Lab 4 Blood Transfusion/Parenteral Nutrition

Question 1

If someone had paralytic ileus could the be on enteral feeding

Answer 1

No since enteral feeding requires a functional GI tract

Question 2

what are some conditions that might require TPN

Answer 2

-bowel obstruction
-UC
-Pancreatitis
-Anorexia
-Chronic diarrhea

Question 3

how many calories does a person generally need per day

Answer 3

25-35 calories/kg/day

Question 4

What are some major complications of TPN

Answer 4

-hyper/hypoglycemia
-Liver failure (since fat going directly into the bloodstream)
-Refeeding syndrome

Question 5

what are some conditions that make someone susceptible to refeeding syndrome

Answer 5

-long standing malnutrition (alcoholics, prolonged vomiting/diarrhea)

Question 6

for how long and at what interval will you check BG for a patient that has started on TPN

Answer 6

check QID for first 3 days

Question 7

If a TPN bag is going to run out before the new bag arrives what solution would you run and at what rate

Answer 7

run D10W in the meantime at the same rate the TPN was running

Question 8

Can you ever combine TPN with anything else

Answer 8

NO since it is incompatible with many things

Question 9

If a lumen had been used for something else than TPN can you use it for TPN

Answer 9

NO TPN must have a dedicated lumen

Question 10

when would a physician consider stopping TPN

Answer 10

when a patient could start meeting about 70% of their nutritional needs enterally

Question 11

What must the patient have for initiation of Peripheral parenteral nutrition

Answer 11

Must have 4 peripheral veins that are larger than 3mm

Question 12

Could you administer medication through an IV that is being used for PPN

Answer 12

NO PPN needs a dedicated IV

Question 13

What are two major complications of PPN

Answer 13

-phlebitis
-losing peripheral vein access altogether

Question 14

what are the main components of blood

Answer 14

-RBC
-WBC
-Platelets
-Plasma

Question 15

What percentage of blood is formed elements and plasma

Answer 15

blood is 45% formed elements and 55% plasma

Question 16

What is plasma made up of

Answer 16

90% water and 10% proteins (like albumin fibrinogen) electrolytes etc

Question 17

what makes up the formed elements portion of blood

Answer 17

99% erythrocytes/RBC and 1% WBC/Platelets

Question 18

approx what is the volume of 1 unit of whole blood

Answer 18

475 mL of both fluid and cells

Question 19

approx what is the volume of 1 unit of PRBC

Answer 19

300 mL of cells and no fluid

Question 20

What is Cryoprecipitate

Answer 20

a blood product that contains clotting factors and proteins

Question 21

What would albumin be used for

Answer 21

to maintain blood volume and attract fluid into the intravascular space

Question 22

what is immunoglobulin used for

Answer 22

to replace antibodies to help fight infection

Question 23

is immunoglobulin compatible with NS

Answer 23

NO

Question 24

what blood type is the universal donor

Answer 24

O-

Question 25

what blood type is the universal recipient

Answer 25

AB+

Question 26

who is responsible for obtaining consent for a blood product

Answer 26

a physician

Question 27

once blood leaves the fridge how long do you have to start the transfusion

Answer 27

once blood leaves the fridge must start the transfusion within 30 min

Question 28

when do you have to replace the transfusion set

Answer 28

after it has been used for 4 hours or been used for 4 units of blood

Question 29

what rate is a blood transfusion usually started at?

Answer 29

50 mL/h

Question 30

how long do you have to leave a blood transfusion running at the starter rate

Answer 30

15 min at starter rate

Question 31

what is the observation schedule for a blood transfusion

Answer 31

-Must stay with patient for 5 MIN -Reassess at 15 min -Check Q1h and then 1 h post transfusion

Question 32

what is the time limit on a transfusion

Answer 32

each unit must be transfused within four hours of starting

Question 33

what is an autologous donation

Answer 33

when a patient donated their own blood for future use

Question 34

what fluid and what volume do you flush with between units of blood and after transfusion has finished

Answer 34

flush with 30-50 mL NS

Question 35

can you Y anything into a blood transfusion

Answer 35

NO nothing can be mixed with a blood transfusion

Question 36

what is the equation for calculating infusion rate after test dose

Answer 36

(Total V-12.5 mL)/(total infusion time-15 min)

Question 37

what classifies as a transfusion fever

Answer 37

anything above 38 degrees or a 1 degree increase from baseline

Question 38

when would a TMS tag have to sent back

Answer 38

-the blood component was issued from another hospital and transfused in transport -there is a transfusion reaction

Question 39

what is an acute hemolytic reaction

Answer 39

when there is an incompatibility between blood product and the patient resulting in hemolysis

Question 40

what organ is most at risk from an acute hemolytic reaction

Answer 40

the kidneys

Question 41

at what volume of blood does an acute hemolytic reaction usually occur by

Answer 41

usually occurs with the first 25 mL of blood

Question 42

at what volume of blood does an anaphylactic reaction usually occur by

Answer 42

usually occurs within the first 10 mL of blood

Question 43

what are two adverse reactions from a transfusion that usually occur quickly after initiation of transfusion

Answer 43

-Acute hemolytic reaction -Anaphylactic reaction

Question 44

when does a febrile reaction usually develop during a transfusion

Answer 44

usually develops later during infusion

Question 45

if someone was receiving a transfusion and started to have hypertension, cough, moist breath sounds what complication may this be

Answer 45

Fluid overload

Question 46

when would you administer oxygen if a person was experiencing a transfusion reaction

Answer 46

if their SpO2 dipped below 94%

Question 47

what would you do if someone started to have a transfusion reaction

Answer 47

-Stop the infusion -Disconnect blood tubing from VAD -start IV fluid -Administer O2 to keep sats above 94% -Use IV fluids to keep BP greater than 90