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NRSG 302 > Week 4 - Blood Admin > Flashcards

Week 4 - Blood Admin Flashcards

1
Q

once a blood transfusion starts how long must the RN stay with the patient?

A

first 5 minutes

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2
Q

when you start administering blood how long is the test dose ran for?

A

15 minutes

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3
Q

how often do you need to do beside checks ?

A

every hour

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4
Q

do you need to do a post-transfusion check? When?

A
  • yes
  • 1 hour post-transfusion
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5
Q

can students initiate a transfusions?

A

no

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6
Q

what is blood composed of?

A
  • RBCs
  • WBCs
  • platelets
  • plasma
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7
Q

what percentage of RBCs make up whole blood?

A

45%

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8
Q

what does RBCs contain?

A

hemoglobin

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9
Q

what do RBCs transport?

A

oxygen

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10
Q

where are RBCs formed? what’s the process called?

A
  • bone marrow
  • process called erythropoiesis
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11
Q

how long do RBCs live for?

A
  • about 120 days (4 months)
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12
Q

what percentage of WBCs make up whole blood?

A

< 1%

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13
Q

what are WBCs part of?

A

inflammatory and immune process

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14
Q

where are WBCs formed?

A

bone marrow

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15
Q

what is the life span of WBCs?

A

13-20 days

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16
Q

what percentage of platelets make up whole blood?

A

< 1%

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17
Q

what are platelets part of?

A

clotting process

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18
Q

where are platelets formed?

A

bone marrow

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19
Q

what is the life span of platelets?

A

about 8-9 days

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20
Q

what is plasma?

A

liquid portion of the blood

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21
Q

what is included in plasma?

A
  • albumin
  • fibrinogen
  • globulins
  • other molecules
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22
Q

what is fibrinogen involved in?

A

blood clotting

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23
Q

in regards to plasma, what is included in other molecules that are included in it?

A
  • dissolved nutrients
  • waste products
  • electrolytes
  • hormones
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24
Q

what is a transfusion?

A

when a blood component/ product made from human blood is given through a needle into a vein

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25
Q

what can be transfused?

A
  • whole blood
  • RBC
  • plasma
  • clotting factors
  • plasma derivatives
  • platelets
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26
Q

what is included in fractionated blood products ?

A
  • certain clotting factors
  • albumin
  • immune globulins
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27
Q

what is another name for clotting factors?

A

cryoprecipitate

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28
Q

if a patient has O positive blood what can they receive for RBCs?

A

O+ or O-

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29
Q

if a patient has O negative blood what can they receive for RBCs?

A

O- ONLY

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30
Q

if a patient has A positive blood what can they receive for RBCs?

A

A+
A-
O+
O-

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31
Q

if a patient has A positive blood what can they receive for RBCs?

A

A-
O-

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32
Q

if a patient has B positive blood what can they receive for RBCs?

A

B+
B-
O+
O-

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33
Q

if a patient has B negative blood what can they receive for RBCs?

A

B-
O-

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34
Q

if a patient has AB positive blood what can they receive for RBCs?

A

all groups

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35
Q

if a patient has AB negative blood what can they receive for RBCs?

A

AB-
B-
A-
O-

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36
Q

if a patient has O positive blood what can they receive for plasma?

A

all groups

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37
Q

if a patient has O negative blood what can they receive for plasma?

A

all groups

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38
Q

if a patient has A positive blood what can they receive for plasma?

A

A
AB

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39
Q

if a patient has A negative blood what can they receive for plasma?

A

A
AB

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40
Q

if a patient has B positive blood what can they receive for plasma?

A

B
AB

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41
Q

if a patient has B negative blood what can they receive for plasma?

A

B
AB

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42
Q

if a patient has AB positive blood what can they receive for plasma?

A

only AB

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43
Q

if a patient has AB negative blood what can they receive for plasma?

A

only AB

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44
Q

if someone is Rh positive what does that mean?

A

D antigen is present

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45
Q

if someone is Rh negative what does that mean?

A

D antigen is absent

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46
Q

not only do we have antigens on the surface of our RBCs we also have antibodies where?

A

blood plasma

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47
Q

we have what type of antibodies in our plasma, as we have on our blood cells?

A

opposite

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48
Q

what are the different types of blood products

A
  • packed red blood cells (PRBC)
  • fresh frozen plasma (FFP)
  • platelets
  • cryoprecipitate
  • albumin
  • IVIG (intravenous immune globulin)
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49
Q

can you give medications the same time you are giving blood products?

A

NO

50
Q

what do packed red blood cells (PRBC) contain?

A

human red blood cells

51
Q

what is the shelf life in a fridge for packed red blood cells (PRBC)?

A

42 days

52
Q

what are the indications for packed red blood cells (PRBC)?

A
  • severe blood loss
  • severely anemic
53
Q

1 unit of blood should raise hemoglobin by what?

