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3910 Health Promotion & Caring: Client's with Health Challenges I > Week 2 Acid/Base & Hematology > Flashcards

Week 2 Acid/Base & Hematology Flashcards

1
Q

Minor Buffer Systems

A
  • Hemoglobin
  • Proteins
  • Phosphates
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2
Q

Major Buffer System

A
  • Bicarbonate-Carbonic Acid
    20 HCO3 : 1 H2CO3 = 20:1 ratio
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3
Q

Nursing Assessments Acid Base Imbalances

A
  • Arterial blood gases (ABGs) - only way to measure body pH
  • Vital signs - RR, SpO2
  • Intake/output, electrolytes
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4
Q

Potassium Acidosis

A
  • 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
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5
Q

Potassium Alkalosis

A
  • H+ inside cell moves outside to balance pH
  • K+ moves inside cell to balance electric forces
  • Decrease serum K+
  • Alkalosis causes hypokalemia
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6
Q

Increased CO2

A
  • Decreased RR
  • Acidosis
  • CNS depression, lung health issues
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7
Q

Decreased CO2

A
  • Increased RR
  • Alkalosis
  • Hyperventilation
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8
Q

Acidosis Compensation

A
  • Increased RR to blow off CO2
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9
Q

Alkalosis Compensation

A
  • Decreased RR to retain CO2
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10
Q

Respiratory Acidosis

A
  • Low pH high CO2
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11
Q

Respiratory Acidosis Causes

A
  • Deficits in lung function = retain CO2
  • Airway obstruction, depression of resp system
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12
Q

Respiratory Acidosis Signs/Symptoms

A
  • Hypoventilation
  • Shallow resps
  • Low RR
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13
Q

Respiratory Acidosis Interventions

A
  1. Support breathing - semi fowlers
  2. Encourage deep breathing & coughing
  3. Administer O2
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14
Q

Respiratory Alkalosis

A
  • High pH low CO2
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15
Q

Respiratory Alkalosis Causes

A
  • Increase in RR, blow of CO2
  • Panic attack
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16
Q

Respiratory Alkalosis Signs/Symptoms

A
  • Hyperventilation
  • Increased RR
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17
Q

Respiratory Alkalosis Interventions

A
  1. Support breathing - semi fowlers
  2. Encourage deep breathing and coughing
  3. Administer O2
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18
Q

Decreased H+

A
  • Alkalosis
  • At risk: upper GI losses, loss of acid
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19
Q

Decreased HCO3-/Increased H+

A
  • Acidosis
  • At risk: lower GI, loss of base, kidney failure, inappropriate secretion of base/retention of H+
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20
Q

Acidosis Compensation

A
  • Increased H+ secretion
  • Urine output
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21
Q

Alkalosis Compensation

A
  • Increased HCO3- secretion
  • Urine output
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22
Q

Metabolic Acidosis

A
  • Low pH & low HCO3-
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23
Q

Metabolic Acidosis Causes

A
  • Lower GI losses = loss of bicarb
  • Kidney failure = inappropriate secretion of bicarb
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24
Q

Metabolic Acidosis Signs/Symptoms

A
  • Diarrhea
  • Kidney failure
  • Compensation by resp system to get rid of acid = increased RR
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25
Q

Metabolic Acidosis Interventions

A
  • Monitor increase K, may administer K removers
  • Correct cause administer IV base
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26
Q

Metabolic Alkalosis

A
  • Hight pH & high HCO3
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27
Q

Metabolic Alkalosis Causes

A
  • Upper GI losses = loss of H+
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28
Q

Metabolic Alkalosis Signs/Symptoms

A
  • Vomiting, high volume of GI suction
  • S/S kidney failure
  • Compensation by resp - retain acid to bring back neutral decrease RR
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29
Q

Metabolic Alkalosis Interventions

A
  • Monitor K, may administer K supplementations
  • Correct cause
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30
Q

Uncompensated

A
  • pH abnormal
  • Other measure normal
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31
Q

Partially Compensated

A
  • pH abnormal
  • Other measure abnormal + opposite
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32
Q

