Final Exam Study Guide PDF

Yellow = Key TopicsPink = Key SubtopicsBlue = Key PointsGreen = Memorization Techniques Respiratory Disorders Control of Ventilation Higher brain centers ( cerebral cortex ) Voluntary control of breathing ○ • Resp centers in pons & medulla•Chemoreceptors for CO2, H+, O2• Respiratory Deterioration No...

Yellow = Key TopicsPink = Key SubtopicsBlue = Key PointsGreen = Memorization Techniques Respiratory Disorders Control of Ventilation Higher brain centers ( cerebral cortex ) Voluntary control of breathing ○ • Resp centers in pons & medulla•Chemoreceptors for CO2, H+, O2• Respiratory Deterioration Normal >>> Respiratory Distress >>> Respiratory Failure >>> Respiratory Arrest•Assess for: Increasing RR, HR, WOB, Accessory muscle use ○Tripod pos, nasal flaring, unable to speak in full sentences , abnormal/decreased lung sounds , mentation changes ○ • Respiratory Distress Increased WOB, RR, HR•SOB•Accessory muscle use • Respiratory Failure Inadequate gas exchange•Tripoding•Nasal flaring •Unable to speak in full sentences •Abnormal lung sounds •Mentation changes • Respiratory Arrest Cessation of breathing • Respiratory Assessment Look•Vitals•Behaviors•Listen Crackles Description: Short, crackling sounds □FineCrackles = HighPitched □Coarse Crackles = LowPitched □ ▪ Mechanism: Excess airway secretion & inflammation (exception is pulmonary fibrosis ) □ ▪ Causes: Pulmonary edema , atelectasis, pneumonia, COPD, CHF, fibrosis, etc. □ ▪ Treatment: Diuretics□Antibiotics for infection □ ▪ ○ Wheezes Description: Continuous, high pitched whistling sounds □Usually heard on expiration □ ▪ Mechanism: Rapid airflow thru obstructed/narrowed airway □ ▪ Causes: Asthma, COPD , pulmonary edema, secretions, CHF, foreign body, tumor □ ▪ Treatment: AIM AlbuterolIpratropiumMethylprednisolone □ ▪ ○ Stridor Description: Squeaking sound □Best heard on inspiration □Emergency□ ▪ Mechanism: Partial obstruction of larynx or trachea□Upper airway obstruction□ ▪ Causes: Obstruction, choking, epiglottitis, croup □ ▪ Treatment: Endotracheal intubation□Surgery□ ▪ ○ Pleural Rub Description: Grating/rubbing sound □Best heard at end of inspiration and beginning of expiration □ ▪ Mechanism: Inflammation of pleura□ ▪ Causes: Pneumonia, pericarditis, pulmonary infarction □ ▪ Treatment: TCDB Turning, coughing, deep breathing □ IS□Antibiotics□ ▪ ○ Rhonchi Description: Rattling/rumbling/snoring sound □ ▪ Mechanism: Mucous secretions or obstruction □ ▪ Causes: Bronchitis , COPD, pneumonia, cystic fibrosis □ ▪ Treatment: Chest percussion □Fluids to loosen & thin mucus □ ▪ ○ • Acute Respiratory Failure Failure of oxygenation and/or ventilation•Not a disease, but symptom of underlying pathology affecting lung function•Classifications : Hypoxemic○Hypercapnic○ • Hypoxemia Traumatic Brain Injury Cerebrospinal Fluid (CSF) Created from blood supply•Washes over brain & spinal cord•Gets reabsorbed into blood supply •CSF leak Indicates break/tear in meninges ○Meninges exist to keep bacteria out ○Signs & Symptoms: Halo sign▪ ○ Risks: Much higher risk of infection ▪ ○ • Frontal Lobe Movement•Emotions•Memory•Language•Social•Sexual•Behavior•Personality• Temporal Lobe Hearing•Speech• Parietal Lobe Bodily sensations • Occipital Lobe Vision• Midbrain Breathing•HR•Temp erature • Cerebellum Balance•Coordination• Skull Fractures Types Linear vs. Depressed: Linear Cracks/breaks in bone □Usually follows straight or nearly straight line □ ▪ Depressed Bone pushed inward causing depression /indentation □Piece of skull depressed into cranial vault □ ▪ ○ Simple