Nur310- Lecture 3- Hemat, blood trans, neutro

What WBC count defines leukopenia?

Total WBC < 4,000/µL

What three blood cell types are reduced in pancytopenia?

Red blood cells, white blood cells, and platelets

What is the primary risk for a client with pancytopenia?

High risk for infection due to being immunocompromised

Are IM injections permitted for clients with pancytopenia?

No, IM injections are strictly prohibited

Are Foley catheters permitted for clients with pancytopenia?

No, Foley catheters should be avoided

How should blood pressures be taken for pancytopenic or thrombocytopenic patients?

Manual blood pressures only

What cardiovascular and GI conditions must be aggressively prevented in pancytopenia?

Hypertension and constipation

What is the primary medical intervention for Thrombotic Thrombocytopenic Purpura (TTP)?

Plasmapheresis

What drug classes are used in the medical management of TTP?

Corticosteroids, Caplacizumab, and Rituximab

What surgical procedure may be performed for refractory TTP?

Splenectomy

What is the priority immediate action for Heparin-Induced Thrombocytopenia (HIT)?

STOP administering heparin immediately

What non-heparin anticoagulant class is given for HIT?

Factor Xa Inhibitors (rivaroxaban, apixaban, fondaparinux)

What therapies are used to clear antibodies or manage severe HIT?

Plasmapheresis and Intravenous Immunoglobulin (IVIG)

What surgical intervention may be required in HIT?

Surgery to remove clots

What is the first step in managing decreased platelet production?

Remove the underlying cause

At what platelet threshold are platelet transfusions usually indicated for decreased production?

Usually below 10,000/µL

What medication class stimulates platelet production in decreased platelet production?

Thrombopoietin receptor agonists

What anti-infective medications are administered for neutropenia?

Antibiotics, antivirals, or antifungals

Which medication class is given to minimize the period of neutropenia?

Colony-stimulating factors

Which specific colony-stimulating factor drugs are used for neutropenia?

Filgrastim and Pegfilgrastim

What route is used to administer Filgrastim and Pegfilgrastim?

Subcutaneous (sub-Q) injection

What is the main side effect of Filgrastim and Pegfilgrastim?

Bone pain (and injection site pain/redness)

Are fresh flowers or plants allowed in a neutropenic client's room?

No, fresh flowers and plants are strictly prohibited

Can a neutropenic client clean up after pets or touch soil?

No, avoid contact with soil, plants, and pet cleanup

What food types must neutropenic clients avoid?

Seafood and raw meats

What hygiene and produce rules must neutropenic clients follow?

Good daily personal hygiene and thoroughly wash all fruits and vegetables

What temperature change requires a neutropenic client to call their provider immediately?

Fever / elevation in temperature

What other symptoms require a neutropenic client to call their provider?

Chills, pain, redness, swelling, bowel/urination changes, sore throat, blisters, or dyspnea

What are the expected outcomes for a neutropenic client?

No infection, normal neutrophil levels, and normal WBC levels

What health history components are assessed for clients with anemia?

Diet, alcohol use, nutrition, recent blood loss/surgery, liver/endocrine/renal/GI/inflammatory disease

What CNS cues indicate severe anemia?

Vertigo/dizziness, HA, depression, impaired cognition, peripheral numbness, paresthesia, ataxia, cheilitis

What cardiovascular cues indicate severe anemia?

Tachycardia, palpitations on exertion/rest, murmurs, and S3 heart sound

What respiratory cues indicate severe anemia?

Dyspnea, tachypnea, and orthopnea

What GI cues indicate severe anemia?

Anorexia, hepatomegaly, splenomegaly, and abdominal distention

What is the primary nursing diagnosis related to oxygen supply/demand in anemia?

Activity intolerance r/t imbalance between oxygen supply and demand AEB dyspnea on exertion & increased HR

What safety-related nursing diagnosis applies to anemic patients experiencing weakness and dizziness?

Risk for falls r/t weakness, dizziness, and decreased endurance

What is the primary indication for Whole Blood transfusion?

Hemorrhagic shock and severe trauma

What is the primary indication for Packed Red Blood Cells (PRBC)?

Anemia and blood loss

What does Fresh Frozen Plasma (FFP) contain?

Lots of clotting factors (and no platelets)

What is the primary indication for Fresh Frozen Plasma (FFP)?

Bleeding due to clotting factor deficiency and hemorrhagic shock

What is the primary indication for Platelets transfusion?

Bleeding caused by thrombocytopenia

What is the primary indication for Albumin infusion?

Hypovolemic shock and large-volume paracentesis

How does Albumin work physiologically?

Moves water from extravascular to intravascular space

What IV solution is required to prime blood tubing?

0.9% Normal Saline (NS)

What minimum needle gauge is required for blood transfusion IV access?

At least a 20-gauge needle

What components must two nurses verify at the bedside before starting a blood transfusion?

ABO/Rh type, unit/ID numbers, patient ID, and expiration date

What visual signs should blood be inspected for before transfusion?

Unusual coloration or gas bubbles

Within what timeframe must a blood transfusion begin after arriving from the blood bank?

Within 15 to 30 minutes

What is the infusion rate during the first 15 minutes of a blood transfusion?

Very slowly at 1 to 2 mL/minute

When are vital signs checked during the initial phase of a blood transfusion?

After the first 15 minutes

How often are vital signs checked after the initial 15-minute period?

Hourly throughout the transfusion

What is the maximum allowed time for a blood transfusion to infuse?

Discontinue if not infused within 4 hours

Why must a blood transfusion be completed within 4 hours?

To prevent bacterial contamination

What causes a blood transfusion reaction?

Immune reaction to donor proteins, donor WBC cytokine release, or incompatible/contaminated blood

What temperature threshold defines a transfusion reaction fever?

38°C (100.4°F) or higher

What skin cues indicate a transfusion reaction?

Pruritus (itching) and urticaria (hives / raised red itchy welts)

What respiratory cue indicates a transfusion reaction?

Dyspnea (trouble breathing / shortness of breath)

What pain locations indicate a transfusion reaction?

Back pain or chest pain/pressure

What is the very first priority action when a transfusion reaction is suspected?

STOP THE BLOOD IMMEDIATELY!

After stopping the blood during a reaction, should the nurse leave the bedside?

No, STAY WITH THE PATIENT

How is IV access maintained following a transfusion reaction?

Disconnect blood tubing and maintain IV access with 0.9% Normal Saline (NS)

What administrative and diagnostic steps follow stopping the blood in a reaction?

Notify provider and blood bank, perform detailed assessment, monitor frequent vital signs