Lab 1 Flashcards
(128 cards)
1
Q
informed consent is required…
A
- for every pt prior to receiving blood or blood products
2
Q
what must be included in informed consent for blood or blood products (5)
A
- provide both verbal & written info that is understood by the pt or substitute decision maker
- be voluntary
- discuss risks, benefits, and alternatives (including doing nothing)
- understand the pt has the right to refuse
- include opportunity for the pt to ask questions
3
Q
who can consent or refuse medical treatment in manitoba?
A
- competent persons 16 years or older can legally give or refuse consent
4
Q
who can give consent if the pt is not competent and/or older than 16 years old (4)
A
- proxy
- guardian
- authorized prescriber
- substitute decision maker
5
Q
who can obtain informed consent (4)
A
- medical resident
- physician
- NP
- registered nurse extended practice
6
Q
when should the informed consent process begin
A
- upon initial admission to allow pt time to make an informed decision and time for consideration of alternatives
7
Q
how long is consent valid for
A
- a consent from signed by the pt is valid for 1 year from the date of the pt’s signature if the same authorized practioner is performing the procedure
- significant changes in the pts condition require new consent
8
Q
describe informed consent in the event of an emergency (4)
A
authorized practitioners can defer consent at their discretion if the following apply:
- pt lacks decision making capacity and subtitute decision maker not available
- urgent transfusion to save life, limb, or vital organ
- reasonable person would consent in the circumstance
- no evidence that the pt objects to the transfusion
9
Q
describe consent by phone; what is required? (3)
A
is acceptable when not able to be done in person, it requires:
- witness throughout the convo
- signature of authorized practitioner who obtained consent
- signature of witness on consent form
10
Q
what do you do if no consent is documented
A
- no blood given until resolved
11
Q
what should you do if treatment is refused
A
- ensure if it documented in the health record
12
Q
what are the most common transfusion associated risks
A
- non-infectious risks
13
Q
describe infectious risk associated w transfusion (2)
A
- very low, but cannot be absolutely guaranteed
- donated blood is a biological product that cannot be risk free of germs
14
Q
what are common non-infectious risks associated w transfusions (9)
A
- transfusion associated circulatory overload
- transfusion associated dyspnea
- transfusion related acute lung injury
- hemolytic reaction
- incompatible transfusion
- hypotensive reaction
- aseptic meningitis
- IVIg headache
- others
15
Q
describe mild allergic reaction r/t transfusions: onset, symptoms, mngmt, can transfusion continue?
A
- begins within 1-45 mins after start of transfusion
- mild hives, rash
- managed w diphenhydramine
- transfusion can continue
16
Q
describe transfusion associated circulatory overload: onset, symptoms, treatment, transfusion proceedings
A
- begins w 1-45 mins after start
- dyspnea, orthopnea, cyanosis, tachycardia, HTN, increased venous pressure
- Tx: O2, diuretics, chest xray
- consider restarting transfusion at reduced rate if clinical status allows
17
Q
describe febrile non-hemolytic reaxction: symptoms, Tx, can transfusion continue?
