Blood Transfussions and Lab Values

A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which of the following reasons?

Lack of erythropoietin

Platelets

150,000-400,000 "150-400 PLATEs at a wedding feast."

Partial thromboplastin time (PTT)

1.5-2x normal value (1.5-2x PT =PTT)

Hematocrit

37%-52% "3752 Hematocrit Lane"

Red BC

4.2-6.1 "42-61 year olds get RED faced, when you ask them their age."

An RN from pediatrics has "floated" to the medical-surgical unit. Which client is assigned to the float nurse?

42-year-old with sickle cell disease receiving a transfusion of packed red blood cells *Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion

White BC

5,000-10,000 "5-10 WHITE bricks, will get you arrested."

The nurse has just received a unit of packed red blood cells from the blood bank for transfusion to an assigned client. The nurse is careful to select tubing especially made for blood products, knowing that this tubing is manufactured with which item?

An in-line filter *The filter helps ensure that any particles larger than the size of the filter are caught in the filter and are not infused into the client.

Which should the nurse observe for as a complication of Factor VIII administration?

Blood transfusion reaction * Factor VIII is a blood product, so the nurse would monitor for a transfusion reaction.

international normalized ratio (INR)

0.7-1.8 (If I am actively bleeding, I Need Rescued (INR) in 0.7 to 1.8 seconds)

A client requiring surgery is anxious about the possible need for a blood transfusion during or after the procedure. The nurse suggests to the client to take which actions to reduce the risk of possible transfusion complications? Select all that apply.

Ask a family member to donate blood ahead of time, or Give an autologous blood donation before the surgery. *A donation of the client's own blood before a scheduled procedure is autologous. Donating autologous blood to be reinfused as needed during or after surgery reduces the risk of disease transmission and potential transfusion complications. The next most effective way is to ask a family member to donate blood before surgery.

Which of the following is the percentage of blood volume consisting of erythrocytes?

Hematocrit

A client has received a transfusion of red blood cells. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which finding?

Increased hemoglobin and hematocrit levels would occur.

The client with ______ would be most susceptible to an allergic transfusion reaction.

alergies

A child is in the hospital with a diagnosis of thalassemia major. Multiple blood transfusions have been ordered along with a chelating agent. The father asks the nurse, "Why does my son get this drug every time he gets blood?" What does the nurse explain as the purpose of chelating drugs?

deferoxamine (Desferal) *A chelating agent is given to eliminate excess iron.

The ______ _________ client would be most susceptible to circulatory overload.

older adult

The nurse is told by a health care provider that a client in hypovolemic shock will require plasma expansion. The nurse anticipates receiving a prescription to transfuse which product?

Albumin *Albumin may be used as a plasma expander. Platelets are used when the client's platelet count is low. Cryoprecipitate is useful in treating bleeding from hemophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Packed red blood cells replace erythrocytes and are not a plasma expander.

A nurse is assisting in monitoring a client who is receiving a transfusion of packed red blood cells (PRBCs). Before leaving the room, the nurse tells the client that it is most important to immediately report which symptoms of a transfusion reaction? Select all that apply.

Chills, chest pain, low back pain, and difficulty breathing. *The nurse should instruct the client to immediately report signs of a transfusion reaction, which can include chest pain, lower back pain, chills, itching, rash, or difficulty breathing. These signs of transfusion reaction would require the nurse to stop the transfusion.

A client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which finding?

Decreased oozing of blood from puncture sites and gums *Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or oozing of blood from puncture sites, wounds, and mucous membranes.

Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6° F orally. Which action should the nurse take?

Delay hanging the blood and notify the health care provider (HCP). *If the client has a temperature higher than 100° F, the unit of blood should not be hung until the HCP is notified and has the opportunity to give further prescriptions. The HCP likely will prescribe that the blood be administered regardless of the temperature, but the decision is not within the nurse's scope of practice to make. The nurse needs an HCP's prescription to administer medications to the client.

One unit of packed red blood cells has been prescribed for a client with severe anemia. The client has received multiple transfusions in the past, and it is documented that the client has experienced urticaria-type reactions from the transfusions. The nurse anticipates that which medication will be prescribed before administration of the red blood cells to prevent this type of reaction?

Diphenhydramine (Benadryl) *An urticaria-type reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction is prevented by pretreating the client with an antihistamine such as diphenhydramine.

A nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant (HSCT). What procedure does the nurse follow?

Infuses the transfusion over a 15- to 30-minute period *The volume of platelets-200 or 300 mL (standard amount)-needs to be infused rapidly-over a 15- to 30-minute period

Which would be an appropriate task to delegate to unlicensed assistive personnel (UAP) working on a medical-surgical unit?

Obtaining vital signs on a client receiving a blood transfusion *Obtaining vital signs on a client is within the scope of practice for UAP

A nurse is to administer packed red blood cells to a client. How does the nurse ensure proper client identification?

Reviews all information with another registered nurse *With another registered nurse, verify the client by name and number, check blood compatibility, and note expiration time. Human error is the most common cause of ABO incompatibility reactions, even for experienced nurses.

