blood component theory TLO 2.3.6 (A)- nursing 212
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| blood is used to manage what | hematologic disease, therapeutic procdures, surgical procedures
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| blood products temporarily supports pt until ___ is resolved | underlying problem is resolved
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| nurse needs to ensure that physician has discussed what with patient before administration of blood products | risks, benefits and alternatives with pt
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| what is the problem with transfusing and OB pt | this can increase risk for infection
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| consent for blood products must be obtained when; when would blood products be given before consent; when pt is admitted to unit are they in an emergent situation anymore; so once on unit what does nurse need to do | prior to administration of blood; in emergent situations b/c there are emergent protocols; no; make sure this is a consent
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| blood groups and types: what are the groups; determining blood groups is based on what; what group has no antigen; | A,B and AB and O; the presence of absence of A & B red cell antigens; O;
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| blood groups and types: Type A blood produces what antibodies; Type B blood naturally produce what antibodies; | Anti-B antibodies; Anti-A antibodies;
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| blood groups and types: Rh Factor- def of Rh factor; def positive Rh; def neg. Rh factor; | an antigenic substance in the erythrocytes; presence of Rh factor; no Rh factor present
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| blood groups and types: what is the universal donor; what is the universal recipient; why is O- the universal donor; why is AB+ the universal recipient; | O-; AB+; no anti A or B or RH factor; they have all the antigens
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| blood groups and types: what Rh (neg or pos) mom will need rogan if they just had their first child and child is Rh neg; why is rogan given; | Rh pos; so mom doesn't build up antibodies against a RH pos babe in the future
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| whole blood: are any components removed; is it used often; when is it used; what is the big risk factor with this; what is the common side effect of fluid overload; how many mL are in whole blood; | no; no; massive hemorrhaging and bleeding out; fluid overload; pulmonary edema; 500 ml
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| what is exchange transfusion; | when your body has developed an immunity against itself and it is killing off its own blood cells ;
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| what should we assess for fluid overload; what would lung sounds sound like; where would crackles be; what are s/s of pulmonary edema | lung sounds, JVD; crackles; in posterior bases; SOB, anxiety, confused
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| packed red blood cells: is this more or less commonly used then whole blood; how many mL are per unit; why is it leukocyte reduced; | more; 250-350 ml; to reduced the risk for hemolytic febrile reaction
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| packed red blood cells: what is the use of it; what are symptoms of anemia; why does RR and HR increase; | severe symptomatic anemia and acute blood loss; pale, tired, SOB, tachycardia, RR increased; body is trying to increase circulation of blood for perfusion b/c not enough RBC's for gas exchange;
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| packed red blood cells: 1 unit of PRBCs increases Hgb by how much; 1 unit of PRBCs increases Hct by how much; how long can it be infused; why can it not be infused more than 4 hours; when should we replace tubing; | 1 g/dL; 3-4%; 2-4 hours; bc it increases risk for bacteria; cannot be used past 4 hours or 2 units- to decrease risk for infection
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| Frozen RBCs: when should they be used after thawing; why is it frozen; | 24 hours; to stockpile blood or for rare donors blood
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| platelets: how many ml are per unit of whole blood; how long can it be kept at room temp; how fast can it be infused; can it be given faster or slower then RBCs; why is it used; tx varies on what | 306- ml; 1-5 days; 15-30 min; faster; bleeding from thrombocytopenia; physician
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| fresh frozen plasma: how much of this is retrieved in one unit whole blood; are there platelets; are there other clotting factors; when does it need to be used after thawing; | 200-250 ml; no; yes-rich in them; 2 hours after thawing;
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| fresh frozen plasma: how fast can it be infused; when is it used; ex of def in clotting factors; | 15-30 min; bleeding caused by deficiency in clotting factors; hemorrhage, massive transfusion, liver disease, vit K deficiency, excessive Coumadin;
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| fresh frozen plasma: why would this be given instead of Vit K for increase INR due to Coumadin therapy; | if pt needs to go to surgery immediately or if they are actively bleeding;