Fully Compensated

A
  • pH normal
  • Measures (1 or both abnormal)
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33
Q

Compensation

A
  • Will eventually break down
  • Correct root cause
  • Just because pH is normal does not mean no intervention
34
Q

Erythrocyte Layer Components

A
  • RBC
  • Hemoglobin HGB
  • Hematocrit Hct
35
Q

Buffy Coat Components

A
  • WBC
  • Platelets Plt
36
Q

RBC Caution

A

Can have low RBC without impacting hemoglobin

37
Q

Hemoglobin HGB

A
  • Protein that carries oxygen
38
Q

Hematocrit Hct

A
  • Reflects hydration
  • % by volume of RBC in proportion to plasma volume
39
Q

Low Platelets Plt

A
  • Poor clotting, more bleeding
  • Thrombocytopenia
40
Q

High Platelets

A
  • Thrombocytosis
  • Clotting
41
Q

Low Hematocrit

A
  • Fluid overload
  • RBCs diluted due to excess fluid
42
Q

High Hematocrit

A
  • Fluid deficit
  • High concentration of RBC due to lack of fluid
43
Q

Prothromin Time/Internationalized Ratio PT/INR

A

Clotting times 11-13 seconds

44
Q

Low PT/INR

A
  • Lower clotting ability
  • More bleeding
  • Thinner Blood
45
Q

High PT/INR

A
  • Quick Clotting
46
Q

High RBCs

A
  • Erythrocytosis
  • Chronic hypoxia
  • Increase erythropoietin
47
Q

Low RBCs

A
  • Anemias
  • Loss/destruction of RBCs
  • Decrease erythropoietin
  • Bone marrow suppression (cancers & chemotherapy)
48
Q

Low Hemoglobin

A
  • Anemias
  • Loss/destruction of RBCs
  • Decrease erythropoietin
  • Bone marrow suppression (cancers & chemotherapy)
49
Q

High WBCs

A
  • Leukocytosis
  • Infection
50
Q

Low WBCs

A
  • Leukopenia
  • Immunosuppression
51
Q

Normal Clotting

A
  1. Vasoconstriction
  2. Formation of platelet plug
    - Adhesion
    - Activation & secretion - recruit more platelets
    - Aggregation - platelet club (not strong) block site
  3. Formation of fibrin clot
    - Clotting factors in blood (12 factors) work to make fibrin threads woven into platelet plug
52
Q

Blood Transfusion Cautions

A
  1. Ensuring correct blood product is administered
  2. Close monitoring for transfusion reactions
53
Q

Pre-Transfusion Role

A
  • Consent
  • Review orders (clear, complete, appropriate)
  • Assessment
  • Equipment
54
Q

Transfusion Consent

A
  • Obtained by physician
  • Only for that type of product
  • Description of product
  • Risks & benefits
  • Alternatives
  • Rationale for treatment
55
Q

Blood Products Without Consent

A
  • Urgent transfusion to preserve life
  • Patient unable to consent & substitute decision maker unavailable
  • No prior evidence refusing blood products (religious/personal)
56
Q

Transfusion Order Components

A
  • First & last name + unique identifier
  • Type of blood product
  • Number of units/amount
  • Rate of infusion
57
Q

Pre-Transfusion Assessment

A
  • Typing
  • Health history
  • Physical Assessment
58
Q

Group/Type & Screen

A
  • Identified patient blood type, always required
  • Exception, emergency give universal donor O-
59
Q

Crossmatch

A
  • Tests patients blood with donor blood
  • Required for all transfusions that are non-emergent/urgent
  • Decrease risk of reaction
60
Q

Health History Questions

A
  • Transfusion history
  • Past transfusion reactions
  • Obstetrical history - fetal blood exposure could create maternal antibodies
61
Q

Physical Assessment

A
  • Vitals - temp max 30 mins prior
  • Respiratory
  • CV - edema, fluid overload risk
  • Integumentary - rashes, petechiae, bruising
62
Q

