MIDTERM Flashcards
TRALI (Transfusion-Related Acute Lung Injury)
development of acute lung injury occurring within 6 hours after the blood transfusion
Transfusion-associated circulatory overload (TACO)
It can occur after transfusion of any type of blood product but is most frequently associated with red blood cells (Smith, 2023). TACO is characterized by volume overload. The patient cannot compensate for increased vascular volume from the blood transfusion
more likely to occur when a person has an underlying heart condition of is an older adult. You mentioned that a diuretic is often used in the treatment of TACO.
furosemide
Septic shock
caused by widespread infection or sepsis
hypotension, tachycardia, fever, bounding pulses, changes in mental status, SOB, and chills.
The acid base imbalance that a person with sepsis/septic shock is at risk for is metabolic acidosis (Morton & Thurman, 2023). Lactic acid release causes metabolic acidosis.
What causes the hyperkalemia that can happen with a transfusion of PRBC?
What causes the hypocalcemia that can happens with a transfusion of PRBC?
Hyperkalemia occurs because most of our potassium is stored inside our cells while hypocalcemia occurs because of citrate.
Aplastic anemia
disease in which a patient is deficient in red blood cells, white blood cells, and platelets
pancytopenia- which means reduced counts of all three types of blood cells.
bone marrow aspiration is often used in the diagnosis
Neutropenia
insufficient numbers of neutrophils due to a decreased production or increased destruction of white blood cells
neutrophil count is below 2,000
what is a thrombocyte? If a patient has received a transfusion of thrombocytes, what should we see?
Thrombocytes are also known as platelets. The primary purpose of a platelet is to initiate the clotting process by producing a “plug” at the site of injury.
decreased bleeding from IV sites and decreased oozing from old lab sites after a transfusion of platelets
Sickle cell crisis/sickle cell disease
chronic hereditary hemolytic anemia that occurs mostly in African or African-Caribbean origin. The sickle cell gene results in abnormal hemoglobin, usually hemoglobin S (HbS). These sickled cells can’t pass through small blood vessels which causes inflammation, obstruction of the vessels and decreased delivery of oxygen. Sickle cell crisis begins suddenly because of an infection or change in temperature or sometimes for no identifiable reason
Triggers for a sickle cell crisis can stem from an infection, a change in temperature, or can happen for no identifiable reason (Morton & Thurman, 2023). Aggressive IV fluid hydration is started right away with a crisis to decrease blood viscosity and maintain renal perfusion (Morton & Thurman, 2023). This will help slow the sickling process.
Pregnancy can increase the risk of sickle cell crisis because the abnormal red blood cells and anemia cause lower amounts of oxygen. This also puts the baby at risk. Strenuous activity increases a person’s blood flow so this could increase the chances of a sickle cell crisis. High altitudes can also cause an increased risk because of the lower oxygen levels at that level
erythropoietin stimulating agents
Erythropoietin stimulating agents are given to help stimulate the bone marrow to make red blood cells (Morton & Thurman, 2023). They are used to treat anemia of chronic disease such as kidney injury, infections, malignancies, and connective tissue diseases. Suppression of red blood cell production, decreased red blood cell survival time, and low serum erythropoietin levels can cause anemia. It is given either by IV or subcutaneously one to three times a week with adjustments being made based on how the patient responds
Hemophilia B
Hemophilia B is a genetic disorder. This is known as the Christmas disease and is because of a deficiency or defect in factor IX
if we suspect Heparin induced thrombocytopenia, what is the first thing we would do? Why?
Non-heparin anticoagulant should be continued until the platelet count has reached a stable plateau.
Someone with hemophilia will often bleed into their joints. How is this treated? Are there medications that someone with hemophilia should avoid?
Hemophilia is often treated with IV or nasal spray desmopressin acetate (Morton & Thurman, 2023). This is a hormone that stimulates the release of factor VIII and control bleeding. Patients with hemophilia should avoid NSAIDS such as Ibuprofen, advil and aspirin as this can cause bleeding. They should also be aware of their safety that could result in injury such as knives, needles and other trauma that can happen. Anything that can put them at risk for bleeding, they need to be aware of. Nurses should be aware of this during cares to avoid further complications.
Heparin induced thrombocytopenia (HIT)
the body rapidly loses platelets and antibodies against the heparin platelets develop (Hinkle et al., 2021). These antibodies cause the development of platelets and can lead to blood clots. This condition can be life threatening if not treated right away
Pernicious anemia
body is unable to produce enough red blood cells due to a deficiency of vitamin B12
Idiopathic thrombocytopenic purpura
hematologic disorder that causes a low platelet count but there is no known cause of the disorder. The risk factors for idiopathic thrombocytopenic purpura are chronic liver disease, bone marrow suppression, pregnancy, HIV, Systemic lupus erythematosus, myelodysplastic syndrome, hepatitis C virus infection, and chronic alcohol use (Lippincott Advisor, 2023). Clinical manifestations of idiopathic thrombocytopenic purpura are petechia, ecchymosis, bleeding mucus membranes, bleeding gums, GI bleed, urinary tract bleed, retinal hemorrhage, and blood oozing from wound any wound sites.
Hypovolemic shock
condition characterized by deficient fluid volume (Hinkle et al., 2021). Severe blood loss is the main cause of this type of shock.
Hypotension
Regarding hypovolemic shock the patient’s heart rate will increase due to decreased blood volume(Morton & Thurman, 2023. This is the body’s method of compensating for the inadequate supply of white blood cells to carry oxygen. In turn the heart pumps faster to attempt to increase blood circulation. This patients’s respiratory rate will also increase to compensate for decreased oxygenation.
Why do we watch a lactic acid level closely when a person has sepsis? What does an elevated level tell us? Is there metabolic acidosis happening here?
Increased blood lactate concentration is common with patients with sepsis and septic shock because there is an increase in O2 demand which the body is not able to deliver. An elevated lactic acid throws the body into anaerobic metabolism, thus breaking down fat and producing ketones. According to Morton et al., p233 (2023), “hypoxia and oxygen debt are associated with anaerobic metabolism” which causes “lactic acid accumulation causes metabolic acidosis in a hypoxic state”
hemolytic transfusion reaction
complication that occurs after a blood transfusion. This happens when the red blood cells that were given during the transfusion are not compatible and the patient’s immune system attacks and destroys them
hemophilia A
genetic disorder and factor 8 is missing. I agree with you that risk for bleeding is the greatest concern for a patient with hemophilia A
DIC (disseminated intravascular coagulation)
systemic syndrome characterized by microthromboses and bleeding. it is potentially life-threatening. Risk factors include sepsis, trauma, cancer, complications during pregnancy, allergic reactions, or other conditions. The primary focus of DIC treatment is addressing the underlying cause while supporting organ function and managing the coagulation process. Sepsis is one of the causes that can precipitate DIC and is a significant risk factor. The diagnosis of DIC is frequently based on laboratory tests that demonstrate the consumption of platelets and clotting factors. DIC lab values typically show low platelet count, prolonged clotting times, decreased fibrinogen levels, and elevated levels of fibrin degradation products
leukostasis
excessive number of immature white blood cells
caused by certain types of lymphomas
Cardiac tamponade
excessive pericardial fluid in the pericardial space or there is a tumor that presses against the heart
Distant or muffled heart sounds is a classic symptom of cardiac tamponade. You are correct that a pericardiocentesis is the preferred method of treatment.
interferons
helpful in the fight against viral infections. There are also often given in the treatment of malignant melanoma.
