Week 2: Fluid Balance Part 2 Flashcards

Question

Blood Transfusion: Packed red blood cells (PRBC)

Answer 1

Major uses: Most common Bleeding or anemia - with S&S of impaired tissue oxygen delivery (tachycardia, SOB, Dizziness) Administration: Blood tubing required Initiate transfusion slowly for first 15 minutes (unless there has been massive blood loss) Transfuse for no longer than 4 hours Expected findings: Accurate change in Hbg 4-6 hours post-transfusion If there is no increase, think bleeding

Answer 2

Major uses: Volume expansion – massive transfusion with PRBCs Clotting factors – coagulopathy, plasma exchange procedures (some disease) Administration: Blood tubing required Initiate transfusion slowly for first 15 minutes (unless there has been massive blood loss) Transfuse over no more than 4 hours

Answer 3

Major uses: Control or prevent bleeding in patients with: Thrombocytopenia (low platelet count) Congenital platelet dysfunction Drug-induced platelet dysfunction Platelet dysfunction following cardiopulmonary bypass Administration: Blood tubing required Initiate transfusion slowly for first 15 minutes (unless there has been massive blood loss) Transfuse over no more than 4 hours

Answer 4

Pre-Transfusion - Consent - Review transfusion orders (clear, complete and appropriate!) - Assessment - Equipment

Answer 5

consent obtained by PHYSICIAN Blood products can only be given without consent in the following circumstances: Urgent transfusion needed to preserve life AND Patient unable to consent and substitute decision maker unavailable AND No evidence of prior reason for refusing blood products due (religious/personal)

Answer 6

must be ordered by a physician or authorized practitioner

Answer 7

Take vitals - TEMP is critical (30 mins prior to transfusion) Respiratory assessment CV assessment (Edema, fluid overload risk, history of CHF) Integumentary (rashes, petechiae, bruising)

Answer 8

antipyretic - fever

Answer 9

Common S&S FeverShaking, chills or rigorsHives, rash, itchiness, swelling Dyspnea, SOB, wheezing Hypo/hypertension Hematuria, diffuse bleedingPain at IV site Nausea, Vomiting Headache

Answer 10

Mild usually self-limiting reaction associated with donor white blood cells or cytokines in the blood component/product. Usually presents with fever and/or rigors (shaking).

Answer 11

Potentially fatal reaction caused by blood group incompatibility. Can also be caused by chemical hemolysis (e.g. incompatible solutions) or mechanical hemolysis (e.g. improper storage). Key signs are hypotension, back pain, fever.

Answer 12

Acute hypoxemia with evidence of new bilateral lung infiltrates on X-Ray and no evidence of circulatory overload. Patients often require ventilatory support. Usually occurs within 1-2 hours of start of transfusion and rarely after 6 hours. Usually resolves within 24-72 hours with death occurring in 5-10%. Cause not fully understood. Postulated to be related to donor or recipient antibodies acquired through pregnancy or transfusion.

Answer 13

Circulatory overload from excessively rapid transfusion and/or in patients at greater risk for overload (e.g. very young, elderly, impaired cardiac function). Preventative measures include slower transfusion rates and pre-emptive diuretics for patients at risk.

Answer 14

Bradykinin-mediated hypotension. Characterized by profound drop in blood pressure usually seen in patients on ACE Inhibitors unable to degrade bradykinin in blood component/product.

Answer 15

1. Stop the transfusion immediately 2. Maintain IV access for treatment but do not flush the blood tubing 3. Check VS 4. Verify the patient ID matches the blood bank label and tag 5. Verify the blood unit number matches the blood bank label and tag 6. Notify physician but remain with patient 7. Notify the blood bank about the reaction (follow organizational policy) 8. Treat patient’s symptom as ordered by physician