Weeks 8+9 Blood and Blood Product Administration Flashcards
1
Q
What does a single unit of whole blood contain?
A
450 mL of blood and 50mL of an anticoagulant
2
Q
What temp are PRBC’s stored at?
A
4*C
3
Q
How long can PRBC’s be stored for?
A
With special preservatives, they can be stored safely for up to 42 days before they must be discarded
4
Q
What temp are platelets stored at?
A
Room temperature bc they cannot withstand cold temps
5
Q
How long can platelets be stored?
A
Only 5 days before they must be discarded
6
Q
To prevent clumping, what is done to platelets?
A
Platelets are gently agitated while stored
7
Q
How long is plasma stored and temp?
A
It is immediately frozen to maintain the activity of the clotting factors within; it lasts for 1 yr if it remains frozen
8
Q
What is plasma albumin?
A
A large protein molecule that usually stays within vessels and is a major contributor to plasma oncotic pressure. This protein is used to expand the blood volume of pts in hypovolemic shock and, rarely, to increase the [] of circulating albumin in pts with hypoalbuminemia.
9
Q
What is unique about both albumin and IVIG compared to other fractions of human blood, cells, or plasma?
A
These products can survive being subjected to heating at 60*C for 10 hrs to free them of the viral contaminants that may be present
10
Q
why are blood donors asked if they have consumed any aspirin or aspirin-containing meds within the past 3 days?
A
although aspirin use does not render the donor ineligible, the platelets obtained may be dysfunctional and therefore not useful. aspirin use within 48-72 hours contraindicates platelet donation. (aspirin does not affect the erythrocytes or plasma obtained form the donor)
11
Q
All blood donors are expected to meet the following minimal requirements:
A
- body weight should exceed 50 kg for a standard 450 mL donation
- people younger than 17 yrs of age are disqualified
- oral temp should not exceed 37.5*C
- the pulse rate should be regular and between 50 to 100 bpm
- the SBP should be b/w 90-180 mmHg and DBP b/w 50-100 mmHG
- the hgb level should be at least 1.94 mmol/L for women and 2.10 mmol/L for men.
12
Q
Directed donation?
A
when a friend or fam of a pt donates blood for that person
13
Q
Which position are blood donors placed in?
A
semi-recumbent position
14
Q
How long does withdrawal of standard 450mL of blood take?
A
15 minutes
15
Q
What is a donor instructed to do after donating blood?
A
The donor is instructed to leave the dressing on and to avoid heavy lifting for several hours, to avoid smoking for 1 hour, to avoid drinking alcoholic beverages for 3 hours, to increase fluid intake for 2 days, and to eat healthy meals for at least 2 weeks.
16
Q
When are autologous donations collected? And how much blood is collected each week?
A
4-6 weeks before sx. Typically 1 unit of blood is collected per week.
17
Q
What is prescribed to pts doing autologous transfusions?
A
iron supplements to prevent depletion of iron stores
18
Q
Phlebotomies are not performed within ___ of surgery (autologous donation)
A
72 hours
19
Q
What is the primary advantage of autologous transfusions?
A
The prevention of viral infections from another persons blood
20
Q
What is hemodilution?
A
About 1-2 units of blood is removed from the patient through a venous or arterial line and simultaneously replaced with colloid or crystalloid solution. the blood obtained is then reinfused after surgery.
21
Q
What is the advantage of hemodilution?
A
the patient loses fewer erythrocytes during surgery, because the added IV solutions dilute the concentration of erythrocytes and lower the hematocrit.
22
Q
What is the most common kind of transfusion reaction?
A
febrile nonhemolytic reaction
23
Q
What is a febrile nonhemolytic reaction?
A
caused by antibodies to donor leukocytes that remain in the unit of blood or blood component
24
Q
Who does febrile nonhemolytic reactions occur in more frequently and why?
A
In pts who have had previous transfusions because they have exposure to multiple antigens from previous blood products and in Rh-negative women who have borne Rh-positive children
25
How is the diagnosis of a febrile nonhemolytic reaction made?