vs. Comminuted vs. Compound: Simple Closed fracture □Bone breaks into 2 or more pieces □ ▪ Comminuted Complicated□Either open or closed fracture □Bone breaks into multiple pieces □Usually caused by trauma □ ▪ Compound Complicated□Open fracture □Broken bone pierces skin □Usually caused by direct trauma □ ▪ ○ Open vs Closed: Open Skin is open□ ▪ Closed Skin is closed□ ▪ ○ • Signs & Symptoms: Depend on type & location of fracture○S/S of skull fractures causing bleeding underneath skin : Racoon eyes Bruising around eyes□ ▪ Battle's sign Bruising on neck under/behind ear □ ▪ ○ • Concerns: Infection○Bleeding○Brain injury ○ • Contusion Focal injuryAffects 1 particular area ○ • Causes bruising & edemaCan lead to significant bleeding ○ • Coup -Contrecoup injury Caused by sudden deceleration ○Initial injury on one side, brain bounces backwards, hits other side of brain in cranial vault○ • Signs & Symptoms: Varies based on area of brain○ • Concussion Diffuse brain injuryMore widespread ○ • Usually minor & benign•Transient mechanical injury•Signs & Symptoms: Sudden disruption of neural activityChange in LOC ▪ ○ Retrograde amnesia ○Headache○ • Post -Concussive Syndrome2 wks to 2 mo•Treatment: Brain rest No lights▪ ○ • Final Exam Study Guide Wednesday, April 5, 2023 8:51 PM New Section 1 Page 1 Failure of oxygenation and/or ventilation•Not a disease, but symptom of underlying pathology affecting lung function•Classifications : Hypoxemic○Hypercapnic○ • Hypoxemia -emia = blood•Low O2 levels in blood•PaO2 <80•Hypoxemia devs into hypoxia if untreated as low O2 in blood means low O2 delivery to tissue • Hypoxia/Hypoxic Respiratory Failure Low O2 supply in body tissues•PaO2 falls enough to cause signs & symptoms of inadequate oxygenation •Early Signs & Symptoms:Agitation○Confusion○Restlessness○High VS Tachypnea▪Tachycardia▪HTN▪ ○ Accessory muscle use○Tripoding○ • Late Signs & Symptoms:Low VS Bradypnea▪Bradycardia▪Hypotension▪ ○ Cyanosis○ECG dysrhythmias ○ • Treatment: O2○Elevate HOB ○Tx underlying cause○ • Hypercapnia/Hypercapnic Respiratory Failure High CO2 in blood•PaCO2 >45 mmHg•Hypercapnia will cause Hypoxia•Chronic hypercapnia causes:COPDOSAAsthma ○ Cystic fibrosis○ • Acute hypercapnia causes:Narcotics○Trauma○Neuromuscular disorder○Toxin○ • Signs & Symptoms: Sedation○Drowsiness○Confusion○Dyspnea○Wheezing○Cyanosis○ • Treatment: Deep breathing to expel excess carbon ○Address reversible causes Narcan▪Antidote for toxin▪ ○ Positive pressure ventilation○ • Hypocapnia Insufficient CO2•Signs & Symptoms: Tinging in hands/feet ○Numbness around mouth ○Carpal spasms - ○ • Causes: Hyperventilation○Hypoxia○ • Treatment: NRB turned off To breath in expelled CO2▪ ○ • Hyperoxia Excess O2•Can cause dmg to alveoli •Signs & Symptoms: Typically none ○ • Treatment: Decrease supplemental O2○Treat underlying cause○ • Flail Chest "Funky chest wall movement" •Fracture of 3+ adjacent ribs•Allows free movement of fractured segment •Life threatening emergency •Impairs gas exchange•Signs & Symptoms: Diminished lung sounds on affected side○Paradoxical chest wall movement Ribs suck inward on inspiration, floats out on expiration▪ ○ Chest pain○Shallow resp○ • Causes: Trauma○ • Risks: Pneumonia○Hypercapnic resp failure r/t high CO2 retention▪ ○ • Treatment: Priority = pain control○Pulmonary hygiene AFTER pain control TCDB Turn, cough, deep breathing□ ▪ IS Re-expand lungs, prevent atelectasis □ ▪ ○ Chest wall stabilizationChest brace▪Strapping affected area▪Surgery▪ ○ • Headache○ Post -Concussive Syndrome2 wks to 2 mo•Treatment: Brain rest No lights▪No sound▪Trynot