A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh-frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that which is the rationale for transfusing fresh-frozen plasma to this client?

To promote rapid volume expansion *Fresh-frozen plasma is often used for volume expansion as a result of fluid and blood loss.

The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse should assess which priority item?

Vital signs *A change in vital signs during the transfusion from baseline may indicate that a transfusion reaction is occurring. This is why the nurse assesses vital signs before the procedure and again after the first 15 minutes.

The nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse should ask which initial question?

"Have you ever had a transfusion before? *Asking the client about personal experience with transfusion therapy provides a good starting point for client teaching about this procedure.

The nurse has just received a prescription to transfuse a unit of packed red blood cells for an assigned client. Approximately how long will the nurse need to stay with the client to ensure that a transfusion reaction is not occurring?

15 min. (For the duration of 50ml) *The nurse must remain with the client for the first 15 minutes of a transfusion, which is usually when a transfusion reaction may occur. This enables the nurse to detect a reaction and intervene quickly.

The nurse is picking up a unit of packed red blood cells at the hospital blood bank. After putting the pen down, the nurse glances at the clock, which reads 1:00. The nurse calculates that the transfusion must be started by which time?

1:30 *Blood must be hung as soon as possible (within 30 minutes) after it is obtained from the blood bank. After that time, the blood temperature will be higher than 50° F, and the blood could be unsafe for use.

A nurse has a prescription to transfuse a unit of packed red blood cells to a client who does not currently have an intravenous (IV) line inserted. When obtaining supplies to start the IV infusion, the nurse should select an angiocatheter of which size?

20 gauge 20 gauge *The IV catheter used for a blood transfusion should be at least 18 or 20 gauge. Compared with IV solutions, blood has a thicker and stickier consistency, and use of an 18- or 20-gauge catheter will ensure that the bore of the catheter is large enough to prevent damage to the blood cells.

Which client is at greatest risk for having a hemolytic transfusion reaction?

34-year-old client with type O blood *Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the client's own antigens is infused, antigen-antibody complexes are formed in the client's blood. Type O is considered the universal donor but not the universal recipient.

The nurse who is about to begin a blood transfusion knows that blood cells start to deteriorate after a certain period of time. Which item is important to check regarding the age of blood cells before the transfusion is begun?

Expiration date *The nurse notes the expiration date on the unit of blood to ensure that the blood is fresh. Blood cells begin to deteriorate over time, so safe storage usually is limited to 35 days. Careful notation of the expiration date by the nurse is an essential part of the verification process before hanging a unit of blood. The nurse also notes the blood identification (unit) number, blood group and type, and client's name. The nurse also inspects the unit of blood for leaks, abnormal color, clots, and bubbles and returns the unit to the blood bank if clots are noted.

A client receiving a transfusion of packed red blood cells (PRBCs) begins to vomit. The client's blood pressure is 90/50 mm Hg from a baseline of 125/78 mm Hg. The client's temperature is 100.8° F orally from a baseline of 99.2° F orally. The nurse determines that the client may be experiencing which complication of a blood transfusion?

Septicemia *Septicemia occurs with the transfusion of blood contaminated with microorganisms. Signs include chills, fever, vomiting, diarrhea, hypotension, and the development of shock.

A client has a prescription to receive a unit of packed red blood cells. The nurse should obtain which intravenous (IV) solution from the IV storage area to hang with the blood product at the client's bedside?

0.9% sodium chloride *Sodium chloride 0.9% (normal saline) is a standard isotonic solution used to precede and follow infusion of blood products. Dextrose is not used because it could result in clumping and subsequent hemolysis of red blood cells.

A nurse is transfusing 2 units of packed red blood cells (PRBCs) to a postoperative client. What post-transfusion electrolyte imbalance does the nurse want to rule out?

Hyperkalemia *During transfusion, some cells are damaged. These cells release potassium, thus raising the client's serum potassium level (hyperkalemia). This complication is especially common with packed cells and whole blood products.

The nurse has just obtained a unit of blood from the blood bank to transfuse into a client as prescribed. Before preparing the blood for transfusion, the nurse looks for which member of the health care team to assist in checking the unit of blood?

Registered Nurse. (RN) *Depending on agency policy, two RNs or one RN and one licensed practical nurse (LPN) must check the label on the blood product together against the client's identification number, blood group, and complete name. This minimizes the risk of error in checking information on the blood bag and thereby minimizes the risk of harm or injury to the client.

Partial thromboplastin time (PTT)

is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem or if your blood does not clot properly.

A nurse is monitoring a client who is receiving a blood transfusion. After 30 minutes of the infusion, the client begins to have chills and back pain. His temperature is 100.1° F (37.8° C). What action should the nurse take first?

Discontinue the infusion and start an infusion of normal saline using new tubing. *Signs of a transfusion reaction include fever, chills, tachycardia, tachypnea, dyspnea, hives or skin rash, flushing, backache, and decreased blood pressure. If the client shows any symptoms of a blood transfusion reaction, the nurse needs to discontinue the infusion immediately, and start an infusion of normal saline using new tubing connected to the hub of the intravenous insertion site. The nurse should stay with the client and monitor his or her condition while a colleague notifies the health care provider immediately.

