ATI Pharmacology Ch 27 - Blood and Blood Products

A nurse is transfusing a unit of packed red blood cells for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2 degree F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply) A. Stop the transfusion B. Place the client in an upright position with feet down C. Remove the blood bag and tubing from the client's IV catheter D. Obtain a urine specimen from the client E. Infuse dextrose 5% in water through the client's IV

A, C, D A. The nurse should stop the transfusion for a rise in temperature of 2 degree F and reports of chills and fever. The client may having a hemolytic reaction to the blood or a febrile reaction. C. The nurse should avoid infusing more PRBCs into the client's vein, and should remove the blood bag and tubing from the client's IV catheter. D. Obtaining a urine specimen to check for hemolysis is standard procedure when the client has a reaction to a blood transfusion. *The nurse should only infuse 0.9% NaCl into the client's IV along with the infusing of PRBCs.

A nurse is preparing to administer an infusion of 300 mL platelet concentrate. The nurse should plan to administer the infusion over which of the following time frames? A. Within 30 min/unit B. Within 60 min/unit C. Within 2 hr/unit D. Within 4 hr/unit

A. Within 30 min/unit Platelets are fragile and should be administered quickly o reduce the risk of clumping. The nurse should administer the platelet concentrate within 15 to 30 min/unit

FFP - Therapeutic uses

Active bleeding or massive hemorrhage Extensive burns Shock Disseminated intravascular coagulation (DIC) Antithrombin III deficiency Thrombotic thrombocytopenic purpura (TTP) Reversal of anticoagulation effects of warfarin Replacement therapy for coagulation factors II, V, VII, IX, X, XI

PRBCs - Types of reactions

Acute hemolytic reaction Febrile nonhemolytic action Anaphylactic reaction Mild Allergic reaction Hyperkalemia Transfusion-associated graft versus host disease Sepsis

Whole Blood - Types of Reactions

Acute hemolytic reaction Febrile nonhemolytic reaction Anaphylactic reaction Mild allergic reactions Circulatory overload Hyperkalemia Transfusion-associated graft versus host disease Sepsis

FPP - Reactions

Acute hemolytic reaction Febrile nonhemolytic reaction Anaphylactic reactions mild allergic reaction Circulatory overload Sepsis

Pheresed granulocytes - Reactions

Acute hemolytic reaction Febrile nonhemolytireaction Anaphylactic reaction Mild allergic reaction Circulatory overload Sepsis

A nurse is preparing to transfuse a unit of PRBCs for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? A. Ensure that the client has a patent IV line before obtaining blood product from the refrigerator. B. Obtain help from another nurse to confirm the correct client and blood product. C. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. D. Stay with the client for the first 15 to 30 minutes of the transfusion.

B. Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reaction from occurring because this reaction is caused by ABO or Rh incompatibility

Hyperkalemia due to lysis of blood cells S&S

Bradycardia, hypotension, iregular heartbea, paresthesias of extremities, muscle twitching, potassium level higher than 5.0 mEq/L

A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse? A. Whole blood B. Platelets C. Fresh frozen plasma D. Packed red blood cells

C. Fresh frozen plasma Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces coagulation factors and can help prevent bleeding. ***Platelets are incorrect because they are transfused for clients who have severe hypothrombocytopenia and are not indicated for clients who have an elevated aPTT

A nurse is assessing a client during transfusion of a unit of whole blood The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A. Epinephrine (Adrenalin) B. Lorazepam (Ativan) C. Furosemide (Lasix) D. Diphenhydramine (Benadryl)

C. Furosemide (Lasix) A loop diuretic may be prescribed to relieve manifestations of circulatory overload.

Acute Hemolytic reaction S&S

Chills, fever, low back pain, tachy cardia, tachypnea, hypotension

Albumin - Pharmacological action

Expands circulating blood volume by exerting oncotic pressure

Platelet concentrate - type of reactions

Febrile nonhemolytic reaction Mild allergic reactions Sepsis

Albumin - Therapeutic uses

Hypovolemia Hypoalbuminemia Burns Adult respiratory distress Cardiopulmonary bypass surgery Hemolytic disease of the newborn

PRBCs - Pharmacological action

Increase number of RBCs

Whole Blood - Pharmacological action

Increases circulating blood volume

Platelet concentrate - Pharmacological Action

Increases platelet counts

Whole Blood - Therapeutic uses

Replacement therapy for acute blood loss secondary to traumatic injuries or surgical procedures. Volume expansion in clients who have extensive burn injury, dehydration, shock

Fresh Frozen Plasma - Pharmacological action

Replaces coagulation factor

Pheresed Granulocytes - Pharmacological action

Replaces neutrophils/granulocytes

Albumin - reaction

Risk for fluid volume excess such as pulmonary edema

Pheresed granulocytes - Therapeutic action

Severe neutropenia (ANC less than 500) Life threatening bacteria/fungal infection not responding to antibiotic therapy Neonatal sepsis Neutrophil dysfunction

PRBCs - Therapeutic uses

Severe symptomatic anemia (Hgb 6 g/dL to 10 g/dL) Hemoglobinopathies Medication-induced hemolytic anemia Erythroblastosis fetalis

Platelet concentrate - Therapeutic uses

Thrombocytopenia (platelet count less than 20,000/mm3) aplastic anemia chemotherapy induced bone marrow suppression Active bleeding (platelet count less than 50,000 mm3)

Anaphylactic reation S&S

anxiety, urticaria, wheezing, shock, cardiac arrest

Circulatory overload S&S

cough, shortness of breath,crackles, hypertension, tachycardia, distended neck veins

Mild allergic reaction S&S

flushing, itching, urticaria

Sepsis S&S

rapid onset of chills and fever, vomiting, diarrhea, hypotension, shock

Transfusion-associated graft versus host disease S&S

rare and occurring 1-2 weeks following transfusion Nausea, vomiting, weight loss, hepatitis, thrombocytopenia

Febrile nonhemolytic reaction S&S

sudden chills, increase in temp greater than 1 degree from baseline, headache