to think ▪No reading/TV/phone/etc▪ ○ • Diffuse Axonal Injury Axonal detachment Typically at border of grey & white matter○ • Inflammatory cascade & neuronal dysfunction leads to neuronal death•Can be minor, moderate, severe Based on size & location○ • Most common cause of persistent vegetative state Coma or significant alteration in cognitive status for remainder of life○ • Can be single sites or multiple sites•Risks: Bleeding at site of injury ○ • New Section 1 Page 2 Pneumothorax Air in pleural space resulting in collapse of lung •Types: Open pneumothoraxAir enters pleural space thru open wound in chest wall ▪Called "sucking chest wound" r/t air sucked in w/ each breath ▪ ○ Closed pneumothoraxAir enters pleural space w/out external injury ▪Often r/t lung disease or can occur spontaneously ▪ ○ • Signs & Symptoms: Decreased breath sounds on affected side ○Chest pain○Tachycardia○Dyspnea○ • Causes: Trauma○Positive pressure vent○Young/skinny/tall/white men○Smoking○ • Treatment: Chest tube to let air out & reinflate lung OR thoracentesis ○Supplemental O2 ○Open pneumothorax: Occlusive petroleum gauze dsg taped on 3 sides○ • Tension Pneumothorax Pneumothorax but air can't escape •Accumulation of air in pleural space•Places tension on heart & great vessels •Always starts as pneumothorax•Signs & Symptoms: Tracheal deviation toward side w/ lung sounds○Absent lung sounds○Low VS○Decreasing oxygenation & cardiac output○ • Causes: Chest trauma○Chest tube○ • Treatment: Needle decompression to allow air to escape ○Chest tube OR thoracentesis ○ • Hemothorax Blood in intrapleural space•Signs & Symptoms Decreased breath sounds on affected side ○Chest pain○Tachycardia○Dyspnea○Increased Hgb r/t pooling of blood in lung ○ • Causes: Trauma○Surgery○ • Treatment: Chest tube to drain blood & reinflate lung OR thoracentesis ○Blood replace PRN ○Supplemental O2 ○ • Chest Tubes Used to drain large amounts air, blood, or fluid from pleural space to re -expand collapsed lung & restore normal negative pressure •Indications: Pneumo thorax ○Hemo thorax ○Pleural effusion○ • Mechanism: Tube in pleural space sucks out all air/fluid/blood into closed 1-way drainage system ○ • Assessment: Monitor RR ○Listen to breath sounds ○Assess for subcut emphysema○Observe for signs of resp distress ○Always keep chest tube drainage system below chest level○ • Monitoring: Assess function of chest tube Observe for tidaling & bubbling in water -seal chamber Tidaling (rise & fall) = good □Cont. bubbling = bad □Gentle NOT vigorous bubbling = good □ ▪ Measure amount of fluid drainage Dark bloody drainage = normal□Document & monitor drainage□Notify HCP :Bright red blood>100 mL/hr □ ▪ ○ • Don'ts: Never clamp during transport○Never continuous bubbling○ • If tube disconnects from collection chamber: Water seal chest tube Place distal end into 250 mL sterile saline▪ ○ • Thoracentesis Toremove small to moderate amounts of excess fluid or air from pleural space •Indications: Pneumo thorax ○Hemo thorax ○Pleural effusion○ • Before Thoracentesis: Stop blood thinners○Provider places needle thru intercostal space to gently puncture lung & drain fluid ○CXR before & after to compare ○ • After Thoracentesis: Deep breathing to help re -expand lungs & promote O2 exchange ○Lie on unaffected lung ( bad lung up ) ○ • Bronchospasm Tightening of bronchus•Signs & Symptoms: Wheezing○ • Treatment: Bronchodilator Albuterol▪ ○ Steroid Prednisone , Solu -Medrol ▪ ○ Anticholinergic Ipratropium▪ ○ • New Section 1 Page 3 Ipratropium▪Supplemental O2 ○Consider smooth muscle relaxantMg▪ ○ Histamines