N450 - Perry Potter Ch 29 - Blood Transfusions
What is the universal donor blood type (Rh factor)?
O-
Three types of blood typing systems
1. ABO 2. Rh Human leukocyte antigen (HLA)
How long is the sample of typing/screening good for?
3 days; another screening to confirm A/B/O and Rh taken from different phlebotomist at a different time
Onset of TRALI (transfusion-related acute lung injury) can occur within 6 hours of transfusion. A. True B. False
A. True Rationale: Onset of TRALI occurs within 6 hours of transfusion of a plasma-containing product, therefore, monitoring of patients during this critical time is essential. (REF: p. 750)
Which of the following is considered a primary cause of transfusion reactions? A. Use of mislabeled unit B. Use of 0.9% NSS C. Use of leukocyte reduction filter D. Use of Y tubing
A. Use of mislabeled unit Rationale: A mislabeled unit, which is considered a clerical error, is one of the main causes of transfusion reactions. Use of 0.9% NSS, Y tubing, or a leukocyte reduction filter does not cause but rather prevents transfusion reactions. (REF: p. 737 & 740)
What is the universal recipient blood type (Rh factor)?
AB+
One unit of PRBC can hang no longer than: A. 1 hour B. 2 hours C. 3 hours D. 4 hours
D. 4 hours Rationale: Because of the instability of blood and of the preservatives used (dextrose), blood hanging for longer than 4 hours can become a medium for bacterial growth. (REF: p. 748)
Blood obtained form the blood bank must be used within what time limit? A. 10 minutes B. 20 minutes C. 30 minutes D. 60 minutes
C. 30 minutes Rationale: Because of the instability of blood and the controlled environment in which it must be stored, it must be used within 30 minutes or removal from that environment. Deterioration of cell components and accumulation of citrate ions opse risks to the patient. . (REF: p. 745,746)
What are two commonly used anticoagulant preservatives?
Citrate-phosphate-dextrose (CPD) and citrate-phosphate-dextrose-adenine (CPDA-1); extends shelf life
Which of the following blood products has the potential to transmit HIV/HIB? (Select all that apply.) A. Whole blood B. Packed red blood cells (RBCs) C. Fresh frozen plasma D. Platelets
Correct answer: A, B, C, D Rationale: Although prevention has greatly increased safe blood supplies over the past decade, all of these blood products have the potential to transmit HIV/HIB.
An 80-year-old patient receiving a blood transfusion is in circulatory overload. What nursing care will be provided for this patient? A. Increase the rate of the transfusion. B. Place the patient in low-Fowler's position. C. Administer diuretics as ordered. D. Perform chest physiotherapy.
Correct answer: C Rationale: Symptoms of circulatory overload include dyspnea, cough, crackles at lung bases, tachypnea, headache, hypertension, tachycardia, increased central venous pressure, and distended neck veins. The nurse will respond by slowing or stopping the transfusion as ordered. Elevate the patient's head. Notify the health care provider. Administer diuretics as ordered.
diretics/ morphine
treats circulatory overload by decreasing intravascular volume (diuresis) and decreases vascular tone (opioid effect)
A patient is to receive blood that has been stored for a long period of time. Which recent laboratory value should the nurse check before administering the unit? 1. Sodium 2. Hematocrit 3. Hemoglobin 4. Potassium
4. Potassium Rationale: When blood is stored, there is continual destruction of red blood cells, which release potassium from the cells into the plasma. If blood is transfused rapidly, there may be transient hyper- kalemia before the potassium is reabsorbed. The hematocrit and hemoglobin values would indicate whether a patient needs a blood transfusion. The sodium level is not relevant to this situation.
What is the most common method of blood transfusion?
Allogenic
To decrease the incidence of Rh antigen transfer between mother and fetus, which medication is administered? A. Methotrexate B. Benadryl C. Methylprednisone D. RhoGam
D. RhoGam Rationale: RhoGam is given IM to the mother. RhoGam can suppress or destroy fetal Rh-positive blood cells that have passed from the fetal to the maternal circulation. (REF: p. 739)
What does the D antigen determine in Rh types?
Presence = Rh (+) Without = Rh (-) Rh (+) blood can be used to tranfuse in person with Rh (-) provided they weren't exposed to Rh (+) before
antihistamine
deceases some allergic responses by blocking histamine receptors
autologous transfusion (or autotransfusion)
patient donated on blood and then reinfused for intravascular volume replacement - pt donates 4-6 weeks before surgery, and more than 72 hours before surgery at latest
Common HLA complications
1. Febrile nonhemolytic reaction (FNH) 2. Immune-mediated platelet refractoriness 3. Transfusion-related acute lung injury (TRALI) 4. Transfusion-associated graft-versus-host disease (TA-GVHD)
Three reasons to perform blood therapy
1. volume to patient following hemorrhage during surgery 2. increase Hg levels 3. provide plasma clotting factors to prevent bleeding
A patient is to receive a blood transfusion. Which nursing action has the greatest impact on preventing a potential transfusion reaction? 1. Administering an antihistamine 15 minutes before the transfusion 2. Comparing the patient's identification bracelet with the blood bag label number 3. Ensuring that the patient knows his or her blood type 4. Obtaining the patient's previous transfusion history
2. Comparing the patient's identification bracelet with the blood bag label number Rationale: Comparing a patient's identification bracelet with the blood bag label number is the most important step to take.
