Blood Transfusion Basics

Blood Transfusion Information

• Vital signs should be charted 15 minutes before and after the transfusion starts.
• Use an 18-20 gauge needle, but mostly a 20 gauge. Key Checks to make:
• Blood type match
• Rh factor compatibility
• Serial number on the blood bag
• Amount of RBCs being administered
• Patient name and medical record number (not birthday) should be verified. Reactions:
• If a reaction occurs, stop the transfusion, take vital signs, hang normal saline, send the blood and supplied back to the lab, check the patient every 3-5 minutes, and get a urine specimen if needed.

Explaining the Need for Blood Transfusions

• Blood transfusions are needed for severe blood loss due to trauma, surgery, or bleeding disorders, to restore blood volume
• They address certain chronic medical conditions like sickle cell disease, thalassemia, or cancer, which cause anemia and low blood counts
• Blood transfusions are required during major surgeries or procedures where significant blood loss is expected
• They replace specific blood components, such as platelets or clotting factors for bleeding disorders
• Blood transfusions support bone marrow or stem cell transplants to replace blood-forming cells.
• Blood transfusions improves oxygen-carrying factors
• Blood transfusions restore depleted blood elements
• Blood transfusions prevent complications
• Blood transfusions raise hemoglobin levels
• Blood transfusions provide antibodies

Blood Types and Rh Factor (Antibodies)

• Type A people have anti-B antibodies
• Type B people have anti-A antibodies
• Type AB people have no antibodies
• Type O people have both anti-A and anti-B antibodies
• Type O is the universal donor and can only receive type O blood.
• Type A can donate to people with type A or AB blood and can only receive type A or type O blood.
• Type B can donate to people with type B or AB blood and can only receive type B or type O blood.
• Type AB can only donate to people with type AB blood and can receive all blood types.
• The Rhesus factor (Rh factor) is a protein on red blood cells and determines if a person’s blood type is Rh-positive (Rh+) or Rh-negative (Rh-).
• Rh positive means the D antigen is present
• Rh negative means no D antigen and the potential to develop anti-D antibodies if exposed to Rh positive blood.
• Rh-positive (Rh+) people have the Rh protein on red blood cells
• Rh-negative (Rh-) people do not have the Rh protein.
• Rh-negative people can only receive Rh-negative blood
• Rh-positive people can receive both Rh+ and Rh-

Universal Blood Types

• Type O negative is the universal donor
• Type AB positive is the universal recipient

Blood Transfusion Reactions Explained

TRALI (Transfusion-Related Acute Lung Injury):

• A serious reaction where plasma from the transfused blood enters the recipient's lungs, causing pulmonary edema and respiratory distress.
• Likely caused by antibodies in the donor plasma. Presence of WBC antibodies from the donor who has a WBC-activating agent in blood leads to transfusion-related acute lung injury(TRALI) and is the leading cause of transfusion-related death. Key Facts about TRALI:
• Onset during or within 6 hours of transfusion
• Signs and symptoms include fever, respiratory failure, hypoxemia, hypotension, and pulmonary edema
• Interventions: Stop transfusion with respiratory support, administer oxygen. Frequently mechanical ventilation, and administer vasopressor agents. Hemolytic Blood Transfusion Reaction:
• A serious complication/incompatibility that occurs when the recipient's immune system destroys the transfused red blood cells. It is caused by ABO or Rh blood group incompatibility between donor and recipient
• Antibodies activate the complement system causing intravascular hemolysis
• This hemolytic reaction can occur with as little as 1-2 cc of RBCs, and a labeling error is the most common problem.
• This specific type of reaction CAN BE FATAL
• Onset typically occurs minutes after starting and COULD take up to a few hours after starting the transfusion
• Signs and symptoms include fever, chills, nausea, vomiting, pain at the transfusion site, back or flank pain, hemoglobinuria (reddish-brown urine), hypotension and tachycardia, shock, flushed and dyspneic (histamine), back/chest/abdominal pain, headache, hemoglobinemia, and hemoglobinuria, olguria with dark urine or anuria, pallor, jaundice bleeding Best Practice: prevention involves strict verification of patient and blood product identities, and screening for irregular antibodies before transfusion. Interventions:
• Immediately stop the transfusion
• Maintain IV access with normal saline
• Monitor vital signs
• Send blood samples and transfusion products for testing supportive care, diuretics may be given to increase urinary output and avoid kidney injury from hemoglobinuria.

