15: 1-3 - Blood Administration

A bus accident occurred in a rural area. Several patients taken to the local hospital required blood transfusions, resulting in a decreased supply of whole blood. One patient is blood type B. The blood bank sends type O− RBCs. What is the nurse's best action? Complete an incident report. Return the blood to the blood bank. Begin intravenous (IV) fluids until type B blood is obtained. Administer the type O blood.

Administer the type O blood. It is acceptable to provide group O RBCs to all patients. This often occurs in emergency situations before blood typing can be performed, and blood banks will often substitute group O RBCs for other blood types if their supply is low.

Identify the blood component that decreases microvascular bleeding during surgery and does not require ABO/Rh testing. Cryoprecipitate. Plasma. Whole blood. Red blood cells. Platelets.

Cryoprecipitate. Cryoprecipitate decreases microvascular bleeding during surgical procedures. Cryoprecipitate is indicated if the patient is bleeding and the fibrinogen level is less than 100 mg/dL.

The nurse is preparing to administer a unit of packed red blood cells to a patient with a history of anemia. Which is the best question the nurse should ask the patient before explaining the procedure? "Have you ever had a blood transfusion before?" "Are you a Jehovah's Witness?" "Do you have any allergies?" "Are you aware of the risks associated with receiving a blood transfusion?"

"Have you ever had a blood transfusion before?" This is the best question to elicit information without creating fear before patient teaching.

The patient has type AB+ blood. Which statement, if made by the patient, would require correction? "It is preferable for me to receive AB+ type blood." "I can only donate blood to another AB+ type individual." "I should not receive type A−, B−, or O− blood." "I can safely receive blood from any blood type group."

"I should not receive type A−, B−, or O− blood." An individual with type AB+ blood can receive blood from any group (with AB being preferable) and can only donate blood to another AB+ type individual. They are known as universal recipients.

Identify the IV catheter gauge typically recommended to infuse blood products in an adult. 18 gauge. 16 gauge. 22 gauge. 24 gauge.

18 gauge. An 18-gauge IV catheter is the recommended gauge for planned blood infusions. A 16-gauge IV catheter is most often used during major surgery, trauma, and obstetric emergencies. A 22-gauge IV catheter is the recommended gauge for use in the elderly and children. A 24-gauge IV catheter is the recommended gauge for pediatric and neonate applications.

Which transfusion reaction results from administering ABO-incompatible blood? Febrile reaction. Allergic reaction. Hemolytic reaction. Graft-versus-host disease

Hemolytic reaction. Administration of the wrong blood type results in a hemolytic reaction and can be life threatening.

A nurse is preparing to administer a unit of packed red blood cells. The patient has an IV of D5½NS infusing. What IV solution should the nurse use to infuse the unit of packed RBCs? D5½NS. Normal saline. D5W. Lactated Ringer's.

Normal saline. Normal saline should be used for priming the blood tubing and in between the infusion of any other solutions and the packed red blood cells.

A patient is to receive an autologous blood transfusion. The patient tells the nurse he is afraid to receive someone else's blood because of the possibility of contracting a disease. What is the nurse's best response? "The autologous blood is your own blood that is transfused." "We can give you Benadryl before the transfusion to help prevent transmission." "I can contact the health care provider to see if platelets could be used rather than blood." "You can request an allogeneic blood transfusion instead."

"The autologous blood is your own blood that is transfused." Patients who have a concern about transfusion-related reactions or transmission of disease find positive advantages in autologous transfusion, where their own blood is transfused. An allogeneic blood transfusion is from other donors and is a greater risk for transmission of disease. Some patients who have a history of frequent transfusion may require premedication with diphenhydramine (Benadryl) to combat acquired sensitivities. It will not prevent disease transmission. Platelets may be from a single donor or multiple donors. Platelets would not be "safer" in regard to disease transmission than an autologous transfusion of the patient's own blood.

What are the initial infusion rate and total infusion time for blood products? 30 mL/min; 4 hours. 2 mL/min; 4 hours. 5 mL/min; 30 minutes. 10 mL/min; 2 hours.

2 mL/min; 4 hours. The infusion rate is 2 mL/min (or 20 gtt/min using macrodrip of 10 gtt/mL) for the initial 15 minutes. All blood products need to be infused within 4 hours of initiating transfusion.

What may happen if lactated Ringer's, electrolytes, or other calcium-containing solutions are administered concurrently with blood products? Hyperchloremic metabolic acidosis occurs. Serum protein concentrations reduce. Calcium binds to citrate resulting in hypocalcemia. Electrolyte imbalance occurs as a result of upsetting the sodium-to-calcium balance.

Calcium binds to citrate resulting in hypocalcemia. Cardiac dysrhythmias, hypotension, and tingling indicate hypocalcemia, which occurs when citrate (used as a preservative for some blood products) binds to the patient's calcium. For this reason it is recommended that blood product administration occur separately from most other IV fluids (except normal saline).

