribed to be given after a blood transfusion? why? what pt assessment need to be done when giving this med?

A

????

120
Q

the first step in the procedure of blood admin is ___

A
  • get consent from the pt
121
Q

treatment order for transfusions must include (8)

A
  • what product
  • amt of product
  • pt name
  • date of transfusion
  • reason/clinical indication
  • rate of infusion/duration
  • special requirements
  • prescribers signature
122
Q

no band no ____

A

blood

123
Q

to obtain a cross match blood sample, what color topped tube is used

A
  • purple
124
Q

blood products can be returned to the blood bank within _____ from time of issue

A
  • 60 min
125
Q

what should you consider w stable non-bleeding pts

A
  • why give 2 when 1 will do? (start w 1, see if it corrects the problem)
  • other alternatives ex. iron therapy

NURS 3532 - Skills 4 (4 decks)

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