Stored in mast cells•Cause leaky blood vessels, leads to edema •Stimulates mucus & fluid production •Important mediator of mild allergic rxn , but only minor contributor to severe (anaphylactic) rxn •Histamine release may be triggered by allergic rxn•Classes: H1 receptors Causes vasodilation, pain, itching, bronchoconstriction , CNS effects ▪ ○ H2 receptors Causes release of gastric acid▪ ○ • Histamine Receptor Antagonists Medication suffix = -ine •H1 receptor antagonists Used to treat mild allergic rxn ○Relieves allergic symptoms by blocking histamine receptors ○Generations: First generation agents: Causes sedation & anticholinergic effects □ ▪ Second generation agents: Rarely cause effects□ ▪ ○ Medications: -ine▪Benadryl (diphenhydramine)▪Claritin▪Allerga▪ ○ • H2 receptor antagonists Treat gastric & duodenal ulcers & GERD ○Blocks effects of histamine in stomach○Medications: -ine▪Pepcid (famotidine)▪Zantac▪ ○ • Anaphylaxis Severe allergic rxn•Signs & Symptoms: Dyspnea○Itching○Hives○Swelling○Wheezing○Anxiety○ • Treatment: Epinephrine Tightens leaky blood vessels caused by histamines ▪Give 0.3 to 0.5 mg IM or subcut ▪Give q5-15 min until S/S resolve ▪ ○ H1 histamine antagonist Benadryl (diphenhydramine)▪ ○ H2 histamine antagonist Pepcid (famotidine)▪ ○ Steroids -one▪Methylprednisolone (Solu -Medrol), Dexamethasone (Decadron) ▪ ○ Bronchodilator Albuterol▪ ○ IV fluidsNS▪ ○ • Pneumonia Infection of lungs •Classified according to causative microorganism Bacteria, virus, mycoplasma, fungi, parasites, chemicals○ • Clinical Classifications: Community -acquired pneumonia (CAP) Pt's who have not been hospitalized or in LTC facility w/in 14 days of onset of S/S ▪ ○ Hospital -acquired pneumonia (HAP)48 hrs after admission to hospital ▪Was not present at time of admission▪ ○ Aspiration pneumonia Abnormal entry of secretions or substances into lower airway▪ ○ Necrotizing pneumonia Complication of bacteria lung infection▪May cause cavitation w/in lung▪ ○ Opportunistic pneumonia Occurs in pt's w/ altered immune response who are highly susceptible to resp infections ▪ ○ • Signs & Symptoms: SOBAltered mental status Agitation▪Restlessness▪Confusion▪ ○ Fever○Productive cough Yellow sputum▪ ○ Crackles○Chest pain○ • Treatment: Treat infectionAntibiotics▪ ○ Pos for pulmonary perfusion Sit up▪Bad lung up , good lung down ▪ ○ Promote good ventilation to recruit alveoli IS▪ ○ Clear secretions /mucus Cough▪Hydration/Fluids▪IS▪ ○ • Acute Respiratory Distress Syndrome (ARDS) Resp failure r/t diffuse lung injury•Cont. hypoxia that doesn't resolve with increasing O2 (FiO2) •Causes interstitial edema •Causes increased surfactant•Diagnosis: Must have ABG for PaO2○ • Signs & Symptoms: Low PaO2/cont. hypoxia despite supplemental O2○Crackles (r/t interstitial edema) ○Pink frothy sputum • New Section 1 Page 4 Pink frothy sputum○Diffuse lung sounds○Treatment: Intubation○Positive pressure vent○High PEEP (to hold alveoli open) ○ • Monitoring Monitor for pulmonary HTN & R HF ○ • Causes: Direct: Respiratory related Pneumonia▪Contusions▪Aspiration▪Near drowning▪ ○ Indirect: Non respiratory related Sepsis▪Pancreatitis▪Head injury▪Blood transfusion▪Hypotension▪OD▪ ○ • Pulmonary Embolism Blood clot•Canform in lungs •Most often form in deep venous system and embolizes or floats to pulmonary system •Causes: Immobility○Cancer○Long bone fracture ○Smoking○Birth control○ • Assessment: CT scan to look for clot ○ • Signs & Symptoms: Dyspnea○Cough○Bloody sputum○Tachycardia○Pain at site of embolism (worsens w/ breathing) ○Pleural rub○ • Treatment: Supplemental