Blood Transfusion Basics Quiz

Course Information

• Course name: NURSN325F
• Course description: Nursing Therapeutics in General Health Care IV
• Topic: Nursing Management of Disturbances in Hematological Functions (Part 1)
• Instructor: MsAmy Leung
• Week: 1

Learning Outcomes

• Describe the applied anatomy and physiology of hematological nursing.
• Identify nursing assessment and common investigations for hematological nursing and related care.
• Describe the definition, etiology, pathophysiology, clinical features, investigations, and diagnosis of common hematological disorders and the related nursing problems and care.
• Describe the definition, purpose, and technique of blood transfusion and bone marrow transplantation and the related nursing problems and care.
• Develop integrative nursing care plans for clients with hematological disorders.
• Describe the basic pharmacological concepts and clinical drug therapy modalities in daily nursing practice and the related nursing considerations for hematological disorders.

Overview

• Structure and functions of the hematological system.
• Assessment.
• Investigation.
• Blood transfusion.
• Splectomy.

Blood

• Exists in a fluid state.
• Circulates through the heart, arteries, capillaries, and veins.
• Serves as a link between body organs.
• Consists of plasma and cellular components.
• Plasma (55%): water, proteins (albumin, globulins, fibrinogen), inorganic salts, urea, dissolved gases, hormones, enzymes.
• Cellular component (45%): erythrocytes (RBC), thrombocytes (platelets), leukocytes (WBCs).

Blood Components

• Derived from stem cells in bone marrow by hematopoiesis.
• Affected by stem cells (in bone marrow) and nutrients (e.g., vitamin B12, iron).

Characteristics of Blood

• Color: Arterial blood is bright red (due to oxygen bound to hemoglobin); venous blood is dark red (due to lower oxygen content).
• Viscosity: 3-4 times more viscous than water; specific gravity 1.046-1.066.
• pH: Slightly alkaline (pH 7.35-7.45).
• Volume: 70-75 ml of blood/kg of body weight; average male and female adults have approximately 5.5 L and 4.5 L of blood respectively.

Functions of Blood

• Transportation: Transports oxygen, carbon dioxide, nutrients, hormones, and metabolic waste products to kidneys and liver.
• Protection: Transports cells and substances involved in immune reactions; clotting.
• Regulation: Regulates fluid balance, body temperature regulation, and acid-base balance.

Types of Blood Cells

• Erythrocytes (RBCs):
• Major component: hemoglobin (Hb).
• Function: exchange of oxygen and carbon dioxide between lungs and tissues.
• Life span: 100-120 days, then destroyed in the spleen and liver.
• Leukocytes (WBCs):
• Function: protection from bacteria and other foreign substances.
• Types: neutrophils (phagocytosis), eosinophils (helminthic infections), basophils (allergic reactions), lymphocytes (B-lymphocytes produce antibodies; T-lymphocytes regulate immune response), monocytes (phagocytosis).
• Platelets:
• Function: form platelet plug to stop bleeding and promote thrombin production.

Hemostasis

• A process that repairs vascular breaks to reduce blood loss from blood vessels while maintaining blood flow.
• Components: blood vessels, platelets, coagulation factors (I to XIII).
• Phases: vasoconstriction/vessel spasm, formation of platelet plug, formation of fibrin clot.

Coagulation Profiles

• Prothrombin Time (PT): Measures the time it takes for a clot to form; helps diagnose clotting disorders, and monitor anticoagulant therapy.
• Activated Partial Thromboplastin Time (APTT): Evaluate adequacy of factors VIII, IX, XI, XII, and monitor patients taking anticoagulants.
• International Normalized Ratio (INR): An international sensitivity index used to determine dosages of oral anticoagulants and monitor anticoagulation therapy.

Hematological System Assessment

• Patients may have disruptions of the hematological, immune, and coagulation systems.
• Important to consider past medical history, including surgeries, splenic injury/splenectomy, tendency to bleed, infectious diseases (e.g., HIV), and cancer.
• Past medications: over-the-counter medications, vitamins, herbs, nutritional supplements, aspirin/aspirin-containing compounds, non-steroidal anti-inflammatory drugs should be considered.
• Family history of hematological or malignant disorders, allergies, and previous blood transfusions.
• Occupation/Exposure to substances (e.g., benzene, pesticides, ionizing radiation). Social history and lifestyle factors.
• Key components of symptoms and physical examination findings: skin and mucous membranes (bruises, infections, drainage); neurologic symptoms; respiratory symptoms; cardiovascular, gastrointestinal, and genitourinary symptoms.

Chief Complaints

• Patient's chief complaints often include fatigue, frequent infections, swollen glands, bleeding tendencies, changes in blood pressure, pulse and alertness.
• Other relevant chief complaints may include dyspnea, shiny smooth tongue, ataxia, pallor of conjunctiva, nail beds, lips, oral mucosa, hematuria, tarry stools, petechiae, bleeding sites that can indicate anemia and various issues related to blood clotting. Fever, tachycardia, abnormal breath sounds, delirium, oral lesions, erythema, swelling, or drainage of the skin are all relevant chief complaints that suggest infection.

Laboratory Tests

• Complete Blood Count (CBC): measures RBCs, Hb, and platelets in the blood sample.
• WBC differential: assesses different types of WBCs to evaluate potential for infection or various types of leukemia.
• Clotting Profile: assesses prothrombin time (PT), activated partial thromboplastin time (APTT) and INR.
• Iron Profile: evaluates serum ferritin, iron, total iron-binding capacity, folate, and vitamin B12.
• Blood Smear: microscopic viewing of blood, using appropriate stains, to examine cells for abnormalities.
• Bone Marrow Aspiration (BMA) and Biopsy: analyzes bone marrow cells for various types.

Blood Product Transfusion

• Understand blood compatibility, antigens, antibodies and different blood types (e.g. ABO blood group system, and Rh factor or system).
• Understand types of blood products (e.g. whole blood, packed red blood cells, platelet concentrate, fresh frozen plasma, cryoprecipitate).
• Understand preparation, implementation, potential complications, and nursing interventions, when performing a blood transfusion.

Splenectomy

• Surgical removal of the spleen.
• Reasons for surgery: trauma, hemolytic or malignant disorders, splenomegaly.
• Laparoscopic technique.
• Benefits of laparoscopic splenectomy: less postoperative pain, less hospitalization, quicker resumption of normal activity, and better cosmetic results.
• Preoperative nursing care (stabilization, evacuation, monitoring, and other relevant preparations).
• Postoperative nursing care (including monitoring for hemorrhage).
• Possible complications (e.g., pancreatitis, fistula formation, hemorrhage, atelectasis, pneumonia).
• Possible diagnoses and nursing interventions (e.g., ineffective breathing pattern, pain management).

Transfusion Reactions

• Various types of transfusion reactions possible, such as febrile nonhemolytic, hemolytic, allergic, circulatory overload, and bacterial contamination.
• Nursing interventions during transfusion reactions, such as stopping the transfusion, notifying the doctor, changing tubing, monitoring vital signs, and other relevant actions.

Test your knowledge on blood transfusion practices, including the necessary checks before transfusion, common reactions, and critical actions to take during the process. This quiz covers key concepts related to blood components and their functions in the human body.