Ivf, Bt & Anti-Hypertensives Rationale PDF

IVF, BT & Anti- Hypertensives RATIONALE BLOOD TYPING & CROSS MATCHING Blood Recipients Recipient Blood Types Donor Blood Type O- O- O+ O+, O- A- A-, A+, AB-, AB+ A+ A+, AB+ B- B-, B+, AB-, AB+...

IVF, BT & Anti- Hypertensives RATIONALE BLOOD TYPING & CROSS MATCHING Blood Recipients Recipient Blood Types Donor Blood Type O- O- O+ O+, O- A- A-, A+, AB-, AB+ A+ A+, AB+ B- B-, B+, AB-, AB+ B+ B+, AB+ AB- AB-, AB+ AB+ AB+ Blood Donors Donor Blood Types Recipient Blood Type AB+ O-, O+, A-, A+, B-, B+, AB-, AB+ AB- O-, A-, B-, AB- A+ O-, O+, A-, A+ A- O-, A- B+ O-, O+, B-, B+ B- O-, B- O+ O-, O+ O- O-  ABO BLOOD TYPING Can Can Blood Antigens Antibodies Donate Receive Type on RBCs in Plasma Blood To Blood From O None Anti-A, Anti-B O, A, B, AB O A A Anti-B A, AB O, A B B Anti-A B, AB O, B AB A, B None AB O, A, B, AB Antigens on RBCs: Determines which blood types can receive a certain type. Antibodies in Plasma: Determines which blood types the immune system would react against if incompatible blood is transfused. The Rh factor, or Rhesus factor, is a protein found on the surface of red blood cells. If blood cells have the Rh protein, they are classified as Rh-positive (e.g., A+, B+), and if they lack it, they are Rh-negative (e.g., A-, B-). This protein plays a crucial role in blood compatibility for transfusions and pregnancy. Rh Compatibility in Blood Transfusions: Rh-Positive (Rh+) Blood: Can receive both Rh+ and Rh- blood. Rh-Negative (Rh-) Blood: Can only receive Rh- blood. In transfusions, both the ABO blood group and the Rh factor must be matched to ensure compatibility. For example: A+ recipients can receive from A+, A-, O+, and O-. A- recipients can only receive from A- and O-. BLOOD TRANSFUSION THERAPY  Rh Incompatibility in Pregnancy 1. First Pregnancy: If an Rh-negative mother is pregnant with an Rh-positive baby, the mother’s blood and the baby’s blood typically don’t mix directly during pregnancy. However, during childbirth (or due to certain events like trauma or miscarriage), the mother can be exposed to the baby’s Rh-positive blood. This exposure can lead the mother’s immune system to develop antibodies against the Rh protein, a process called sensitization. 2. Subsequent Pregnancies: If the mother becomes sensitized and has Rh antibodies in her blood, these antibodies can cross the placenta and attack the red blood cells of any future Rh-positive babies. This can cause hemolytic disease of the newborn (HDN) or erythroblastosis fetalis, which leads to: 1. Severe anemia in the baby. 2. Jaundice. 3. Heart failure. 4. In severe cases, fetal death.  Prevention with Rh Immunoglobulin (RhoGAM)  To prevent sensitization, Rh-negative mothers typically receive an injection of Rh immunoglobulin (RhoGAM): Administered around the 28th week of pregnancy and within 72 hours after childbirth if the baby is Rh-positive. It works by destroying any Rh-positive fetal cells in the mother’s bloodstream before her immune system can react to them, thus preventing antibody formation.  This preventive measure has been highly effective in reducing cases of Rh incompatibility complications in pregnancies. CLIENT ASSESSMENT:  Assess for any cultural or religious beliefs regarding blood transfusions.  A Jehovah’s Witness cannot receive blood and blood products.  Ensure that the INFORMED CONSENT has been obtained.  Determine whether the client has ever experienced any previous transfusion reactions.  Check the client’s vital signs  Assess renal, circulatory, and respiratory status and client’s ability to tolerate intravenously administered fluids.  If the client’s temperature is elevated, notify physician before beginning the transfusion, a fever may be cause for delaying the transfusion in addition to masking a possible symptom of an acute INTERVENTION DURING ADMINISTRATION OF BT:  Verify doctor’s order.  Inform client and explain purpose of the procedure.  Check for Cross-Matching and Blood Typing.  Obtain a record, baseline vital sign.  Practice Strict ASEPSIS.  At least 2 nurses check the label of the blood transfusion. Check the following:  Serial Number  Blood Component  Blood Type  Rh Factor INTERVENTION:  Expiration Date  Screening test (VDRL for STD, HBSAg for Hepa B., Malarial Smear for Malaria).  Warm blood at room temperature before transfusion.  Identify client properly.  Use IV cath gauge 18 or 19.  Use BT set with filter to prevent administration of blood clot and other particulates.  Start transfusion slowly at 10 gtts/min. Remain at bedside for 15-30 minutes.  