REMINDER : You will have ABGs and tele / EKG strips to analyze
Module 1: Chapters 1, 28, 29, 30
● Types of blood cells
○ Erythrocytes= RBCs
○ Leukocytes= WBCs, fight infection
○ Thrombocytes= platelets
○ Plasma= fluid portion of blood
○ Blood cells are created in bone marrow, spleen and reticuloendothelial system
○ Myeloid stem cells produce RBCs, WBC’s and platelets
○ Complete Blood Count
■ Blood sample drawn from vein
○ WBC’s: 5,000- 10,000
■ Basophil: inflammatory/allergy response, contain histamine
■ Eosinophil: allergy response and parasitic infection
■ Monocyte: fighting infection
■ Neutrophil: bacterial infection, first to respond to immune event
■ Lymphocyte: viral infections, immune response
● B lymphocyte
● T lymphocyte: cellular immunity
■ Leukopenia: decreased WBC’s (below 5000)
■ Leukocytosis: increased WBC’s (above 10,000)
○ RBC’s: 4.5- 5.5 million
■ Hgb
● Men: 14-18 g/dL
● Women: 12-16 g/dL
■ Hct
● Men: 42-52%
● Women: 37-47%
○ Anemia: low RBC’s
○ Polycythemia: increased RBC’s
○ Pancytopenia: lower than normal RBC and WBCs
○ Platelets: 150,000- 400,00
■ Thrombocytopenia: decreased platelets, risk for bleeding
■ Thrombocytosis: increased platelets, risk for clotting
, ■
● Transfusions: blood and platelets
○ Hang with normal saline, 3-way “Y” tubing (usually)
○ Begin slowly (10 drops/min)
○ Initiate within 30 minutes from blood bank, finish transfusion in 4 hours
○ Monitor closely, stay with patient for first 15 mins**
○ Monitor vitals, observe for adverse reactions
■ If reaction occurs stop transfusion and notify HCP
○ Assessments: VERIFY→ right blood type, patient, blood component
■ TWO nurses to verify
■ Check ABO compatibility
■ Expiration date
■ Check signed consent for blood transfusion
○ O negative = Universal donor, no antigens
○ AB+ = universal recipient, no antibodies
○ Lab determines patient blood type (A, B, AB, O) and Rh factor (+ or -)
■ Positive Rh factor can receive + and - blood
■ Negative Rh factor can only receive - blood
○ Antigens: proteins that elicit immune response, on red blood cells
○ Antibodies: protect body from invaders, found in plasma, opposite of antigen
○ Wrong blood given causes agglutination: clumping/lysis of RBCs
○ Crossmatching
■ Blood from donors and recipients are mixed
■ Positive = antibodies against donor cells
■ Negative = pair is compatible
● Complications of blood transfusions- how you would know, assessments, nursing
considerations, patient education
■ Acute Hemolytic Reaction: most serious and life-threatening
● Occurs after infusion of incompatible RBCs
○ Leads to activation of coagulation system and release of
vasoactive enzymes that result in vasoactive instability,
cardiorespiratory collapse, and DIC (Disseminated intravascular
coagulation)
● S/S:
, ○ Fever, chills, backache
○ Lumbar, flank, chest pain
○ Flushing of face
○ Tachycardia
○ Chest tightness, anxiety
○ Hypotension
○ Hemoglobinuria: hemolysis occurs at rapid rate, overwhelms the
kidneys so that they can't break it down fast enough so
hemoglobin is expelled via urine
○ Dyspnea
○ C-V collapse
● Interventions:
○ Stop transfusion and notify HCP
○ Disconnect tubing
○ Infuse NS (different tubing so no leftover blood products)
○ DO NOT GIVE MORE DONOR BLOOD
○ Monitor need for dialysis
○ Administer O2, fluids, vasopressor meds
■ Febrile Reaction: reaction to antibodies directed against leukocytes/platelets
● Occurs immediately or 1-2 hours after transfusion is completed
● S/S:
○ FEVER (most common)
○ Chills
○ N/V/Headache