O2 ○Anticoagulation Enoxaparin▪Heparin▪ ○ Possible embolectomy ○ • Tuberculosis (TB) Infectious disease caused by Mycobacterium TB •Commonly infects lung •Prevalence of TB increasing•Risk Factors: Poor/underserved minorities ○Crowded institutions ○Migrants/refugees○Immunosuppressed ppl ○IV drug use○ • Early Signs & Symptoms: Flu-like symptoms ○Dry cough○Night sweats○Weight loss○Fatigue○Crackles○ • Late Signs & Symptoms: Blood in sputum○Resp failure○Dyspnea○Death○ • Testing & Diagnosis: CXR○TBSkin test ○QuantiFERON blood test ○Sputum culture ○ • Treatment: 3 months of 4 drug TB cocktail, then 5 months of Isoniazid & Rifampicin○ • Arterial Blood Gas Why do ABGs Oxygenation•Ventilation•pH•Acid/Base eval•Lactic acid• Arterial Blood Gasses (ABG) pH Normal = 7.35 -7.45 ○Acidic = <7.35○Alkalotic = >7.45○ • PaO2 Partial pressure of O2○Normal = 80 -100 mmHg ○Mild Hypoxemia = 60 -79 mmHg ○Moderate Hypoxemia = 40 -59 mmHg ○Severe Hypoxemia = <40 mmHg○ • PaCO2 Acid○Respiratory○Partial pressure of CO2○Normal = 35 -45 mmHg ○ • SaO2 Saturation of Hgb w/ O2○Normal = 95 -100% ○Mild Hypoxemia = 91 -94% ○Moderate Hypoxemia = 86 -90% ○Severe Hypoxemia = <85%○ • HCO3 ( Bicarbonate)Base ○Meta bolic ○Normal = 22 -26 ○ • New Section 1 Page 5 Oxygenation Process of delivering O2 to blood •Normal PaO2 = 80 -100 mmHg • Ventilation Movement of air in/out of lungs•Normal PCO2 = 35 -45 mmHg • Buffers Primary regulator of acid -base balance •Act chemically to change strong acids to weaker ones orbind acids to neutralize them • Acidosis pH <7.35•Too much acid•Not enough base•Signs & Symptoms: Lethargy○Confusion○Comatose○Low BP ○Dysrhythmias○Many drugs won't work○ • Alkalosis pH >7.45•Too much base•Not enough acid•Signs & Symptoms: Irritable○Dizzy○Confusion○Tachy cardia ○Dysrhythmias○Muscle cramps/tingling○ • Respiratory Acidosis Causes: Hypoventilation○ • Treatment: Improve vent Supplemental O2 ▪Bronchodilators▪Ambulate▪ ○ • Respiratory Alkalosis Causes: Hyperventilation○ • Treatment: Decrease vent NRB w/ mask turned off▪ ○ • Metabolic Acidosis Occurs when an acid other than carbonic acid accumulates in body or when bicarbonate is lost from body fluids •Treatment: Treat underlying cause○Sodium bicarbonate○ • Causes: Lactic acidosis Sepsis▪Shock▪HF▪ ○ Ketones DKA▪Starvation▪ ○ Kidney failure○Toxins/poisons○ • Metabolic Alkalosis Occurs when a loss of acid or a gain in bicarbonate •Treatment: Treat underlying cause○Diamox (Acetazolamide)○Fluids○Hypokalemia tx○ • Causes: Chloride depletion Vomiting▪NG suction▪Diuretics▪ ○ Bicarbonate injection○Massive blood transfuse○Oral antacid use○ • Hematology Type and Screen What blood type do I have? • Type and Crossmatch Does my blood match that of the donor • Active Bleeding Signs & Symptoms: Altered mental status Confusion○Restlessness○ • Clammy skin •Dizzy•Pale•Increased HR •SOB•Weakness• Polycythemia Excess RBCs•>12g/dL Hgb • Anemia Decreased production of RBCs•Mild = 10 -12g/dL Hgb •Moderate = 6 -10g/dL Hgb •Severe <6 g/dL Hgb •Signs & Symptoms:• New Section 1 Page 6 Signs & Symptoms: Dyspnea○Pale skin ○Tachycardia○ • Treatment: Treat underlying cause○RBC Transfusion In moderate anemia w/ symptoms & severe anemia▪ ○ Nutrient supplements ○ • Types of Anemia: Iron-Deficiency Anemia:Possible cause: Inadequate dietary intake □Gastric bypass□Pregnancy□Malabsorption□Blood loss□ ▪ Signs & Symptoms: GImanifestationsStomatitis Inflammation of mouth & lips◊  Glossitis Inflammation of tongue◊  □ ▪ Treatment: Treat underlying cause□Iron□ ▪ ○ Sickle Cell Anemia: Genetic disorder that causes abnormal Hgb▪Incurable▪Highly