Oxygenation-Problems-Introduction.pdf

Presented by: ROMMEL M. BANA-AY, MAN, RN  Oxygen (O2) is one of the most important elements required to sustain life. WHY? GLYCOLYSIS ►Metabolism of cells Improper metabolism = weak & unhealthy cells Weak, unhealthy = serious health problem...

Presented by: ROMMEL M. BANA-AY, MAN, RN  Oxygen (O2) is one of the most important elements required to sustain life. WHY? GLYCOLYSIS ►Metabolism of cells Improper metabolism = weak & unhealthy cells Weak, unhealthy = serious health problems  Major Components of OXYGENATION Oxygenation 1. Ventilation – movement of air into  is the process of SUPPLYING and out of the lungs OXYGEN to the body cells to  Alveolar ventilation -refers to the SUPPORT their METABOLIC PROCESSES. It is the saturation 350 ml of air left in the airways of a substance (particularly after ventilation that participates BLOOD) with Oxygen. in gas exchange 2. Diffusion – the Exchange of Gas (CO2 and O2) between the Alveoli and Capillaries and between the Capillaries and Tissues. 3. Perfusion – movement of blood through pulmonary circulation, including the pulmonary capillaries where gas exchange takes place. Systems involved in Perfusion: 1. Respiratory system Gas exchange Regulation of blood pH Innate immunity 2. Cardiovascular system ▪ Transport and Exchange of nutrients, waste products, and gases ▪ Regulates blood supply & blood pressure How Oxygen is delivered to the body? Function of the Respiratory System Gas Exchange and Transport Respiration- exchange of oxygen and CO2 at the alveolar- capillary level (external respiration) and at the tissue- cellular level (internal respiration) 1. Oxygen Transport Dissolved in plasma (3%) or bound in hemoglobin (97%) 2. Carbon Dioxide Transport Carried by blood in following ways: ✓Combined with water as carbonic acid (70%) ✓Coupled with hemoglobin (23%) ✓Dissolved in plasma (7%) ✓RBCs contain carbonic anhydrase, rapidly breaks down CO2 into hydrogen ions and bicarbonate ions  Function of the Respiratory System 3. Regulation Between Ventilation and Perfusion Ventilation (air flow) and perfusion (blood flow) determines efficiency of gas exchange V-Q balance differs from top to the base of the lung; blood flow and ventilation are greater in the more dependent lung segments at the base of the lung  Function of the Respiratory System Regulation of Acid-Base Balance Respiratory acidosis/alkalosis Reaction to Injury Defense by Clearance Mechanisms Cough Mucociliary system Macrophages Lymphatics Defense by Respiratory Epithelium Alveoli lack mucous layer to trap foreign particles and cilia to propel them to the pharynx for elimination Type II cells in alveolar membrane are resistant to injury and contain macrophages  Common Symptoms ✓ Noncardiac chest pain ✓ Dyspnea ✓ Cough ✓ Hemoptysis ✓ Wheezing ✓ Stridor ✓ Nasal and sinus complaints General Appearance Upper Respiratory Structures ✓Clubbing of the fingers ✓Nose and sinuses ✓Cyanosis ✓Mouth and pharynx ✓Trachea  Lower Respiratory Structures and Breathing Thoracic Inspection Chest configuration Barrel chest Funnel chest (pectus excavatum) Pigeon chest (pectus carinatum) Kyphoscoliosis Breathing patterns and respiratory rates  Lower Respiratory Structures and Breathing Thoracic Palpation Thoracic Percussion Respiratory excursion Diaphragmatic excursion Tactile fremitus Percussion sounds Flatness Dullness Resonance Hyperresonance Tympany Lower Respiratory Structures and Breathing  Lower Respiratory Structures and Breathing  Noninvasive Testing Pulse Oximetry Percentage of hemoglobin saturated with oxygen Noninvasive Testing Pulmonary Function Testing Include measurement of lung volumes, lung mechanics, diffusion capabilities of lungs Performed using a spirometer that has a volume-collecting device attached to a recorder Noninvasive Testing Chest X-ray Noninvasive Testing Ventilation-Perfusion Scan radioactive agent injected into a peripheral vein then a scan is obtained to determine blood perfusion through the lungs Noninvasive Testing CT Scan and MRI  Invasive Tests Laryngoscopy Visual examination of the larynx and is used to diagnose laryngeal papillomas, nodules, polyps, or