Stroke and Areas of Brain control

• Frontal Lobe: Movement, thinking, reasoning (judgement), behavior (emotions), memory.
• Temporal Lobe: Language, understanding, behavior, memory, hearing.
• Brain Stem: Breathing, alertness/sleep, blood pressure, body, heart rate, temperature, digestion, swallowing.
• Parietal Lobe: Knowing right from left side, sensation, reading.
• Occipital Lobe: Vision.
• Color Blindness Cerebellum: Coordination, balance, fine muscle control.

Stroke Definition

• Is a medical emergency caused by a disruption in blood supply to the brain, resulting in brain cell death and loss of function.
• 2 main types: Ischemic stroke and Hemorrhagic stroke
• Ischemic stroke is caused by a blockage in an artery supplying blood to the brain, often due to a blood clot, and accounts for about 87% of strokes
• Hemorrhagic stroke is caused by bleeding into or around the brain from a ruptured blood vessel, and accounts for about 13% of strokes What you should know:
• Stroke symptoms depend on the area of the brain affected and can include sudden numbness or weakness, confusion, trouble speaking or understanding, vision problems, dizziness, and severe headache.
• Prompt treatment is crucial to recovery Known as Cerebrovascular Accident or Brain Attack
• Blood flow to an area of brain or spinal cord is cut off therefore Ischemia identified as inadequate blood flow or decrease blood circulation
• Central Nervous System is deprived of oxygen and nutrients thus causing cellular death
• Focal neurological deficit related to ischemia
• Memory, muscle control, sensory, i.e. vision or emotions controlled by affected area are impaired or lost
• Loss of function varies on location and extent of cellular death in the brain
• Classic stroke persist for at least 24 hours
• Strokes can occur anytime

Stroke Etiology and Pathophysiology

• Brain requires continuous supply of O2 and glucose for neurons to function - interruptions of continuous supply causes
• Neurologic metabolism to be altered in 30 seconds
• Metabolism stops in 2 minutes
• Cell death occurs in 5 minutes
• Atherosclerosis is a major cause of stroke which Can lead to thrombus formation and contribute to emboli

Ischemic Stroke (Clot)

• A clot occludes blood flow to organ tissues It can be:
• Thrombotic.
• Embolic.
• A clot formed somewhere else in the body and travels through the blood vessels to the brain.
• Constitutes 85% of all strokes and Two-thirds are associated with HTN and diabetes Often Preceded by a TIA A clot stroke: -Occurs when a blood clot blocks an artery supplying blood to the brain, interrupting the flow of oxygen-rich blood, depriving the brain tissue of oxygen and nutrients. Key Facts/Time-frames: Within minutes, the affected brain cells begin to die, causing irreversible damage or infarction in that area of the brain. Ischemic Stroke percentages:Account for about 87% of all strokes and can be caused by a thrombotic clot forming in an artery already narrowed by atherosclerosis or an embolic clot that travels from another part of the body, often the heart.

Hemorrhagic Stroke (Bleeding)

• Account for approximately 10-20% of all strokes
• Bleeding in the brain that damages surrounding tissue It can be:
• Intracerebral hemorrhage (ICH)
• A blood vessel within the brain bursts
• Usually occurring at the bifurcations of major arteries at the base of the brain (the cerebral lobes, basal ganglia, thalamus, brainstem, and cerebellum)
• Subarachnoid hemorrhage (SAH)
• Bleeding into the space surrounding the brain.
• This type of happens due to conditions like uncontrolled hypertension that weakens blood vessel walls, leading to an intracerebral hemorrhage where bleeding occurs directly into the brain tissue.
• Hemorrhagic strokes can also result from abnormalities like a ruptured aneurysm or arteriovenous malformation, causing a subarachnoid hemorrhage with bleeding into the space surrounding the brain.
• The accumulated blood exerts pressure and damages brain cells in the affected area. Hemorrhagic strokes are less common than ischemic strokes but often more deadly.