painful ▪Fatality risk by middle age▪Treatment: Pain control□O2support □IV fluids □Infection management□ ▪ Complications: All body systems may be affected □Renal failure□Stroke□Increased infection risk□ ▪ ○ Hemolytic Anemia: Caused by destruction of RBCs ▪ ○ Acute Anemia: Trauma▪ ○ Chronic Anemia: Disease▪ ○ Nosocomial Anemia: Hospital -acquired ▪ ○ Chemotherapy Induced Anemia: Caused by chemotherapy ▪ ○ • Levels of Anemia Mild Anemia: Hgb 10-12 ▪Little to no symptoms ▪ ○ Moderate Anemia: Hgb6-10 ▪Increased cardio symptoms ▪"Roaring in ears"▪ ○ Severe Anemia: Hgb <6 ▪Several S/S involving multiple body systems▪ ○ • Foods Rich in Iron Meat•Fish•Poultry•Spinach•Green leafy vegetables •Whole grains• Leukocytosis High WBC• Leuko/neutro penia Low WBC•WBC • Thrombocytosis Excess platelets • Thrombocyto peni a Low platelets •Platelets <150,000 •Causes: Liver disease ○Chemotherapy○Aspirin○DIC○Spleen disorders○ • Treatment: Dependent on symptoms, cause, & severity○Platelet transfusion IfPlatelets less than <20,000 or <80,000 and actively bleeding ▪ ○ • Disseminated Intravascular Coagulation (DIC) Abnormal response in clotting cascade•Not a disease, a condition r/t underlying cause •May be chronic or acute•Most often in chronically ill pt's w/ autoimmune disorders •Complications: Hemorrhage○Thrombosis○Often clotting & hemorrhage at same time○ • Risk Factors (Acute): Shock○Hemolytic transfusion rxn○Severe tissue dmg○ • Risk Factors (Chronic): Liver disease○Cancer○Systemic lupus erythematosus○ • Treatment: Tx underlying cause ○Treat S/S○ • Thrombosis Treatment: Heparin○ • New Section 1 Page 7 ○Hemorrhage Treatment: PRBC transfusion ○Platelets & FFP if life threatening○ • Transfusion Foundations Restores blood vol•Increases O2 carrying capacity•Provides clotting factors•Provides nutrients•Gather pt H&P •Requires consent & Paul Gann from MD •Use Y -Tubing w/ filter primed w/ 0.9% NS (250 mL) •Ensure IV patency >22 gauge primed IV w/ NS ○ • Know rationale•Requires 2 licensed personnel check •Get VS at baseline, q15 min, PRN, end of transfuse •Start slow (25 -50 mL) •Stay with pt for first 15 -20 min •Never add medications to blood product •Use dedicated line w/out interruption •Risks: Fluid overload○Alteration in electrolytes ○Acute febrile rxn ○Multiple organ failure○Infection○Human error○Iron overload○Hypocalcemia○Hepatitis○…○ • Autologous Transfusion Transfusion of pt's own blood •Stored like whole blood•Can be frozen for 6 mo•Benefits: No infectious disease transmission○No risk of transfusion rxn○ • Allogenic Transfusion Infusion of donor's blood into pt •Risks: Risks r/t not self○Fluid overload○Alterations in electrolytes○Increased risk of multiple organ failure○Increased risk of infection○Human error○ • Intraoperative Blood Salvage Collection & reinfusion of blood lost operatively•Has all advantages of autologous transfusion •Blood has to be given w/in 12 hrs • Blood Donors Must be 16 yrs old •Must weigh >110 lbs •Must be in good general health •Must be free of infectious disease & blood borne pathogens • Blood Types Type OBloodNo antigens○A & B antibodies Can only receive O▪ ○ Universal donor○ • Type ABloodA antigen Can receive A blood type▪ ○ Anti-B antibodiesCan't receive B blood type▪ ○ • Type BBloodB antigens Can receive B blood type▪ ○ Anti-A antibodiesCan't receive A blood type▪ ○ • Type ABBloodA & B antigens Can receive A & B blood type▪ ○ No antibodies○Can only give to AB○Universal receiver○ • Rh+ Rh antigen○No antibodies○Can receive positive or negative blood○ • Rh-No Rh antigen○Can only receive