A
- fever present during or up to 4 hours after transfusion
- Tx: acetaminophen
- transfusion can continue
18
Q
describe anaphylactic reaction r/t transfusions: onset, symptoms, treatment, can transfusion continue
A
- onset: 1-45 mins after start of transfusion
- Sx: severe rash, upper or lower airway obstruction, hypotension
- stop transfusion, do not restart
- Tx: supportive ventilatory support as indicated
19
Q
describe bacterial contamination r/t transfusions: symptoms, treatment
A
- Sx: rigors, fever, tachycardia, hypotension, dyspnea, NV, DIC
- Tx: stop transfusion, notify blood bank, return residual product, collect blood cultures, supportive therapy, abx
20
Q
describe acute hemolytic transfusion rxn: why does it occur, symptoms
A
- occurs when wrong ABO blood is transfused
- Sx: fever, chills, hemoglobinuria, pain, hypotension, NV, dyspnea, renal failure, DIC
21
Q
describe transfusion associated acute lung injury: onset, symptoms, treatment
A
- onset: within 1-2n hours after start, can be delayed up to 6 hrs
- Sx: dyspnea, hypoxemia, fever, hypotension, no evidence of circulatory overload
- Tx: supportive care, mechanical ventilation if needed
22
Q
what are 2 rules r/t transfusion safety
A
- dont transfuse blood if other non-transfusion therapies or observation would be just as effective and safe
- if pt does require blood transfusion, do not transfuse more than 1 red cell unit at a time when transfusion is required in stable, non-bleeding pts –> 1 unit of blood is usually adequate if non-bleeding & stable
23
Q
what are indications for a 2nd unit of blood (2)
A
- active blood loss
- ongoing symptoms of anemia
23
Q
what are indications for a 2nd unit of blood (2)
A
- active blood loss
- ongoing symptoms of anemia
24
according to best practice, orders for blood components and/or plasma protein products should include: (7)
- pts name and unique identifier
- date & time order written & signed legibily
- type of blood to be admin
- rate at which transfusion to be admin
- duration of transfusion
- any special requirements (ex. warmer, irradiated)
- any pre-meds if required
25
the healthcare professional drawing blood must positively id the pt by confirming with the id band.... (2)
- first and last name
| - unique identifier (PHIN)
26
once a blood sample is collected, the tube is labelling in the presence of the pt and includes... (6)
- first and last name
- PHIN
- date
- time
- facility name
- phlebotomist initials
27
when must positive pt ID be established (2)
- time of pre-transfusion blood testing
| - admin of any/all blood, blood components, and/or plasma protein products
28
what must be done if discrepanies are discovered during positive pt identification at the bedside and at the lab
- at the bedside: blood samples must not be collected
| - in the lab: sample rejected and request new blood draw from the unit
29
what is a transfusion medicine results report (TMRR)
report generated by Canadian Blood Services that indicates:
- indicates pt ABO group, Rh and antibody status
- expiry date and time
30
the TMRR is received in the pt care area within..... how long is it valid for?
- received within 1-24 hrs depending on priority
| - valid for 72 hrs
30
the TMRR is received in the pt care area within..... how long is it valid for?
- received within 1-24 hrs depending on priority
| - valid for 72 hrs
31
what is the most common cause of transfusion reactions
- mis-identificiation of pts
32
what is the second sample protocol
- ensures that no pt receives group specific blood until at least 2 samples are received w the same ABO group results
33
what are 2 types of pts r/t second sample protocol
1. never had a type and screen
| 2. previous type and screen on file
34
describe what is done for pts who have never had a type and screen (2)
- receive group O red cells until a second type and screen is completed
- second sample requested by blood bank after issue of 2 units O group red cells
35
describe what is done for pts w a previous type and screen on file r/t second sample protocol (2)
- issues group specific blood immediately
| - no need for second sample to be sent
36
what is to be included in the Request for Release of Blood/Blood Derivative form to Blood Bank (4)
- unit where blood is needed
- unit phone number
- when its required
- first and last name of ordering practioner
37
when is the Request for Release of Blood/Blood Component/Deriviate form used by the blood bank: (4)
when you need to:
- order plts (stored at CBS)
- request blood products for a pt with an antibody
- request irradiated plts or red cells
- request a copy of a pts result report
38
describe the admin of emergency blood (5)
- pre-transfusion sample must be drawn prior to admin of emergency red cells
- note on request of release form that emergency units are being requested
- phone the blood bank to notify themm
- complete tag w pt demographic info
- authorized practitioner to sign ROT
39
