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Nursing 130 1st exam
N130 Blood admin.&IVPB 1st Exam OLOL
| Question | Answer |
|---|---|
| Types of blood products | Whole blood, packed RBC's, Leukocytes, Platelets, Fresh Frozen Plasma, Albumin and Cyoprecipates & WBCs. |
| Reasons for Blood Transfusions | To increase circulating blood volume, to increase oxygen carrying capacity, to provide selected cellular components as replacement thearapy. |
| How are blood transfusions used to increase circulating blood volume? | After surgery, trauma, or hemorhage use whole blood and albumin to increase circulating blood volume. |
| What type of blood transfusion would one use to increase oxygen carring capacity for severe anemia? | Packed Red Blood cells. |
| What type of blood transfusion would one use to provide selected cellular components as replacement thearapy? | Clotting factors, platelets, albumin, fresh frozen plasma, cryoprecipitate. |
| What type of blood transfusion would one use to provide selected cellular components as replacement thearapy for Neutropenic patients? | WBCs |
| Amount of Whole Blood Products | 300-550 mls |
| Amount of Packed RBCs | 300-350 mls |
| Amount of Leukocyte-poor RBC's | 200-250 mls |
| What do Leukocyte-poor RBC's- prevent? | Febrile, non-hemolytic transusion reactions. |
| non-hemolytic | not breaking down of red blood cells |
| Autologous tansfusion | Autotransfusion, collection of a clients own blood. |
| How many weeks before a planned surgery can a patients blood be obtain for an anticipated Autologous transfusion? | up to five weeks before the planned surgery. |
| What are some examples of surgery that an Autologous transfusion could be used for? | Heart, orthopedic, plastic, gynecological |
| How many units of blood can a patient donate for an Autologous transfusion? | One to Five units depending on how the patient tolerates & acceptable hematocrit. |
| Why is Autologous transfusion good for the patient? | Because it is safer for the patient. |
| What are two ways to obtain blood for an Autologous transfusion other than obtaining it from the patient before surgery? | During perioperative blood salvage |
| What are some examples of periopertive blood salvage? | Vascular, orthopedic, organ transplant, & Traumtic injuries |
| What are some examples of postoperative blood salvage? | Mediastinal and chest-tube drainage, joint, & spinal surgery. |
| What is a Homologous transfusion? | When the donor and recipient are different people. |
| what is a designated or directed donor? | Family/friends donate blood |
| What is an ABO system based on? | The presence or absence of A and B red cell antigens. |
| What is the RH factor? | Antigen found on the membrane of RBCs of most people. |
| How many people in the US population have the RH factor? | 85% |
| What is RH positive? | When the factor is present |
| What is RH negative? | When the factor is absent |
| If a person is RH negative who can they recieve blood from? | They MUST recieve blood from an RH negative person. |
| If person that is RH negative recieves RH positive blood what will happen? | The Blood will develop anti-RH antibodies and if the person recieves future RH positive blood , serious reactions with clumping and hemolysis of red blood cells will occur. |
| What is hemolysis? | The destruction of RBCs. |
| Where is HLA (Human Leukocyte Antigen) found? | On the surface of circulating platelets, WBCs, & most tissues. |
| What is the HLA (Human Leukocyte Antigen) responsible for? | Febrile reactions in patients recieving transfusion that contains platelets from several donors. |
| What is the universal donor? | O negative |
| Why is O negative the universal donor? | Becuase it does not have A, B, or RH antigens. |
| What is the universal Recipient? | AB positive |
| What antibodies does AB positive not have? | Anti-A and Anti-B |
| What does AB positive have that allows it to recieve either RH positive or negative blood? | The RH Factor |
| What are the blood donor qualifications? | Screened carefully and blood is tested for HIV, Hepatitis B, Hepatitis C, and other viruses |
| What will a nurse assess for prior to blood administration when assesing the IV line? | Assess for infiltration or infection. 18-19-20 gauge |
| Prior to blood administration what baseline assessments will the nurse do? | Assess if patient knows reason for transfusion, Asses any reactions in the past. |
| What will the nurse instruct the patient to report during or after a blood transfusion? | Any chills, dizziness, fever, itching, rash or any untoward effect |
| Vital signs, Assessing skin for eruptions or rashes, assessing age and any cardiovascular history, and checking for signed transfusion consent form are all things the nurse must do when? | Upon assement of the patient prior to a blood transfusion. |
| What is the first procedure the nurse performs for blood administration? | Wash hands |
| What solution does the nurse hang with blood administration set? | 0.9% Normal Saline |
| What size gauge catheter does the nurse use to connect to the current IV or start an IV with? | 18-19-20 gauge catheter |
| How should the nurse obtain the blood product from the blood bank? | According to agency policy. |
| What is the controled temperature that blood must be stored in a refrigerator at? | 4 degrees C |
| Blood must be started within how many minutes after leaving the blood bank? | thirty minutes |
| Blood transfusions must be completed within what amount of time? | 4 hours |