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| Albumin: does this come from pharmacy or blood bank; why does it come from pharmacy; what is it prepared from; what are the two % solutions it is available; | pharmacy; bc there are no AB Rh factors and no cells- no need to be careful with blood typing; Plasma; 5% and 25%;
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| Albumin: 25 g/100 ml has an osmotically equal to how many mls of plasma; is this hyper, hypo or iso tonic; ex of pt who would receive this; what pt would not receive this ever; does this transmit viruses; | 500 ml; hyperosmolar/hypertonic; liver pt; CHF pt; no b/c it can be heat treated b/c there are no cells;
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| Albumin: when is it used; why is it used for hypovolemic shock; pt receiving this is at risk for what; what should be frequently assessed for fluid overload; with fluid overload where will fluid be pulled into | hypovolemic shock, hypoalbuminemia; bc it is a volume expander; fluid overload; lung sounds, pulse ox, rr, the intravascular space
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| cryoprecipitates: what do these come from; how much is usually in a bag; when are these used; ex of clotting factors; | fresh frozen plasma; 10-20 ml; replacement of clotting factors; VIII, hemophilia, von Willebrand's disease, fibrogen;
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| Von willebrand's disease: what is the deficiency caused by; what does von willebrand factor do; | deficiency of Von Willebrand factor;helps blood platelets clump together and still to blood vessel wall- nec for normal blood clotting
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| the procedure of admin blood: what is nurses responsibility to make sure pt has given ____; what should be assessed on pt prior to hanging blood; | consent; baseline vs, lung sounds, I&O;
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| why do Jehovah witnesses refuse blood; | they believe that the soul is in the blood and they would rather die from lack of blood due to the fact if they took blood they would loose their souls;
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| the procedure of admin blood: what type of IV do we want; when would we need 2 sites; | 20 gage or larger; if IV is hung for ABX an dBP meds, any meds that cannot be stopped- no meds can be hung with blood;
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| the procedure of admin blood: what is the only thing that can be hung with blood; what is purpose of NS; | NS; tubing is primed with it and then blood goes through and then after transfusion line is finished with saline- saline needs to prime line, and has to flush line- to keep line open
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| the procedure of admin blood: what temp should be reported to MD; why are there premeds ordered b4 blood; | 38.8 C or 100 F; MD wants then to be in effect before blood to reduce the chance of reaction
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| the procedure of admin blood: what are examples of premeds; why is Lasix given between units; does RN have to get the blood; ___ identifyers are needed | Tylenol or benedryl; to prevent fluid overload; no; pt
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| the procedure of admin blood: whose policies an procedures should be followed; will blood product consent be found; who would get smaller then 20 gage caths; why should small gages be used sparingly | the agencies; on the chart; babies, peds, cancer, very elderly; bc small gage causes cells to lyce an they are not as effective
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| what products can use a smaller than 20 gage; what size saline bag should be used; why is dextrose and lactated ringers not used; what baseline vital should be reported to the physician | platelets, albumin, and clotting factors; 250-500 ml bag; due to hemolysis; baseline fever
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| what is a safety measure for blood product check; what should be inspect on the bag; what should be explained to pt; explain to pt when they should call you | 2 RNs check; inspect for leaks; risk factors of reaction; rash, chills, SOB, pounding, itchingl
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| blood should be started when; blood product should never be placed where; why can it not be placed in med fridge; if blood is not used with in __ min it should be returned to what; | upon arrival to the unit; in the fridge; blood will deteriorate bc temp in fridge is not appropriate for blood; the blood bank;
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| for the 1st 15 min/ or 50 ml of blood the rate of infusion should be set at what; the nurse should stay for how long during the infusion; why should the nurse stay for the 1st 15 min; | 2 ml/min; for the 1st 15 min; in case there is a reaction;
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| when is a reaction to a blood transfusion most likely to occur | the 1st 15 min of admin
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| what is used for rapid transfusions or large volume in minutes | a blood warmer