female pts under 45 years require the use of ??? for emergency situation
- group O- red cells
40
all clinical orders for blood products should include: (6)
- first and last name of pt
- PHIN
- DOB
- physician who ordered the product
- product requested what and how much
- where is it going (location)
41
the transporter must present w ??? at the hospital blood bank to pick up a blood product
- documentation (verbal orders not acceptable)
41
the transporter must present w ??? at the hospital blood bank to pick up a blood product
- documentation (verbal orders not acceptable)
42
at what point can blood products be returned to the blood bank
- if they have not been out of a controlled enviro for no more than 60 mins from the time of issue
ex. if blood no longer required, IV no longer patent and needs to be restarted
43
once the blood product arrives in the transfusion area, a complete visual insepction is completed to look for:
- leakage
- discoloration
- clots
- expiry date
44
what is done if the blood product does not pass visual inspection
- send back to the blood bank immediately
45
prior to admin of blood & blood products, what needs to be completed? (4)
2 person verification to verify:
- complete order from authorized practicioner
- intended recipient's ABO group, Rh status, and any antibodies
- donation ID number, donor ABO group, and Rh status
- positive ID of the intended recipient
46
describe rules r/t transfusion of blood or blood products (3)
- ensure correct tubing for product being administered
- never add med to infusion
- refer to site specific policy & procedures for pediatric considerations
47
describe the infusion rate & duration of blood (3)
- infusion of one unit of RBC must not exceed 4 hrs
- initiate at slower rate and remain w pt for first 15 min
- increase rate as ordered after initial 15 min if no signs of adverse reaction
48
describe the removal of the manilla tag w blood transfusions
- do not remove until the transfusion is complete
| - after transfusion is complete, remove and place tag in confidential waste
49
when should admin sets for blood & blood products be changed? (5)
after:
- four consecutive units
- more than 30 mins between units
- do not use same set for diff products
- set becomes occluded
- max of 4 hours
50
where is documentation of the blood transfusions be done on
- cumulative blood product record
51
what is included on the cumulative blood product record (5)
- product name
- donation lot and sequence number
- date & time
- initials of 2 prescribers that checked product
- vital signs
52
what is done after the record of transfusion is completed
- returned to the blood bank to complete vein to vein standards
53
describe VS monitoring w admin of transfusion (5)
VS:
- before transfusion begins
- after first 15 min
- every hour during
- at the end
- one hour post transfusion
54
describe monitoring r/t transfusions
- remain w pt for the first 15 min
| - increase freq based on pts clinical presentation
55
what should you observe for during the first 15 min of every transfusion: (15)
new onset of:
- temp rise >1*C
- SOB
- HTN
- hypotension
- hypoxemia
- chills
- rigors
- rash
- uritcaria
- pruritis
- jaundice
- hemoglobinuria
- bleeding @ IV site
- pain (back, chest, bone, abdomen)
- tachycardia
56
what should you do if at any time during the transfusion you suspect a transfusion rxn (8)
- stop transfusion immediately
- refer to transfusion reaction algorithim
- maintain IV w NS using a new IV set
- assess VS and monitor minimum q15 min
- contact physician or autorized practicioner for medical assessment and treatment
- perform visual inspection of product
- repeat 2 nurse check for clerical discrepancies
- notify blood bank
57
what are the objectives for blood transfusion (3)
- increase circulating blood volume after surgery, trauma, or hemorrhage
- increase # of RBCs & maintain hgb in people w severe anemia
- provide selected cellular components as replacement therapy (clotting factors, plts, albumin)
58
what is the determination of blood groups based off
- presence or absence of A and B RBC antigens
59
what are the four types of blood types
- A
- B
- AB
- O
60
what antigen is present w type A? who can they donate to? who can they receieve from? what serum antibodies?
- A antigen
- anti-B antibodies
- donate: A, AB
- receive from: A, O
61
type b blood: what antigens? what antibodies? can donate to? can receive from?
- B antigen
- anti-A antibodies
- donate: B, AB
- receive from: B, O
62
type O blood: antigens? antibodies? donate to? receive from?
- absence of antigens
- anti-A and anti-B antibodies
- donate to all
- receive from O
63
type AB blood: antigens? antibodies? receive from? donate to?
- presence of A and B antigens
- no serum antibodies
- donate to: AB
- receive from: all
64
individuals w typw A blood naturally produce..... type B?
- type A = naturally produce anti-B antibodies
| - type B = naturally produce anti-A antibodies
65
what is the universal blood donor? why?