○ Tachycardia
○ Nonproductive cough
● Interventions:
○ Discontinue transfusion
○ Keep vein open with NS
○ Notify HCP
○ Monitor vital signs
○ Administer antipyretic
■ Allergic Reaction: can occur immediately or within 1 hour of transfusion
● Mild reaction:
○ Urticaria (a rash of round, red welts on the skin that itch
intensely, sometimes with dangerous swelling), localized
erythema (superficial reddening of the skin), facial flushing,
dyspnea, wheezing, itching
○ Nursing actions:
■ Pause transfusion, keep vein open, notify HCP, monitor
vital signs and administer antihistamine orders (or
sometimes benadryl 30 min before transfusion),
■ Resume transfusion if symptoms abate with
antihistamine
, ■ Have O2 device at bedside
● Severe reaction:
○ Anxiety, hypotension, shock, wheezing, urticaria
○ Nursing actions:
■ Discontinue transfusion, keep vein open with NS,
administer epinephrine, administer CPR if necessary,
anticipate order for steroids, maintain BP
■ Prevention using well washed RBCs where plasma has
been extracted
○
● Transfusion transmitted diseases
○ HIV
○ Hep B and C
○ Syphilis
○ Cytomegalovirus
○ Bacterial infections
● Pharm alternatives to transfusions
○ Iron supplements via diet, oral supplements or IV route
○ Iron rich diet
○ Erythropoiesis stimulating agents- Epoetin Alfa
○ Preoperative autologous blood donation: when patient donates own blood prior to
surgery in case of the need of a transfusion (usually in the setting of surgery)
● Anemias: Types, complications, medical management, nursing process of the patient with
anemia For types know hemolytic:(You don’t have to memorize all the types but focus
on abnormal hemoglobin, sickle cell, thalassemia, antibody related, DIC and the others in
NOT ANTIBODY related) → see below
○ Thalassemia
Module 1: Chapters 1, 28, 29, 30
● Types of blood cells
○ Erythrocytes= RBCs
○ Leukocytes= WBCs, fight infection
○ Thrombocytes= platelets
○ Plasma= fluid portion of blood
○ Blood cells are created in bone marrow, spleen and reticuloendothelial system
○ Myeloid stem cells produce RBCs, WBC’s and platelets
○ Complete Blood Count
■ Blood sample drawn from vein
○ WBC’s: 5,000- 10,000
■ Basophil: inflammatory/allergy response, contain histamine
■ Eosinophil: allergy response and parasitic infection
■ Monocyte: fighting infection
■ Neutrophil: bacterial infection, first to respond to immune event
■ Lymphocyte: viral infections, immune response
● B lymphocyte
● T lymphocyte: cellular immunity
■ Leukopenia: decreased WBC’s (below 5000)
■ Leukocytosis: increased WBC’s (above 10,000)
○ RBC’s: 4.5- 5.5 million
■ Hgb
● Men: 14-18 g/dL
● Women: 12-16 g/dL
■ Hct
● Men: 42-52%
● Women: 37-47%
○ Anemia: low RBC’s
○ Polycythemia: increased RBC’s
○ Pancytopenia: lower than normal RBC and WBCs
○ Platelets: 150,000- 400,00
■ Thrombocytopenia: decreased platelets, risk for bleeding
■ Thrombocytosis: increased platelets, risk for clotting
, ■
● Transfusions: blood and platelets
○ Hang with normal saline, 3-way “Y” tubing (usually)
○ Begin slowly (10 drops/min)
○ Initiate within 30 minutes from blood bank, finish transfusion in 4 hours
○ Monitor closely, stay with patient for first 15 mins**
○ Monitor vitals, observe for adverse reactions
■ If reaction occurs stop transfusion and notify HCP
○ Assessments: VERIFY→ right blood type, patient, blood component
■ TWO nurses to verify
■ Check ABO compatibility
■ Expiration date
■ Check signed consent for blood transfusion
○ O negative = Universal donor, no antigens