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| in blood transfusion when are vital signs rechecked; why do we check vital signs; | after 1st 15 min, hourly, and at completion; we are checking for reaction;
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| what is most common sign of reaction | temp
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| for blood transfusion - when is rate of infusion is increased | this is according to orders and pt condition
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| for blood transfusion what should focused assessment be | lung sounds, temp, rr, O2 sats, pulse
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| Acute blood transfusion reaction: the adverse reaction to blood can range from ___ to ____; reaction is most likely to occur with in how many ml admin or how many min admin; who determines what type reaction occurred post reaction; | mild symptoms to anaphylactic shock; 50 ml 15 min; blood bank;
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| Acute blood transfusion reaction: we are least likely to have a reaction to what; why do we not have a reaction to albumin; | albumin; there are no cells;Acute blood transfusion reaction:
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| Acute blood transfusion reaction: what should we 1st do when we note a reaction; after the transfusion is stopped what should be run through the line; after the line is patenan;t what should we do; after we call physician what should we check; | stop the transfusion; NS; call the physician; vital signs, identifiers,urine output;
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| Acute blood transfusion reaction: the s/s of reaction are treated with what; what is saved and sent to blood bank for exam; what does the blood bank examine; | physician order; the blood tubing and bag; contamination, mistake in typing;
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| what blood is used in emergent situation; why is O- used in emergent situation; | O-; if there is no time to type and screen;
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| Acute blood transfusion reaction: after orders are reaceived to treat s/s what form does nurse have to fill out; we should document what; why are blood and urine samples ordered; | blood transfusion reaction form; what we did with that problem and eval the outcome; to check for hemolysis
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| what reaction occurs in the first 15 min of transfusion | acute hemolytic reaction
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| acute hemolytic reaction: within how many min does the reaction occur; what is the most common cause; | with in the 1st 15 min of reaction; ABO imcompatible blood;
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| Acute blood transfusion reaction: ABO incompatible blood- when cross matching with urine specimens we may accidently ____ with another specimen; what is the main reason for incompatibility; how can we prevent this; | mislabel; admin the wrong blood to the wrong person; check and double check with focus;
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| Acute blood transfusion reaction: pathophys- what happens to the cells; agglutination of the cells can obstruct what; when the capillaries are obstructed what is blocked; ___ is hemolysed; hemolysis of RBCs leads to increased ___ in plasma and urine; | they agglutinate; capillaries; blood flow; RBCs; Hgb
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| Acute blood transfusion reaction: pathophys- with hgb in urine what would we see; Hgb can also obstruct ___; obstruction of renal tubules leads to ____ renal failure; def DIC; | blood in urine; renal tubules; acute; disseminated vacular clotting;
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| Acute blood transfusion reaction: pathophys- with DIC what happens; reaction can cause what serious thing | pt bleeds out bc all clotting factors have been used to make clots; death
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| Acute blood transfusion reaction: pathophys- what are systematic s/s; vascular s/s; where will pain be; why is there flank/ lumbar pain; what is heart rate; what is rr; temp; | fever and chills; hypotension and uncontrollable bleeding; in lumber region; b/c the flow is blocked to the kidneys; tachy; fast SOB; elevated
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| febrile reaction: this is mostly caused by ___ incompatibility; do we stop this transfusion; what is first intervention; if pt has had f or more transfusions what do they develop; how is reaction prevented; what do filters do; what are leukocyte poor prod | leukocyte; no; call physician; antibodies to WBCs in blood product; by using filters from blood bank to; they reduce leukocytes; filtered washed or frozen
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| febrile reaction: what meds may be given; when are these meds given; | Tylenol, Benadryl; 30 min prior to transfusion
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| febrile reaction: s/s- what suddenly happens; what will fever be; what other s/s; | sudden chils or fever; > 1 deg C/ 2 deg F; HA, flushing, anxiety, vomiting and muscle pain;