cancer  Invasive Tests Bronchoscopy direct inspection and examination of the larynx, trachea, and bronchi through a flexible fiberoptic bronchoscope diagnostic: detection of tumors, inflammation, or strictures, obtain tissue biopsies therapeutic: removal of retained secretions or foreign bodies, control bleeding in bronchus  Invasive Tests Bronchoscopy Complications: reaction to local anesthetic, infection, aspiration, bronchospasm, hypoxemia, pneumothorax, bleeding, and perforation NPO 6 hours prior Pre-op meds include sedatives and anticholinergics Remove dentures and other oral prostheses Topical anesthetic may be sprayed on the pharynx NPO after the procedure until cough reflex returns ; may offer ice chips then fluids eventually  Invasive Tests Thoracoscopy pleural cavity is examined with an endoscope Small incisions are made into the pleural cavity in an intercostal space Chest tube may be inserted after the procedure and the pleural cavity is drained by negative-pressure water-seal drainage  Invasive Tests Thoracentesis and Pleural Fluid Analysis Insertion of needle into pleural space for removal of pleural fluid or airs Diagnostic test to detect inflammatory, infectious, or cancerous disorders  Invasive Tests Biopsy  Laboratory Tests Sputum Culture Nose and Throat Cultures Arterial Blood Gases Health History & Clinical Manifestations HEALTH HISTORY Demographic information (age, gender, ethnic origin) Family history of genetic abnormalities associated with cardiovascular disorders Height, current weight and usual weight CLINICAL MANIFESTATION Chest pain or discomfort Shortness of breath or dyspnea Edema and weight gain Palpitations Fatigue Dizziness and syncope ASSESSING CHEST PAIN CHEST PAIN CHARACTER, DURATION PRECIPITATING RELIEVING LOCATION, EVENTS MEASURES RADIATION Angina Substernal or 5-15 Usually related Rest Pectoris retrosternal pain minutes to exertion, Nitro- spreading across emotion, eating glycerin chest; may radiate to cold. Oxygen inside of arm, neck, or jaw. ASSESSING CHEST PAIN CHEST PAIN CHARACTER, DURATION PRECIPITATING RELIEVING LOCATION, EVENTS MEASURES RADIATION Myocardial Substernal pain or >15 minutes Occurs Morphine Infarction pain over spontaneously sulfate precordium; may but may be Successful spread widely sequela to reperfusion of throughout chest. unstable angina. blocked coronary Pain in shoulders and artery hands may be present. ASSESSING CHEST PAIN CHEST PAIN CHARACTER, DURATION PRECIPITATING RELIEVING MEASURES LOCATION, EVENTS RADIATION Pericarditis Sharp, severe Intermittent Sudden onset. Sitting upright substernal pain Pain increases Analgesia to the left of the with Anti-inflammatory sternum; may be inspiration, meds felt in swallowing, epigastrium and coughing, and may be referred rotation of to neck, arms, trunk. and back. ASSESSING CHEST PAIN CHEST PAIN CHARACTER, DURATION PRECIPITATING RELIEVING LOCATION, EVENTS MEASURES RADIATION Pleuritic Pain arises from 30+ minutes Often occurs Rest pain inferior portion of spon-taneously. Time pleura; may be Pain occurs or Broncho- referred to costal increases with dilators margins or upper inspiration. abdomen; patient able to localize pain. PHYSICAL ASSESSMENT  INSPECTION OF THE SKIN Pallor Peripheral cyanosis Central cyanosis Xanthelasma- yellowish, slightly raised plaques in the skin Reduced skin turgor Cold, clammy skin; diaphoresis Ecchymosis normally distended in supine and collapsed in 45-degree angle IF PRESENT, it suggests increased venous pressure (RHF, circulatory overload, superior vena cava obstruction, tricuspid valve regurgitation) above 3 cm= ELEVATED  DIAGNOSTIC EVALUATION Cardiac Enzyme Analysis CREATINE KINASE MYOGLOBIN Early marker of MI Most specific enzymes analyzed in acute MI A heme protein with a small molecular Level rises within 4-8 hours weight peak 12-24 hours Rapidly released from damaged myocardial tissue and accounts for its normalize 3-4 days early rise Level rises within 1-3 hours peak 4-12 hours normalize 24 hours TROPONIN I Contractile protein found only in cardiac muscle Level rises within 3-4 hours peak 4-24 hours normalize 1-3 weeks PERIPHERAL/ VASCULAR DISORDERS  The vascular system consists of two interdependent systems The right side of the heart pumps blood through the lungs to the pulmonary circulation the left side of the heart pumps blood to all other body tissues through the systemic circulation. The blood vessels in both systems channel the blood from the heart to the tissues and back to the heart. Contraction of the ventricles is the driving force that moves blood through the vascular system.  