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PCC4 > Perfusion: Blood Transfusion > Flashcards

Perfusion: Blood Transfusion Flashcards

1
Q

What are LPNs able to do with regard to blood transfusions?

A
  1. obtaining unit from blood bank
  2. Crosschecking of ID prior to initiating transfusion w/ RN
  3. Monitoring during transfusion
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2
Q

What are the objectives of transfusion therapy?

A
  1. replacement or expansion of circulating volume

2. Maintenance of oxygen-carrying capacity of the blood by supplying red blood cells

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3
Q

What are the types of blood products that can be given?

A
  1. whole blood
  2. packed RBC
  3. Modified packed RBCs
  4. Fresh Frozen Plasma
  5. Platelets
  6. Cryoprecipitate
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4
Q

What are the uses for whole blood?

A
  1. acute massive blood loss greater than 25%

2. neonatal exchange transfusion

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5
Q

When is whole blood contraindicated?

A

In patients with chronic anemia who are normovolemic and require only red cell mass increase

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6
Q

How is Packed Red Cells prepared?

A

by the removal of 200-250mL of the plasma from a unit of whole blood

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7
Q

What can packed red cells be used for?

A
  1. the treatment of anemia in normovolemic patients requiring only an increase in RBC mass and Oxygen-carrying capacity
  2. Active GI bleed
  3. Hypovolemic shock
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8
Q

What must the patient and Packed red cells be in order to give Packed Red Cells?

A

ABO compatible

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9
Q

What are the 4 different types of modified packed RBCs

A
  1. Saline-washed RBCs
  2. Frozen-thawed-deglycerolized PRBCs
  3. Leukocyte-poor washed RBCs
  4. Leukocyte-filtered PRBCs
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10
Q

What are saline-washed RBCs used for?

A
  1. neonatal and intrauterine transfusion

2. recurrent or severe allergy to plasma proteins

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11
Q

What are frozen-thawed deglycerolized PRBCs used for?

A
  1. rare blood types

2. Autologous transfusion

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12
Q

What are Leukocyte-poor washed RBCs used for?

A
  1. repeated nonhemolytic febrile transfusion reactions
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13
Q

What are people who have leukocyte-poor washed RBCs at risk for?

A
  1. post-transfusion cytomegalovirus
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14
Q

What is Fresh Frozen Plasma?

A
  1. plasma separated from cells and frozen with in 6 hours of collection from donor
  2. contains most clotting factors
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15
Q

What is fresh frozen plasma used for?

A
  1. the treatment of actively bleeding patients w/ multiple coagulation deficiencies 2-degree liver disease
  2. Patients with DIC
  3. Dilutional coagulopathy 2-degree massive volume load or volume replacement
  4. warfarin reversal
  5. to provide blood volume expansion or a source of protein
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16
Q

When should fresh frozen plasma be used by?

A

w/in 24 hours of thawing

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17
Q

When are platelets usually given?

A
  1. presence of functionally abnormal platelets

2. second-degree thrombocytopenia (uremia, leukemia, chemotherapy)

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18
Q

What information is needed before given platelets?

A
  1. ABO compatibility (preferred)
  2. Rh (preferred)
  3. Specific platelet filter (required)
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19
Q

What is cryoprecipitate?

A
  1. extracted from cold-thawed plasma
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20
Q

What should the patient be before giving cryoprecipitate?

A

ABO compatible

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21
Q

What is cryoprecipitate usually given for?

A
  1. used to control bleeding associated with a deficiency or defect in one of the coagulation factors
  2. Treatment of Hemophilia A, von Willebrand’s disease, Factor VIII deficiency, hypofibrinogenemia, obstetric complications
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22
Q

What are the different types of Plasma Derivatives?

A
  1. 5% Albumin
  2. 25% Albumin (hypertonic)
  3. Plasma Protein Fraction
  4. Factor IX Concentration
  5. WBCs (granulocytes)
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23
Q

When is 5% albumin usually given?

A
  1. plasma volume expansion in hypovolemic shock secondary to trauma or surgery
  2. Supports blood pressure during hypotensive episodes
  3. Used to induce diuresis in FVE
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24
Q

When is 25% albumin typically used?