- type O
| - has neither A or B antigens
66
what is the universal recipient and why
- type AB
| - produce neither antibody
67
what causes a transfusion reaction
- if blood that is mismatched w the pt's blood is transfused
- it is an antigen-antibody reaction
68
what is another consideration when matching for blood transfusions
- Rh factor
69
what is Rh factor
- antigenic substance in the erythrocytes
70
describe the influence that Rh + vs Rh- has on blood transfusions
- Rh+ = can receive from Rh - or + blood
| - Rh- = can only receive Rh-
71
what is an autologous transfusion
- collection of a pt's own blood which is then reinfused during surgery
72
what is the benefit to an autologous transfusion
- decreased risk of complications such as mismatched blood and exposure to bloodborne infectious agents
73
how much blood can be collected autologously
1-5 units
74
when is assessment completed when transfusing blood or blood components
- before, during, and after the transfusion
75
what documentation should be done/checked pre-transfusion (3)
- check for pt consent (and expiry)
- obtain cross match sample
- confirm physician order
76
what should be included on the physician order for a transfusion (6)
- blood product
- pt name
- product amt (how many units)
- clinical indication
- rate of infusion
- duration
77
what assessments should be done pre-transfusion
- baseline VS
| - ensure IV patent, signs of infection or infiltration
78
what size of IV is recommended for transfusions and why
- 18-20 G
| - bc blood is thicker and stickier than IV fluids
79
what is included in pre-transfusion admin set prep (3)
- prime blood tubing w 0.9% NS
- obtain a baxter pump
- prime a separate primary line w NS and hang at bedside for emergency use only (in case of reaction)
80
why is NS used to prime blood admin tubing
- prevent hemolysis or breakdown of RBCs
81
what comes from the blood bank after faxing the request to the blood bank (3)
- blood component bag
- blood component tag
- record of transfusion (ROT)
82
what is done once the blood has arrived to the unit
- grab the chart & RN to complete your checks
83
what is done during the first check and where
- pt identification at the nursing sent
84
what does nurse 1 vs nurse 2 do during the 1st check
- nurse 1: read from ROT first & last name (letter by letter) & PHIN or unique identifier
- nurse 2: compare and verifiy info on both with admission sheet
85
what does nurse 1 vs nurse 2 do during the second check
- nurse 1: read from ROT first and last name (letter by letter), PHIN, donation unit # or lot #, ABO/Rh blood type (donor), compatability status
- nurse 2: compare and verify w component tag
86
what is checked during the 3rd check
- component verification
87
what does nurse 1 vs nurse 2 do during the 3rd check
- nurse 1: read from blood component tag product type, donor ABO/Rh, donor unit # or lot #, crossmatch expiry date (on tag), unit expirary date (on bag), modifiers (ex. irradiated)
- nurse 2: compare and verify the info on component bag
88
what else is checked during the component verification (3rd check) (3)
- verbally inspect blood product
- make sure to check volume in the bag
- document the 2-person verification process on the cumulative blood product record (CBPR)
89
what is done during the 4th check
- pt ID and verification at the bedside
90
describe what is done during the 4th check
- check pts last & first name and PHIN on pt ID armband with the component/PPP tag attached to donor unit
- ask pt to state/spell their last & first name and DOB (if capable)
- if pt cannot give verbal id, a nurse must confirm identity by stating letter by letter and number by number from the ID armband to the corresponding info on the component/PPP tag attached to the donor unit
- same 2 individiuals must sign CBPR
91
what should be worn when setting up blood transfusions
- gloves
92
describe how to set up your blood transfusion (4)
- spike blood component bag
- make sure clamp NS to prevent backflow into the saline bag
- prime the line w blood
- insert into baxter pump
93
describe the infusion rate of a blood transfusion
- start infusion rate slow: 30-50 mL/h for first 15 min (timer starts once blood hits the vein)
- then set to ordered rate
94
what is done after setting up the infusion and setting the infusion rate
- label the line
| - attach to pt
95
describe VS assessment r/t blood transfusions (5)
- prior to transfusion
- after first 15 (and stay w the pt during first 15)
- hourly during transfusion
- end of transfusion
- 1-hr post transfusion
96
what must be documented r/t transfusions? where is it documented
- type of blood, blood component or PPP
- donor unit # (including check digit and center code) or lot #
- time infusion starts and ends
- VS
- pt education and response during and after transfusion
- total volume infused (fluid bal record)
*document on cumulative blood product record*
97
what is done w the ROT after initiating the blood transfusion
- complete & return it to the blood bank as soon as the pt's blood mixes w the blood/blood component (after 15 min of constant observation)
98
what is the purpose of the ROT
- ensure traceability from the donor's veins to the recipient's veins
- provides evidence for the pt & CBS in the event that many years later it is discovered that the current blood supply is tainted
99
what pt education should be completed r/t transfusions (6)
- explain they are getting blood
- ask if pt knows reason why they are getting the transfusion
- ask if they have had a previous transfusion or rxn
- explain the procedure
- educate on the importance of letting you know if they are feeling any different & signs of a transfusion rxn
- ensure they have given consent & signed the consent form
100
what is done once the transfusion is complete (2)
- discard tubing & blood bag in the biohazard waste bin
| - place blood component tag in confidential waste
101
what is a transfusion rxn
- systemic response by the body to incompatible blood
102
what are some causes of a transfusion rxn (3)
- RBC incompatibility
- allergic senstivity to the components of the blood
- allergic sensitivity to the potassium or citrate preservative in the blood
103
what is a second category of transfusion rxns?
