Blood Transfusion Basics

Blood Transfusion Information

• Vital signs checked before the of blood transfusions at 15 minutes before hanging and 15 minutes after starting
• Use an 18-20 gauge, mostly 20 gauge needle for blood transfusions
• Check blood bag and inputs:date, blood type needed vs what the patient has (Rh factor), check cereal number, amount of RBCs to be transfused, patient name, medical record number vs birthday
• If reaction occurs: stop transfusion, take vital signs, hang normal saline, send blood back to lab, check the patient every 3-5 minutes, and obtain urine specimen

Reasons for Blood Transfusion

• Replenish blood volume lost from trauma, surgery, or bleeding disorders that lead to anemia
• Treat chronic conditions causing anemia or low blood counts like sickle cell, thalassemia, or cancer
• Prepare for bone marrow or stem cell transplants to replace blood-forming cells
• Improve oxygen-carrying capacity
• Restore depleted blood elements
• Prevent complications
• Raise hemogolobin levels
• Provide antibodies
• Replace clotting factors in bleeding disorders

Blood Types and Rh Factor

• Type A blood: anti-B antibodies, can donate to A or AB, receives A or O
• Type B blood: anti-A antibodies, can donate to B or AB, receives B or O
• Type AB blood: no antibodies, can donate to AB, can receive all blood types
• Type O blood: anti-A and anti-B antibodies, can donate to anyone, and can only receive type O
• Rh factor is a protein on red blood cells determining if type is Rh-positive (Rh⁺) or Rh-negative (Rh⁻)
• Positive means D antigen is present
• Negative means no D antigen, risk to develop anti-D if exposed to Rh positive blood

Blood Type Matching

• Rh-negative people can only receive Rh-negative blood
• Rh-positive people can receive both Rh+ and Rh-
• O negative is the universal donor
• AB positive is the universal recipient

Blood Transfusion Reactions

• Transfusion-Related Acute Lung Injury (TRALI) causes pulmonary edema , respiratory distress becuase of donor plasma antibodies
• Presence of WBC antibodies from donor with WBC-activating agent in blood -Leading cause of transfusion-related death
• Fever, respiratory failure, hypoxemia, hypotension, pulmonary edema
• Stop transfusion, respiratory support, administer oxygen, may need mechanical ventilation, administer vasopressor agents
• Hemolytic Blood Transfusion Reaction caused by ABO or Rh incompatibility that activates the complement system to destroy transfused blood cells
  • Labeling errors most common problem which can be fatal with as little as 1-2 cc of RBCs
  • Fever, chills, nausea, vomiting, pain at transfusion site/back/flank/chest/abdomen/head, hemoglobinuria , hypotension, tachycardia, shock, flushed skin, dyspnea, haemoglobinaemia, haemoglobinuria, olguria/anuria, pallor, jaundice
• Strict verification of patient/product identity and screening for irregular antibodies required for prevention
• Immediately stop the transfusion, maintain IV access with normal saline, monitor vitals, send blood samples/products for testing, supportive care, and administer diuretics to increase urinary output

Cerebral Control: Lobes

• Frontal Lobe: movement, thinking, reasoning (judgment), behavior (emotions), and memory
• Temporal Lobe: language understanding, behavior, memory, and hearing
• Parietal Lobe: knowing right from left side, sensation, and reading
• Occipital Lobe: vision
• Cerebellum: coordination, balance, and fine muscle
• Brain Stem: breathing, alertness/sleep, blood pressure, body homeostasis, heart rate, temperature, digestion, and swallowing

Stroke Definitions and Facts

• Medical emergency caused by a disruption in blood supply that leads to brain cell death and loss of function
• Ischemic stroke- blockage in brain artery, caused by blood clot, 87% of strokes
• Hemorrhagic stroke- ruptured blood vessel bleeding in or around brain, 13% of strokes
• Symptoms depend on area of the brain affected that include numbness/weakness, confusion, trouble speaking/understanding, dizziness, vision problems, severe headache
• Cerebrovascular Accident/Brain Attack- cutting off in blood flow to brain or spinal cord that causes ischemia, oxygen/nutrient deprivation, cellular death, neurological deficit impacting memory, muscle control, sensation, vision, or emotions
• Loss of function depends on location/extent of cellular death, lasting >24 hours, and can occur anytime
• Etiology and Pathophysiology causes interruption that alters metabolism at 30 seconds, stops in 2 minutes, and causes cell death in as little as 5 minutes caused by brain requirment for continuous oxygen/glucose, with atherosclerosis and thrombus/emboli formation