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| allergic reaction: this occurs due to pt sensitivity to _____ in the donar blood; what can be given prior to prevent the reaction; what is given if there is a severe reaction; s/s if mild; s/s of severe; | sensitivity; antihistamines; epi or corticosteroids; flushing, itching, urticaria hives; axiety, urticaria, dyspnea, wheezing, cyanosis, bronchospasms, hypotension, shcck and cardiac arrest
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| circulatory overload: what pt is at risk for circulatory overload; does larger or smaller quantities of blood increase this risk; does quick admin or slow admin cause this; s/s; what should we assess | cardiac or renal insufficiency elderly; yes; quick; caough,dyspnea, pulmonary congestion, HA, HTN, tachycardia, JVD; SOB, crackles
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| circulatory overload: why is there a HA; we can reduce this by doing what to PAcked RBCs; we should tell pt to report s/s of what; | increased fluid; split the units so 1/2 a unit can be given in 4 hours; SOB
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| sepsis: how can blood products become infected; bacterial contamination can lead to what; s/s | improper handling, storage; bacteremia, sepsis, septic shock; rapid onset of chills, high fever, vomiting, diarrhea, marked hypotension or shock
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| transfusion related acute lung injury: this is aka; this is characterized by the sudden development of what; what does not cause this; what does cause this; | trali; non cardiogenic pulmonary edema; the heart pump; increased volume;
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| transfusion related acute lung injury: when does this occur after transfusion; does this surpass hemolytic reaction with death | 2-6 hours after - 72 hours after; yes
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| what is the leading cause of transfusion related death | TRALI
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| transfusion related acute lung injury: s/s; what is the tx; | fever, hypotension, tachypnea, dyspnea, decreased pulse ox, frothy sputum, confused; physician orders, diuretics, rapid response;
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| massive blood transfusion reaction: this is a complication of transfusing what type of blood volume; occurs when replacing what; this can happen when blood exceeds what; why is there an imbalance of normal blood elements; how do we decrease this risk | large amounts; RBCs; total blood volume; results due to the lack of clotting factos, albumin, platelets that are not found in RBC transfusion; careful monitoring of lab parameters during transfusion
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| massive blood transfusion reaction: how many units of RBCs cause this; why does hypothermia occur; why is there cardiac dysrhythmias; why is there a citrate toxicity | 8-10 u with in a few hours at a rate of 1 unit over min; lg amts cold blood; lg amts of cold blood why fluid warmer used; this is the preservative;
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| massive blood transfusion reaction: why is there hypocalcemia; s/s hypocalcemia; how do we prevent this; | the citrate in the solution binds with calcium creating less circulating calcium in the blood; muscle tremors and ekg changes; infuse 10% calcium gluonate;
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| massive blood transfusion reaction: how much calcium gluconate should be given with each liter of blood; | 10 ml;
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| massive blood transfusion reaction: hyperkalemia- s/s; preventions of reactions to massive blood transfusions | nasea, muscle weakness,diarrhea, paresthesias, flaccid paralysis of cardiac resp muscles, cardiac arrest; blood warming equipment, electrolyte monitoring during massive transfusions of blood
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| delayed blood reactions: infection- what is the most common virus transmitted by blood; what hep is common; what other virus; what pt have high rate of HIV; | hepatitis; hep B, C; HIV; hemophilia pt;
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| delayed blood reactions: infection- why does hemophilia pt have high risk for HIV; other viruses; | due to large numbers of donors needed for antihemophilic factors, numbers are decreasing though; herpes, Epstein-barr, human t cell leukemia, cytomegalovirus, malaria;
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| delayed blood reactions: iron overload- the excess iron can sometimes deposit where; | in the heart, liver, and pancreas and joints causing dysfunction
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| autologous transfusion: def; when do you start PRIOR to surgery; how much blood may we donate; blood can be saved when; how can it be salvaged postoperatively; | collection and reinfusion of pts own blood; 5 weeks prior to procedure; 1-5 units; during perioperative blood salvage; from mediastinal, chest tube, hemorrhage, joint and spinal surgery;
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| autologous transfusion: why is it safer | due to decreased risk of complications such as mismatched blood, decreased risk of exposure to blood borne infectious agents;
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