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Hematologic Concerns
CAPA Blood components/disorders and Blood products
| Question | Answer |
|---|---|
| When is preoperative hemoglobin selectively recommended? | Neonates; elderly; menstrating women; and pateints with bone marrow suppression, malignancy, or genetically determined anemia |
| What are risks of blood transfusions? | Hemolytic allergic reactions, acute lung injury, transmission of virus, and bacterial contamination. |
| What is the minimum hgb/Hct to trigger transfusion? | No specific minimum - based on serious anemia risk such as oxygen deficit and decreased perfusion |
| What is the "shelf life" of stored blood? | 35-42 days |
| After 14 days what is increased in stored blood? | Toxic enzymes from dead WBC and platelets |
| What problem does the citrate used to preserve stored blood cause? | Hypocalcemia from the ionized calcium binding with the citrate. |
| What issues arise with aging stored blood? | Hyperkalemia (Potassium released from cell lysis), Acidosis, increased risk factors for multiple organ failure |
| What may exclude a patient from being eligible for autologous tranfusion? | weight, age, anemia, or cardiac conditions |
| What is the function of red blood cells? | Critical transporter of oxygen to tissues. |
| Where are red blood cells produced? | bone marrow |
| What organ removes RBCs? | spleen |
| What stimulates production of RBCs? | erythropoietin (produced by the kidney) |
| What is the life span of a RBC? | 120 days |
| What are common symptoms of anemia? | weakness and fatigue |
| What symptoms might indicate ACUTELY low hemoglobin? | Low SpO2, Hypotension, tachycardia |
| Chronic renal failure, Addison's disease, and thyroid diseases may cause what hematological condition? | Inadequate RBC production |
| A patient Postgastrectomy is as risk for what blood disorder? | Insufficient Vit B12 needed for erythropoiesis resulting in Hgb defecit |
| Drug and alcohol use may cause what blood problem? | decreased Hgb resulting from liver disease. |
| What medications may result in aplasia? | phenytoin, chloramphenicol (suppresses bone marrow) |
| What precipitates a sickle cell crisis? | Hypoxia, fever, acidosis (spur RBC to sickle) |
| What are symptoms of sickle cell crisis? | severe pain from decreased perfusion due to "clogged" peripheral capillaries and decreased oxygen carrying capacity of RBCs |
| What is the impact of pherocytosis on RBCs? | Cell life is reduced to 14 days |
| What are some cause of cell hemolysis | trauma, destruction, infection, defective prosthetic heart valves or blood pumps |
| What may cause anemia from inadequate intake of folic acid or iron? | malnutrition, alcoholism, anorexia, ileal disease (Crohn's or colitis), or surgical resection |
| What is polycythemia? | exaggerated RBC, hemoglobin, hematocrit, WBC production. |
| What may cause polycythemia? | high altitude, perenteral erythropoietin, bodily response to perceived hypoxemia such as COPD, pulmonary hypertension, or pheochromocytoma |
| How do you treat polycythemia? | chronic anticoagulation, splenectomy, phlebotomy |
| What are signs and symptoms of polycythemia? | ruddy complexion, weakness, angina, headache, palpitations, hypertension, spenomegaly, claudication, and phlebitis |
| What is the most common type of Leukemia? | AML (Acute Myelocytic Leukemia). It is 80% of all adult leukemias. |
| What type of leukemia generally affects children? | ALL (Acute lymphocytic leukemia) |
| What are indications of Hodgkin's disease? | Enlarged lymph nodes starting ar neck and axilla, fever, night sweats, weight loss, fatigue, liver and spleen enlargement |
| Enlarged lymph nodes, spleen enlargement, and jaudice are signs of what disease? | Lymphoma |
| Affects adults over 70 with bone pain, fractures, bleeding and bruising. | Multiple myeloma |
| How do you treat a patient with leukocytosis? | increased oxygen, prevent tissue damage, tranfuse blood as ordered, prevention of infection |
| What may cause Leukopenia? | bone marrow suppression, immunosuprression, radiation, toxins, or drugs |
| What organ is essential to proper coagulation? | Liver - adequate live function to produce a cascade of interrelated clotting factors is required. |
| What common drug interfers with platelets and decreases coagulation? | aspirin |
| What 3 things are required for clotting? | Functional platelets, normal calcium, and specific enzymes |
| What composes the extrinsic pathway for clotting? | thromboplastin released and a sequence of events leads to a fibrin clot |
| What triggers the extrinsic pathway? | tissue injury |
| What compses the Intrinsic pathway? | Proenzyme (Factor VII) is activated and spurs a cascade of clotting factors. This process occurs within the blood |