Ischemic vs Hemorrhagic Stroke

• Ischemic Stroke (Clot)- Thrombotic - clot in artery supplyig blood to brain OR Embolic - clot formed somewhere else in body clot.
• Ischemic strokes make up 85% of all strokes, assoc with HTN/diabetes, often preceded by a TIA deprives brain tissue of oxygen/nutrients
• Hemorrhagic Stroke (Bleeding) in 10-20% of all strokes that damage surrounding tissue
• Intracerebral hemorrhage in cerebral lobes, basal ganglia, thalamus, brainstem, and cerebellum that bursts a blood vessel in the brain
• Subarachnoid hemorrhage in space surrounding brain with ruptured aneurysm/arteriovenous malformation
• Hemorrhagic strokes are deadlier and are defined as a vessel rupturing to bleed in or around the brain with causes like uncontrolled hypertension

Transient Ischemic Attacks (TIA)

• Temporary focal loss of neurologic function from ischemia that resolves usually within 3 hours
• TIAs may be micro-emboli temporarily blocking blood flow and serve as a warning sign of cerebrovascular disease
• Symptoms typically resolve within 24 hours when blood flow is restored
• Requires prompt evaluation and treatment to prevent future stroke

Types of Strokes Explained

• Thrombotic stroke- blood clot forms in artery to brain, blocking flow
• Embolic stroke- traveling clot lodges in cerebral artery
• Hemorrhagic stroke- weakened blood vessel ruptures, bleeding in/around brain

Hemorrhagic Stroke Causes

• Intracranial Hemorrhagic Stroke: bleeding directly to the brain matter, usually occurring at bifurcations of major arteries
• Main causes are uncontrolled hypertension that weakens vessels over time, cerebral aneurysms (weakened/ballooned vessel walls), arteriovenous malformations, head trauma/injury, thinners/anticoagulants use, and bleeding disorders

Subarachnoid Strokes

• Subarachnoid hemorrhage (SAH): bleeding between brain and membranes from ruptured cerebral aneurysm/AVM
• Leaked blood puts pressure on brain causing symptoms and requires prompt treatment to prevent more damage/death
• Hypertension or trauma accounts for 17%, while 20% in younger persons have unknown causes

Cerebral Aneurysms

• Dilation of the walls of a cerebral artery from weakness that causes bulging/weakened wall, leads to subarachnoid hemorrhagic stroke if ruptured
• Risk factors include hypertension, smoking, connective tissue disorders
• Treatments are surgical clipping or endovascular coiling

Arteriovenous Malformations

• Arteriovenous Malformation (AVM) : gene mutation, blood shunting past capillaries with rapid circulating blood flow
• Causes vasodilation of the upstream artery and rupture most often in the brain/spinal cord creating connection causing high-flow, high-pressure shunting that damages brain by depriving Oxygen and nutrients from brain tissue
• Hypertensive hemorrhage- elevated blood pressure damages small brain vessels that causes increased pressure to accumulates and shift brain structures
• Increased intracranial pressure causes headaches, vomiting, vision changes, decreased consciousness, permanent neurological deficits , cognitive impairment, seizures, hydrocephalus, or complications if bedbound

Hemorrhagic Stroke: Causes and Effects

• Cause- Edema (Vasogenic & Cytotoxic), Compression
• Main causes- uncontrolled BP, aneurysms, AVMs, head trauma, thinners, and clotting disorders that leads to headaches, nausea, vomiting, seizures, altered consciousness, weakness/paralysis, vision problems, dizziness, difficulty speaking/swallowing and can result in coma, brain herniation, permanent damage, or death if not treated promptly

