Week 9: Treas pg 1490-1492, Replacement of Blood + Blood Products

Question 1

What does not restore oxygen-carrying capacity or replace clotting factors?

Answer 1

IV fluids

Question 2

When are Blood products infused?

Answer 2

infused when the patient has experienced significant blood loss, diminished oxygen-carrying capacity., or a deficiency in one of the blood components

Question 3

How is donated blood separated?

Answer 3

each unit of donated blood is separated into multiple components, such as RBCs, plasma, platelets, and clotting factors
-thus, one unit of donated blood may be used in the care of 4 patients

Question 4

What you need to be eligible to donate blood?

Answer 4

a person must be in good health, at least 16 years old, and weigh at least 110 lbs
-each potential donor is screened for travel to certain countries and for a variety of disorders (HIV, hepatitis, or “mad cow’s” disease)

Question 5

Blood Groups: 4 main groups

Answer 5

A, B, AB, O

based on the presence or absence of certain antigens and antibodies

Question 6

Antigen

Answer 6

proteins that illicit immune response

Question 7

Antibody

Answer 7

protects the body from “invaders”

-tells the blood/body what to destroy

Question 8

Why do you not want to have the same antigen and antibody?

Answer 8

because it will attack itself

• AB= no antibodies, A + B antigens
• A= B antibodies, A antigens
• B= A antibodies, B antigens
• O= A+B antibodies, no antigens

Question 9

AB blood type is considered what?

Answer 9

universal recipient

-because of the absence of plasma antibodies

Question 10

O blood type is considered what?

Answer 10

universal donor

-because of the absence of antigens

Question 11

Rh Factors

Answer 11

an additional antigen that is important in blood typing
-if the antigen is present you are Rh-positive (Rh+)
-if the antigen is absent you are Rh-negative (Rh-)
>8 groups: ARh+, Arh-, BRh+, BRh-, ABRh+, ABRh-, ORh+, ORh-
>people who are Rh+ may receive blood with or without Rh factor
>people who are Rh- ay receive only Rh- blood

Question 12

Sequence of what happens once blood is donated

Answer 12

several tests are performed on the sample
-first, the sample is tested for ABO group (blood type) and RH type (+ or -) as well as any unexpected RBC antibodies that may cause problems in a recipient
-Screening Tests–> assess for evidence of donor infection with hepatitis B and C viruses, HIV, human T-lymphotropic viruses, West Nile virus, and syphillis
>if all disease screenings are negative, the blood is acceptable for transfusion and is placed in the pool of available products

Question 13

When a potential donor is identified what process if performed?

Answer 13

crossmatching

Question 14

Crossmatching

Answer 14

identifies possible minor antigens that will affect the compatibility of the donor blood in the recipient

Question 15

Process of Crossmatching

Answer 15

RBCs from the donor blood are mixed with plasma from the potential recipient
-a reagent is added, and the sample is observed for clumping or agglutination; if no clumping is observed, the risk of transfusion reaction is low, and it is safe to transfuse the sample of blood

Question 16

Autologous

Answer 16

(self-donated)

• when possible, self donated units of blood are given instead of blood from a donor
• this negates the risk of a mismatch or exposure to undetected disease

Question 17

Process of Autologous donation

Answer 17

the patients blood is usually collected in the pre-operative weeks for possible transfusion during elective surgery

• autologous donation is most often done with orthopedic, cardiac, and vascular surgeries
• the process of donating autologous blood stimulates the bone marrow to produce new blood cells
• given adequate time for recovery, the collected cells may be wholly or partially replaced prior to surgery

Question 18

Blood Products: Several Blood products are available for transfusion

Answer 18

• Whole Blood
• RBC
• Platelets
• Plasma
• WBC
• Plasma Derivatives

Question 19

Blood Products: Whole Blood

Answer 19

contains RBCs, WBCs, and platelets suspended in plasma

Question 20

Blood Products: RBC

Answer 20

prepared from whole blood by removing the plasma

• RBCs can raise the clients hematocrit and hemoglobin levels while minimizing an increase in volume
• RBCs are available for transfusion as packed RBCs (PRBC)

Question 21

Blood Products: Platelets

Answer 21

help the clotting process by sticking to the lining of blood vessels

• units of platelets are prepared by using a centrifuge to separate the platelet-rich plasma from the donated unit of whole blood;
• the platelet rich plasma is then centrifuged again to further concentrate the platelets
• platelets are used to treat clients who have a shortage of platelets or have abnormal platelet function

