BLOOD TRANSFUSION AND BLOOD PRODUCTS.
Purpose
1. Improve oxygen transport—RBCs
2. Volume expansion—whole blood, plasma, and albumin
3. Provide proteins—fresh frozen plasma, albumin, and plasma protein fraction
4. Coagulation factors—cryoprecipitate, fresh frozen plasma, and fresh blood
5. Platelets—platelet concentrate and fresh whole blood
B. Types of blood and blood products
1. Whole blood
a. Provides all components
b. Takes 12 to 24 hours for Hgb and Hct to rise
c. Volume overload can occur from large amount.
d. Complications include hepatitis, acquired immunodeficiency syndrome (AIDS), transfusion reaction, sodium (Na) and potassium (K) excess, and calcium depletion from citrate (preservative) in massive transfusions.
e. Usually administered at rate of three to four hours for 1 unit
2. RBCs (packed RBCs)
a. RBCs provide twice the amount of Hgb as an
equivalent amount of whole blood.
b. Complications include transfusion reactions; less frequently than with whole blood because plasma proteins are not given
c. Takes almost or nearly around two to four hours to administer 1 unit.
3. Fresh frozen plasma
a. Contains all coagulation factors
b. Can be stored for 12 months
c. Takes 20 minutes to thaw and then is hung immediately and infused quickly because it loses its coagulation factors rapidly at room temperature
4. Platelets
a. Will raise the recipient’s platelet count by 10,000/L
b. One unit pooled from 4 to 8 units of whole blood
c. Single donor platelet transfusions may be necessary for clients who have developed antibodies; may need compatibility testing
d. Infused quickly
5. Factor VIII fractions (cryoprecipitate)
a. Contains factor VIII, fibrinogen, and factor XIII which is common
b. Used in the treatment of hemophilia
c. Infused quickly
C. Management of clients receiving blood products
1. Determine a prior history of transfusions or transfusion reactions.
2. 18- or 19-gauge needle used
3. Sodium chloride always used as intravenous (IV) solution; never use dextrose solution; dextrose causes agglutination of blood cells
4. Two nurses (usually registered nurses [RNs]) MUST verify ABO group, Rh type, patient and blood numbers, and expiration date.
5. Before starting transfusion, take baseline vital signs including temperature for safer side .
6. Initially, infusion rate is 2 cc/min.
7. Stay with client for first 15 minutes and monitor vital signs, including temperature, frequently (temperature elevation suggests a transfusion reaction).
8. Monitor for transfusion reactions:
a. Hemolytic
(1) Causes
(a) ABO or Rh incompatibility (antibodies in recipient plasma react with antigen in donor cells)
(b) Use of dextrose solutions (agglutinated cells block capillary blood flow)
(2) Manifestations include headache, nausea, vomiting, chills, flushing, jaundice, dyspnea, signs of shock, renal shutdown, and disseminated intravascular coagulation.
(3) Stop IV infusion; saline IV; send blood unit and client blood to the lab.
b. Allergic
(1) transferring antigen or antibody from donor or recipient; client has immune sensitivity to foreign serum protein; allergic donors
(2) Manifestations are allergies—urticaria, laryngeal edema, wheezing, dyspnea, bronchospasm, or anaphylaxis
(3) Stop transfusion; give antihistamine and epinephrine as ordered by doctor and inform flood docter.
9. Document carefully.
Include type of blood component, blood unit number, date and time infusion starts and ends, amount infused, client reaction, and vital signs.
Anemia is an insufficient number of RBCs. Anemia
can be caused by blood loss, manufacture of
insufficient RBCs, or abnormal destruction of RBCs.
Iron Deficiency Anemia
A. Chronic microcytic (little cells), hypochromic
(little color) anemia caused by either inadequate
absorption or excessive loss of iron
B. Assessment
1. Fatigue, dizziness
2. Pallor
3. Cold sensitivity
4. Palpitations
5. Brittle hair and nails
6. Decreased Hgb, Hct, and RBC
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Medical Nursing Exam MCQ 2024
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