It is acceptable practice to place blood into refrigerators or freezers located in patient care areas. False True

False Standard refrigerators/freezers located in patient care areas are unable to ensure accurate temperature regulation of blood products. For this reason they should never be used to store blood products.

Identify the transfusion reactions that result in immediate cessation of the transfusion. (Select all that apply.) Hemolytic reaction. GVHD. Hyperkalemia. Febrile, nonhemolytic reaction. Allergic reaction.

Hemolytic reaction. Febrile, nonhemolytic reaction. Allergic reaction. Hemolytic, allergic, and febrile, nonhemolytic reactions, as well as infectious disease transmission, are life-threatening reactions that require immediate cessation of the transfusion.

What is the primary reason for meticulous care to avoid human error in transfusion therapy? When errors occur, blood products are wasted, leading to a blood shortage. Human error can lead to life-threatening transfusion reactions. Patients may become confused regarding their blood type. Preventing human error reduces health care costs.

Human error can lead to life-threatening transfusion reactions. Incorrect patient identification and incorrect labeling of blood lead to the administration of incompatible blood and cause life-threatening transfusion reactions.

The nurse is transfusing a large amount of blood to a trauma patient. The nurse knows to observe the patient for: Hypotension and cardiac dysrhythmias. Crackles in the lungs and increased central venous pressure. Headache and muscle pain. Wheezing and chest pain.

Hypotension and cardiac dysrhythmias. Hypotension and cardiac dysrhythmias are the initial reactions to massive transfusions. Mild hypothermia, hypocalcemia, and hemochromatosis (iron overload) may also occur in patients receiving massive transfusions.

Which of the following would be an early indication of an adverse transfusion reaction? Hypertension. Feelings of faintness. Increase in body temperature. Bradycardia.

Increase in body temperature. An elevation in temperature or heart rate is one of the first signs that a person is having an adverse reaction to a transfusion.

A postoperative patient is receiving a unit of packed red blood cells and requests pain medication for a pain level of 8. Upon review, the nurse sees the patient may have 3 mg of morphine sulfate IV push. What is the nurse's best action? Administer the morphine sulfate intramuscularly this one time. Initiate a second VAD and administer the morphine sulfate. Stop the blood transfusion, flush the port closes to the insertion site with normal saline, administer the morphine, flush with normal saline, and restart the blood infusion. Inform the patient he will have to wait until his blood transfusion is complete and provide nonpharmacological methods of pain relief.

Initiate a second VAD and administer the morphine sulfate. Never inject medication into the same IV line with a blood component because of the risk for contaminating the blood product with pathogens and the possibility of incompatibility. If IV medications need to be administered during the transfusion, a second IV site is necessary.

Why is warming a unit of blood products in a microwave or under hot water from the tap contraindicated? Preparation of blood products is the blood bank's responsibility. It makes the blood product too hot to infuse and as it cools it coagulates. It can create a leak in the blood packaging. It destroys the blood product.

It destroys the blood product. Use of microwaves or hot water destroys blood products because the heat generated cannot be adequately moderated to protect blood products from damage.

What is the benefit of using a large-bore intravenous (IV) catheter for administering blood products? Large-bore IV catheters are used so that flushing the line before and after blood product infusion is easier. Large-bore IV catheters allow a more consistent rate of administration than smaller catheters. Large-bore IV catheters are necessary when a pressure bag is being used. Large-bore IV catheters promote rapid flow of blood components.

Large-bore IV catheters promote rapid flow of blood components. An 18- to 20-gauge catheter is appropriate for the general population. A large-bore IV catheter (i.e., 14 to 16 gauge) is used when rapid infusion is required. The consistency of the rate of infusion may be affected by many factors independent of catheter size. A pressure bag may be used when a small-bore cannula (e.g., 24 gauge) is the vascular access device (VAD).

A patient has type O+ blood. Which of the following blood types can the patient receive? A+. B−. O−. None of these. AB+.

O−. An individual's blood type determines the antigens present on the red blood cells (RBCs). In this particular case the patient lacks antigens on their RBCs and may receive either O− or O+ type blood

The patient states, "I don't know my blood type, I just know that I'm a universal donor." The nurse correctly interprets this statement, inferring that the patient most likely has which blood type? O+. A+. AB+. AB−. O−.

O−. People with type O− blood are considered universal donors because they lack antigens to cause an immunologic response with any of the other blood types.

Which of the following types of autologous blood donations has the advantages of containing more viable RBCs than stored blood, having a normal pH, and containing higher levels of a chemical that increases the oxygen-carrying capacity of hemoglobin than other types of blood donations? Hemodilution. Preoperative. Perioperative. Allogeneic.

Perioperative. Perioperative blood contains more viable RBCs and 2,3-DPG than stored forms of blood. In addition, the pH is normal.