Arteries distribute oxygenated blood from the left side of the heart to the tissues, whereas the veins carry deoxygenated blood from the tissues to the right side of the heart. Capillary vessels located within the tissues connect the arterial and venous systems. These vessels permit the exchange of nutrients and metabolic wastes between the circulatory system and the tissues. Arterioles and venules immediately adjacent to the capillaries, together with the capillaries, make up the microcirculation. The lymphatic system complements the function of the circulatory system. Lymphatic vessels transport lymph (a fluid similar to plasma) and tissue fluids (containing proteins, cells, and cellular debris) from the interstitial space to Structures of the Vascular System ✓Systemic circulation ✓Pulmonary circulation General Blood Vessel Structure Tunica intima Tunica media Tunica adventitia Vascular Segments Arteries and arterioles Microcirculation Venules and veins Lymphatics  Function of the Vascular System Resistance Affects blood flow according to the: ✓ Radius of the vessel ✓ Fluid viscosity ✓ Length of the vessel  Function of the Vascular System A. Capillary Exchange ✓Diffusion ✓Filtration ✓Pinocytosis  Function of the Vascular System B. Cardiovascular Control ✓ Regulation of arterial pressure ✓ Local regulation of blood flow  Function of the Vascular System C. Cardiovascular Adjustment to Exercise ASSESSMENT OF THE VASCULAR SYSTEM Clinical Manifestations Pain Skin changes Sensory changes Edema Lower extremity ulcers  Arterial Venous Location Distal; buttocks, thigh, calf, Around ankle or entire leg feet Pain Claudication Aching, throbbing, burning, Rest pain heaviness at end of day Continuous pain worsens with Nocturnal cramping elevation Relief of Claudication- cessation of manifestation muscle use Rest pain- dependent position Infection Present if open ulcer May be present if open ulcer Thick toenails often indicate fungal infection or arterial insufficiency  Arterial Venous Skin Pale Darkened brown color above Cooler than other skin areas the ankle Absence of hair Dependent cyanosis Temperature may be higher than other skin areas Brawny edema Sensation Decreased Pruritus may be present Tingling, numbness Pulses Absent or diminished May be difficult to palpate if Often disappears with edema is present exercise Muscle mass Reduced in chronic disease Unaffected  Arterial Venous Ulcer Dry, pale gray, or yellow; Broad, shallow, but may be description necrotic deep pink or beefy Small, painful ulcers Ulcer bed moist; may have copious drainage Operative Arterial bypass Vein ligation/stripping procedures Angioplasty Valve grafts Stent placement Sclerotherapy Laser or radiofrequency ablation Ankle-Brachial Index (ABI) Used to predict severity of arterial vascular disease Uses Doppler device to take BP measurements in the arms and ankles Ankle systolic pressure/brachial systolic pressure Decreased ABI result with exercise is indicator that arterial disease is present Physical Examination Inspection Palpation Skin color Temperatur Hair e distribution Pulses Capillary Auscultation refill time Limb blood Muscle pressure atrophy Edema Diagnostic Testing Noninvasive Tests Ankle-brachial Index Doppler Ultrasonography Ultrasonic Duplex Scan Air Plethysmography Impedance Plethysmography Exercise Testing CT Scan/MRI Diagnostic Testing Invasive Tests Arteriography Venography Magnetic Resonance Angiography Vascular Endoscopy (Angioscopy) Intravascular Ultrasonography Diagnostic Testing Laboratory Tests Total lipid profile Coagulation studies HEMATOLOGY Anatomic & Physiologic Overview Blood and sites of blood production (bone marrow, reticuloendothelial system/RES) ❑ Formed elements ▪ 45% ❑ Plasma – fluid portion of blood ▪ 55% of blood volume ▪ Contains albumin, globulin, fibrinogen, electrolytes, nutrients, waste products  BLOOD ► A liquid connective tissue that has three general functions: 1. Transportation 2. Regulation 3. Protection  BLOOD 40-45% of fluid volume Produced by the bone marrow, about 175 billion RBCs, 70 million neutrophils, and 175 billion platelets each day Comprise 7-10% of body weight; 5-6 L in volume Carries oxygen and nutrients to the body cells for cellular metabolism Carries hormones, antibodies, and other substances to their sites of action or use Carries waste products produced by cellular metabolism to the lungs, skin, liver, kidneys, where they are transformed and eliminated from the body Components of Blood Blood Plasma Formed Elements Watery liquid extracellular Cells and cell fragments matrix that contains RBCs dissolved substances WBCs Gamma globulins Platelets Antibodies or immunoglobulins Hematocrit Percentage of total blood Plasma proteins (mainly volume occupied by RBCs synthesized by the liver) Albumin Globulin Fibrinogen FORMED ELEMENTS  Hematopoiesis ►Process by which formed elements of blood develop Red bone marrow ▪ Highly vascularized connective tissue and is the primary site for hematopoiesis ▪ Bones of axial skeleton, pectoral and pelvic girdles, proximal epiphyses of the humerus and femur ▪ Derived from mesenchymal cells or pluripotent stem cells (hemocytoblasts) Hematopoiesis BONE MARROW ► Site of hematopoiesis, 4-5% of body weight Adult: pelvis, ribs, vertebrae, sternum ► Consists of islands of cellular components (red marrow) separated by fat (yellow marrow) As people age, proportion of active marrow is gradually replaced by fat  BONE MARROW Extramedullary hematopoiesis: in adults with disease that causes marrow destruction, fibrosis, or scarring, the liver and spleen can resume production of blood cells  BONE MARROW Highly vascular; contain primitive cells (stem cells) that have the ability to self-replicate and can differentiate into either myeloid or lymphoid stem cells Lymphoid stem cells give rise to either T or B lymphocytes and myeloid cells differentiate into erythrocytes, leukocytes, and platelets BONE MARROW BLOOD CELLS  Erythrocytes (Red Blood Cells) Biconcave disk, flexible that can pass through capillaries Very thin membrane allowing oxygen and carbon dioxide to easily diffuse across it Consist primarily of hemoglobin, which contains iron and makes up 95% of the cell mass; enables the red cell to perform its principal function, the transport of oxygen  Erythrocytes (Red Blood Cells) Oxygen-carrying hemoglobin molecule Globin – four polypeptide chains Heme – bound to each four chains; has Fe at the center that can combine reversibly with one O2 molecule, allowing each hemoglobin to bind to four O2 molecules Oxygen readily binds to hemoglobin in the lungs and is carried as oxyhemoglobin (makes arterial blood a brighter red than venous blood) In venous blood, hemoglobin combines with hydrogen ions produced by cellular metabolism and buffers excessive acid 15 g/ 100 mL of blood HEMOGLOBIN  Erythropoiesis Erythrocyte production Stimulated by erythropoietin, a hormone primarily produced by the kidney Typically takes 5 days For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folic acid, pyridoxine (vitamin B6), protein  Erythropoiesis o Iron stores and metabolism ▪ rate of iron absorption is regulated by the amount of iron already stored in the body and by the rate of erythrocyte production ▪ Stored as ferritin and when required, the iron is released into the plasma, binds to transferrin, and is transported to into the membranes of the normoblasts ▪ With iron deficiency, bone marrow iron stores are rapidly depleted; hemoglobin synthesis is depressed, and the erythrocytes produced are small and low in hemoglobin FERRITIN Erythropoiesis Vitamin B12 and folic acid metabolism ✓ Required for synthesis of DNA in RBCs ✓ Derived from the diet; folic acid is absorbed in the proximal small intestine, but only small amounts are stored within the body ✓ Vitamin B12 only found in foods of animal origin; combines with intrinsic factor in the stomach