Week 2 Acid/Base & Hematology Flashcards
Minor Buffer Systems
- Hemoglobin
- Proteins
- Phosphates
Major Buffer System
- Bicarbonate-Carbonic Acid
20 HCO3 : 1 H2CO3 = 20:1 ratio
Nursing Assessments Acid Base Imbalances
- Arterial blood gases (ABGs) - only way to measure body pH
- Vital signs - RR, SpO2
- Intake/output, electrolytes
Potassium Acidosis
- High H+ outside of cell, move into cell to balance pH
- K+ moves outside cell to balance electric forces
- Increase serum K+
- Acidosis causes hyperkalemia
Potassium Alkalosis
- H+ inside cell moves outside to balance pH
- K+ moves inside cell to balance electric forces
- Decrease serum K+
- Alkalosis causes hypokalemia
Increased CO2
- Decreased RR
- Acidosis
- CNS depression, lung health issues
Decreased CO2
- Increased RR
- Alkalosis
- Hyperventilation
Acidosis Compensation
- Increased RR to blow off CO2
Alkalosis Compensation
- Decreased RR to retain CO2
Respiratory Acidosis
- Low pH high CO2
Respiratory Acidosis Causes
- Deficits in lung function = retain CO2
- Airway obstruction, depression of resp system
Respiratory Acidosis Signs/Symptoms
- Hypoventilation
- Shallow resps
- Low RR
Respiratory Acidosis Interventions
- Support breathing - semi fowlers
- Encourage deep breathing & coughing
- Administer O2
Respiratory Alkalosis
- High pH low CO2
Respiratory Alkalosis Causes
- Increase in RR, blow of CO2
- Panic attack
Respiratory Alkalosis Signs/Symptoms
- Hyperventilation
- Increased RR
Respiratory Alkalosis Interventions
- Support breathing - semi fowlers
- Encourage deep breathing and coughing
- Administer O2
Decreased H+
- Alkalosis
- At risk: upper GI losses, loss of acid
Decreased HCO3-/Increased H+
- Acidosis
- At risk: lower GI, loss of base, kidney failure, inappropriate secretion of base/retention of H+
Acidosis Compensation
- Increased H+ secretion
- Urine output
Alkalosis Compensation
- Increased HCO3- secretion
- Urine output
Metabolic Acidosis
- Low pH & low HCO3-
Metabolic Acidosis Causes
- Lower GI losses = loss of bicarb
- Kidney failure = inappropriate secretion of bicarb
Metabolic Acidosis Signs/Symptoms
- Diarrhea
- Kidney failure
- Compensation by resp system to get rid of acid = increased RR
Metabolic Acidosis Interventions
- Monitor increase K, may administer K removers
- Correct cause administer IV base
Metabolic Alkalosis
- Hight pH & high HCO3
Metabolic Alkalosis Causes
- Upper GI losses = loss of H+
Metabolic Alkalosis Signs/Symptoms
- Vomiting, high volume of GI suction
- S/S kidney failure
- Compensation by resp - retain acid to bring back neutral decrease RR
Metabolic Alkalosis Interventions
- Monitor K, may administer K supplementations
- Correct cause
Uncompensated
- pH abnormal
- Other measure normal
Partially Compensated
- pH abnormal
- Other measure abnormal + opposite
Fully Compensated
- pH normal
- Measures (1 or both abnormal)
Compensation
- Will eventually break down
- Correct root cause
- Just because pH is normal does not mean no intervention
Erythrocyte Layer Components
- RBC
- Hemoglobin HGB
- Hematocrit Hct
Buffy Coat Components
- WBC
- Platelets Plt
RBC Caution
Can have low RBC without impacting hemoglobin
Hemoglobin HGB
- Protein that carries oxygen
Hematocrit Hct
- Reflects hydration
- % by volume of RBC in proportion to plasma volume
Low Platelets Plt
- Poor clotting, more bleeding
- Thrombocytopenia
High Platelets
- Thrombocytosis
- Clotting
Low Hematocrit
- Fluid overload
- RBCs diluted due to excess fluid
High Hematocrit
- Fluid deficit
- High concentration of RBC due to lack of fluid
Prothromin Time/Internationalized Ratio PT/INR
Clotting times 11-13 seconds
Low PT/INR
- Lower clotting ability
- More bleeding
- Thinner Blood
High PT/INR
- Quick Clotting
High RBCs
- Erythrocytosis
- Chronic hypoxia
- Increase erythropoietin
Low RBCs
- Anemias
- Loss/destruction of RBCs
- Decrease erythropoietin
- Bone marrow suppression (cancers & chemotherapy)
Low Hemoglobin
- Anemias
- Loss/destruction of RBCs
- Decrease erythropoietin
- Bone marrow suppression (cancers & chemotherapy)
High WBCs
- Leukocytosis
- Infection
Low WBCs
- Leukopenia
- Immunosuppression
Normal Clotting
- Vasoconstriction
- Formation of platelet plug
- Adhesion
- Activation & secretion - recruit more platelets
- Aggregation - platelet club (not strong) block site - Formation of fibrin clot
- Clotting factors in blood (12 factors) work to make fibrin threads woven into platelet plug
Blood Transfusion Cautions
- Ensuring correct blood product is administered
- Close monitoring for transfusion reactions
Pre-Transfusion Role
- Consent
- Review orders (clear, complete, appropriate)
- Assessment
- Equipment
Transfusion Consent
- Obtained by physician
- Only for that type of product