Risk Factors for Hemorrhagic Stroke

• Obesity, hypertension, smoking, alcohol, genetics, older age, male gender, aneurysms, family history, thinners use, head trauma, amphetamine/cocaine use

Hemorrhagic Stroke Warning Signs

• Sudden severe headache, nausea, vomiting, seizures, weakness/numbness on one side, speech difficulty, vision problems, dizziness, neck stiffness, altered mental status, loss of consciousness, hemiparesis, lack of balance, brainstem involvement - change in level of conciseness

Complications of Hemorrhagic Stroke

• Hypoxia, decreased cerebral blood flow, extension of injury, and cerebral vasospasm that causes reduced brain blood and injury
• Permanent brain damage/tissue, disabilities like paralysis, speech/cognitive problems
• Seizures, recurrent bleeding, hydrocephalus, as well as immobility issues like blood clots, bedsores, or pneumonia

Right vs Left Brain Functions

• Right Brain: artistic/creative (art awareness, creativity, imagination, intuition, insight, holistic thought, music, 3-D forms, left-hand control, causes Hemiplegia, deny minimize problem, Perceptual Deficits, Impulsive, and Impaired Judgment, neglect, spatial-perceptual deficits, , rapid performance, deny issues,safety and time problems
• Left Brain: academic/logical (analytic thought, logic, language, reasoning, science/math, written, numbers, righy-hand control), causes Paralysis and Aphasia (speeach impaiments), Impaired right/left discrimination, Slow performance, cautious, Aware of deficits depression, anxiety, Impaired comprehension related to language

Stroke Assessment

National Institutes of Health Stroke Scale is a neurologic assessment that evaluate 12 different neurological elements.

• Assess function, sensory, assess specific ability (scale 0-4).
• Higher score indicates higher impairment and for severity/treatment that predict the patient outcome ( Glasgow Coma Scale used as neurological assessment tool)
• For nursing assessment: conciseness, vital signs, strength, speech

Severe Brain Damage

• Decerebrate posturing: upper brain stem damage/lesions in Midbrain/Pons woth arched back, hands flexed outward, straight arms/legs, pointing toes, that is ridged
• Decorticate posturing: damage to corticospinal tracts with flexed wrists/fingers towards chest, adducted/flexed arms, and stiff legs that leads to limited movments

Diagnostic Stroke Studies

• To confirm stroke and identify cause: Computed Tomography (CT) is primary within 4 hours that IDs cerebral hemorrhage, Magnetic Resonance Angiography ( MRA) for vessel formation
• EKG, MRI for real-time biology accurate view and identifying/treating
• Lumbar Puncture with cerebral hemorrhage or ruptured aneurysm

Stroke Treatment

• Acute Pharmacological Treatment: Thrombolytic/fibrinolytic therapy that can be used for ischemic strokes

Stroke Medicatons

• Mannitol is used for hemorrhagic stroke while Antiocoalguants are contradicted for treatment and can cause further bleeding
• Chronic Pharmacological Treatment: Antiplatelet drugs like Aspirin, Coumadin, and Statins
• Zocor (simvastatin): Side effects are Muscle pain, elevated liver enzymes, headache, abdominal pain and to instruct to take liver check, report muscle pain/weakness, avoid alcohol/grapefruit juic
• Aspirin: Antiplatelet-Side effects stomach pain/heartburn/bruising/hearing issues that you administer with food/antacids, assess for bleeding, instruct on NSAID precautions/milk, do not lie down after taking, watch for bleeding
• Plavix (clopidogrel): Antiplatelet-Side effects: bruising, bleeding, headache, diarrhea that you need to Monitor platelets, instruct not to stop without doctor's order, watch for bleeding
• Coumadin (warfarin): Anticoagulant-Side effects: bleeding, bruising, fatigue, dizziness and you monitor consistent INR, vitamin K intake, watch for bleeding