A patient with a history of congestive heart failure has an order to receive one unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?

4pm. When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth.

The nurse has discontinued a unit of blood that was infusing into a client because the client experienced a transfusion reaction. After documenting the incident appropriately, the nurse sends the blood bag and tubing to which department?

Blood Bank *The nurse returns the blood transfusion bag containing any remaining blood to the blood bank. This allows the blood bank to complete any follow-up testing procedures needed once a transfusion reaction has been documented.

A client with severe blood loss resulting from multiple trauma requires rapid transfusion of several units of blood. The nurse asks another health team member to obtain which device for use during the transfusion procedure to help reduce the risk of cardiac dysrhythmias?

Blood-warming device *If several units of blood are to be administered, a blood warmer should be used. Rapid transfusion of cool blood places the client at risk for cardiac dysrhythmias. To prevent this, the nurse warms the blood with a blood-warming device.

The nurse enters a client's room to assess the client, who began receiving a blood transfusion 45 minutes earlier, and notes that the client is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client most likely is experiencing which complication of blood transfusion therapy?

Circulatory Overload *Circulatory overload is caused by the infusion of blood at a rate too rapid for the client to tolerate. With circulatory overload, crackles are present in addition to dyspnea. An allergic reaction, which is one type of blood transfusion reaction, would produce symptoms such as flushing, dyspnea, itching, and a generalized rash. Hypovolemia is not a complication of blood transfusion. With bacteremia, the client would have a fever, which is not part of the clinical picture presented.

The nurse enters a client's room who began receiving a blood transfusion 45 minutes earlier to check on the client. The client is dyspneic and has a bounding pulse. The nurse listens to the client's lung sounds and notes the presence of crackles in the lung bases. Which complication of blood transfusion therapy should the nurse determine that this client is most likely experiencing?

Fluid Overload *With fluid overload, the client has the presence of crackles in the lungs in addition to dyspnea. Other clinical manifestations include hypertension, a bounding pulse, distended jugular veins, restlessness, and confusion.

The nurse, listening to the morning report, learns that an assigned client received a unit of granulocytes the previous evening. The nurse makes a note to assess the results of which daily serum laboratory studies to assess the effectiveness of the transfusion?

WBC count *The client who has neutropenia may receive a transfusion of granulocytes, or white blood cells. These clients often have severe infections and are unresponsive to antibiotic therapy. The nurse notes the results of follow-up white blood cell counts and differential to evaluate the effectiveness of the therapy.

The ______ ________ client would be most susceptible to a transfusion-associated graft-versus-host disease.

immune suppressed

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information?

• The primary advantage is prevention of viral infections. • It is safer for clients with a history of transfusion reactions. • If not needed immediately, the blood can be frozen for future use.

Prothrombin time (PT)

is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot.

A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse's first action?

Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery.

An RN assesses multiple clients who are receiving transfusions of blood components. Which assessment indicates the need for the RN's immediate action?

Respiratory rate of 36 on a client receiving red blood cells (RBCs). *An increased respiratory rate indicates a possible hemolytic transfusion reaction. The nurse should quickly stop the transfusion and assess the client further.

The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should be taken next?

Run normal saline at a keep-vein-open rate. *If the nurse suspects a transfusion reaction, the nurse stops the transfusion and infuses normal saline at a keep-vein-open rate pending further health care provider prescriptions. This maintains a patent IV access line and aids in maintaining the client's intravascular volume.

Prothrombin time (PT)

11-12.5 (If the TP (PT) is gone from the roll, you will drip dry in 11-12.5 seconds)

Hemoglobin

12-18 "12-18 year olds love to travel the GLOBe (globin)"

international normalized ratio (INR)

A standardized measure of the clotting ability of blood based on the ratio of an individual's prothrombin time to the normal mean prothrombin time, used especially to monitor the risk of bleeding in patients receiving anticoagulant therapy.

One hour after the completion of a fresh frozen plasma transfusion, a patient complains of shortness of breath and is very anxious. The patient's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the patient is experiencing which of the following problems?

Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. It is more likely to occur when plasma and platelets are transfused. Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours). Signs and symptoms include acute shortness of breath, hypoxia (arterial oxygen saturation [SaO2] less than 90%; pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FIO2] ratio of less than 300), hypotension, fever, and eventual pulmonary edema.

A client who is receiving a blood transfusion suddenly exclaims to the nurse, "I don't feel right!" What does the nurse do next?

Stops the transfusion *The client may be experiencing a transfusion reaction. The nurse should stop the transfusion immediately

A nurse is transfusing a unit of whole blood to a client when the health care provider requests the following: "Furosemide (Lasix) 20 mg IV push." What does the nurse do?

Waits until the transfusion has been completed to administer Lasix *This is the best course of action in the scenario. The nurse should not administer Lasix while the blood is infusing. Stopping the infusing blood to administer the drug-and then re-starting it-is also not the best decision.

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?

Disconnect the blood tubing, flush with normal saline, and administer morphine.