By exluding other potential causes, such as hemolytic reaction or bacterial contamination of the blood product
26
S+S of febrile nonhemolytic reaction?
chills (minimal to severe) followed by fever (more than 1*C elevation)
27
When does a fever typically begin in a febrile nonhemolytic reaction?
within 2 hours after the reaction has begun
28
How can a febrile nonhemolytic reaction be prevented?
by further depleting the blood component of donor leukocytes (give "clean" blood free of WBC)
(This is accomplished by a leukocyte reduction filter)
29
Which reaction is the most dangerous?
acute hemolytic reaction
30
What is an acute hemolytic reaction?
the most dangerous, and potentially life-threatening, type of transfusion reaction occurs when the donor blood is incompatible with that of the recipient
31
What esentially happens with the blood in an acute hemolytic reaction?
antibodies already preset in the recipients plasma rapidly combine with antigens on donor erythrocytes, and the erythrocytes are destroyed in the circulation
32
In an acute hemolytic reaction, where does the most rapid hemolysis occur?
In ABO incompatibility
33
What are the most common causes of acute hemolytic reactions?
errors in blood component labelling and pt identification hat result in the administration of an ABO-incompatible transfusion
34
S+S of an acute hemolytic reaction?
fever, chills, low back pain, nausea, chest tightness, dyspnea, and anxiety; hemoglobinuria; hypoTN; bronchospasm; and vascular collapse may result; ARF; DIC
35
Tx goals of acute hemolytic reactions?
maintaining blood volume and renal perfusion and preventing and managing DIC
36
Onset of allergic reactions?
5-15 minutes
37
S+S of an allergic reaction?
urticaria, itching, and flushing
38
If an allergic reaction is mild, what might it respond to?
antihistamines
39
What happens if the symptoms of an allergic reaction respond to antihistamines?
the transfusion may be resumed
40
What medications are allergic reactions typically managed with?
epinephrine; corticosteroids; and vasopressor support if necessary
41
What is circulatory overload?
if too much blood is infused too quickly, hypervolemia can occur
42
Which patients are at higher risk of experiencing circulatory overload?
patients who already have increased circulatory volume eg. those with heart failure
43
How can circulatory overload be preventeD?
if the administration rate is sufficiently slow
44
Which blood products put pts at increased risk of experiencing circulatory overload?
pts receiving fresh-frozen plasma or even platelets
45
S+S of circulatory overload?
dyspnea, orthopnea, tachycardia, and sudden anxiety; JVD, crackles at the base of the lungs, and an increase in BP; if the transfusion is continued, pulmonary edema can develop, as manifested by severe dyspnea and coughing of pink, frothy sputum
46
What are your nursing actions if the circulatory overload is severE?
the pt is placed in an upright position with the feet in a dependent position, the transfusion is discontinued, and physician is notified
47
What medication may be ordered in circulatory overload to treat severe dyspnea?
oxygen and morphine
48
What is bacterial contamination?
contamination can occur at any point during procurement or processing but often results from organisms on the donors skin
49
Which blood products are at greater risk of bacterial contamination?
platelets
50
How long do blood products need to be transfused in? and why?
4 hours because warm room temperatures promote bacterial growth
51
What are the signs of bacterial contamination?
fever, chills, and hypoTN (these signs may not occur until the transfusion is complete)
52
What is bacterial contamination usually treated with? What happens if it is not treated immediately?
fluids and broad-spectrum antibiotics; septic shock can occur
53
Tranfusion-Related Acute Lung Injury?
TRALI is portentially fatal, idiosyncratic reaction that occurs in less than 1 in 5000 transfusions
54
What is TRALI thought to involve?
antibodies in the donors plasma that react to the leukocytes in the recipients blood
55
Onset of TRALI?
abrupt (usually within 6 hours of transfusion, often within 2 hours)
56
S+S of TRALI?