and the complex is absorbed in the distal ileum Red Blood Cell Destruction Average lifespan is 120 days Aged RBCs lose elasticity and become trapped in small blood vessels and the spleen and removed by reticuloendothelial cells in the liver and spleen Most of the hemoglobin are recycled, others are broken down to form bilirubin and is secreted in the bile  White Blood Cells (Leukocytes) Have nuclei and do not contain hemoglobin Functions: Protect the body from invading microorganisms and foreign entities Phagocytosis Neutrophils arrive at the given site within 1 hour after the onset of inflammatory reaction and initiate phagocytosis, but are short-lived Influx of monocytes follows and become macrophages Primary function of lymphocytes is to attack foreign material White Blood Cells (Leukocytes) T lymphocytes are responsible for delayed allergic reaction, rejection of foreign tissue, and destruction of tumor cells (cellular immunity) B lymphocytes are capable of differentiating into plasma cells and produce immunoglobulins (Ig), which are protein molecules that destroy foreign material by several mechanisms (humoral immunity) Eosinophils and basophils function in hypersensitivity reactions; eosinophils are important in phagocytosis of parasites; increase in allergic states indicate that these cells are involved in hypersensitivity reaction (neutralize histamine) WHITE BLOOD CELLS  White Blood Cells (Leukocytes) Granulocytes Agranulocytes ► Presence of granules in the Monocytes cytoplasm of the cells 5%, largest of the leukocytes Eosinophils Remain in the circulation for a short time before entering the Basophils tissues and transforming into Neutrophils macrophages (polymorphonuclear nuetrophils/PMNs or Lymphocytes segmented neutrophils) Major source of production is the thymus Complete their differentiation and maturation primarily in the lymph nodes and in the lymphoid tissue Principal cells of the immune system  Platelets ► Granular fragments of giant cells in the bone marrow called megakaryocytes ► Production in bone marrow regulated by thrombopoietin ► Control bleeding ► Circulate freely in the blood in an inactive state, nurturing the endothelium of blood vessels ► Adhere to the site of injury and form a platelet plug, temporarily stopping the bleeding ► Normal lifespan of 7 to 10 days PLATELETS  Summary of Formed Elements in Blood Name and Number Characteristics Functions Appearance RBC (Erythrocytes) 4.8 million/uL in 7-8um diameter Hemoglobin females biconcave discs transports most of 5.4 million /uL in without nuclei the O2 and part of males Live for 120 days CO2 in blood WBC (Leukocytes) 5,000-10,000 u/L Granular Neutrophils 60-70% 10-12 um Phagocytosis Cytoplasm has very fine, pale iliac granules Eosinophils 2-4% 10-12 um Combat the effects Large, red-orange of histamine in granules fill the allergic reactions cytoplasm  Summary of Formed Elements in Blood Name and Number Characteristics Functions Appearance WBC (Leukocytes) 5,000-10,000 u/L Granular Basophils 0.5-1% 8-10 um Liberate heparin, Large cytoplasmic histamine, and granules appear serotonin in allergic deep blue purple reactions, intensifying overall inflammatory response  Summary of Formed Elements in Blood Name and Number Characteristics Functions Appearance WBC (Leukocytes) 5,000-10,000 u/L Agranular Lymphocytes (T 20-25% Small 6-9 um; Mediate immune cells, B cells, natural large 10-14 um responses (antigen- killer cells) Cytoplasm forms antibody) a rim around the B cells develop into nucleus that looks plasma cells (antibodies) sky blue T cells attack invading viruses, cancer cells Natural killer cells attack a wide variety of infectious microbes Monocytes 3-8% 12-20 um Phagocytosis Kidney shaped or (transforms into horseshoe shaped macrophages)  Summary of Formed Elements in Blood Name and Number Characteristics Functions Appearance Platelets 150,000-400,000 2-4 um cell Formation of (Thrombocytes) /uL fragments that live platelet plug in for 5-9 days hemostasis Contains many Release chemicals vesicles but no that promote nucleus vascular spasm and blood clotting  Hemostasis Sequence of responses that stop bleeding Three