Stroke Nursing Interventions

• Monitor emotional distress and status conciseness: vital signs, and level of consciousness through pupil size with oxygen saturation
• Monitor ADL;s especially swallowing so keep the patient NPO until evaluated by speech therapist and suction if possible, note unilateral neglect for sides/extremidies
• Ensure Safety and proper measures; if patient is having hard time swallowing Airway, Breathing, and Circulation - Ensure patent airway, oxygenation, and circulation,Neurological Monitoring, Positioning ,Swallowing Precautions andFall Precautions
• Bladder/Bowel Managemeny

Stroke and Seisures Patho and Education

• Stroke education includes, deficits, rehabilitation, and prevention + community resources such ADL's: Exercises: Diet: Psychological
• Educate to prevent high BP, cardiac rthym/ function - Discuss modifiable risks like lifestyle changes to include FAST signs education
• Stroke Laboratory Tests includes: CBC, Prothrombin, time Glucose, Cholesterol, Clopidogrel,, and ABgs and plan for Rehabilitation by explanation that is family inclusive
• Dysphagia is difficulty swallowing while Aphagia is complete inability or refusal to swallow

Seizures

• Sudden, uncontrolled electrical activity in the brain lastiing 30-120 seconds with potentail changes to : behavior, Status, Respiritations, and consiseness . May or may not show changes and is not always emergancy

Causes of siezures

• Mostly caused by genes that are linked to structural, vascular and infections. Like Low levels = none Structural - Lesions to the brain - Can occur in any area
• High Intracranial pressure/ Stroke/ Hear Infarction/ Ischemic Attack/ Migraine headache/ Sleep disorders are vascular causes while: Genetics/ Developmental mutations/Gamma-aminobutyric acid are causes related towards the common nueortranmimter defincency
• Metabolic disorde like hypoglycemia, genetic/perinata/lead and vascular issues are contributing couses witth exposre to infection toxins, alcohol. Unknow is often called idopathic

Epilepsy

• last 5 or more minutes in 2 episodes with unkown causes. Is a chronicle distrubamce that has requuence due to nurons that are not identified. Need to EEG

Status Epilepticus

• Not regained even though > 30. min with Establisihing airway, , D10 and medicatons of Valium/ Ativan every 10 minutes to surpress any damage/complications for controls

Siezure Classifications and Causes;

• Non-epileptic is cuased by abnormal neuronal firing such as Pyschilogacl sytress or head injuries versus Secondary is conditing under the brain such as infencions , vascular, heac injuries and disbancce. Primary has idiotpathic or genitic preposissions and has unknown on set
• Sherpath Ai: primary idiopathic or genetic predisposition (childhood absence or juvenile myoclonic epilepsy for examples) while developing are cuased by brais tumor, certibal palsey and malfmations
• Defintiiong myoclonic are jeriing movements and tone cause stiffiness that myolonic tonis

Siezure Defitions and Types

• Focal are One the heomspere or partial is small part causes Twitching, while generalised are widespreas, and unknown cannnot be detmeriend.

• Aura ( feeling,)

• Atonic ( limpenss Clinc, rthmich movements

• Epoxy recurung unproveded

• Partial - ocalized wiht or woithotu awareness

• Mycoling - brief jeriks that are caused from altred staus and heachches and musscels siffern and cantract/relac and tonic phace is 1020 seconds

• Types : Tonis/Clonic, Atonic, Genralised, Abscena, Partial and Unkown type.

Siezure Medications

• Primary: Tegretol (carbo)is Antypepectci for Seconadry and genrlised but can worrsing absense
• Nurse Interventionss: Monitor vissual changes, lver CBs and give whout crushisng

Laminictal and Keppra

• Side effects include somolence, dizziness, headache, nausea, and potentially life-threatening rash and can Slowly titrate the dose to avoid rash and Interacts with other antiepileptics and oral contraceptives while Keppar has generally well tolerated main side effects such,loss of appetite an you just monotir with -No known drug interactions
• Dilantian are used to help Manages focal and generalized seizures and helps with sidee effects. Thearputci level 10-20

Nursing Interventions

• Keep side rails padded or Lying flat, give Oxygen, sucction and know review chart to know the cause and medation levels and chart activisieds
• Keep maintain awirways, Protect the patient from injury by clearing the area and positioning on their side
• If needed admin meds, provide a quite area and educate on preventions to maintain comphesvive.