ATI - Blood Administration
A patient about to receive a unit of packed RBCs states, "this is my third unit of blood today. I don't want to get some disease from all this blood." Which of the following would be your best response?
"Donated blood is carefully screened for infectious diseases." Rationale: This is the best response because it offers the patient some factual information to help allay his concerns. You might continue to explain that the approach to blood safety in the U.S. includes stringent donor selection practices and the use of screening tests for HIV/AIDS, hepatitis B and C, syphilis, and other infectious diseases. Infected blood and blood products are safely discarded and are not used for transfusions.
A type of protein the immune system produces to neutralize a threat of some kind, such as an incompatible substance in the blood, is called an...
Antibody Rationale: an antibody is a protein the immune system produces to neutralize a threat. Antibodies are also called agglutinins.
A patient is about to receive a unit of red blood cells. The unit of blood has arrived and you are about to initiate the transfusion. Which of the following procedures will help you protect the patient against the possibility of a blood-group incompatibility?
Comparing the ID numbers on the blood unit with those on the order form and the wristband. Rationale: After comparing the patient's identification from the hospital wristband, the facility identification number, and a second patient identifier - typically the patient's date of birth - with the blood order sheet, you must check the barcode wristband, comparing the unique identification number with the number on the order form and on the unit of blood. This helps ensure that all documentation of the type of blood the patient is about to receive is the correct type for that patient. Most facilities mandate that you have a second qualified staff person check the patient's identifiers as well.
Which is an essential nursing action prior to starting a blood transfusion?
Ensure informed consent has been obtained. Rationale: It is the responsibility of the prescribing healthcare provider to answer the patient's questions about need, risks, and benefits, but a nurse can witness the patient's signature indicating informed consent. This must be done prior to obtaining or administering the blood.
You started a transfusion of packed RBCs about 1 hour ago. Your patient has suddenly developed shaking chills, muscle stiffness, and a temperature of 101.4 Fahrenheit. He appears flushed and reports a headache and "nervousness". Your patient has most likely developed which type of transfusion reaction?
Febrile nonhemolytic. Rationale: This is the most common type of transfusion reaction. The characteristic fever usually develops within 2 hours after the transfusion is started. Other classic symptoms include chills, headache, flushing, anxiety, and muscle pain. this type of reaction is usually a result of sensitization to the plasma, platelets, or white blood cells. although this type of reaction is not life-threatening, it can be frightening and uncomfortable for the patient.
A platelet transfusion is indicated for a patient who...
Has thrombocytopenia. Rationale: Thrombocytopenia is a low platelet count. when platelet count drops below 20,000/mm3, a transfusion of platelets is generally indicated.
Prior to administering a blood transfusion, it is essential to explain to the patient that...
He must immediately report any subjective symptoms like chills, nausea, or itching. Rationale: Although you can identify objective signs of a transfusion reaction (changes in vital signs, flushing, cyanosis, coughing, and to some extent dyspnea), you might not be able to tell if the patient is experiencing subjective symptoms (chills, nausea, chest pain, headache, backache, muscle pain). subjective signs are important clues, and you must be aware of them.
A patient who is anticipating total hip replacement is considering autologous transfusion. When teaching this patient about autologous transfusion, it is important to emphasize that...
It reduces the risk of mismatched blood. Rationale: Mismatched blood can cause an immune response to another person's antigens. Because the patient is her own donor, there is no risk of exposure to another person's antigens.
When administering a transfusion of packed red blood cells, it is important to...
Make sure the entire unit is transfused within 4 hours. Rationale: Infusion times that exceed 4 hours increase the risk for bacterial proliferation. Ideally, a unit of packed red blood cells is infused within 2 hours. Patients at risk for fluid-volume excess will require slower rates, but the entire transfusion must not exceed 4 hours.
You are caring for a patient with severe trauma whose blood type is A. A blood transfusion is ordered stat. you know that the patient can safely receive blood from blood group O because...
Type O blood contains no A antigens. Rationale: Type O blood contains no antigens at all, which is why people with type O blood are considered universal donors - because their blood can be transfused to people with any ABO-related type without putting them at risk for an ABO compatibility. It is the specific antigens in the transfused blood that trigger hemolytic reactions. Since type O has no antigens, it is safe for this patient and for any other patient.