A
  1. plasma volume expansion
  2. Treatment of hypovolemic shock
  3. Treatment of thermal injury associated w/ hyperproteinemia
  4. Prevention and Treatment of cerebral edema
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25
Q

What is Plasma Protein Fraction typically used for?

A

Same things as 5% albumin

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26
Q

What is Factor IX concentration typically used for?

A
  1. prevention and control of bleeding w/ Hemophilia B

2. Factor VII and X deficiencies

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27
Q

What are WBCs typically given for?

A
  1. Profound neutropenia in patients expected to recover

2. severe granulocytopenia

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28
Q

What should physician orders include for blood components?

A
  1. blood components to be transfused
  2. Number of units to be transfused
  3. Possibly pre-medication
  4. use of blood warmer
  5. Microaggregate or leukocyte depleting filtration
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29
Q

What needs to be done with regard to issue and transfer before giving?

A
  1. getting the blood from the blood bank
  2. Mandatory blood transfusion requisition
  3. Transfer mode to floor depends on the agency
  4. Generally one unit transported at a time
  5. Visual exam before leaving blood bank for unusual color, clotting, presence of air bubbles, evidence of contamination, and integrity container
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30
Q

How many people should cross-check the patient before giving blood?

A

2

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31
Q

What should be cross-checked with the patient before giving blood?

A

Check the patient’s ID, date of birth, blood tag, transfusion requisition form, ABO and Rh compatibility, and expiration date at the bedside

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32
Q

How should patient identification be done?

A
  1. check name and unit number on blood tag with face sheet in patient’s chart
  2. ask patient to identify himself or herself by complete name
  3. hospital numbers in ID bracelet must correspond with numbers on blood tag
  4. Any discrepancy must be investigated and corrected prior to transfusion
  5. Blood should NEVER be given to patient lacking ID bracelet
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33
Q

How should blood be handled?

A
  1. transfusion begins within 30 minutes of leaving the blood bank to prevent excessive warming
  2. Should never be placed in the nursing division refrigerator
  3. Unit of blood must be returned to blood bank if 30-minute time limit can’t be met
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34
Q

What is the general rule regarding temperature before giving blood?

A

Notify the physician if the temp is 1-degree centigrade or 1.8 degrees above the patient’s normal temperature prior to initiation of transfusion

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35
Q

What is the only solution that can initiate a transfusion?

A

Normal saline

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36
Q

Why can’t Dextrose 5% and Lactated Ringers be used with blood?

A
  1. dextrose in water will cause red cell hemolysis

2. LR: Its calcium content overcomes the anticoagulant effect of the preservative allowing small clots to develop

37
Q

Should anything ever be added or given with blood or administered simultaneously through the same set except normal saline?

A

NO

38
Q

What is the standard blood filter?

A

170 microns

39
Q

What micro aggregate filter amount is often ordered for patients with compromised pulmonary function?

A

20-40 microns

40
Q

What peripheral venipuncture sites should be used and avoided?

A
  1. use veins with adequate diameter to ensure flow of viscous component
  2. avoid lower extremities in adults
  3. avoid areas of joint flexion
41
Q

What is the general rate of infusions?

A

1.5-2 hours

42
Q

What usually happens if the infusion is longer than 4 hours?

A

a separate unit is needed

43
Q

How long should blood be hung for with bacterial proliferation?

A

> 4 hours hang time

44
Q

During the 1st 15 minutes of blood transfusions should the rate be slow or fast and why?

A

Slow to observe for immediate reactions

45
Q

What are the signs and symptoms of a transfusion reaction?

A
  1. Change in vital signs
  2. chills
  3. headache
  4. dyspnea
  5. Urticaria
  6. Flushing
  7. Nausea/vomiting
  8. Lumbar or flank pain
46
Q

What is the only thing that can warm blood?

A

Blood warmers (controlled temperature devices specifically designed to warm blood)

47
Q

What should the nurse try to avoid being scheduled during transfusions?

A

Diagnostic tests or therapies

48
Q

What must be done after a transfusion is completed?

A
  1. flush set with approximately 50 mL of Normal Saline
  2. All transfusion-related equipment to be disposed of per agency protocol
  3. Continue patient observation for one hour post-transfusion
49
Q

What should be documented with blood transfusions?