- Description of product
- Risks & benefits
- Alternatives
- Rationale for treatment
Blood Products Without Consent
- Urgent transfusion to preserve life
- Patient unable to consent & substitute decision maker unavailable
- No prior evidence refusing blood products (religious/personal)
Transfusion Order Components
- First & last name + unique identifier
- Type of blood product
- Number of units/amount
- Rate of infusion
Pre-Transfusion Assessment
- Typing
- Health history
- Physical Assessment
Group/Type & Screen
- Identified patient blood type, always required
- Exception, emergency give universal donor O-
Crossmatch
- Tests patients blood with donor blood
- Required for all transfusions that are non-emergent/urgent
- Decrease risk of reaction
Health History Questions
- Transfusion history
- Past transfusion reactions
- Obstetrical history - fetal blood exposure could create maternal antibodies
Physical Assessment
- Vitals - temp max 30 mins prior
- Respiratory
- CV - edema, fluid overload risk
- Integumentary - rashes, petechiae, bruising
Pre-Transfusion Medications
- Antipyretic - history of febrile reactions
- Antihistamine - history of allergic reactions
- Oral route - 30mins prior
- IV route - immediately prior
Equipment Considerations
- Saline is the only fluid that can be given with blood
- Prime tubing with saline ONLY
- Reaction, new saline bag, not attached to blood
Transfusion MUSTS
- Start transfusion within 30 minutes of picking up blood
- Independent double check of blood (2 registered staff)
- 5 rights of transfusion
- Finish within 4 hours
- Document baseline vitals
- Document start & finish time + patient tolerance
5 Rights of Transfusion
- Patient
- Product
- Amount
- Rate
5.Time
Transfusion Monitoring
- 0-15mins start SLOW (50mL/hr) monitor closely
- 15mins recheck vitals, if stable increase rate according to orders
- Q hour, reassess vitals & patient
- Increase vitals monitoring if patient at high risk of complication/reaction - Instruct pt to notify immediately (hives, itching, fever, chills, SOB, pain at infusion)
Packed Red Blood Cells Major Uses
- Most common type of transfusion
- Bleeding/anemia
- S/S of impaired tissue oxygen delivery
- Tachycardia, SOB, dizziness
Pack Red Blood Cells Administration
- Blood tubing required
- Typically infuse over 1.5-2hours
- Slower infusion for patients at risk for circulatory overload
PRBCs Impact
- Changes to Hemoglobin 4-6hrs post transfusion
- 1 unit of PRBCs typically = increase 10g/L Hbg 3%Hct
- No increase, think bleeding
Fresh Frozen Plasma Uses
- Volume expansion - massive transfusion with PRBCs
- Clotting factors, coagulopathy, plasma exchange
Fresh Frozen Plasma Administration
- Blood tubing required
- 30mins-2 hours
Platelets Uses
- Control/prevent bleeding
- Low platelet counts
- Congenital platelet dysfunction
- Poor function of platelets - medications
- Post cardiopulmonary bypass
Platelet Administration
- Blood tubing required
- Infuse over 60mins
S/S Transfusion Reaction
- Within 6 hours post transfusion
- Change in body temp*****
- Shaking, chills, rigors
- Hives, rash, itchiness, swelling
- Dyspnea, SOB, wheezing
- Hypo/hypertension
- Hematuria, diffuse bleeding
- Pain at IV site
- Nausea, vomit
- Headache
Minor Allergic Reaction
- Reaction to allergen in the blood component/product
- Mild rash, itching, warm
- Administer antihistamines
- Slow transfusion
- Most common reaction
Anaphylaxis
- Potentially fatal
- Emergency, difficulty breathing, loss of airway, hives
- Stop transfusion
Febrile Non-Hemolytic
- Self-limit reaction associated with donor WBCs/cytokines
- Mild fever, rigors
- Administer antipyretics
- Slow transfusion
Bacterial Sepsis - Platelet Pool & RBCs
- Potentially fatal, bacteria introduced to blood
- Room temp storage - Platelets more common
- Emergency
- Stop transfusion
Acute Hemolytic Transfusion Reaction
- Potentially fatal, blood group incompatibility
- Emergency, hypotension, back pain, fever
- Stop transfusion
Transfusion Related Acute Lung Injury TRALI
- Acute hypoxemia, no evidence of circulatory overload
- Emergency, dyspnea & tachypnea, SpO2 below 90%
- Stop transfusion
Transfusion Associated Circulatory Overload TACO
- Due to rapid transfusion
- Mild fluid volume overload symptoms
- Tachycardia, hypotension, SpO2 drops
- Administer diuretics
- Prevent by transfusing very slowly
Emergency Reaction
- Stop transfusion immediately
- Maintain IV assess, do not flush blood tubing
- Check vitals
- Verify patient ID matches blood bank tag & label
- Verify blood unit number matches blood bank label & tag
- Notify physician, remain with patient
- Notify blood bank about reaction
- Treat symptoms as ordered by provider
