NRSG 302 Week 4

Function of RBCs

Transports oxygen, contains hemoglobin

Created in bone marrow

Function of WBCs

Inflammatory and immune response

Created in bone marrow

Function of platelets

Involved in clotting process

Created in bone marrow

Function of plasma

Transporting fluid

Contains nutrients and electrolytes

Blood composition

55% plasma, 45% formed elements

1 unit of whole blood =?

475 mL of fluid and cells

1 unit of PRBC =?

240-340 mL of cellular replacement without fluids

Cryoprecipitate

Clotting factors and proteins

What is given to manage coagulopathies

Frozen plasma

What is given to maintain blood volume and why

Albumin

Attracts fluids

What is given to replace antibodies to fight infection

Immune globulin

What crystalloid is not compatible with immune globulins

NS

Indications for blood

Trauma, hemorrhage, anemias, cellular replacement, accidents, surgery, tx of bleeding and clotting disorders, supportive treatment of illnesses

Universal donor

O-

Universal recipient

AB+

When is a type and screen + crossmatch valid for 96h

If pt has been transfused with RBCs/platelets or pregnant in the last 3 mos

When is a type and screen + crossmatch valid for 28h

Pt has not been transfused or pregnant within last 3 mos

What kind of blood cells can O+ receive

O+ or O-

What kind of plasma can O+ receive

All groups

What kind of blood cells can O- receive

O- only

What kind of plasma can O- receive

All groups

What kind of blood cells can A+ receive

A+, A-, O+, O-

What kind of plasma can A+ receive

A, AB

What kind of blood cells can A- receive

A-, O-

What kind of plasma can A- receive

A, AB

What kind of blood cells can B+ receive

B+, B-, O+, O-

What kind of plasma can B+ recieve

B, AB

What kind of blood cells can B- receive

B-, O-

What kind of plasma can B- receive

B, AB

What kind of blood cells can AB+ receive

All groups

What kind of plasma can AB+ receive

Only AB

What kind of blood cells can AB- receive

AB-, B-, A-, O-

What kind of plasma can AB- receive

Only AB

What must the patient know as part of consent for blood

Why they require the product, the components being administered, the risks and benefits, is given the opportunity to ask questions

What must an order for blood contain

Patient identifiers, date and time, rate and duration of infusion, amount and type of components, sequence of products, any special requirements or medications

Equipment required for a blood transfusion

Product information sheet, blood administration set, 500-1000mL NS primed on standby, compatible IVF to flush line following transfusion/between units, 20g PVAD (18g for rapid infusion) or CVAD, IV pump

2 nurse check system - before bedside

Verify order, allergies and indications for blood

Signed consent form

Verify type and screen

Ensure IV access

Assess pt comfort

Obtain baseline VS + cardiopulmonary status

Obtain blood from lab with req

Visual blood bag check

What temp in baseline vitals means the MRP should be notified

> 37.8

Visual blood bag check

Integrity, clotting, purplish colouring, bubbling, expiry, label intact and legible without alterations

What to check/confirm for RBCs or autologous blood

Expiry date and time, label indicates product and coincides with the prescriber's order, verify ID, at least one port cover is sterile and intact, no discolouration of cells, no hemolysis, no visible clots, no bubbling or foaming, no leaks

What is autologous blood

Patient's own blood that has been donated prior to procedure

What to confirm/check with platelets, FFP and cryoprecipitate

Expiry date and time, at least one port cover sterile and intact, colour clear to slightly opaque, beige to yellow, salmon to pink colour, bright yellow to greenish brown discolourations are acceptable, no clots or fibrin strands, no grey discolouration, no excessive bubbling or foaming, no leaks

What to check/confirm with "other blood products" (not RBC, platelets, FFP or cryo)

Expiry date and time

If product is pooled, ensure label indicates number of units in pool, at least one port cover sterile and intact, no cloudiness, no cracks in container, no leaks

2 nurse check system - at bedside

Confirm ID, blood type and verbal consent

Assess previous rxns and allergies

Transfusion number with blood band and compatibility tag

Unit number (serial number) matches blood bank slip

Blood type and components, including Rh factor, expiry, volume

When should you return the TMS compatibility tag

If the blood component was issued from another hospital and transfused during transport

If there is a transfusion reaction

Within how long of the blood leaving the blood bank should it be administered

30 mins

Test dose

50mL/hr for 15 mins

How long does the RN need to stay after initiating an infusion?