Transient Ischemic Attacks (TIA)

• Temporary focal loss of neurologic function caused by ischemia, that resolves within 3 hours
• Related to micro-emboli that temporarily block blood flow, acting as a Warning sign of progressive cerebrovascular disease TIAs
• Temporary disruption of blood flow to part of the brain, which causes brief neurological symptoms similar to a stroke, such as weakness, numbness, vision changes or difficulty speaking.
• Symptoms typically resolve within 24 hours as the blockage is temporary and blood flow is restored.
• A TIA is a warning sign that the patient is at high risk for a full stroke in the near future. Prompt evaluation and preventative treatment is crucial after a TIA to reduce the risk of a subsequent stroke occurring.

Different Types of Strokes

• A thrombotic stroke occurs when a blood clot (thrombus) forms in an artery supplying blood to the brain, which blocks/inhibits blood flow often due to atherosclerosis or buildup of plaque in the arteries.
• An embolic stroke is caused by a wandering clot (embolus) that travels from another part of the body, such as the heart, and lodges in a cerebral artery, obstructing blood flow.
• A hemorrhagic stroke results from bleeding within or around the brain when a weakened blood vessel ruptures.

Understanding Hemorrhagic Stroke

• Intracranial Hemorrhagic Stroke stems from Bleeding directly into the brain matter.
• It usually occurs at bifurcations of major arteries at the base of the brain (the cerebral lobes, basal ganglia, thalamus, brainstem, and cerebellum) The main causes of hemorrhagic stroke are:
• Uncontrolled hypertension (high blood pressure) which can weaken and damage blood vessel walls in the brain over time, making them are prone to rupture.
• Cerebral aneurysms - weakened, ballooned areas on artery walls that can rupture and bleed into the brain.
• Arteriovenous malformations (AVMs) - abnormal tangled connections between arteries and veins are prone to rupture.
• Head trauma or injury causes bleeding and hematoma formation in or around the brain,
• Using blood thinners or anticoagulants which increase bleeding risk,
• Bleeding disorders or conditions that affect blood clotting can all increase Hemorrhagic risks

Subarachnoid Strokes

• A type of hemorrhagic stroke where bleeding occurs into the subarachnoid space, which puts pressure on the brain. Key Facts:
• It isUsually caused by a ruptured cerebral aneurysm or arteriovenous malformation (AVM).
• Leaked blood puts pressure on the brain and can cause stroke symptoms like sudden severe headache, nausea, vomiting, seizures, and loss of consciousness.
• These Strokes are medical emergencies requiring prompt treatment to prevent permanent brain damage or death. What to be aware of: hypertension, or trauma—accounts for 17%. Even with advances in diagnostic testing, 20% of strokes in younger persons continue to be of unknown cause.

Cerebral Aneurysm

• Also known as an intracranial aneurysm, is a dilation of the walls of a cerebral artery that develops as a result of weakness in the arterial wall.
• Causes localized weakening of the artery wall, which allows it to balloon outward abnormally. Cerebral aneurysms
• Very dangerous because they can rupture and cause bleeding into the brain, leading to a subarachnoid hemorrhagic stroke.
• Risk factors include hypertension, smoking, and inherited connective tissue disorders.
• Symptoms only appear until the aneurysm ruptures, causing a sudden, severe headache and other stroke symptoms.
• Unruptured aneurysms are often treated by surgical clipping or endovascular coiling to prevent rupture.