SOB, hypoxia (SPO2 <90%), hypoTN, fever, and eventually pulmonary edema
57
What can you do to prevent death in TRALI?
aggressive supportive therapy such as oxygen, Intubation, fluid support)
58
What blood products typically cause TRALI to occur?
plasma and to a lesser extent, platelets
59
Delayed hemolytic reaction?
usually occur within 14 days after transfusion, when the level of antibody has been increased to the extent that a reaction can occur
60
S+S of delayed hemolytic reaction?
fever, anemia, increased bilirubin level, decreased or absent haptoglobin, and possibly jaundice, rarely there is hemoglobinuria
61
Are delayed hemolytic reactions dangerous?
No, but it is still important to recognize them bc subsequently transfusions with blood products containing these antibodies may cause a more severe hemolytic reaction
62
Interventions for delayed hemolytic reactions?
the reaction is usually mild and requires no intervention
63
what are 3 common complications resulting from long-term PRBC transfusion therapy?
Infection; iron overload; transfusion reaction
64
what is the purpose of a blood transfusion?
the transfusion of blood and blood components restores and maintains quality of life for pts with hematological disorders, cancer, injury, or surgical intervention
65
Allogenic blood?
blood donated from someone else
66
What are the 3 blood-typing systems?
ABO, Rh, and human leukocyte antigen (HLA)
67
Explain blood group type A.
Type A antigen is present; anti-B antibodies
68
Explain blood group type B
type B antigen is present; anti-A antibodies
69
Explain blood group type AB
Type A and B antigens present ;neither antibody so they can receive blood from everyone
70
Explain blood group type O
Neither A nor B antigens are present; both A and B antibodies and can receive only type O blood
71
Rh type?
presence or absence of the D antigen
72
Antibodies and antigens... which are the agglutinogens and agglutinins
Antibodies are the agglutinins. Antigens are the agglutinogens
73
When does a reaction in the Rh system occur?
a person with Rh-negative blood is exposed to a large volume (200 mL or more) of Rh-positive blood will develop enough antibodies to cause a severe transfusion reaction with repeat exposure. these antibodies take up to 2 weeks to form.
74
Purpose of RhoGam?
It can suppress or destroy the fetal Rh-positive blood cells that have passed from the fetal to the maternal circulation.
75
What are the most common HLA complications?
febrile nonhemolytic reaction; immune-mediated planted refractories; TRALI; transfusion-associated-graft-versus-host disease
76
When must a blood sample be collected and sent to the lab?
within 72 hours for typing and compatibly screening
77
In emergency situations, what might a rapid transfusion of blood lead to?
dysrythmias and reduction of core temperature
78
What must you verify when assessing blood products?
order for specific blood or blood product with date, time to begin transfusion, special instructions, duration, and any pretransfusion or post transfusion meds to admin.; pts transfusion history
79
What are some premeds that might be ordered?
antihistamines and antipyretics
80
What is an appropriate IV guage for an adult?
14-24 guage
81
What do large gauge catheters promote?
rapid flow of blood components
82
What is an appropriate IV gauge when rapid infusion is required?
14-18 guage
83
What is an appropriate IV guage for a neonate, pediatric, or older adult pt?
22-24 gauge
84
Which lab values should a nurse assess prior to blood transfusion?
hct, coagulation values, platelet count, and potassium
85
What is required from the pt prior to a blood transfusion?
CONSENT
86
What is the only solution that is compatible with blood?
0.9% NS
87
when implenting blood transfusion, what do you check the blood bag for?
any signs of contamination (ie. clumping, clots, gas bubbles, purplish colour) and presence of leaks
88
what can air bubbles, clumping, clots and discolouration be an indication of?
bacterial contamination or inadequate anticoagulation of stored component and are contraindications for transfusion of that product
89
what should you verbally verify as you are administering blood products?
verbally compare and correctly verify pt, blood product, and type with another person considered qualified by your agency before initiating transfusion. check the pt using 2 identifiers; transfusion record number and pts identification number match and that pts name is correct on all documents; check unit number on blood bag with blood bank form to ensure that they are the same. check expiration and time.
