Blood Transfusion Guidelines

Blood Transfusion Information

• Chart vital signs 15 minutes before and after for blood transfusions
• Use 18-20 gauge needles, mainly 20 gauge for transfusions
• Verify blood type, Rh factor, serial number, and volume of RBCs
• Patient details required include name and medical record number
• If a reaction occurs during transfusion, stop, monitor vitals, and use normal saline
• Return blood to the lab and continuously check in on the patient every few minutes while getting a urine specimen

Blood Transfusion Reasons

• Blood transfusions may be needed due to severe blood loss from trauma, surgery, or bleeding disorders to restore blood volume and treat anemia
• Chronic conditions, such as sickle cell disease, thalassemia, or cancer, can cause anemia and low blood counts, which may require a transfusion
• Major surgeries or procedures may lead to significant blood loss, necessitating a transfusion
• Transfusions are used to replace specific blood components like platelets or clotting factors in patients with bleeding disorders
• In bone marrow or stem cell transplants, transfusions replace blood-forming cells
• Transfusions improve oxygen carrying capacity, restore depleted blood elements, prevent complications, raise hemoglobin levels, and provide antibodies

Blood Types and Antibodies

• Type A blood: Contains anti-B antibodies
• Type B blood: Contains anti-A antibodies
• Type AB blood: Contains no antibodies
• Type O blood: Contains both anti-A and anti-B antibodies

Blood Types - Who Can Donate and Receive

• Type O: Universal donor, can only receive Type O blood
• Type A: Can donate to Type A or AB, can only receive Type A or O
• Type B: Can donate to Type B or AB, can only receive Type B or O
• Type AB: Can donate to Type AB, can receive all blood types

Rh Factor Explained

• The Rh factor (Rhesus factor) determines if blood type is Rh-positive (Rh⁺) or Rh-negative (Rh⁻)
• Rh positive: The D antigen is present
• Rh negative: The D antigen is absent, but there is potential to develop anti-D antibodies if exposed to Rh positive blood

Blood Transfusions and Rh Factor Compatibility

• Rh-negative individuals: Can only receive Rh-negative blood
• Rh-positive individuals: Can receive both Rh+ and Rh-

Universal Blood Types

• Universal donor: O negative
• Universal recipient: AB positive

Transfusion Reactions: TRALI

• TRALI (Transfusion-Related Acute Lung Injury): Plasma from transfused blood induces pulmonary edema, respiratory distress and lung injury
• TRALI cause: WBC antibodies from donor
• TRALI onset: During or within 6 hours of transfusion
• TRALI symptoms: Fever, respiratory failure, hypoxemia, hypotension, pulmonary edema
• TRALI interventions: Stop transfusion, administer oxygen, respiratory support and vasopressor agents; mechanical ventilation may be needed

Transfusion Reactions: Hemolytic Transfusion

• Hemolytic reaction: Recipient's immune system destroys transfused red blood cells due to ABO or Rh incompatibility which activates the complement system leading to hemolysis
• Can be fatal with as little as 1-2 cc of RBCs
• Labeling errors are a common problem
• Hemolytic reaction Onset: Minutes or hours after starting the transfusion
• Hemolytic reaction symptoms: Fever, chills, nausea, vomiting, pain at the infusion site, back or flank pain, reddish-brown urine, hypotension, tachycardia, shock, flushed skin, dyspnea, chest or abdominal pain, headache, abnormal bleeding, pallor, jaundice
• Prevention: Strict verification and screening for antibodies
• Intervention: immediately stop the transfusions and maintain IV access with normal saline

Interventions for Reactions to Blood Transfusions

• Intervention: immediately stop transfusion
• Intervention: Maintain IV access with normal saline
• Intervention: monitor vital signs
• Intervention: send blood samples and transfusion products for testing, provide supportive care and diuretics

Brain Lobe Functions - Frontal Lobe

• Brain lobe functions: Controls movement, thinking, reasoning/judgement, behavior/emotions, and memory

Brain Lobe Functions - Temporal Lobe

• Brain lobe functions: Controls language understanding, behavior, memory, and hearing

Brain Stem Functions

• Brain stem functions: Controls breathing, alertness/sleep, blood pressure, heart rate, temperature, digestion, and swallowing

