NUR 112 - Blood Transfusion.txt

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TomWruble
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150929
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NUR 112 - Blood Transfusion.txt
Updated:
2013-03-17 12:50:08
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blood transfusion clinical nur112 keynursing
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Blood Transfusion
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  1. Define Anemia:
    • a reduction in either
    • the number of RBCs
    • the amount of hemoglobin
    • the hematocrit (percentage of packed RBCs per deciliter [dL] of blood)
  2. Anemic lab values less than Hemoglobin, total - Females
    • 18-44: 117-155 g/L
    • 45-64: 117-160 g/L
    • 65-74: 117-161 g/L
  3. Anemic lab values less than Hemoglobin, total - Males
    • 18-44: 132-173 g/L
    • 45-64: 131-172 g/L
    • 65-74: 126-174 g/L
  4. Anemic lab values less than Hematocrit - Females
    • 18-44: 35%-45%
    • 45-74: 37%-47%
  5. Anemic lab values less than Hematocrit - Males
    • 18:44: 42%-52%
    • 45-64: 39%-50%
    • 65-74: 37%-51%
  6. Identify 5 signs and symptoms of anemia:
    • Pallor
    • cool to touch
    • intolerance of cold temperature
    • fatigue
    • dyspnea on exertion
  7. Identify the HGB level that you would anticipate a patient to require blood:
    • 80g/L or 8g/dL
    • 70g/L or 7g/dL for Sickle Cell pt
  8. Identify the type of IV solution that can be safely used with blood administration
    0.9% Sodium Chloride (Normal Saline)
  9. Identify the best method for prevention of a transfusion reaction:
    • Determine that the blood component is correct
    • and the identification of patient is correct
    • Take patient's vital signs immediately before starting the transfusion
    • Begin the infusion slowly
    • Remain with the patient for the first 15 to 30 minutes
    • (usually severe reaction occurs within the first 50ml of blood infusion)
  10. Identify steps to accurately ID the blood:
    • Check the physician's prescription together with another RN(or LPN) to determine:
    • the patient's identity and ID band name and number are identical to those on the blood component tag.
    • Examine the blood bag label, the attached tag, and the requisition slip to ensure that the ABO and Rh types are compatible.
    • Check the expiration date, and inspect the product for discoloration, gas bubbles, or cloudiness.
  11. You are preparing to administer a unit of blood at 0800. Identify the times for the first 5 sets of vitals:
    • 1.) 0800
    • 2.) 0805
    • 3.) 0810
    • 4.) 0815
    • 5.) 0915
  12. Identify the nurses role during the first 15 minutes of a blood transfusion:
    • The nurses role during the first 15 minutes of a blood transfusion is to:
    • monitor the patient for any adverse reaction (such as:
    • unsusual sensations
    • chills
    • shortness of breath
    • hives
    • itching
    • changes in vital signs
  13. IdentifY the maximum time a unit of blood can infuse over
    4 hours
  14. IdentifY the minimum time a unit of blood can infuse over (Consider this emergent)
    1.5 - 2 hours
  15. Identify the most commonly occurring transfusion reactions:
    Febrile reaction to donor white blood cells, platelets, or plasma protein; does not cause hemolysis
  16. Identify 3-5 signs and symptoms of febrile transfusion reaction:
    • Chills
    • tachycardia
    • fever
    • hypotension
    • tachypnea
  17. Identify 3-5 signs and symptoms of a hemolytic transfusion reaction:
    • Fever and chills
    • headache
    • chest pain
    • lower back pain
    • tachycardia
    • hemoglobinuria
  18. Identify 3-5 signs and symptoms of a bacterial transfusion reaction:
    • Tachycardia
    • hypotension
    • fever
    • chills
    • shock
  19. IdentifY 3-5 signs and symptoms of an anaphylactic transfusion reaction:
    • Wheezing
    • dyspnea
    • chest tightness
    • cyanosis
    • hypotension
  20. IdentifY 3-5 signs and symptoms of a delayed hypersensitivity reaction:
    • Itching
    • urticaria
    • flushing
  21. Identify the steps you would take if a patient developed a febrile transfusion reaction:
    • a.) discontinue the transfusion immediately.
    • b.) keep the vein open with a normal saline infusion in new tubing.
    • c.) notify the primary care provider
    • d) give antipyretics as ordered.
  22. IdentifY the steps you would take if a patient developed a hemolytic transfusion reaction:
    • a) stop transfusion immediately.
    • b.) remove blood tubing, provide new tubing for normal saline infusion.
    • c.) maintain vascular aaccess with normal saile, or according to agency protocol.
    • d.) notify primary care provider immediately.
    • e.) monitor vital signs.
    • f.) monitor intake and output.
    • g.) send remaining blood, bag, filter, tubing, a sample of the client's blood and a urine sample to the laboratory.