| What lab value would you obtain for a patient on Coumadin? | PT |
| What does Prothrombin Time asses? | conversion of prothrombin to thrombin and factors I, II, V, VII, X |
| A prolonged PT results in what? | Increased risk of significant bleeding |
| What may cause a prolonged PT? | liver disease, Vit K deficiency, lack of fibrinogen, prothrombin, or clotting factors V, VII, X |
| How do you treat a prolonged PT? | Vitamin K injections or Fresh Frozen Plasma |
| What lab value do you monitor for a patient on heparin? | PTT |
| What does PTT assess? | Intrinsic coagulation pathway (alterations in clotting factors) |
| Aspirin alters what? | Platelet function for it's 7 day life |
| NSAIDs have what effect on platelets? | alter function wit recovery in 2 days |
| What characterizes ITP? | spontaneous bleeding |
| When does ITP usually affect children? | after immunization or viral infection with chicken pox, mumps, or measles |
| Whom does Chronic ITP usually affect? | adults, primarily women, under 50 |
| What causes DIC? | clotting factor consumption |
| What is a symptom of DIC? | simultaneous active bleeding and intravasculat clotting |
| Hemophilia A is a lack of what clotting factor? | Factor VIII |
| Hemophilia B is a lack of what clotting factor? | Factor IX |
| This hemophilia will cause significant bleeding into tissues and joints if not treated with regular clotting factor | Hemophilia A (Factor VIII deficiency) |
| Christmas Disease | Hemophilia B |
| This hemophilia requires routine infusions of FFP | Hemophilia B |
| This bleeding disorder has a reduced activity of Factor VIII and impaired platelet "stickiness" | von Willebrand's disease |
| How do treat Von Willebrand's disease preoperatively? | Desmopressin (DDAVP) and cryoprecipitate in scheduled twice daily doses. |
| What is 1 unit of packed red blood cells equal to? | 250-300mL with a hematocrit of 70-80% |
| Why would you transfuse PRBCs? | to restore oxygen carrying capacity |
| What is the purpose of washing RBCs? | decrease sensitization to human leukocyte antigens, minimize febrile and allergic reactions, or pretransplant renal patients |
| What is in PRBCs? | RBC, nonfunctional WBC and platelets with little plasma |
| Who would receive Frozen Washed RBCs? | bone marrow transplant recipient, autologous transfusion, |
| What is the purpose of platelet transfusion? | Restore clotting ability |
| How do you infuse platelets? | through microaggregate filter |
| What are some reasons you would infuse platelets? | Leukemia, DIC, Thrombocytopenia, chemotherapy or radiation platelet suppression |
| What is contained in FFP? | Unconcentrated plasma containing all coagulation factors except platelets |
| Do platelets have to be ABO compatible? | no |
| Does FFP have to be ABO compatible? | Yes |
| What would Cryoprecipitate be used to treat? | Hemophilia A, DIC, Von Willebrand's disease, Obstetric complications, Fibrinogen deficiency |
| What is Cryoprecipitate? | Concentrated factors derived from FFP |
| Does Cryoprecipitate have to be ABO compatible? | Yes |
| Why would use albumin? | To treat hypovolemia or hypoproteinemia |
| A and B are ____________ carried on the RBC | antigens |
| Blood naturally has ______________ to antigens not on RBCs | antibodies |
| What percentage of people are Rh+ | 80% |
| How do you treat a Rh- mother preganant with an Rh+ fetus? | RhoGAM |
| What IV fluid do you hang with Blood? | Normal Saline |
| When do you change blood tubing? | After every 2 units of blood |
| True/False: You can add medications to a blood infusion just as you would IV fluids. | FALSE - NEVER add medication to a unit of blood or piggyback into the tubing. |
| Who do you notify if a blood transfusion reaction occurs? | Blood bank, Surgeon, Anesthesiologist. |
| What causes hemolytic reaction to a blood transfusion? | ABO incompatibility |
| What are signs of hemolytic reaction? | Sudden high fever, hypotension, hematuria, flank pain, dyspnea, tachypnea, tachycardia, palpitations, and substernal pain |
| Why is transfusing the sedated patient more risky? | Patient cannot report pain, Muscle relaxants may limit shivering, difficult to distinguish hypotension caused by transfusion or hypovolemic shock |
| What do you do if your patient has a hemolytic blood transfusion reaction? | STOP TRANSFUSION, Infuse NS, inform physician, send unit of blood along with patient blood and urine samples to blood bank |
| How do you treat a patient with a hemolytic blood transfusion reaction? | Acetaminophen for fever, Benadryl for itching, Furosemide if needed, fluid managment, frequent monitoring |
| What is major concern with Allergic transfusion reactions (usually occur in patient with significant allergy history) | Assess for glottal edema |
Created by:
keviannk
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