Brain Lobe Functions - Parietal Lobe

• Brain lobe functions: Controls knowing right from left, sensation, and reading

Brain Lobe Functions - Occipital Lobe

• Brain lobe functions: Controls vision

Brain Functions - Cerebellum

• Brain Functions: Controls coordination, balance, and fine muscle control

Stroke Definition

• Stroke definition: Medical emergency due to disrupted brain blood supply, leading to cell death and loss of function

Ischemic Stroke

• Ischemic Stroke: Blockage in brain blood supply, often from clots, accounts for 87% of strokes

Hemorrhagic Stroke

• Hemorrhagic Stroke: Bleeding into or around the brain from vessel rupture, accounts for 13% of strokes

Stroke Symptoms

• Variable but stroke symptoms may include numbness/weakness, confusion, impaired speech, vision, dizziness, and headache

Powerpoint: Stroke Info

• Terminology: Known as Cerebrovascular Accident or Brain Attack
• Blood flow cut off: Blood flow is cut off to brain or spinal cord area
• Ischemia: Inadequate blood flow or decreased blood circulation that deprives the brain of oxygen and nutrients, causing cell death and neurological deficits
• Permanent or classic stroke: Stroke persists for at least 24 hours, and can occur anytime

Stroke Etiology and Pathophysiology

• Brain requires continuous O2 and glucose for neurons
• Altered neurologic metabolism: Occurs in 30 seconds after flow is interrupted
• Metabolism stops: Occurs in 2 minutes after the stop of blood flow
• Cell death: Occurs in 5 minutes after the stop of blood flow
• Atherosclerosis: A major stroke cause that can lead to thrombus/emboli

Ischemic Stroke (Clot) Details

• Ischemic Stroke/Clot: Blood flow is hindered to tissues and organs
• Thrombotic: A blood clot that is formed in an artery that supplies blood to the brain
• Embolic: A clot that forms in the body, moves through the blood and blocks supply
• HTN and diabetes: Two thirds of strokes are attributed to HTN and diabetes
• TIA: Ischemic Strokes often preceded by TIA

Ischemic Strokes Explained

• Ischemic strokes account for about 87% of all strokes
• Thrombotic clots forming in arteries or embolic clots from elsewhere in the body are common
• Ischemic stroke is when blood flow is blocked, causing damage to brain tissue
• Irreversible damage or infarction can occur within minutes

Hemorrhagic Stroke (Bleeding) Details

• Hemorrhagic Stroke: Bleeding in the brain; damages the tissues
• Intracerebral hemorrhage (ICH): Blood vessel bursts within the brain at base arteries
• Subarachnoid hemorrhage (SAH):Bleeding into brain surrounding space

Hemorrhagic Strokes Explained

• Hemorrhagic stroke is less common but often deadly
• They account for approximately 10-20% of all strokes.
• Ruptures and bleeding: They are because of ruptures causing bleeding into the brain
• Hypertension: A cause when it weakly damages blood vessel walls

Transient Ischemic Attacks (TIAs)

• TIAs are temporary focal loss of neurological function caused by ischemia; generally resolves within 3 hours, but up to 24 hours max
• Possibly occurs due to micro-emboli
• TIA is a warning sign of a future stroke so have prompt evaluation/tx

Types of Brain Clots: Thrombotic

• Thrombotic stroke: When blood clots in the brain as a result of plaque buildup and atherosclerosis

Types of Brain Clots: Embolic

• Embolic stroke: Occurs when a clot travels from other parts of body and blocks cerebral flow

Types of Brain Clots: Hemorrhagic

• Hemorrhagic stroke: Results from bleeding caused by vessel ruptures, disrupting brain functions

Hemorrhagic Stroke - Intracranial Hemorrhages

• Bleeding directly into brain matter at major cerebral bifurcations in lobes, stem, ganglia, and cerebellum

Hemorrhagic Causes

• Uncontrolled hypertension: Causes weakened vessel walls to rupture
• Cerebral aneurysm - weakened, ballon artery walls that can rupture
• AVM: Abnormal connection that can potentially rupture
• Trauma, Injury, blood thinner/ anti coagulants, bleeding disorders