A
  1. Component ID number
  2. Date/time of initiation and completion
  3. Venipuncture site- type/gauge of cannula
  4. Volume of normal saline infused
  5. Volume and component transfused
  6. Rate of transfusion
  7. ABO &Rh classification- recipient/donor unit
  8. Vital signs
  9. Patient tolerance
  10. Use of equipment (warmer)
  11. Signatures of both individuals involved in the patient-blood identifying process
50
Q

When do immediate reactions typically occur?

A

within 48 hours of transfusion (most occur within the first 15 min)

51
Q

When can delayed reactions occur?

A

within days, months, or years after transfusion

52
Q

Why would an immediate reaction occur?

A

The recipient’s entire antibody load reacts with the donor’s red cells with resultant rapid destruction of red cells through hemolysis

53
Q

What can happen if 30 mL of incompatible blood are given to a patient?

A

fatal outcomes

54
Q

How could a reaction be prevented?

A

Proper identification!!!!

55
Q

What are some potential life-threatening consequences of a blood transfusion reaction?

A
  1. severe hypotension
  2. shock
  3. Disseminated intravascular coagulation (DIC)
  4. Acute renal failure
56
Q

What are the symptoms of an immunologic IMMEDIATE transfusion reaction?

A
  1. burning sensation along vein
  2. fever and chills
  3. Nausea
  4. SOB
  5. Lumber and chest pain
  6. Hypotension
  7. Flushing
  8. Oozing of blood at IV site
  9. Anuria
  10. hemoglobinura
57
Q

What are the nursing interventions for an immunologic immediate transfusion reaction?

A
  1. Stop the transfusion
  2. KVO w/ normal saline
  3. If “Y” tubing, attach new fluid setup connected directly to cannula
  4. DO NOT open the flow to the NS of the “Y” set- results in patient receiving additional red blood cells
  5. Notify physician and supervisor
  6. Notify blood bank
  7. Initiate approved reaction protocol
58
Q

What are the treatments for immediate transfusion reactions?

A
  1. increase renal perfusion (Rapid infusion of IV fluids, Administration of diuretics, Maintain urinary flow rate of an adult at or over 100 mL/hour for at least 18-24 hours)
  2. Management of shock with vasopressors
  3. In severe reactions w/ prolonged renal failure- dialysis
59
Q

What is the most frequently encountered reaction?

A

Febrile nonhemolytic reactions

60
Q

How do febrile nonhemolytic reactions occur?

A

recipient’s anti-HLA antibodies reacting against antigens on donor’s WBC or platelets

61
Q

What are the symptoms of febrile nonhemolytic reactions?

A
  1. Seldom occur earlier than one hour after initiation of transfusion, generally 1-6 hours after initiation
  2. flushing
  3. temperature
  4. chills
  5. anxiety
  6. Muscle pain
  7. Headache
62
Q

What are the nursing interventions for febrile nonhemolytic reactions?

A
  1. stop the transfusion
  2. KVO w/ normal saline w/ a new fluid set connected to the cannula
  3. Notify physician
  4. Notify the blood bank
  5. Treatment usually symptomatic
  6. transfusion may continue if Dr. orders with mild reaction
  7. Prevent with subsequent units (filters)
63
Q

How do Urticarial reactions occur?

A

Believed to be the presence of soluble substances in the donor’s plasma reacting with IgE antibodies on the recipient’s mast cells and basophils

64
Q

What are the signs and symptoms of urticarial reactions?

A
  1. erythema
  2. hives
  3. pruritis
65
Q

What are the nursing interventions for urticarial reactions?

A
  1. stop flow of blood and KVO with NS
  2. Notify the physician
  3. Notify the blood bank
66
Q

What is the treatment for urticarial reactions?

A
  1. administration of IM or IV antihistamine

2. Transfusion is often ordered to continue after administration of antihistamine

67
Q

What are the distinctive features of anaphylactic reactions to transfusions?

A
  1. occurs after the infusion of only a few mL of blood or plasma
  2. ABSENCE OF FEVER
68
Q

What are the symptoms of anaphylactic transfusion reactions?

A
  1. anxiety
  2. flushing
  3. hypotension
  4. GI distress
  5. respiratory distress
  6. Angioedema
  7. Vascular collapse
  8. Loss of consciousness
69
Q

What are the nursing interventions for anaphylactic transfusion reactions?