  23. Monitoring IV Therapy:
    • Credit at beginning of Shift
    • Assess Fluid! Additives-Medications, Vitamins
    • Check IV Site Hourly-Infection, Infiltration, Bleeding, Phlebitis
    • Change IV Tubing every 72 hrs
    • Monitor for complications
    • Prevent infection
  24. Potential Complications of IV Therapy:
    • Fluid Overload-� Dry Cough, Rales/Crackles SOB, distended neck vein
    • Air Embolism
    • Septicemia
    • Infiltration - Swelling, Pain, Pallor, cool
    • Extravisation - Medication infusing into SubQ Tissues -> Necrosis
    • Phlebitis - redness, pain, warmth, red streak up arm
  25. Discontinuing a Peripheral IV:
    • Preventing Bleeding & Catheter Embolism:
    • No Scissors
    • No Alcohol-may cause bleeding
    • Elevate/Apply Pressure
  26. Administration of Blood Products:
    • Patient needs RBCs, Platelets, Albumin, Clotting Factors
    • decreased Platelet Count
    • decreased Hemoglobin
  27. Universal Donor:
    0-
  28. Universal Recipient
    AB+
  29. Rhesus/Rh Factor
    Rh factor antigen is present on RBCs of 85% of Americans, i.e. +
  30. RBC Compatibility
    • Group:Compatible With:
    • 0+ → 0+0-
    • 0- → 0- (Universal Doner)
    • A+ → A+ A- 0+ 0-
    • A- → A- 0-
    • B+ → B+ B- 0+ 0-
    • B- → B- 0-
    • AB+ → AB+ AB- 0+ 0- A+ A- B+ B- (Universal Recipient)
    • AB- → AB- 0- A- B-
  31. When used for transfusion: Whole Blood
    Acute Hemorrhage-Replaces Blood Volume & all blood products (rarely used)
  32. When used for transfusion: RBCs/Packed Cells
    Anemia, Surgery, Bleeding Disorders-Increases 02-carrying capacity & Hct
  33. When used for transfusion: Autologous RBCs
    Planned Elective Surgery-Blood Replacement
  34. When used for transfusion: Platelets
    Bleeding Disorders, Platelet Deficiency-Platelets Replacement
  35. When used for transfusion: Fresh Frozen Plasma/FFP
    Expands Blood Volume & provides Clotting Factors
  36. When used for transfusion: Albumin/Plasma Protein
    Expands Blood Volume & provides Plasma Proteins
  37. When used for transfusion: Clotting Factors/Cryoprecipitate
    Clotting Factor Deficiency/Fibrinogen
  38. Blood Products for Transfusion:
    • Whole Blood
    • RBCs/Packed Cells
    • Autologous RBCs
    • Platelets
    • Fresh Frozen Plasma/FFP
    • Albumin/Plasma Protein
    • Clotting Factors/Cryoprecipitate
  39. Autologous Transfusion:
    • Patient donates blood 4-6 weeks before surgery
    • Can be frozen for up to 10 years
    • Discarded if not used by patient donor
  40. Administering Blood Products:
    • Use only Normal Saline IV
    • Two (licensed - RN or LPN) nurses check each unit together
    • Stay with patient for the first 15 min
    • Infuse no faster than 5 mL/min
    • Infuse within 2-4 hr
    • Change tubing every 2 Units (to avoid bacterial contamination)
    • Transfusion Reaction
    • --Stop Immediately
    • --Call doctor STAT
    • --Keep line open with Saline
    • --prepare STAT Drugs
    • --Urine sample/Blood & tubing back to Lab
  41. Potential Transfusion Reactions:
    • Acute Hemolytic Reaction: Most Dangerous/Life-threatening-Blood Types not Compatible
    • * Prventable
    • * Possible Labeling Error during Type & Crossmatch/ Careful ID of Recipient
    • * Chills, Fever, Headache, Backache, Dyspnea, Cyanosis, Chest Pain, Tachycardia, Hypotension
  42. Delayed Hemolytic Reaction: Could occur within 14 days of transfusion
    • * Fever
    • * Anemia
    • * inc Bilirubin
    • * Jaundice
  43. Febrile Nonhemolytic Reaction: Most Common
    • * Pt reacts to antibodies in the donors WBC's
    • * Fever (within 2 hr of transfusion) Chills, Muscle Stiffness-treated with Antipyretics(tylenol/benadryl)
  44. Allergic Reaction: Sensitivity to donor Plasma Proteins
    * Urticaria(hives), Pruitis, Wheezing-may respond to Antihistamines(Benadryl)
  45. Circulatory Overload: Blood administered Faster than Circulation can accommodate
    • * Cough, Dyspnea, Crackles/Rales, JVD, Tachycardiam HTN
    • * Treated with O2, Diuretics
  46. Bacterial Transfusion Reaction/Sepsis: Contaminated Blood
    • * Symptoms may not occur till after transfusion
    • * Treated with Antibiotics, Fluids
    • * S/S of FLU
  47. Transfusion Related Acute Long Injury
    • * Idiosyncratic reaction
    • * Antibodies of the dollor stimulates WBC's in the recipient -> this occludes the vasculature in the lungs
    • * Symptoms of pulmonary edema within 4 hours of transfusion
    • * Tx with 02, diuretics, ventilatory support
  48. Intraoperative & Emergency Blood Salvaging:
    • * Using a cell saver
    • * Blood lost in Sterile Cavity is suctioned into Cell Saver
    • * RBCs are washed with saline & returned as IV Infusion (Vascular, Thoracic, Orthopedic Surgeries)
  49. Correct fluid level in drip chamber?
    About 1/2
  50. Clamp to regulate IV?
    Roller
  51. When to use a slide clamp?
    Goes into pump or stops IV push
  52. IV piggyback abbreviation?
    IVPB

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