| What are the identification and checks a nurse must complete before blood transfusions? | Patients name, Identification number, Patients's blood type & RH type are compatible with donors blood group and Rh type, expiration date, inspect for blood clots, & empty urine drainage or have patient void. |
| For baseline vitals before a blood transfusion, the physician should be notified if the patient has a temp of | 100 degrees F or higher |
| When starting an infusion of blood product the first thing the nurse does is | Prime in-line filter with blood |
| The nurse must start the administration slowly, no more than______ for the first 15 minutes | 25-50ml 2 ml per minute or 20 gtts/min |
| How long should a nurse stay with a patient that has just started a blood transfusion? | For the first 15 minutes |
| How often should vital signs be checked on a patient that is having a blood transfusion? | q 15 minutes for the first half hour; then q half hour or hour according to agency policy. |
| What should the nurse observe the patient for during the blood transfusion? | flushing, dyspnea, itching, hives, or rash |
| What is Dyspnea? | Air hunger resulting in labored or difficult breathing, sometimes accompanied by pain. |
| When can the infusion rate be increased? | After the first 15 minutes if there is no adverse effects. |
| How long does a blood transfusion take? | Usually two to four hours, Ideal is two hours. |
| What are important things for the nurse to do during the blood transfusion? | Assess for transfusion reaction and document. |
| For severe blood loss a patient may recieve transfusions through | a central venous catheter |
| A blood warming device is often used | for severe blood loss when blood has to be given to the patient quickly. |
| Central Venous Catheter | A catheter inserted into the superior vena cava to permit intermittent or continuous monitoring of central venous pressure, to administer medications or nutrition, or to facilitate obtaining blood samples for chemical analysis. |
| Rapid administration of cold blood can results in | cardiac dysrhythmias |
| Platelet transfusion should be transfused over | 15 minutes |
| If a patient has a history of platelet transfusion reaction what should the nurse do? | premedicate with an antipyretic nd or an antihistamine. |
| Avoid giving a platelet trnsfusion if the patient is | febrile |
| When should a platelet count be checked when a patient is given platelet transfusion? | One hour after the end of the transfusion |
| When Albumin is given how is the rate of insusion determined? | By concentration, blood volume, indication of a patient response |
| What is normal blood volume for Albuin? | 5%-> 2-4 ml/min 25%->1ml/min |
| For Hypovolemia Albumin is transfused at 5% OR 25% as rapidly as needed as tolerated & repeated in | 15-30 minutes |
| When a patient has burns, hypoproteinemia what is transfused? | Albumin |
| What can be given as a volume expander until cross matching for whole blood transfusion is complete? | Albumin |
| What can be given to increase intravascular colloidal oncontic pressure? | Albumin |
| What gauge needle should Albumin be given through? | At least 20 gauge needle |
| What are possible blood transfusion reactions? | Acute hemolytic, febrile, non-hemolytic, mild allergic, anaphylactic, circulatory overload, sepsis |
| What is the most common blood transfusion reaction? | non-hemolytic |
| What is the cause of an acute hemolytic reaction? | ABO or RH incompatibility |
| Chills, fever, low back pain, flushing, tachycardia, tachypnea, hypotension, chest pain, facial flushing, shock, hrmoglobinuria, acute renal failure, death are signs and symptoms of what? | An Acute hemolytic reaction |
| What is the onset of an acute hemolytic reaction? | Immediate |
| How would a nurse prevent an acute hemolytic reaction? | Step by step detailed procedure of checking for correct patient and identification of compatible correct blood or blood product, and follow agency policy. |
| What causes a febrile or nonhemolytic reaction to a blood transfusion? | sensitization to donor white blood cells, platelets, or plasma proteins. |
| What are the signs and symptoms of a febrile nonhemolytic reaction to a blood transfusion? | sudden chills and fever ( rise greater than 1 degrees celcius) headache, flushing, anxiety, and muscle pain. |
| What is the cause of a mild allergic reaction to a blood transfusion? | sensiivity to foreign plasma proteins. More common in an individual with a history of allergies. |
| What are the signs and symptoms of a patient that is having a mild allergic reaction after a blood transfusion? | Flushing, itching, and urticaria (hives) |
| What is the cause of an Anaphylactic reaction in a blood transfusion? | Infusion of IgA-deficent recipient who has developed IgA Anibody. |
| What are the signs and symptoms of an Anaphylactic reaction when a patient has had a blood transfusion? | Anxiety, urticaria, wheezing, progressing to cyanosis, shock, possible cardiac arrest. |
| What is the cause of Circulatory overload when a patient has had a blood transfusion? | Fluid administered faster than the circulation can accommodate |
| Which patients are at particular risk for circulatory overload during a blood transfusion? | Older adults, cardiopulmonary diseases, renal patients. |
| What are the signs and symptoms of a patient who is experiences circulatory overload during a blood transfusion? | cough, dyspnea, pulmonary congestion (crackles), headache, hypertension, tachycardia, distended neck veins. |