mechanisms: 1. Vascular spasm 2. Platelet plug formation 3. Blood clotting Hemostasis Platelet Plug Vascular Spasm Formation Arterial smooth muscles Platelet contain platelet- contract derived growth factor Reduces blood loss for (PDGF) causing proliferation several minutes to several of vascular endothelial cells, hours vascular smooth muscle fibers, fibroblasts Platelet plug formation: Platelet adhesion Platelet release action Platelet aggregation Platelet Plug Formation Hemostasis Blood Clotting If blood is drawn from the body, it thickens and forms a gel called a clot A clot consists of a network of insoluble protein fibers called fibrin in which formed elements of blood are trapped A series of chemical reactions that culminates in formation of fibrin threads Involves several substances known as clotting (coagulation) factors Blood Clotting Cascade HEMATOLOGIC STUDIES  CBC Identifies the total number of blood cells as well as the hemoglobin, hematocrit, and RBC indices Peripheral Blood Smear Manual examination of the peripheral smear A drop of blood is spread on a glass slide, stained, and examined under a microscope Peripheral Blood Smear  Bone Marrow Aspiration and Biopsy Assess how a person’s blood cells are being formed and to assess the quantity and quality of each type of cell produced within the marrow Usually aspirated from the iliac crest and occasionally from the sternum Local anesthesia through the skin and SQ to the periosteum of the bone; approximately 5 mL of blood and marrow is aspirated  Bone Marrow Aspiration and Biopsy Bone marrow biopsy best performed after the aspiration and in a slightly different location, because the marrow structure may be altered after aspiration; skin may be punctured first with a surgical blade to make a 3- to 4- mm incision Risks involved include bleeding and infection Pressure is applied to the site for several minutes and then covered with a sterile dressing Site of biopsy may ache for 1 to 2 days Bone Marrow Aspiration Bone Marrow Biopsy  THERAPIES FOR BLOOD DISORDERS Splenectomy Therapeutic Apheresis Therapeutic Phlebotomy Blood Component Therapy Special Preparations Splenectomy Surgical removal of the spleen which may be required after trauma to the abdomen Severe hemorrhage can occur if the spleen is ruptured because the spleen is very vascular Also a possible treatment for hematologic disorders Enlarged spleen may be the site of excessive destruction of blood cells Some patients with grossly enlarged spleens develop severe thrombocytopenia as a result of platelets being sequestered in the spleen Splenectomy Complications may include atelectasis, pneumonia, abdominal distention, and abscess formation Vulnerable to overwhelming lethal infections and should receive the pneumococcal vaccine (Pneumovax) before undergoing splenectomy Therapeutic Apheresis Means separation; blood is taken from the patient and passed through a centrifuge, where a specific component is separated from the blood Remaining blood is then returned to the patient Entire system is closed, reducing the risk for bacterial contamination Also used to obtain larger amounts of platelets from a donor than can be provided from a single unit of whole blood  Types of Apheresis Procedure Purpose Examples of Clinical Use Platelet pheresis Remove platelets Extreme thrombocytopenia; single-donor platelet transfusion Leukapheresis Remove WBCs (can be Extreme leukocytosis; harvest specific to neutrophils WBC for transfusion or lymphocytes) Erythrocytapheresis Remove RBCs RBC dyscrasias (sickle cell (RBC exchange) disease); RBCs replaced via transfusion Plasmapheresis Remove plasma Hyperviscosity syndromes; proteins renal and neurologic diseases Stem cell harvest Remove circulating Transplantation (donor harvest stem cells or autologous) Therapeutic Phlebotomy Removal of a certain amount of blood under controlled conditions Patients with elevated hematocrits or excessive iron absorption can usually be managed by periodically removing 1 unit (500 mL) of whole blood  Blood Component Therapy A single unit of whole blood contains 450 mL of blood and 50 mL of an anticoagulant Practical to separate one whole