TOPIC 6 - anemia & blood transfusions Flashcards
blood disorders
iron deficiency
vitamin B12 deficiency
folic acid deficiency
sickle cell anemia
aplastic anemia
anemia is
a deficiency of the number of erythrocytes
change in quantity or quality of Hgb
change in volume of packed RBC (Hct)
causes of anemia
blood loss, impaired production of erythrocytes, increased destruction of erythrocytes
clinical manifestations are based on
rate at which anemia has evolved
severity
coexisting diseases
symptoms of anemia
fatigue, weakness, SOB, lightheadedness, pallor, palpitations, chest pain, angina, MI, dizzy, fainting, rapid HR, glossitis
normocytic anemia
aplastic or sickle cell anemia
CAUSES:
aplastic: inherited, leukemia, CKD, something taken into the body
sickle cell: inherited
clinical manifestations of sickle cell disease
fever, swelling, tenderness, tachypnea, HTN, nausea, vomiting
triggers for sickle cell episodes
hypoxia or deoxygenated RBC caused by:
viral or bacterial infection
high altitude
surgery
blood loss
dehydration
low body temp
microcytic anemia
iron deficiency or thalassemia
causes and risk factors for iron deficiency
inadequate intake of iron
poor GI absorption
blood loss (most common)
causes of thalassemia
inadequate Hgb production which decreases RBC production
s/s of thalassemia
physical and mental growth changes, pale and jaundice, splenomegaly, hepatomegaly, cardiomyopathy
treatment of thalassemia
blood transfusion and splenectomy
macrocytic anemia
vitamin B12 deficient or folic acid deficient
foods rich in folic acid
orange juice, romaine, spinach, liver, rice, barley, sprouts, wheat germ, beans, peanuts, broccoli, asparagus, peas, chickpeas, eggs, meats, poultry, milk, shellfish
assessment
neuro - increased somnolence, fatigue, headache
resp - dyspnea on exertion, decreased O2
cardio - tachy, murmurs, ortho hypotension
integumentary - pallor, cool to touch, intolerance of cold, brittle nails
nursing diagnosis
ineffective tissue perfusion, risk for FVD, acute pain, risk for impaired skin integrity, deficient knowledge, ineffective coping
treatments
focus on treating underlying cause, blood transfusions as ordered, iron/B12/folic acid supplements, epoetin alpha injections, routine blood monitoring
interventions
cluster and plan activities and rest
exercise program to increase activity intolerance
nutrition plan
hemophilia
missing link in the clotting cascade (cant clot)
TYPE A: missing factor VIII
TYPE B: missing factor IX
assessments
slow persistent prolonged bleeding, delayed bleeding after minor injuries, uncontrollable hemorrhage, epistaxis, GI bleed, hematuria, kidney failure, splenic rupture, ecchymoses and SQ hematoma, compartment syndrome, neuro (pain, paralysis), hemarthrosis
acute interventions
stop the bleeding - direct pressure
admin clotting factors
rest joint if bleeding
assess airway bleeding
types of blood products
packed RBC
fresh frozen plasma
platelets
albumin
Rh factor
check first (on blood bag)
blood type, name, MRN, exp date, unit #, both RNs document
before transfusion
verify order, consent, labs, 20 gauge IV, use 0.9% NaCl to prime tubing, obtain blood, verify again
during transfusion
vitals prior to infusion, vitals every 15 min after begin, every hour until completed, use blood transfusion tubing, only 0.9% NS to prime, remain with client 15-30 min of infusion, infuse over 2-4 hours, monitor for reaction
possible complications
fluid volume overload, mild allergic reaction, febrile reaction, acute hemolytic reaction