90
which ions might expired blood contain?
citrate ions
91
if a transfusion reaction occurs, what does the lab send off?
a urine specimen
92
When should a blood transfusion be initiated?
within 30 minutes from time of release from blood bank
93
Even though we aren't allowed to administer anything else through the IV tubing, why do we still use y-tubing?
it facilitates maintenance of IV line access with NS in case or will need more than 1 unit of blood
94
before hanging the blood component for administer, what should the nurse do to the bag and why?
genetly invert bag 2-3x, turning back and forth because gentle agitation suspends RBCs in anticoagulant
95
what should the initial flow rate during the first 15 minutes be?
1-2 ml/min or 10-20 gtt/min
96
Why do we start off with a slow infusion rate when infusing blood products?
it initially minimizes volume of blood to which pt is exposed, thereby minimizing severity of reaction
97
What should you do in the event of a transfusion reaction?
stop the transfusion; start 0.9% NS with a new primed tubing attached directly to the VAD hub; and notify the HCP immediately. do not discard the blood product or tubing bc they may need to be returned to the blood bank. do no infuse saline through existing tubing bc it will cause blood in tubing to enter pt.
98
Pt develops irritation or phlebitis at venipuncture site. What should you do?
transfusion should be stopped at first sign of infiltration, and IV line removed. Insert new VAD in area ABOVE previous location or opposite arm. Restart product if remainder can be infused within 4 hours of initiation of transfusion. institute nursing measures to reduce discomfort at infiltrated or phlebitic area.
99
Fluid volume overload occurs, and/or pt exhibits difficulty breathing or has crackles on auscultation of lungs. What should you do?
slow or stop infusion, elevate HOB, and inform hcp. administer diuretics, morphine, and/or O2 as ordered by HCP. continue freq assessments and closely monitor VS and I&O
100
In a paediatric pt, how much blood do you begin with infusing?
infuse the first 50mL or 20% of volume (whichever is smaller) of a blood transfusion very slowly in peds pt. nurse should stay with the child during this time frame.
101
Who is NOT a good candidate for a home transfusion?
pts who have had prior transfusion reactions, acute angina, or heart failure are not good candidates
102
How long does a nurse have to stay with pt at a home transfusion?
the entire time an for 30-60 mins after transfusion.
103
When do life threatening reactions typically occur?
within the first 15 minutes
104
What type of reaction does a fever typically indicate?
onset of acute hemolytic reaction, febrile nonhemolytic reaction or bacterial sepsis
105
What type of reaction does tachycardia and/or tachypnea and dyspnea indicate?
acute hemolytic reaction or circulatory overload
106
What type of reaction does a drop in BP indicate?
infectious disease transmission, an acute hemolytic reaction or anaphylaxis
107
What type of reaction does hives or skin rash, including assessment of trunk or back indicate?
these are early indications of an allergic reaction, anaphylaxis, or graft-versus-host disease
108
What type of reaction does flushing indicate?
early indication of acute hemolytic reaction or febrile nonhemolytic reaction
109
What type of reaction does GI symptoms indicatE?
N/V are present in acute hemolytic transfusion reactions, anaphylaxis, or infectious disease transmission
110
What type of reaction does wheezing, chest pain, and possible cardiac arrest indicate?
indications of anaphylactic reaction
111
With a transfusion reaction, why is the following medication administered: epinephrine?
stimulates SNS to relieve resp distress and combat vasodilation in anaphylaxis
112
With a transfusion reaction, why is the following medication administered: antihistamine?
diminishes some aspects of allergic response by blocking histamine receptors
113
With a transfusion reaction, why is the following medication administered: antibiotics?
admin when bacterial contamination or sepsis is suspected
114
With a transfusion reaction, why is the following medication administered: antipyretics/analgesics?
admin to relieve fever and discomfort in acute hemolytic reactions, febrile nonhemolytic reactions, graft-versus-host disease, and bacterial sepsis
115
With a transfusion reaction, why is the following medication administered: diuretics/morphine?
treats circulatory overload by reducing intravascular volume and decreasing vascular tone
116
With a transfusion reaction, why is the following medication administered: corticosteroids?
stabilizes cell membranes, decreasing histamine release. admin in severe allergic reactions.