negative blood○ • Whole Blood Both plasma & formed elements•Used to restore vol & circulation in profuse bleeding •Requires type & crossmatch •Carries greatest risk for hypersens rxn • Packed RBC's Red blood cells w/ plasma removed as much as possible •Most common form of blood given•Indication: Anemia○ • Requires type & crossmatch •Less danger of fluid overload vs. whole blood •Frozen•May be stored for 10 yrs•Administration: Good for autologous transfuse ○Must be used w/in 24 hrs of thawing ○Transfusion must start w/in 20 min from removal from fridge ○Infuse @ 1.5 -4 hrs per unit ○ • Platelets Given when platelets <20,000 or <80,000 & actively bleeding •Jumbo packs increase risk of disease• New Section 1 Page 8 Jumbo packs increase risk of disease•Does not require type & crossmatch •Centrifuged from units of whole blood•Platelet count will rise ~10k per unit given, 6 units for full dose•Indication: Bleeding○Thrombocytopenia○Functionally abnormal platelets ○ • Fresh Frozen Plasma High in clotting factors•Requires type & crossmatch•Liquid portion of whole blood•Contains no platelets, leukocytes, RBC's•Must be used w/in 2 hrs of thawing •Rate of infuse depends on pt status•Indication: Coagulation disorders Hemophilia▪Liver disease▪Reverse effects of warfarin▪ ○ • Albumin Protein extracted from plasma•Commercially manufactured Not considered a blood product○ • Stored for 5 yrs•High risk of fluid overload•Rate of infuse depends on pt status•Indication: Hypovolemia○Hypoalbuminemia○Shock○Chronic liver failure○ • Clotting Factors Cryoprecipitated antihemophilic factor Factor 8, Fibrinogen , Factor 13 ○ • Prepared from FFP•Infuse as rapid as possible•Indication: Hemophilia○Fibrinogen deficiency○ • Stored for 1 yr•Must be used w/in 6 hrs of thawing • Allergic Reactions to Transfusions Mild Allergic ReactionAntibodies react w/ plasma proteins in donor blood○Signs & Symptoms: Flushing▪Hives▪Itching▪ ○ Treatment: Slow rate1.Prepare to medicate2.Continue infusion3. ○ • Severe Allergic ReactionAntibody -antigen reaction ○Signs & Symptoms: Anxiety▪Hives▪Throat tightness▪Tongue swelling▪Wheezing▪Cyanosis▪ ○ Treatment: Stop transfusion1.Call MD2.Manage pt3.Possible code4. ○ • Hemolytic ReactionInfuse of incompatible blood products○Signs & Symptoms: Usually dev w/in 1st 15 min▪Fever▪Back/abd/chest/flank pain▪Tachycardia▪Tachypnea▪Dyspnea▪Hypotension▪Jaundice▪Dark urine▪ ○ Treatment: Stop infuse1.Send remaining product to blood bank2.Draw new blood samples3.Repeat testing4.Provide supportive therapy HR□BP□I/O□ 5. Give no more blood products until new crossmatch 6. ○ • Febrile ReactionCaused by sensitivity○Signs & Symptoms: Chills▪Rigors▪Fever▪Vomiting▪ ○ Treatment: Give antipyretics ▪ ○ • Sepsis Reaction Bacterial contaminated blood○Signs & Symptoms: Chills▪Fever▪Vomiting▪Diarrhea▪Hypotension▪ ○ Treatment: Stop transfuse1.Call MD2.Obtain blood cultures3.Give IV fluids & ABX4.Prepare for labs5.Save blood & tubing for lab analysis6. ○ • Circulatory Overload Product given faster than circulation can tolerate • New Section 1 Page 9 Product given faster than circulation can tolerate○Signs & Symptoms: Cough▪Dyspnea▪Crackles▪HTN▪Tachycardia▪JVD▪ ○ Treatment: HOB up1.Slow transfuse2.Call MD3.Give diuretics4.Supplemental O25.Monitor BP/HR6. ○ Transfusion Related Acute Lung Injury (TRALI) #1 cause of transfusion related deaths○Signs & Symptoms: Develop w/in 1 -6 hrs ▪Fever▪Chills▪Tachypnea▪Dyspnea▪Frothy sputum ▪Hypoxemia▪Respiratory failure▪Pulmonary edema▪Hypotension▪ ○ Treatment: Ventilatory support▪CXR▪BP support▪ ○ • New Section 1 Page 10