Subarachnoid Hemorrhage Stroke

• Subarachnoid Hemorrhage Strokes: Ruptures that cause leaking into the brain area, causing stroke symptoms like a headache, vomiting, and seizures
• 17% percent from hypertension and medical emergencies account for SAH

Cerebral Aneurysms Explained

• Also known as intracranial aneurysms, they are the dilation of arterial walls due to weakness

Cerebral Aneurysms Info

• Cerebral Aneurysms: Can be dangerous because they cause bleeding if ruptured.
• Cerebral Aneurysms risk factors: hypertension, smoking, tissue disorders.
• Cerebral Aneurysm treatment: surgical clipping or endovascular coiling can be considered

Arteriovenous Malformation (AVM): Info

• Gene mutation + shunting past capillaries causes AVMs
• Location: often in the brain or the spinal cord
• AVM blood flow leads to vessel dilation + rupturing

AVM Explained

• Arteriovenous Malformation - abnormal connection with blood directly shunted to the veins bypassing the capillary
• AVM are dangerous: because vessels are ruptured

Hypertensive Hemorrhage Detail

• ICH are hemorrhagic strokes from uncontrolled elevated blood pressure
• Hypertensive hemorrhages: causes can be weak vessels rupture in the brain areas and needs to be treated quickly to manage ICP

Hypertensive Hemorrhage Side Effects

• ICP is increased.
• Brain herniation can occur if bleeding occurs
• Permanent neurological problems
• Seizures: from irritation to surrounding regions
• Hydrocephalus: results is the normal fluid pathways are blocked
• Pneumonia: can occur from bed rest

Hemorrhagic stroke causes

• The main causes are edema, hypoxia, cellular trauma

Hem Morragic Stroke: Answer Sheet summary

• Uncontrolled high blood pressure
• Brain injury or trauma
• AVMS + Cerebral aneurysm = increases ruptures

Risk Factors of Hemorrhagic Stroke

• Obesity, hypertension, cigarette use, alcohol
• Male gender
• Aneurysm/genetic factors
• Increased age

Main Risk Factors for Hemorrhagic Stroke per Sherpath

• Uncontrolled Hypertension/pressure with medications
• History of illicit drug or Heavy alco use
• Aneurysms/AVMS
• Head Trauma
• Blood disorders and medications

Warning Signs of Hemorrhagic Stroke:

• Sudden, severe headache alongside vomiting and nausea
• Vision issues, with numbness and paralysis and neck stiffness
• Altered mental status, confusion and coordination

Hemiparesis

• Numbness and/or weakness of limbs, especially one side of the body

Stroke Symptom of Intracranial hemorrhages

• Vomiting and altered consciousness
• Brainstem causes Seizures or changes

Cerebal and AVM symptomology

• Headache and losses of consciousness
• Oculomotor issues or visual disturbances

Complications of Hemorrhagic Stroke

• Hypoxia, Brain Edema occurs
• Cerebral vasospasm/ brain injury is common

Complications from hemorragic Stroke

• Paralysis and cognitive or health issues arises
• Hydrocephalus/Seizures can occur

R vs L Brain function

• Right Brain: Responsible for the artistic side: Art and 3D awareness, intuition
• Left Brain: Responsible for analytic thinking, Numbers + logical skills

R Side Damages Manifestation

• Neglect left side + minimizes problem
• Impulsivity
• Loss of judgement

L Side Damages Manifestation

• Losing speech with impaired discrimination
• Impaired comprehension
• Cautious and Anxiety

Stroke Scale

• NIH stroke scale: Assesses consciousness with sensory processing and orientation
• Utilizes scale of 0-4 to scale the issues patients face due to the severity for proper treatment with good intervention
• Can measure: the issues, the treatment and patient results

Nursing Neuro Status Assesment

• Unequal pupils, speech disturbances and headaches
• Confusion and Paralysis + Distres
• Monitor Seizures, resp. issues and heart changes

Nursing Process with Levels of Consciousness.