Monitor VS. INTERVENTION:  DO NOT MIX MEDICATION TO Blood Transfusion.  Administer 0.9 % NaCl before, during, or after BT. Never administer IVF with Dextrose.  Administer BT for 4 hours (Whole Blood, PRBC). For Plasma, Platelets, cryoprecipitate transfuse quickly (20 minutes).  Observe potential complications, notify physician. COMPLICATIONS TRANFUSION REACTION  Is an adverse reaction that occurs as a result of receiving a blood transfusion.  Delayed transfusion reactions can occur days to years after transfusion. Signs include fever, mild jaundice, and decreased hematocrit level. ALLERGIC REACTION  Caused by sensitivity to plasma protein or donor antibody which reacts with recipient antigen.  Manifestation:  Flushing  Rashes  Pruritus  Laryngeal Edema  DOB FEBRILE, NON HEMOLYTIC  Caused by hypersensitivity to donor white blood cells, platelets, or plasma protein.  MOST symptomatic complication of BT.  Manifestation:  Sudden chills and fever  Flushing  Headache  Anxiety  Warm to touch  Muscle pain SEPTIC REACTION  Caused by the transfusion of blood component contaminated by bacteria.  Manifestation:  Rapid onset of chills  Vomiting  Diarrhea  Hypotension  Shock CIRCULATORY OVERLOAD  Caused by administration of blood volume at a rate greater than the circulatory system can accommodate.  Manifestation:  Rise in venous pressure  Dyspnea  Crackles or Rales  Distended neck vein  Cough  Elevated BP HEMOLYTIC REACTION  Caused by infusion of incompatible blood products.  Manifestation:  Low back pain (First Sign)  Chills  Feeling of fullness  Tachycardia / Tachypnea  Hypotension/ vascular collapse  Flushing  Bleeding NURSING INTERVENTION:  STOP BLOOD TRANSFUSION IMMEDIATELY  Start an IV line (0.9 % NaCl or PNSS)  Collect urine specimen to detect presence of bacteria, which may be causing the adverse reaction.  Monitor Vital signs  Send unused blood or BT set to the blood bank for laboratory examination.  Administer ANTIHISTAMINE, DIURETICS, CORTICOSTEROIDS, and BRONCHODILATORS as ordered.  Notify Physician.  Make relevant documentation. INTRAVENOUS FLUIDS  Isotonic, Hypotonic, or IV Fluid Name Color Coding (Hospital) Hypertonic 0.9% Normal Saline (NS) Isotonic Green Lactated Ringer's (LR) Isotonic Yellow D5W (5% Dextrose in Isotonic (in bag); Hypotonic Red Water) in body 0.45% Normal Saline (1/2 Hypotonic Red NS) D5NS (5% Dextrose in Hypertonic Yellow and Black Stripe Normal Saline) 3% Normal Saline Hypertonic Pink D10W (10% Dextrose in Hypertonic Blue Water) D5LR (5% Dextrose in Hypertonic Pink Lactated Ringer's) Plasma-Lyte Isotonic Purple  Isotonic Solutions: Have the same osmolarity as blood plasma (approximately 290 mOsm/L). Do not cause cells to swell or shrink. Commonly used to maintain hydration without altering electrolyte balance. Hypotonic Solutions: Have a lower osmolarity than blood plasma (< 290 mOsm/L). Can cause cells to swell and potentially burst (lyse) as water moves into the cells. Often used for rehydration purposes. Hypertonic Solutions: Have a higher osmolarity than blood plasma (> 290 mOsm/L). Can cause cells to shrink as water moves out of the cells into the hypertonic solution. Used to treat conditions like hyponatremia (low sodium levels). Isotonic solutions are used for fluid resuscitation and maintaining hydration. Hypotonic solutions are primarily used for rehydrating cells. Hypertonic solutions are used to draw fluid out of cells and treat specific electrolyte imbalances.  Osmolarity IV Fluid Name Type Effect on Cells (Approx.) 0.9% Normal Saline Isotonic 308 mOsm/L No effect on cell size (NS) Lactated Ringer's Isotonic 273 mOsm/L No effect on cell size (LR) Initially isotonic; becomes D5W (5% Dextrose Isotonic (initially); 252 mOsm/L hypotonic in body due to in Water) hypotonic (in body) metabolism of dextrose 0.45% Normal Hypotonic 154 mOsm/L Cells swell Saline (1/2 NS) D5NS (5% Dextrose Hypertonic 560 mOsm/L Cells shrink in Normal Saline) 3% Normal Saline Hypertonic 1026 mOsm/L Cells shrink D10W (10% Hypertonic 505 mOsm/L Cells shrink Dextrose in Water) 5LR (5% Dextrose in Lactated Hypertonic 560 mOsm/L Cells shrink Ringer's) Plasma-Lyte Isotonic 294 mOsm/L No effect on cell size DRIP CHAMBERS: MACRODRIP CHAMBER  Use if the solution is thick or is to be infused rapidly.  The drop factor varies from 10-20 drops/mL.  Read the tubing package to determine how many drops per millilitre are delivered. MICRODRIP CHAMBER  Has a short vertical metal piece where the drop forms.  It delivers about 60 drops/mL.  Microdrip chambers are used if fluid will be infused at a slow rate (