A trauma patient has received 6 units of red blood cells. Plasma and platelets are now prescribed. What is the primary reason the nurse changes the blood administration tubing between packed RBCs (PRBCs), platelets, and/or plasma? Platelets should run through tubing different than tubing used for RBCs. Plasma is unable to pass through tubing that has previously filtered red blood cells. Blood tubing must be changed every hour. Blood tubing must be changed every 6 units.

Platelets should run through tubing different than tubing used for RBCs. Fibrin strands and debris in the filter may trap platelets.

Identify the blood component that can be stored for up to 5 days at room temperature. Whole blood. Plasma. Red blood cells. Platelets. Cryoprecipitate

Platelets. Platelets may be stored up to 5 days at room temperature.

Why might dysrhythmias and a reduction in core body temperature occur in a recently transfused patient? Rapid administration of nonwarmed blood products. An air embolism. Hypocalcemia. Volume overload.

Rapid administration of nonwarmed blood products. Rapid administration of nonwarmed solutions may result in iatrogenic hypothermia. An air embolism may result in symptoms related to heart attack or stroke. A volume overload may result in shortness of breath and edema. Hypocalcemia may result in muscle twitching and numbness of the extremities, which should resolve as blood passes through the liver.

What should the nurse do first if a patient receiving a blood transfusion develops a skin rash, edema, and wheezing? Slow the rate of the transfusion. Stop the transfusion immediately. Discard the blood bag and tubing. Reassess the patient in 10 minutes.

Stop the transfusion immediately. These are signs of an allergic reaction. Stop the transfusion immediately and connect normal saline-primed tubing at the vascular access device (VAD) to prevent any subsequent blood from infusing from tubing.

A patient is Rh(D) positive. The patient is to receive a unit of RBCs. The blood bank sends Rh(D)-negative RBCs. What is the nurse's best action? Request a unit of AB+ blood be sent from the blood bank for the patient. Send the blood product back to the blood bank because Rh(D)-negative RBCs should not be transfused to Rh(D)-positive patients. Ask if the patient has ever been exposed to Rh(D)-negative blood before. Use the blood product supplied because Rh(D)-negative RBCs may be safely transfused to Rh(D)-positive patients.

Use the blood product supplied because Rh(D)-negative RBCs may be safely transfused to Rh(D)-positive patients. It is acceptable to transfuse Rh(D)-negative RBCs to Rh(D)-positive patients.

A patient is Rh(D) negative. A patient is to receive a transfusion of plasma. The blood bank sends Rh(D)-positive plasma. What should the nurse do? Use the blood product supplied because Rh(D)-positive plasma may be safely transfused to Rh(D)-negative patients. Contact the health care provider for further pretransfusion orders. Send a sample of the patient's blood to the blood bank for repeat Rh typing before administering plasma. Send the blood product back to the blood bank because Rh(D)-positive plasma should not be transfused to Rh(D)-negative patients.

Use the blood product supplied because Rh(D)-positive plasma may be safely transfused to Rh(D)-negative patients. It is acceptable to transfuse Rh(D)-positive plasma to Rh(D)-negative patients because the Rh(D)-antigens are associated with RBCs rather than plasma.

A febrile nonhemolytic transfusion reaction typically occurs when the patient's antibodies react to transfused: Red blood cells (RBCs). White blood cells (WBCs). Fresh frozen plasma (FFP). Corticosteroids.

White blood cells (WBCs). A febrile transfusion reaction is caused by a patient's antibodies responding to antigens present on transfused leukocytes (WBCs) or platelets in a donor's blood.

Which blood product places a patient at a higher risk of fluid overload after transfusion? Red blood cells (RBCs). Whole blood. Leukocyte-poor RBCs. Cryoprecipitate. Platelets.

Whole blood. A unit of whole blood is 450 to 500 mL. Other blood products are substantially less volume.

Identify the blood component that elevates hematocrit (Hct) by 3% and hemoglobin (Hgb) by 1 g/dL when 1 unit is administered. (Select all that apply.) Whole blood. Plasma. Cryoprecipitate. Red blood cells. Platelets.

Whole blood. Red blood cells. A unit of whole blood should elevate hematocrit by 3% and hemoglobin by 1 g/dL in a nonhemorrhaging adult. A unit of red blood cells is expected to raise Hgb and Hct levels the same amount as whole blood.

Compatibilities for ABO type for donor and recipient are required for which blood products? (Select all that apply.) Colloid components (e.g., albumin) Whole blood. Red blood cells. Platelets. Plasma.

Whole blood. Red blood cells. Platelets. Plasma. All of the blood products listed should be blood typed before use to avoid life-threatening complications. Cryoprecipitate and colloid components (such as albumin) do not require ABO or Rh typing.

When do adverse reactions from blood transfusions usually occur? Within the first 15 minutes of the transfusion. One hour after the transfusion has been completed. Upon completion of the transfusion. After the first hour of the transfusion.

Within the first 15 minutes of the transfusion. Adverse reactions typically occur during the first 15 minutes. This is why the transfusion is started slowly and why it is so important for the nurse to intensely monitor the patient in the first 15 minutes.