Arteriovenous Malformation (AVM)

• This occurs from a Gene mutation that results in Blood shunting past all the capillaries to the blood. Key Info:
• Rapidly circulating blood flow leads to vasodilation of the upstream artery, causing it to weaken and possibly even rupture creating a AVM.
• AVMs occur Most often in the brain and spinal cord but can occur anywhere in the body. Facts About Blood Flow:
• This is an abnormal tangle of arteries and veins with no intervening capillary network, forming short circuit in the normal circulatory pathway.
• This abnormal connection causes high-flow, high-pressure shunting of blood directly from arteries to veins, bypassing the capillary bed.
• AVMs in the brain are particularly dangerous as the high-pressure blood flow can cause the weakened blood vessels to rupture, leading to hemorrhagic strokes as The abnormal AVM blood flow deprives surrounding brain tissue of adequate oxygen and nutrients.

Hypertensive Hemorrhage

• Also known as a hypertensive intracerebral hemorrhage (ICH).
• A type of hemorrhagic stroke caused by uncontrolled or severely elevated blood pressure. Key Information:
• This high blood pressure weakens and damages the small blood vessels in the brain over time, eventually causing the vessels to rupture and bleed into the surrounding brain tissue.
• The accumulated blood puts pressure on the brain and damages brain cells, and typically occur in areas like the basal ganglia, thalamus, cerebellum, and pons. Prompt treatment to control bleeding and reduce intracranial pressure is critical. Side Effects:
• Increased Intracranial pressure from the accumulated blood compressing brain tissue which can cause headaches, vomiting, vision changes, and decreased consciousness.
• Brain herniation occurs the bleeding and swelling become severe enough to shift brain structures
• Permanent neurological deficits such as paralysis, speech/language problems, or cognitive impairment depending on the area of the brain affected.
• Seizures stem from irritation to surrounding brain regions
• Hydrocephalus occurs when a buildup of cerebrospinal fluid if blood blocks normal fluid pathways.
• Complications like pneumonia or blood clots from are due to being bedbound during recovery.

Cause and effects of Hemorrhagic Stroke

• Edema
• Vasogenic edema: The influx of fluid and solutes into the brain through an incompetent blood-brain barrier that develops rapidly following injury
• Cytotoxic edema: Cellular swelling Cellular swelling that occurs in brain ischemia and trauma
• Compression Hemorrhagic Stroke is mainly Caused by:
• Uncontrolled high blood pressure
• Cerebral aneurysms
• Arteriovenous malformations
• Head trauma or injury
• Use of blood thinners
• Bleeding disorders affecting clotting The effects depend on the location and severity, but can include:
• Headache or loss of consciousness
• Weakness, paralysis or numbness
• Vision problems Other Things that can happen
• Brain herniation and Death

Risk Factors of Hemorrhagic Stroke

Major Risk Factors Include:

• Obesity
• Hypertension
• Cigarette smoking
• Excessive alcohol intake
• Genetic predisposition for aneurysm formation and Family history
• Male gender and increased age Others Risk factors include:
• Cerebral aneurysms or arteriovenous malformations (AVMs)
• Blood thinning medications
• Head trauma or injury
• Cocaine or amphetamine use

Warning signs of a Hemorrhagic stroke

• Sudden, severe headache
• Vision problems like double vision
• Neck stiffness General things you should look for:
• Nausea and vomiting, or seizures
• Weakness number paralysis on one side of the body
• Dizziness, loss of balance or lack of coordination
• Altered mental status the loss of consciousness
• Hemiparesis is Numbness or weakness of the face, arms

Hemorrhagic Strokes Key Components to look for

Patients may present with Sudden severe headaches the loss of consciousness for a variable period also visual disturbances from a Ruptured aneurysm Other key Components can include: Visual disturbances, tinnitus, or a change in level of consciousness.

Complications of Hemorrhagic Stroke

• Hypoxia.
• Extension of Injury and or decreased cerebral blood flow
• Vasospasm
• The narrowing can account for for patients who survive the initial intracranial bleed Brain Injury/ Cerebral Edema due to:
• Bleeding and increases in intracranial pressure resulting in death Also be aware of/Monitor for/Prevent!
• Recurrent Bleeding/Seizures. Complications from immobility like pneumonia

Right Brain functioncs Vs Left Brain function.

Right side:

• This side is in charge of function of L side of body, it handles creativity and the arts.
• The Left side is in charge of logic, math,numbers the L side of the body and speech.