1. Review level with ABCS assess and mental status.
2. Language- dysarthria
3. Check nerve functions
4. Note paralysis and abnormalities
5. Check mental stability for hypertension and vitals

Decerebrate Posturing Damage

• Decerebrate posture occurs with brain stem damages that causes a loss of all cordinal + brain functions

Decorticate Posturing Explained

• Damage to corticospinal tracts caused by the damage and abnormal posture

Decorticate Symptoms

• When flexed over to the chest- arms are internally rotated + stiff
• Indicates to damage to brain

Diagnostics of Strokes

• Confirm a Stroke and determine the cause
• If a stroke is confirmed, do a CT to check the brain for how many hours the issue is
• Utilized MRIs to follow up with the hemorrhage and function with artery bloods

More procedures

• Spinal taps: assess brain for CSF fluids
• Increasing ICP results

Stroke Meds and their process

• Ischemic: Utilized TPA
• Hemorrahagic: Utilized intravenous medications alongside with chronic Meds:

Stroke Meds Specificities

• Zocor (simvastatin): Causes muscle pain + liver issues with alcohol can cause interaction
• Aspirin/Plavix: Causes anti platlet use to not lie down while still up and use bleeding precautions
• Coumadin + diet changes

Stroke Process

• Monitor vitals with neuro statuses
• Note levels/ pupils and saturations
• Assist the cardiac rythm and med changes
• Reposition safely and teach client

Stroke Interventions 2

• Suction clients with Dysphagia,
• Check reflex
• NPO protocol
• Safety measures through RN care

Quick intervention action items

• ABC/ stabilize the stroke patient, with oxygen and safety

Rehab Actions

• Utiliized the bed alarms while in the care
• Manage bladder movement
• Refer to OT, ST, PT for proper movement
• educate on medicine + adaptations to life

Labs Checks

• Stroke can cause CBC,PT,PTT,INR,Glucose problems, etc
• Management of known risks= manage to care for those who were stroke history

Signs of Stroke

• Remeber FAST action card (face/weakness/action/slurring/Time)
• Educate family for those problems and make a plan of care

Seziures and Etiology

• Burst of uncontrolled electrical activity in the brain: mostly lasting 30 second-2min with the possobility for the patients to be in stable states
• Note; not all symptoms are emergencies

Sherpath AI review- Seizure cause

• Seziures disturb the brain and can causes neuron misfire and can lead to muscular spasmas, convulsions, change and even losses of conscious
• Trauma or trigger can occur and be chronic= also known as epilepsy

Traits:

• Genetics issues and transmitters
• Brain is hurt by lesions and traumas vascularly.
• Increased pressure + Strokes

AI on Seziures

• Many issues, some are kidney issues,
• Injuries or tumors
• Encephalopathy

. Al - Etiology:

• Toxin, exposure, alcohol

Al -Structural Problems

• Lesions + tumors that effects neuron movement

Al -Vasccularly

• Strock effecting blood movement and infections leading to swollen membrane / parasite response

Al AI epilepsy and treatments

• lasting 2-5min with reoccurences, make diagnosis fast + make management so test properly and get treatment and intervention with medicine so it limits the action of reoccurence

State Epilepticus

• Losses of conscious more than 30+min + not remembering what occurs
• Priority: get airway
• Med+ establish a way + quick blood check.

Seizures Medications - Valium and Ativan

• Give fast while stoping the seizures to determine the point and to stop it!
• Its urgent to check and minimize damage and brain activities!
• Some factors: no adhering/brain tumours

Seizures Causes

• Non-Epileptic= Disturbance and the result of neuronal activity
• Secondary to a condition= A tumor and head trauma
• Genetic or long term

Seziure Med Review

• Tegretol- Complex partially with generalized tonic
• Lamiictal- Partial + gastric

And many general factors to check such as the blood level/ kidney test + visual

. Seizures intervention with safety is first

• Suction and provide oxygen

Nursing Intervention for a Seziure

• Review charts + meds
• Note causes
• Know patients and action and meds!
• Al: Protect while providing rescuer breathing

Prevent injury + maintain O2 + airway check

Other intervention actions

• Medicate safety + give space through a quiet rest and educate patient on life and medications and contact team

Seizures terminology

• Auras: Sensations + signs
• Atonic: losses +drops
• Clonic: jerk moves
• Epilepsy: Neuro dissorder - Unprovoked

Al actions and Seizure Meds

• Myoclonic : Brief and quick
• Postictal: State of issues occurring
• Tonic: stiffens+ lose control
• Seizure Med - carb is used in seizure related and the same and also for many seizure but some can lead to reactions.