Term
| Purpose of Blood Component Therapy |
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Definition
Increase H&H:carry oxygen to cells, replace loss during active bleeding
Increase Intravascular volume
Replace deficiencies: Platelets, clotting factors |
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Term
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Definition
Used in hemorrhage or shock
-repalces volume and components (RBCs, plasma proteins, clotting factors, palsma)
-Large risk for incompatibility, overload, blood-born pathogens |
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Term
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Definition
Used for severe or symptomatic anemia-specifically boosts H&H
-usually if hemoglobin is <8.0
-1 unit should increase Hgb by 1g/dl in a 70kg adult
-no clotting factors
-Risk for Blood born pathogens |
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Term
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Definition
Used for thrombocytopenia and continued hemorrhage
-one unit (30-60 ml) raises it 30k-50k
NO compatibility testing needed, but do NEED Rh factor
--Risk of blood born pathogens |
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Term
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Definition
Restores clotting factor and plasma protein
-Need cross matching but not Rh- should be ABO compatible
-One unit = 200-250 mls
Thawed in water bath
--Risk for blood born pathogens |
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Term
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Definition
Hypovolemic shock and trauma, hypoalbuminemia (ascites, 3rd spacing)
-Moves water from extravascular to intravascular space
-5% to 25% solution
--risk of hypersensitivity and blood born pathogens |
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Term
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Definition
Replacement of clotting factors VIII and fibrinogen
-Rh compatibility not needed
-10-20mls/bag
Contains hemagglutinins
Risk of hemolysis |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| universal recipient--A, B, AB, O |
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Definition
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Term
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Definition
Presence of D antigen
--Should not be exposed to Rh+ blood
May cause severe hemolytic reaction |
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Term
| Administration Procedure for Blood Products |
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Definition
-Physicians order
-discuss religious/cultural beliefs about transfusion
-patient consent
-Type and Crossmatch
-Blood band on patient
-18 gauge or larger IV access
-Special Y-tubing and filter
--only with normal saline, blood can not be on the floor for more than 20 minutes
-Must have 2 RN's
-Invert bag
-Establish baseline vitals
-remain with pt for first 15 minutes
-Take vitals q15 minutes for first hr., maximum infusion time=4hrs. |
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Term
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Definition
Most common reaction to blood
-symptoms may often occur in the first 15 min. or delayed
s/s: chills, fever, headache, muscle pain
-WBC incompatibility
-often occurs with hx of multiple transfusions: need filter, washed cells, antipyretic |
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Term
| Allergy/Hypersensitivity Reactions |
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Definition
Sensitivity to blood donor's plasma proteins
-may be mild or anaphylactic
s/s: wheezing, reddened wheal on skin, itching, dyspnea, edema, shock, anaphylaxis
-occur during or after transfusion
TX: antihistamines for prevention, epinephrine and/or steroids for severe reaction |
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Term
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Definition
Caused by infusion of incompatible blood
-clotting RBCs may cause organ damage
-Free Hgb may block renal tubules causing renal failure
-Often after 100-200mls of incompatible blood
s/s: initial burning along IV site, flushing face, chills, fever, SOB, lower back pain, chest pain, tachycardia, hypotension, dark urine, jaundice
TX: prevention by careful checking of id to blood
-obtain specimens
-treat shock, maintain urine output (possible foley)
-need new type and crossmatch prior to next transfusion |
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Term
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Definition
Identify patients at risk s/s: crackles, SOB, JVD transfuse slowly lasix may be fiven between units
(like fluid overload) |
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Term
| Massive Transfusion Reaction |
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Definition
Caused by infusing large volumes of blood too quickly
--imbalance blood factors (clotting factor, albumin, platelets not in RBCs)
-hypothermia, hyperkalemia, citrate toxicity causing hypocalcemia
--monitor electrolytes and use blood warmers |
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Term
| Delayed Transfusion Reactions |
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Definition
Infections:(blood born/transmitted infections)
Hepatitis B and C Human herpes virus type 6 HIV HTLV-1 CMV Malaria West Nile Virus |
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Term
| Slow or Stopped Transfusion |
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Definition
Check bag height, check flow clamp
-make sure blood covers filters
-gently rock bag to agitate cells
-squeeze tubing or flash bulb
-untape dressing and check site
-dilute w 50-100cc normal saline |
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Term
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Definition
Autologous donor
-pt. may donate their own blood prior to surgery, may be frozen
-good for rare blood types, reaction and disease may be avoided
AUTOTRANSFUSION
-collection device used to collect, filter and return blood lost in surgery or trauma
-clots may occur and prevent re-transfusion
-may lack coagulation factors |
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Term
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Definition
An out pouching or dilation of the arterial wall, frequently involving the aorta
-most are found in the abd. aorta below the renal arteries
but may also occur in the thoracic or popliteal or femoral artery
-occurs more in men |
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Term
| Risk factors for Aortic Aneurysm |
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Definition
Risk increases with age, >65 y.o.