A

10 g/L

54
Q

how do you know someone has low blood loss?

A
  • known blood loss
  • low BP
  • tachycardia
55
Q

how do you know someone has severe anemia?

A
  • low hemoglobin
  • pale
  • fatigue
  • weakness
56
Q

does a hemoglobin level of < 60g/L require a transfusion?

A
  • likely appropriate
  • transfuse 1 unit and re-check pt symptoms and Hb before giving second unit
57
Q

does a hemoglobin level of <70g/L require a transfusion?

A
  • consider transfusion
  • transfuse 1 unit/ re-check pt symptoms and Hb before giving second unit
58
Q

does a hemoglobin level of <80g/L require a transfusion?

A
  • consider transfusion if pt has pre-existing cardiovascular disease or evidence of impaired tissue oxygenation
59
Q

does a hemoglobin level of 80-90g/L require a transfusion?

A

likely inappropriate unless evidence of impaired tissue oxygenation

60
Q

does a hemoglobin level of >90g/L require a transfusion?

A

likely inappropriate

61
Q

does a bleeding patient require a transfusion?

A
  • maintain Hb greater than 70g/L
  • if pre-existing cardiovascular disease maintain Hb >80g/L
62
Q

a unit of packed blood cells contains how many mL?

A
  • approximately 300mL (240-340mL)
  • check label on bag for actual volume
63
Q

fresh frozen plasma contains what?

A
  • plasma proteins
  • all clotting factors
  • no functional platelets
64
Q

after collecting plasma how long do you have to freeze it?

A

within 8 hours of collection

65
Q

how long does fresh frozen plasma take to thaw?

A

30 minutes

66
Q

what are the indications for giving someone fresh frozen plasma?

A
  • replacement of multiple plasma coagulation factors
  • massive hemorrhage
  • clinical significant coagulation abnormalities
  • urgent warfarin therapy reversal
  • plasma exchange in TTP or HUS
67
Q

what do platelets contain?

A
  • human blood cells
  • traces of RBC may be present
68
Q

can you put platelets in a fridge?

A

no

69
Q

how do you store platelets?

A
  • 20-24 degrees for up to 5 days
  • need to be gently agitated during storage
70
Q

how many mLs are in 1 unit of platelets

A

about 350mL

71
Q

when do you need to check the patient’s platelet count for a transfusion of platelets?

A
  • 15 mins - 1 hour post infusion
72
Q

what are the indications for using platelets?

A
  • bleeding from thrombocytopenia
  • platelet function abnormality
73
Q

what is cryoprecipitate derived from?

A

fresh frozen human plasma

74
Q

what is in cryoprecipitate ?

A

specific proteins involved in clotting

75
Q

cryoprecipitate need to be stored at what and for how long?

A

minus 18 for a max of 12 months

76
Q

what are the indications for cryoprecipitate use?

A
  • hypofibrinogenemia
  • hemophilia A
  • massive hemorrahge
  • prior to invasive procedures where volume limitations are critical
77
Q

what is albumin?

A

human product derived from pooled venous plasma (5% or 25%)

78
Q

what is albumins equivalency to plasma?

A

isotonic

79
Q

what are the indications for using albumin 5%?

A
  • low albumin/ hypoproteinemia
  • liver failure
  • burn therapy
  • renal dialysis
  • conditions associated with volume deficit
80
Q

what are the indications for using albumin 25%?

A
  • same as albumin 5%
  • hypovolemic shock
81
Q

what does IV immune globulin (IVIG) contain?

A

human plasma or plasma proteins

82
Q

what does IV immune globulin (IVIG) provide?

A
  • antibodies that body cannot make in its own to fight infections
83
Q

when do you need to take IV immune globulin (IVIG) out of the fridge prior to using it?

A

at least 24 hours prior to infusion

84
Q

what are the indications for IV immune globulin (IVIG)?

A

autoimmune diseases
infectious diseases
idiopathic diseases

85
Q

blood components and blood products are always run via what?

A

dedicated VAD/ lumen as primary line

86
Q

can you piggyback blood components/ blood products into another IV line?

A

no

87
Q

what can you only use for elective blood component transfusions?

A

single filtered tubing

88
Q

what is the max hang time for a unit of blood product?

A
  • 4 hours max
  • if still running at 4 hours must stop and throw remaining out due to bacterial proliferation
89
Q

after removing a blood product from a fridge how long do you have to start the infusion?

A

within 30 minutes after removal from frdige

90
Q

when do you need to change the filter tubing for blood product administration?

A
  • after 4 units are give
  • before platelets
  • after 4 hours
  • if filter debris is causing sluggish flow
91
Q

what back-up solution must be primed and hung at the bedside when giving blood products?

A
  • normal saline 500-1000mL
92
Q

who must obtain written informed consent for blood and blood components?

A

physician or NP

93
Q

who confirms consent ?