unit of blood into its primary components: erythrocytes, platelets, and plasma (leukocytes are rarely used); because plasma is removed, a unit of PRBCs is very concentrated Blood Component Therapy Each component must be processed and stored differently to maximize the longevity of the viable cells and factors within it PRBCs stored at 4’C and can be stored for up to 42 days with special preservatives Platelets must be stored at room temperature because they cannot withstand cold temperatures, and they last for only 5 days before they must be discarded; may be gently agitated to prevent clumping Plasma is immediately frozen to maintain activity of the clotting factors within and may last for 1 year Special Preparations Factor VIII concentrate (antihemophilic factor) is a lyophilized, freeze-dried concentrate of pooled fractionated human plasma Factor IX concentrate (prothrombin complex) contains factors II, VII, IX, and X Plasma albumin is a large protein molecule that usually stays within vessels and is a major contributor to plasma oncotic pressure and is also used to expand the blood volume of patients Immune globulin is a concentrated solution of the antibody IgG BLOOD TRANSFUSION ► Administration of blood and blood components  Blood Indications Compatibility Nursing Consideration Component Whole blood Restore blood volume ABO identical Seldom administered Complete (pure) lost from hemorrhage, Rh type must match Use blood administration tubing to blood trauma, burns infuse within 4 hours Exchange transfusion in Avoid fluid overload sickle cell disease Warm blood if giving a large quantity Use only with normal saline solution PRBCs Restore or maintain ABO identical but group AB Use blood administration tubing to oxygen-carrying capacity may receive AB, A, B, or O infuse within 4 hours Correct anemia and Rh type must match Use only with normal saline solution surgical blood loss Avoid administering packed RBCs for Increase RBC mass anemic conditions correctable by Red cell exchange nutritional or drug therapy WBC (Leukocytes) Treat sepsis unresponsive ABO identical but group AB Give 1 unit daily for 4 to 6 days or until to antibiotics and life- may receive AB, A, B, or O the infection resolves threatening Compatibility with human Premedicate with antihistamines, granulocytopenia leukocyte antigen (HLA) acetaminophen or steroids preferable but not necessary If fever occurs, administer an antipyretic unless patient is sensitized and don’t discontinue the transfusion; Rh type must match instead, reduce the flow rate as ordered Administer slowly over 2 to 4 hours Give the transfusion with antibiotics to treat infection  Blood Indications Compatibility Nursing Consideration Component Platelets Treat bleeding caused ABO compatibility Use a blood filter or leukocyte-reduction by decreased circulating identical; Rh negative filter platelets or functionally recipients should receive As prescribed, premedicate with abnormal platelets Rh negative platelets antipyretics and antihistamines if the Improve platelet count patient’s history includes a platelet preoperatively in a transfusion reaction or to reduce chills, patient whose count is fever, and allergic reaction 50,000/uL or less Use single donor platelets if the patient needs repeated transfusions Platelets aren’t used to treat autoimmune thrombocytopenia FFP Treat postoperative ABO compatibility Administer infusion rapidly hemorrhage Rh match not required Large-volume transfusions of FFP may Correct an require correction for hypocalcemia undetermined because citric acid in FFP binds calcium coagulation factor Must be infused within 24 hours of deficiency being thawed Warfarin reversal Albumin Replace volume lost Not required Contraindicated in severe anemia because of shock from Administer cautiously in cardiac and burns, trauma, surgery, pulmonary disease because heart or infections failure may result from circulatory Treat hypoproteinemia overload  Blood Indications Compatibility Nursing Consideration Component Factor VIII Treat hemophilia A ABO compatibility not Administer by IV injection using a filter concentrate and von Willebrand’s required needle