-smoking
-Atherosclerosis & arteriolsclerosis
-HTN
-Trauma
-Marfan syndrom: changes the structure of BVs |
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Term
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Definition
Affects all the layers of the vessel wall
-Fusiform: uniform in shape (symmetrical dilation, regular shape)
-Circumferential: all the way around the diameter |
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Term
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Definition
Trauma causes a disruption of all the layers of the arterial wall leading to a contained bleed
Saccular: out pouching of the vessel wall
Berry: congenital, often happens in the brain |
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Term
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Definition
Aneurysm that has a break causing blood to leak out
--LIFE threatening emergency |
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Term
| Symptoms of Aortic Aneurysm |
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Definition
Symptoms develop slowly and aneurysm may rupture without warning
Common ones: thoracic, abdominal, femoral, popliteal |
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Term
| Abdominal Aneurysm Symptoms |
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Definition
| pulsating mass, midabdominal or lumbar back pain, cool, cyanotic extremities, claudication |
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Term
| Thoracic Aneurysm Symptoms |
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Definition
| back, neck, chest pain, dyspnea, hoarseness, dysphagia, edema of the face and neck, JVD |
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Term
| Popliteal and Femoral Aneurysms Symptoms |
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Definition
| Intermittent claudication, pain at rest, numbness, pulsative mass in popliteal fossa |
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Term
| Symptoms of Dissecting Aneurysm |
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Definition
Extremely sudden, excruciating pain (tearing or ripping sensation
syncope (pass out)
dyspnea
BP increases then drops out |
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Term
| Complications of Aneurysm |
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Definition
Rupture: most common (mortality 50%), pt. may bleed to death, need emergency surgery, massive bleeding into abd cavity or retroperitoneal space
-weakness, paralysis
-ischemia/infarction of major organs
-aortic regurgitation |
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Term
| Diagnostic Tests for Aneurysm |
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Definition
Often in physical exam or Chest X-ray done for other conditions
-CT scan most accurate test to determine the size
ABD, femoral, extremity US
EKG
Angiography- assess involvement of other vessels
Transesophogeal echo (TEE) |
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Term
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Definition
Prevent rupture!
-assess size, location and surgical risk
-Keep BP under control: long term beta blockers, nipride, calcium channel blockers
Constant VS and UO monitoring |
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Term
| Surgical Repair of Aneurysm |
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Definition
Only if: >5cm, growing rapidly, pt. is symptomatic
Endovascular stent graft: metal sheath with fabric covering placed through femoral artery, shorter hospital stay, lower cost, fewer complications
Open Sugery: remove aneurysm, insert synthetic fabric graft, requires about 6 day hospital stay, 8 week rehab
--need long term anticoagulant therapy |
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Term
| Disseminated Intravascular Coagulation |
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Definition
DIC: a serious bleeding disorder including both clotting and bleeding
-always caused by an underlying condition
-Can be mild to life threatening
-Can affect one organ or can be widespread and eventually cause multiple organ failure |
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Term
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Definition
Tissue damage or toxins activates clotting cascade
-excessive thrombin cause accelerated clotting
-thrombi and emboli cause ischemia and necrosis
-decrease in clotting factor and platelets
-clots break down
-leads to uncontrollable bleeding |
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Term
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Definition
Trauma
Sepsis
OB complication
Cancer
Fat Embolism
Aortic Aneurysm
Acute glomerulonephritis |
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Term
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Definition
Bleeding: oozing or bleeding from incisions and punctures sites
-bruising, purpura, petichea
-GI bleeding
-hemoptysis
-tachycardia, hypotension
-hematuria, renal failure
-increased ICP
Clotting
-cyanosis or extremities
-dyspnea, tachypnea
-Mental status change |
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Term
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Definition
clotting tests are prolonged (PT, PTT)
raw materials used for clotting are decreased
Fibrin degradation products are elevated, D-dimer elevated
CBC and Platelets |
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Term
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Definition
Diagnose quickly, resolve underlying problem
-blood products (platelets, FFP)
-Anticoagulant therapy
-symptomatic treatment |
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Term
| Top Nursing Priorities for DIC patients |
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Definition
1. Ineffective tissue perfusion r/t decreased blood flow: assess extremities, cap refill, pulses
-do not elevate legs, minimize invasive procedures
2. Impaired gas exchange r/t clots: O2 sat. monitoring, bed rest in high fowlers
3. Pain r/t ischemia: handle gently, cool compresses
4. Fear r/t uncertain prognosis
-maintain calm environment, respond promptly to calls |
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