A

nurse

94
Q

what gauge is used for infusing blood?

A
  • 22, 20, 18 ok
  • 16 or 14 for trauma
95
Q

what are the steps in the pre-transfusion process for the nurse?

A
  • confirm consent
  • blood type/ crossmatch is ordered
  • blood product ordered and checked
  • lab draws blood/ puts transfusion band on client
  • IV site assessed
96
Q

what are the steps for blood administration ?

A
  1. obtain blood
  2. verify
    - physicians order
    - correct patient
    - product as per blood product verification record
  3. pre-transfusion assessment
    - vitals
    - resp/ cardiac assessment
    - IV
    - patient comfort
  4. verification of correct blood
97
Q

for the pre-transfusion assessment when must this be done?

A

within 30 minutes of starting transfusion

98
Q

what is included in the verification of correct blood step for blood administration?

A
  • pt name, ID#, DOB
  • TMS ID number/ band
  • product name
  • product #
  • product & recipient blood group
  • inspection of blood
  • documentation/ verification check at desk and bedside
99
Q

when does the pt receive a TMS ID number/ band?

A

with initial crossmatch for blood group specific products

100
Q

when do clients not require a TMS number?

A

when receiving blood components that do not have an ABO designation

101
Q

what are the 3 mandatory verification checks that must be done with 2 nurses to ensure you have the right patient ?

A
  • blood product check
  • document check
  • bedside check
102
Q

all clients require the following identifiers prior to administration/ transfusion of any blood components. What are they?

A
  • wearing a facility patient ID band with ID #
  • first and last name
  • client’s birth-date
  • must be wearing TMS/ lab band with TMS ID number
103
Q

what products require a 2 person verification ?

A
  • RBC
  • FFP
  • platelets
  • cryoprecipitate
104
Q

what products require a 1 person verification ?

A
  • albumin
  • IVIG
  • coagulation factors
  • Rh immune globulin
  • Hepatitis B immune globulin
  • varicella zoster immune globulin
105
Q

what is the rate of the test dose at the beginning of a blood transfusion?

A

50mL/hr

106
Q

how much blood is given in the first 15 minutes (test dose)?

A

12.5mL

107
Q

how long must the RN stay with the patient 1:1 after starting the infusion?

A

5 minutes

108
Q

When does the RN need to check vital signs before, during and after a blood infusion?

A
  • just before starting
  • after 15 minutes starting
  • check hourly during transfusion
  • check at completion of infusion
  • 1 hour post- transfusion
109
Q

what are you monitoring for throughout a blood product transfusion?

A
  • chills
  • abdominal pain
  • increased temp
  • abnormal VS
  • abnormal chest assessment
110
Q

when would you need to stop a blood tranfusion regarding temperature increasE?

A

if temp increases 1 degree or more celsius AND temp greater than 38 celsius

111
Q

what is the max amount of time you have to infuse blood once out of the fridge?

A

4 hours

112
Q

after completing a transfusion what do you need to do to the line?

A

flush with 30-50mL NS or compatible IV fluid

113
Q

how long must a pt wait to be discharged after a transfusion?

A

60 minutes

114
Q

what are some potential reaction symptoms people may experience during the first 24 hours after a transfusion?

A
  • rash/ hives
  • vomiting
  • difficulty breathing
  • increased cough
  • headache
  • disturbed by bright light
  • fever
  • chills
  • back pain
  • red/ brown urine
115
Q

what are some potential reaction symptoms people may experience AFTER the first 24 hours after a transfusion?

A
  • headache
  • disturbed by bright light
  • fever
  • chills
  • back pain
  • red/ brown urine
  • yellow skin or eyes
  • lethargic
116
Q

what are the different types of transfusion reactions?

A
  • acute hemolytic
  • febrile non-hemolytic
  • non-immune hemolysis of RBC’s
  • allergic/ urticarial
  • sepsis
  • anaphylactic
117
Q

what would cause a hemolytic febrile reaction? when would this happen?

A
  • ABO/Rh incompatibility
  • within first 15 minutes
118
Q

what are some signs and symptoms that someone has delayed hemolytic? When would this occur?

A
  • 2-14 days after transfusion
  • fever
  • decreased Hgb/ Hct
  • increased bilirubin
  • jaundice
119
Q

is fluid overload a true reaction from a blood transfusion?

A

no

120
Q

what are the steps for an immediate response to anaphylaxis from blood infusion?

A
  • stop infusion
  • start resuscitative measures
  • disconnect blood admin
  • flush line
  • connect/ run NS
  • confirm pt ID is consistent with blood product
121
Q

what are some medications a doctor might order for medical treatment for a transfusion reaction?

A
  • diuretics
  • antihistamines
  • antipyretics
  • corticosteroids
122
Q

what is the most frequent cause of blood transfusion reactions ?

A

nurses having poor knowledge about changing blood transfusion sets

NRSG 302 (8 decks)

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