Right Side Brain Damage

• Paralyzed left side: hemiplegia
• Left-sided neglect
• Spatial-perceptual deficits
• Tends to deny or minimize problems
• Rapid performance, short attention span
• Impulsive, safety problems
• Impaired judgment
• Impaired time concepts

Left Side Brain Damage

• Paralyzed Right side. hemiplegia
• Impaired speech/language aphasias
• Impaired right/left discrimination
• Slow performance, cautious
• Aware of deficits: depression, anxiety
• Impaired comprehension related to language, math

Stroke Neurological Assessment NIH

• Complete stroke Neurological Assesment
• Assess 12 different neurological elements Assess function and sensory impairment
• The Score can evaluate the stroke's severity and help predict patient outcome.

Nursing Neurological Assessment:

-Assess all systems, and check VS for abnormalities like hypertension or bradycardia.

• Note any confusion or fluctuations during speech Note any paralysis or abnormalities. Check gait tone and visual fields

Decerebrate VS Decorticate Posturing

Decerebrate Posturing:

• Caused by upper brain stem damage. It is an abnormal body posture indicating brain damage -There are indications of lesions also to the Brainstem and or mid brain -Involves the rigid Extension of the arms and legs with arching the head backwards Decorticate Posturing: -Injury to Brains Corticspinal tract (one or both) that is also an abnormal body posture indicating brain damage -Involves flexing wrists and fingers near the chest with stiff extensions of legs and inward flexing of feet.
• The position of the limbs is not an indication of the damage of the brain like those that lead to stroke or neurological conditions

Diagnostic Studies - stroke

• Aim to confirm the stroke confirm identifying cause

Stroke - Computed Tomography (CT) primary test

Must to be 4 hours after stroke as. Magnetic Resonance Angiography. Is identify bleeding and vessels.

Stroke - EKC

• Can identify Ruptured vessles

Stroke - Lumbar punture

Positive test can indicat brain damage that can increases pressure on the nervous

Stoke - Phermacological Treatment

• Aims to Reestablish blood flow by using tPA to treat

Stroke - Nursing Intervention

• Monitor vs, and keep patient safe while notifying Provider

Important Stroke Definitions

Dysphasia: Difficulty or obstruction with swallowing. Aphagia: Complete inability to swallow. Patient cannot transfer food or fluids to the stomach.

Siezures

-Uncontrolled electrical activity, that comes on suddenly Can cause changes in breathing function.

Siezures - Ai Statement

• Uncontrollable in Electrical functions that can spread Seventy percent of people can spread and turn into convulsing

Seizures Causes

• Genetics like mutations in gamma that's common
• Structure caused by brain leisons and the vascularture

Siezures - Ai Statement 2

-Most causes can have the effect that it will be the only -However eplilepsy is a repeat occurence that can have an identified base.

Structure and Vascular Seizures - Cause

Can increase presssure that may be caused by heart failure or strokes

Siezures - Unknown and Infections

May be caused by Hydrosephalious

Epilepsy

• Is a problem that has a 2 time window and unknown reason
• Can still be treated with anti - seizure medications as a priority

Status eplipticus

• Immediatie action, must be done by a nurse, the doctor or both Estabilish priorty is airway - then hypoglycemia -then medications

Seizure Clssifications

All can stem and be in combo wit other

Seizure - Ai Statement

Can use medcations - but trauma not medical

Key Terms for Seizures:

• Aura is a weird smell
• Atonic may fall head
• Clonic rythimic muscle spasm
• Myolcnic - quick shock spasm
• Potistical - After state coma confusion
• Tonic stage - stifness

All medications discussed must be for specific type of seizure, or may worsen.

• tegretol may worsen absencese or myclonic.

Lamictal

• May causes dangerouss rash that needs titrate.

Diailtin

• Causes long term side effects Lupusus, hirutism extra.

Siezure Main Nursing Intervention

• Maintain airway call provider prevent and administer the ordered

What to do with Siezures

• O2 to prevent side effect