| What is the cause of sepsis in a blood transfusion? | transfusion of contaminated blood components |
| What are the signs and symptoms of sepsis when a patient recieves a blood transfusion. | Rapid onset of chills, high fever, vomiting, diarrhea, and marked hypotension and shock. |
| When should blood be stoped during a transfusion if there is a reaction? | Immediately |
| Wht should the nurse hang if a blood transfusion is stopped because of a reaction? | 0.9% Normal Saline with another tubing to KVO |
| How often should vital signs be checked on a patient that had a reaction to a blood transfusion? | q 5 minutes |
| What should be obtained and sent to the lab when a patient has a reaction to a blood transfusion? | Urine Specimen |
| What should be done with left over blood after a patient has a reaction to a blood transfusion and the transfusion is stopped.? | Send unit, tubing, labels, & filter to blood bank. Also, notify Blood bank. |
| What emergency medications should a nurse be prepared to give if necessary when a patient has a reaction to a blood transfusion? | Antihistamines, vasopressors, fluids, steroids |
| What should the nurse be prepared for if a patient has a reaction to a blood transfusion? | Be prepared for CPR. |
| When a patient has a reaction to a blood transfusion, the nurse must ________ the reaction. | Document |
| What can cause RBC lysis? | room temperature and old blood |
| What is a citrate reaction caused by during a blood transfusion? | interaction of the citrate with the inonized calcium in the recipents blood, resulting in low ionized calcium lecels. ( calcium binds with the citrate) |
| What can a Citrate reaction during a blood transfusion do to the patient? | effect clotting mechanism of the patient. |
| What can happen if a patient has a citrate reaction during a blood transfusion? | It can result in hypocalcemia. |
| What is the drop factor for blood tubing? | 10 drops/ml |
| Never inject medication into an IV line with_ _____ _____ _____. | A blood component transfusion. |
| What should be documented when a patient recieves a blood transfusion? | Date and time of starting and completing the transfusion, type of blood transfused, vital signs (every time checked), absence or presence of any reaction or complication, status of IV site, disposition of the blood bag and tubing. |
| What are the purposes of IV Therapy? | Restore or maintain fluid & electrolytes, administer medications, provide nutrition, and facilitate blood transfusion. |
| The Nurses responsibilitesfor IV skills & IVPB meds. aare | Initiate, monitor, and Discontinue |
| What responsibilites does the nurse have during the initiation phase? | Correct solution, equipment, select site & start infusion, and calculate & regulate the rate. |
| What responsibilites does the nurse have during the monitoring phase? | Maintain the system, Identify and correct problems, monitor the patient, and watch for complications. |
| What are three examples of Crystalloids? | Isotonic, Hypotonic, and Hypertonic |
| What are two characteristics of Colloids? | Always Hypertonic, Plasma expander |
| What are four types of IV solutions? | Crystalloids, Colloids, Total Parenteral Nutrition (TPN) and blood and blood products. |
| Albumin 5% | osmotically equal to plasma |
| Albumin 25% | draws about 4 times their volume in interstitil fluid into the circulation within 15 mins of admin. |
| Microdrop | 60 gtt/ml |
| Macrodrop | 10-12-15-20 gtt/ml depends on manufactor |
| Drop factor | # of drops to equal 1 ml |
| KVO | Keep vein open |
| What will happen if there is not adequate fluid going? | It can clot off |
| What is the minimal KVO rate? | 10-15 ml/hr check agencies policy |
| OLOLRMC minimal rate is | 20 ml/hr |
| Before you spike a primary or piggyback what should you do first? | Close the rollar clamp. |
| How often should you monitor IV? | every two hours |
| Don't put tape on what? | Tegaderm. |
| Don't watch tape completely around arm because it will | impare circulation |
| Rate of inusion depends on | height of the IV fluid container, IV tubin size, fluid viscosity, & size of IV catheter. |
| Raising the bag usually_____ the rate | increases |
| What are ways to assess for patency? | Lowering the IV bag below the level of the IV insertion site and observing for blood. Compare the size of arms. Applying light pressure over teh IV cannula and observing for decrease flow of IV fluid. |
| Positional IV | Rate can decrease or increase depending on position of extremity. |
| recommends tubing change every | 72 hours |
| IV must be flushed every___hours to make sure it doesn't clot off | six |
| Infiltration | swelling above insertion site, coolness to touch, pallor, possible decrease in flow rate |
| Phlebitis | tenderness, redness, warmth, pain |
| Speed shock | dumping meds too fast on a patient |
| LOC | Level of consiousness |
| ICP | Intercranial pressure |
| IF patient has an air embolism | place patient on left side and lower head. |
| What are ways to avoid an air embolism? | prime tubing, tighten all connections, use air detection pump and be very careful with central lines |
| What are three ways to administer IV meds? | Large-volume infusions, intravenous bolus, and piggyback. |
| Extravastation | inadvertent administration of a nonvesicant solution into surrounding tissue |
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