Question 22

Blood Products: Plasma

Answer 22

is the liquid portion of the blood

• it is 90% water and makes up about 55% of blood volume
• plasma may be transfused whole or may be separated into specific products such as albumin, clotting factor concentrates, and immune globulins

Question 23

Blood Products: WBC

Answer 23

specifically granulocytes (neutrophils, eosinophils, or basophils) can be collected by centrifugation of whole blood
-they are transfused within 24 hours after collection and are used for infections that are unresponsive to antibiotic therapy

Question 24

Blood Products: Plasma Derivatives

Answer 24

are concentrates of specific plasma proteins prepared from many units of plasma
-plasma derivatives include a variety of clotting factors, immune globulins, and albumin

Question 25

What to do before beginning a transfusion?

Answer 25

verify the written prescription for the blood product

-it is critical to identify the patient and the blood product when transfusing blood

Question 26

What to do when initiating a transfusion?

Answer 26

• obtain a set of vital signs 5 to 15 minutes before initiating a transfusion
• inspect the IV site to be sure it is patent before hanging the blood product

Question 27

Rationale for: Obtain a set of vital signs 5 to 15 minutes before initiating a transfusion

Answer 27

if a patients temperature is elevated, inform the primary care provider before hanging the transfusion

• most patients experience a minor elevation in temperature after a transfusion is given
• a preexisting elevated temperature may exacerbate this response; as a result, premedication may be prescribed

Question 28

Rationale for: Inspect the IV site to be sure it is patient before hanging the blood product

Answer 28

nurses commonly use a 20-gauge catheter to infuse blood- and a larger size for rapid flow rates
-for elderly or smaller children you will need a smaller 22 or 24 gauge catheter

Question 29

Transfusion Reactions

Answer 29

• Allergic
• Bacterial
• Febrile
• Hemolytic Reactions
• Circulatory Overload

Question 30

Transfusion Reactions: Allergic

Answer 30

allergy to blood being transfused

Question 31

Transfusion Reactions: Allergic: S+S

Answer 31

flushing, itching, wheezing, urticaria (hives); anaphylaxis if severe

Question 32

Transfusion Reactions: Allergic: Nursing Responsibilities

Answer 32

• stop the transfusion
• replace with a saline infusion
• notify the provider immediately
• administer prescribed antihistamine

Question 33

Transfusion Reactions: Bacterial

Answer 33

contamination of the blood

Question 34

Transfusion Reaction: Bacterial: S+S

Answer 34

fever, chills, vomiting, diarrhea, hypertension

Question 35

Transfusion Reaction: Bacterial: Nursing Responsibilities

Answer 35

• stop the transfusion reaction
• replace with a saline infusion
• notify the provider
• administer antibiotics as ordered
• treat symptoms

Question 36

Transfusion Reactions: Febrile

Answer 36

temperature elevation due to sensitivity to WBC, plasma proteins, or platelets

Question 37

Transfusion Reactions: Febrile: S+S

Answer 37

fever, chills, warm, flushed skin, aches

Question 38

Transfusion Reaction: Febrile: Nursing Responsibilities

Answer 38

• stop the transfusion
• replace with saline infusion
• notify provider
• treat symptoms

Question 39

Transfusion Reaction: Hemolytic Reactions

Answer 39

destruction of RBCs as a result of infusing incompatible blood; occurs in 1 in 600,000 transfusions

Question 40

Transfusion Reactions: Hemolytic Reactions: S+S

Answer 40

fever, chills, dyspnea, chest pain, tachycardia, hypotension; can be fatal

Question 41

Transfusion Reactions: Hemolytic Reactions: Nursing responsibilities

Answer 41

• stop transfusion immediately
• replace with saline infusion
• notify provider immediately
• send remaining blood, including tubing and filter; a sample of venous blood, and the first voided urine to the lab for analysis
• treat shock

Question 42

Transfusion Reactions: Circulatory Overload

Answer 42

administering too great a volume or too rapidly

Question 43

Transfusion Reactions: Circulatory Overload: S+S

Answer 43

persistent cough, crackles, hypertension, distended neck veins

Question 44

Transfusion Reactions: Circulatory Overload: Nursing Responsibilities

Answer 44

-slow or stop the transfusion
-monitor vital signs
-place client upright
-notify the provider
(do not replace with saline infusion because they are in fluid overload)