A
  1. stop the transfusion
  2. KVO with NS through a new fluid set connected to the cannula
  3. Obtain emergency medical intervention
  4. Treat as a drug anaphylactic reaction
70
Q

Why can bacterial sepsis occur because of nonimmunologic immediate transfusion reactions?

A

Bacterial contamination of unit of blood:

  1. occurred at the time of donation
  2. during component preparation
  3. result of improper storage
  4. result of damage to container
71
Q

What are some preventative measures that can be taken to prevent bacterial sepsis with an interaction?

A
  1. visually inspect blood prior to giving

2. do not give if it has a purple color, presence of clots, bubbles, or a compromised container

72
Q

What are the signs and symptoms of bacterial sepsis with reactions?

A
  1. elevated temp
  2. rapid onset of chills
  3. Marked hypotension
  4. vomiting
  5. diarrhea
  6. shock
  7. DIC
  8. renal failure
73
Q

What are the nursing interventions for bacterial sepsis due to a reaction?

A
  1. stop the transfusion
  2. KVO with NS through new fluid set connected to the cannula
  3. Aseptically preserve the suspected component container and attached set
  4. Notify the physician STAT
  5. Notify the blood bank
  6. Treat aggressively; directed at managing shock and treating sepsis
74
Q

Why can circulatory overload occur?

A
  1. transfusion administered too rapidly
  2. excessive volume administered
  3. Individuals of small stature
  4. Age-very young or elderly
  5. Patients already cardiac or pulmonary decompensated
75
Q

What are the symptoms of circulatory overload?

A
  1. severe pounding headache
  2. dyspnea
  3. Tachycardia
  4. HTN
  5. Engorged neck veins
76
Q

What are the nursing interventions for circulatory overload?

A
  1. stop the transfusion
  2. place the patient in fowler’s position
  3. notify Dr. STAT
  4. Administer O2 and a diuretic
77
Q

Why could someone get hypothermia during a transfusion?

A
  1. occurs when massive volumes of cold blood are rapidly infused
  2. Risk intensified when transfusion administered via central venous access
78
Q

What are the signs and symptoms of hypothermia because of transfusions?

A
  1. shaking chills
  2. vasoconstriction
  3. hypotension
  4. cardiac arrest if untreated
79
Q

What are the nursing interventions for transfusion-induced hypothermia?

A

Provide warmth measures

notify physician STAT

80
Q

What can be done to prevent transfusion-induced hypothermia?

A

Use designated automatic blood warmer during rapid transfusion therapy and during massive replacement therapy.

81
Q

How can citrate toxicity occur with transfusions?

A

Rare reaction caused by the preservative citrate. Citrate chelates the recipient’s serum calcium w/ resultant hypocalcemia

82
Q

What are the symptoms of citrate toxicity?

A
  1. tingling of fingers
  2. circumoral tingling
  3. muscular cramping
  4. hypotension (if untreated)
  5. Convulsions
  6. possible cardiac arrest
83
Q

What patients are at high risk for citrate toxicity?

A

patients with impaired liver functions

84
Q

What are the nursing interventions for citrate toxicity?

A
  1. stop the transfusion
  2. notify the physician STAT
  3. Treat w/ administration of IV calcium chloride if patient severely symptomatic
85
Q

What are the possible causes for an air embolism?

A
  1. failure to clear administration set of air prior to use
  2. employing improper technique when changing blood/fluid container
  3. Haphazard use of Y-type administration set
  4. Accidental disconnect of the set from the cannula
86
Q

What are the Symptoms of an air embolism

A
  1. sudden onset of pallor
  2. Cyanosis
  3. Weak, rapid pulse
  4. Dyspnea
  5. Hypotension
  6. Convulsions
  7. Shock
  8. Possible cardiac arrest
87
Q

What are the nursing interventions for air embolism?

A
  1. stop source of air
  2. Place patient on L side in Trendelenburg
  3. Obtain immediate medical assistance
88
Q

What must be reported to the FDA and CDC?

A
  1. transfusion-related fatalities must be reported to the FDA within 24 hours and a written report of investigation within 7 days
  2. Transfusion generated sepsis reported to the CDC

PCC4 (38 decks)

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