disease Cryoprecipitate Treat factor VIII ABO compatibility Add normal saline solution to each deficiency and required bag as necessary to facilitate infusion fibrinogen disorders Rh match not required Must be administered within 6 hours of thawing Complications Febrile Nonhemolytic Reaction Caused by antibodies to donor leukocytes that remain in the unit of blood or blood component Most common type of transfusion reaction Occurs more frequently in patients who have had previous transfusions and in Rh-negative women who have borne Rh-positive children S/sx: chills, fever (more than 1’c elevation and typically begins 2 hours after transfusion is begun) Complications Acute Hemolytic Reaction Most dangerous and potentially life-threatening type of transfusion reaction occurring when the donor blood is incompatible with that of the recipient Antibodies already present in the recipient’s plasma rapidly combine with antigens on donor erythrocytes are destroyed in the circulation (intravascular hemolysis) Complications Acute Hemolytic Reaction Most rapid hemolysis occurs in ABO incompatibility; can occur after transfusion of as little at 10 mL of PRBCs S/sx: fever, chills, low back pain, nausea, chest tightness, dyspnea, and anxiety; hypotension, bronchospasm, and vascular collapse As the erythrocytes are destroyed, the hemoglobin is released from the cells and excreted by the kidneys; hemoglobin appears in the urine Complications Allergic Reaction Urticaria (hives) or generalized itching Cause is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused S/sx: urticaria, itching, flushing Reactions are mild and respond to antihistamines; is symptoms are resolved, transfusion may be resumed Can be rarely severe with bronchospasm, laryngeal edema, and shock Managed with epinephrine, corticosteroids, and vasopressor support Complications Circulatory Overload Hypervolemia from too much blood infused too quickly S/sx: dyspnea, orthopnea, tachycardia, sudden anxiety, jugular vein distention, crackles at the base of the lungs, increase in BP For severe overload, the patient is placed in an upright position with the feet in a dependent position and the transfusion is discontinued, and the physician is notified IV line is kept patent with a very slow infusion of normal saline solution or a saline heparin lock device Oxygen and morphine may be needed to treat severe dyspnea  Complications Bacterial Contamination Can occur at any point during procurement or processing but often results from organisms on the donor’s skin Many bacteria cannot survive in the cold temperature used to store PRBCs but platelets are at greater risk of contamination because they are stored in room temperature Preventive measures include meticulous care in the procurement and processing of blood components When PRBCs or whole blood is transfused, it should be administered within a 4-hour period  Complications Bacterial Contamination S/sx: fever, chills, hypotension (may not occur until the transfusion is complete) As soon as recognized, any remaining transfusion is discontinued and the IV line is kept open with normal saline MD and blood bank are notified, the blood container is returned to the blood bank for testing and culture Sepsis is treated with IV fluids and antibiotics, corticosteroids, and vasopressors Complications Transfusion-Related Acute Lung Injury Thought to involve antibodies in the donor’s plasma that react to the leukocytes in the recipient’s blood Occasionally the reverse occurs; antibodies present in the recipient’s plasma agglutinate the antigens on the few remaining leukocytes in the blood component being transfused Another theory suggests that an initial insult to the patient’s vascular endothelium causes neutrophils to aggregate at the injured endothelium; various substances within the transfused plasma then activate these neutrophils and the end result is interstitial and intra-alveolar edema, as well as extensive sequestration of WBCs within the pulmonary capillaries Complications Transfusion-Related Acute Lung Injury Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours) S/sx: acute shortness of breath, hypoxia (O2 sat