Pre-Transfusion Medications

A
  • Antipyretic - history of febrile reactions
  • Antihistamine - history of allergic reactions
  • Oral route - 30mins prior
  • IV route - immediately prior
63
Q

Equipment Considerations

A
  • Saline is the only fluid that can be given with blood
  • Prime tubing with saline ONLY
  • Reaction, new saline bag, not attached to blood
64
Q

Transfusion MUSTS

A
  • 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
65
Q

5 Rights of Transfusion

A
  1. Patient
  2. Product
  3. Amount
  4. Rate
    5.Time
66
Q

Transfusion Monitoring

A
  1. 0-15mins start SLOW (50mL/hr) monitor closely
  2. 15mins recheck vitals, if stable increase rate according to orders
  3. Q hour, reassess vitals & patient
    - Increase vitals monitoring if patient at high risk of complication/reaction
  4. Instruct pt to notify immediately (hives, itching, fever, chills, SOB, pain at infusion)
67
Q

Packed Red Blood Cells Major Uses

A
  • Most common type of transfusion
  • Bleeding/anemia
  • S/S of impaired tissue oxygen delivery
  • Tachycardia, SOB, dizziness
68
Q

Pack Red Blood Cells Administration

A
  • Blood tubing required
  • Typically infuse over 1.5-2hours
  • Slower infusion for patients at risk for circulatory overload
69
Q

PRBCs Impact

A
  • Changes to Hemoglobin 4-6hrs post transfusion
  • 1 unit of PRBCs typically = increase 10g/L Hbg 3%Hct
  • No increase, think bleeding
70
Q

Fresh Frozen Plasma Uses

A
  • Volume expansion - massive transfusion with PRBCs
  • Clotting factors, coagulopathy, plasma exchange
71
Q

Fresh Frozen Plasma Administration

A
  • Blood tubing required
  • 30mins-2 hours
72
Q

Platelets Uses

A
  • Control/prevent bleeding
  • Low platelet counts
  • Congenital platelet dysfunction
  • Poor function of platelets - medications
  • Post cardiopulmonary bypass
73
Q

Platelet Administration

A
  • Blood tubing required
  • Infuse over 60mins
74
Q

S/S Transfusion Reaction

A
  • 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
75
Q

Minor Allergic Reaction

A
  • Reaction to allergen in the blood component/product
  • Mild rash, itching, warm
  • Administer antihistamines
  • Slow transfusion
  • Most common reaction
76
Q

Anaphylaxis

A
  • Potentially fatal
  • Emergency, difficulty breathing, loss of airway, hives
  • Stop transfusion
77
Q

Febrile Non-Hemolytic

A
  • Self-limit reaction associated with donor WBCs/cytokines
  • Mild fever, rigors
  • Administer antipyretics
  • Slow transfusion
78
Q

Bacterial Sepsis - Platelet Pool & RBCs

A
  • Potentially fatal, bacteria introduced to blood
  • Room temp storage - Platelets more common
  • Emergency
  • Stop transfusion
79
Q

Acute Hemolytic Transfusion Reaction

A
  • Potentially fatal, blood group incompatibility
  • Emergency, hypotension, back pain, fever
  • Stop transfusion
80
Q

Transfusion Related Acute Lung Injury TRALI

A
  • Acute hypoxemia, no evidence of circulatory overload
  • Emergency, dyspnea & tachypnea, SpO2 below 90%
  • Stop transfusion
81
Q

Transfusion Associated Circulatory Overload TACO

A
  • Due to rapid transfusion
  • Mild fluid volume overload symptoms
  • Tachycardia, hypotension, SpO2 drops
  • Administer diuretics
  • Prevent by transfusing very slowly
82
Q

Emergency Reaction

A
  1. Stop transfusion immediately
  2. Maintain IV assess, do not flush blood tubing
  3. Check vitals
  4. Verify patient ID matches blood bank tag & label
  5. Verify blood unit number matches blood bank label & tag
  6. Notify physician, remain with patient
  7. Notify blood bank about reaction
  8. Treat symptoms as ordered by provider

3910 Health Promotion & Caring: Client's with Health Challenges I (15 decks)

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