Administration of blood and blood products can be delegated to the nursing assistive personnel (NAP). 1. True 2. False
2. False Rationale: Only a registered nurse (RN) (or in some states a licensed practical nurse [LPN]) may administer blood or blood products; the task may not be delegated.
Human leukocyte antigen (HLA) complications include: 1. Fetal hemolysis. 2. Transfusion-related acute lung injury (TRALI). 3. Rh incompatibility. 4. No reaction.
2. Transfusion-related acute lung injury (TRALI) Rationale: HLAs are immunogenic antigens, which cause serious transfusion reactions such as TRALI. Fetal hemolysis and Rh incompatibility are not a direct result of HLAs.
The nurse is preparing a blood transfusion infusion set. Which solu- tion should be used to prime the tubing? 1. 0.45% sodium chloride ( 12 NS) 2. Dextrose 5% in 0.45% sodium chloride (D5 12NS) 3. 0.9% sodium chloride (normal saline [NS]) 4. Dextrose 5% in 0.9% sodium chloride (D5NS)
3. 0.9% sodium chloride (normal saline [NS]) Rationale: Normal saline is the only intravenous solution that should be used with blood because of its isotonic quality. Dextrose solutions cause hemolysis of the red blood cells
Anticoagulant preservative citrate-phosphate-dextrose-adenine (CPDA-1) maintains the shelf life for donated blood by how many days? 1. 21 2. 14 3. 35 4. 42
3. 35 days Rationale: The addition of adenine adds 35 days to the shelf life of the blood.
A patient with A- bloodtype needs a blood transfusion. Which blood types are appropriate for the patient to receive? 1. A+orA− 2. A−orO+ 3. A−orO− 4. A+ or AB-
3. A- or O- Rationale: Only negative blood types can be given to a patient with a negative blood type.
How long can you have the blood bag in room temperature? Same time it expires and can't return to blood bank
30 mins
Place the following steps for the administration of a unit of packed red blood cells (PRBCs) in the correct order. 1. Verbally compare and correctly verify patient and blood product 2. Check appearance of blood for leaks, bubbles, clots, or purplish color 3. Prepare Y-tubing administration set with 0.9% normal saline solution (NSS) 4. Obtain baseline vital signs
4, 2, 1, 3
A patient receiving a blood transfusion begin having signs and symptoms of a transfusion reaction. In addition to stopping the transfusion and assessing vital signs, what else should the nurse do? 1. Hang a new infusion setup with D5W to maintain an access for medications 2. Finish infusing the blood remaining in the tubing and flush the tubing with the normal saline hanging on the Y-tubing 3. Keep the existing tubing patent with a dextrose solution in case diphenhydramine is needed 4. Hang a new infusion setup with normal saline to maintain an patient receiving a blood transfusion begins having signs and intravenous (IV) access
4. Hang a new infusion setup with normal saline to maintain an patient receiving a blood transfusion begins having signs and intravenous (IV) access Rationale: It is essential to maintain an IV access, but you do not want the patient to receive any more of the current blood. Another blood administration set should be primed with a new bag of normal saline in case more blood needs to be given. Remember to keep the old blood bag and saline and the administration set and send them to the appropriate department per protocol for analysis.
During the administration of blood the health care provider orders intravenous (IV) antibiotics to be infused. The most appropriate intervention is to: 1. Stop the transfusion. 2. Piggyback into the transfusion. 3. Question the order. 4. Start a new IV site.
4. Start a new IV site Rationale: No medications or solutions (other than 0.9% normal saline solution [NS]) are to be administered with blood. Blood should never be stopped to administer another medication or solu- tion; therefore starting a new IV is the most appropriate action.
A 65-year-old patient is brought to the ER by his wife. The patient has jaundice and is complaining that he developed a fever the day before. The wife informs the nurse that her husband had a blood transfusion 5 days ago. What type of transfusion reaction does the nurse suspect? A. Anaphylactic B. Delayed hemolytic C. Graft versus host D. Allergic
Correct answer: B Rationale: Immune response mounted by the recipient against non-ABO donor antigens, usually as the result of destruction of transfused red blood cells (RBCs) by alloantibodies not detected during the cross-match. Symptoms include unexplained fever, unexplained decrease in hemoglobin/hematocrit (Hgb/Hct), increased bilirubin levels, and jaundice. Reaction occurs 2 to 14 days after the transfusion.
What's the precaution in initial blood delivery?
Start slow first 15mins, 1-2mL/min. Monitor patient for any adverse reactions. After 15 mins, check 30 mins, then at 1hour. Increase rate of infusion after 15mins w/o complications and w/i 4 hours. Tubing only good for 4 hours- can infuse 2 units in tubing.
allogenic
donated from someone else
antibiotics
if bacterial contamination / sepsis is suspected
IV fluids
rapid admin counteracts symptoms of anaphylactic shock
antipyretics / analgesics
relieve fever/discomfort in acute hemolytic rxns, febrile non-hemolytic rxns, grafts-versus-hosts disease, bacterial sepsis
corticosteroids
stabilizes cell membranes, decreases histamine release. admin in severe allergic reactions
epinephrine
stimulates SNS. relieves respiratory distress and combats vasodilation in anaphylaxis.