First 5 mins

Assessment during infusion

Baseline, 15 mins, can increase rate here if stable, then q1h until completion and one hour post

S/S of transfusion reaction

Fever, chills, SOB, back/flank pain, skin rash, itchiness, NV, tachycardia, hypotension, restlessness, anxiety, dyspnea

What is the potential reaction when hives/itching present?

Mild allergic

What is the potential reaction when fever/chills present?

Febrile non-hemolytic or acute hemolytic

What is the potential reaction when hypotension presents?

Bacterial contamination or anaphylactic

What is the potential reaction when dyspnea presents?

Acute lung injury or volume overload

What to do if a transfusion reaction occurs

Stop infusion, disconnect, start NS, assess ABCs and VS, apply O2 to maintain > 94%, call MRP, manage symptoms, monitor UO, send all blood, tubing, labels, paperwok and transfusion reaction record to TMS, document

What labs will be ordered in case of a transfusion reaction?

Hgb, culture, type and crossmatch, urine spec

Acute hemolytic reaction

Antibodies attack and destroy RBCs

Usually occurs quickly (first 25mL) and is most life threatening

Due to mismatched blood

S/S of acute hemolytic reaction

Chills, lumbar pain, IV site pain, hypotension, tachycardia, tachypnea, dyspnea, nausea, flushing

May be delayed by 2-14 days - shows up as jaundice

Anaphylaxis rxn to blood

Often occurs within first 10 mL, can occur later due to sensitivity to donor components

S/S of anaphylaxis rxn to blood

Rash, itchiness, hives, flushing, wheezing, respiratory distress, swelling, emesis, hypotension, tachycardia

Febrile rxn to blood

Usually develops later during infusion due to reaction to proteins in blood products

S/S of febrile rxn

Fever increase of 1 degree, tachycardia, hypotension, sudden chills, flushing, malaise, muscle pain, headache

S/S of fluid volume overload

Hypertension, dyspnea, bounding pulse, moist breath sounds, cough, JVD

Bacterial sepsis

Potentially fatal reaction caused by bacteria inadvertently introduced into the blood component/product or originating from the donor

More common in platelets due to room temp storage

Indications for TPN

Paralyzed or nonfunctional GI tract, conditions where GI tract requires rest (bowel obstruction, ulcerative colitis, pancreatitis, short bowel syndrome), NPO for an extended period of time, chronic or extreme malnutrition, chronic diarrhea or vomiting requiring surgery, chemo induced malnutrition

Major components of TPN

Carbohydrates, protein, fat, electrolytes, vitamins, trace elements/minerals

Complications with TPN

Hyper/hypoglycemia, dehydration, electrolyte imbalances, thrombosis, infection, liver failure, micronutrient deficiencies, hypersensitivity, refeeding syndrome

What to do if a patient is hypoglycemic while receiving TPN

Initiate D10W at same rate

S/S of hypersensitivity rxn with TPN

Fever, chills, NV, hives, back pain, headache, dyspnea, chest pain

Refeeding syndrome

Occurs when a client is severely malnourished and suddenly received nourishment (carbs) again

Starts with low K, Mg and P

Pancreas secretes insulin so that the cells can take up the sugar, but K + Mg + P are also pulled in

Dangerously low serum levels of Mg, P and K

When can TPN be stopped?

When the patient is able to get adequate nutrition (70% of protein and calorie needs)