- diseases transmitted by infected blood donors who are asymptomatic
104
what are examples of diseases transmitted thru transfusions
- malaria
- hepatitis
- AIDs
105
describe what to do if a blood reaction is suspected (10)
- stop the transfusion immediately
- keep the IV line open by piggybacking NS directly into the IV line (do not turn off the blood and simply turn on the NS connected to the y-tubing set, this would cause the blood remaining in the tubing to be infused)
- notify the physician & blood bank immediately
- recheck identifying tags & numbers
- remain w the pt, observe S&S, monitor VS & U/O, as often as q5min
- treat symptoms as per physicians order (emergency drugs, prep for CPR, etc.)
- obtain urine specimen & send to lab to determine the presence of hgb as a result of RBC hemolysis
- obtain blood sample as indiciated
- save the blood container, tubing, attached labels, and transfusion record, and return to the lab
- document the incident
106
what fluids cannot be used w blood transfusions and why
- dextrose or LR = RBC hemolysis
| - no meds via the same tubing as well
107
most pts not in danger of fluid overload can tolerate the infusion of 1 unit of PRBCs over ____ h, the transfusion should not take longer than n4 hr
- can usually tolerate over 2 hr
| - should not take longer than 4 h --> risk of bacterial growth in the product once it is out of refrigeration
108
what is the most common cause of hemolytic transfusions
- ABO-incompatible blood
109
what is an acute hemolytic rxn
- when antibodies in the recipients serum react w antigens on the donor's RBCs
= agglutination of cells --> obstruct capillaries and blood floiw
= hemolysis of RBCs= release of free hgb into plasma = AKI
110
why do nurses stay w the pt during the first 15 min of a transfusion
- the clinical manifestations of an acute hemolytic rxn usually develop within the first 15 min
111
what is a delayed transfusion rxn
- transfusion rxn that occurs 24 hr to 14 days after admin
112
what causes a febrile reaction?
- reaction due to leukocyte incompatability ---> when individuals receive 5 or more transfusions they develop circulating antibodies to the WBCs in the blood product
113
how are febrile reactions prevented
- admin of acetaminophen and diphenhydramin 30 min before transfusion
114
what is used to prevent allergic rxn r/t transfusion? what can treat a severe reaction?
- prevent: antihistamines
| - treat: epi or corticosteroids
115
who is at higher risk of developing circulatory overload r/t transfusions
individual w renal or cardiac insufficiency
116
what is transfusion-related acute lung injury
- sudden development of noncardiogenic pulmonary edema
117
what is a massive blood transfusion rxn
- an acute complication of transfusing lrg volumes of blood products or when replacement of RBCs or blood exceeds the total blood vol within 24 hrs
= imbalance of normal blood elements bc clotting factors, albumin, and plts are not found in RBC transfusions
118
what other problems may occur w massive blood transfusions (3)
- hypothermia (if cold blood)
- dysrhythmias (if cold blood)
- hyperkalemia (if K leaks from RBCs)
119
what medication is commonly prescribed to be given after a blood transfusion? why? what pt assessment need to be done when giving this med?
????
120
the first step in the procedure of blood admin is ___
- get consent from the pt
121
treatment order for transfusions must include (8)
- what product
- amt of product
- pt name
- date of transfusion
- reason/clinical indication
- rate of infusion/duration
- special requirements
- prescribers signature
122
no band no ____
blood
123
to obtain a cross match blood sample, what color topped tube is used
- purple
124
blood products can be returned to the blood bank within _____ from time of issue
- 60 min
125
what should you consider w stable non-bleeding pts
- why give 2 when 1 will do? (start w 1, see if it corrects the problem)
- other alternatives ex. iron therapy