○ AB+ = universal recipient, no antibodies
○ Lab determines patient blood type (A, B, AB, O) and Rh factor (+ or -)
■ Positive Rh factor can receive + and - blood
■ Negative Rh factor can only receive - blood
○ Antigens: proteins that elicit immune response, on red blood cells
○ Antibodies: protect body from invaders, found in plasma, opposite of antigen
○ Wrong blood given causes agglutination: clumping/lysis of RBCs
○ Crossmatching
■ Blood from donors and recipients are mixed
■ Positive = antibodies against donor cells
■ Negative = pair is compatible
● Complications of blood transfusions- how you would know, assessments, nursing
considerations, patient education
■ Acute Hemolytic Reaction: most serious and life-threatening
● Occurs after infusion of incompatible RBCs
○ Leads to activation of coagulation system and release of
vasoactive enzymes that result in vasoactive instability,
cardiorespiratory collapse, and DIC (Disseminated intravascular
coagulation)
● S/S:
, ○ Fever, chills, backache
○ Lumbar, flank, chest pain
○ Flushing of face
○ Tachycardia
○ Chest tightness, anxiety
○ Hypotension
○ Hemoglobinuria: hemolysis occurs at rapid rate, overwhelms the
kidneys so that they can't break it down fast enough so
hemoglobin is expelled via urine
○ Dyspnea
○ C-V collapse
● Interventions:
○ Stop transfusion and notify HCP
○ Disconnect tubing
○ Infuse NS (different tubing so no leftover blood products)
○ DO NOT GIVE MORE DONOR BLOOD
○ Monitor need for dialysis
○ Administer O2, fluids, vasopressor meds
■ Febrile Reaction: reaction to antibodies directed against leukocytes/platelets
● Occurs immediately or 1-2 hours after transfusion is completed
● S/S:
○ FEVER (most common)
○ Chills
○ N/V/Headache
○ Tachycardia
○ Nonproductive cough
● Interventions:
○ Discontinue transfusion
○ Keep vein open with NS
○ Notify HCP
○ Monitor vital signs
○ Administer antipyretic
■ Allergic Reaction: can occur immediately or within 1 hour of transfusion
● Mild reaction:
○ Urticaria (a rash of round, red welts on the skin that itch
intensely, sometimes with dangerous swelling), localized
erythema (superficial reddening of the skin), facial flushing,
dyspnea, wheezing, itching
○ Nursing actions:
■ Pause transfusion, keep vein open, notify HCP, monitor
vital signs and administer antihistamine orders (or
sometimes benadryl 30 min before transfusion),
■ Resume transfusion if symptoms abate with
antihistamine
, ■ Have O2 device at bedside
● Severe reaction:
○ Anxiety, hypotension, shock, wheezing, urticaria
○ Nursing actions:
■ Discontinue transfusion, keep vein open with NS,
administer epinephrine, administer CPR if necessary,
anticipate order for steroids, maintain BP
■ Prevention using well washed RBCs where plasma has
been extracted
○
● Transfusion transmitted diseases
○ HIV
○ Hep B and C
○ Syphilis
○ Cytomegalovirus
○ Bacterial infections
● Pharm alternatives to transfusions
○ Iron supplements via diet, oral supplements or IV route
○ Iron rich diet
○ Erythropoiesis stimulating agents- Epoetin Alfa
○ Preoperative autologous blood donation: when patient donates own blood prior to
surgery in case of the need of a transfusion (usually in the setting of surgery)
● Anemias: Types, complications, medical management, nursing process of the patient with
anemia For types know hemolytic:(You don’t have to memorize all the types but focus
on abnormal hemoglobin, sickle cell, thalassemia, antibody related, DIC and the others in
NOT ANTIBODY related) → see below
○ Thalassemia
