Week 14 Hematologic Disorder: Blood Transfusion PDF

1/18/2019 HEMATOLOGIC DISORDER: BLOOD TRANSFUSION WEEK 14      Objectives Define disease condition Discuss Therapeutic Procedures and Nursing Interventions Explore Nursing assessments Discuss complications of disease condition Explore diagnostic findings 1 1 1/18/2019 BLOOD TRANSFUSION White bl...

1/18/2019 HEMATOLOGIC DISORDER: BLOOD TRANSFUSION WEEK 14      Objectives Define disease condition Discuss Therapeutic Procedures and Nursing Interventions Explore Nursing assessments Discuss complications of disease condition Explore diagnostic findings 1 1 1/18/2019 BLOOD TRANSFUSION White blood or components of whole blood can be transfused. Blood components include packed red blood cells (RBC), plasma, albumin, clotting factors, prothrombin complex, cryoprecipitate, and platelets. Incompatibility is a major concern when administering blood or blood products Blood is typed based on the presence of antigens 2 2 1/18/2019 BLOOD TRANSFUSION Another consideration is the Rh factor. Blood that contains D antigen makes the Rh factor positive. Rh positive blood given to an Rh negative person will cause hemolysis 3 3 1/18/2019 BLOOD TRANSFUSION Transfusion Types 1. Transfusion from blood donors 2. Autologous transfusion: The client’s own blood is collected in anticipation of future transfusions (elective surgery). This blood is designated for and can be used only by the client. 3. Intraoperative blood salvage: Blood loss during certain surgeries can be recycled through a cell-saver machine and transfused intraoperatively or postoperatively (orthopedic surgery) 4 4 1/18/2019 BLOOD TRANSFUSION Indications for Transfusion Excessive blood loss (hemoglobin 6-10 g/dl and depending on symptoms)whole blood Anemia (hemoglobin 6-10 g/dl and depending on symptoms)-packed RBCs Chronic renal failure-packed RBCs Coagulation factor deficiencies such as hemophilia-fresh frozen plasma Thrombocytopenia/platelets dysfunction (platelets < 20,000 or < 80,000 and actively bleeding)- platelets 5 5 1/18/2019 BLOOD TRANSFUSION Before Transfusion Access laboratory values, such as hemoglobin and hematocrit Verify order for specific blood products Obtain blood samples for compatibility determination Initiate large-bore IV access Assess for a history of blood-transfusion reaction Obtain blood products from the blood bank. Inspect the blood for discoloration, excessive bubbles, or cloudiness 6 6 1/18/2019 BLOOD TRANSFUSION Before Transfusion Cont’d Following specific institution protocol, confirm the client’s identity blood compatibility, expiration date of the blood product with another nurse Prime the blood administration set with normal saline (NS). Blood products are only infused with NS. Never add medications to blood products Ascertain whether or not a filter should be used Obtain baseline vital signs Begin the transfusion. Use a blood warmer if needed 7 7 1/18/2019 BLOOD TRANSFUSION During Blood Transfusion Cont’d Remain with the client for the first 15mins of the infusion (reaction occur most often during first 15 mins) and monitor Vital signs Rate of infusion Respiratory status Sudden increase in anxiety 8 8 1/18/2019 BLOOD TRANSFUSION During Blood Transfusion Cont’d Notify the primary care provider immediately for any signs of reaction Complete the transfusion within 2-4hrs time frame to avoid bacterial infection Breath sounds Neck-vein distention 9 9 1/18/2019 BLOOD TRANSFUSION Following the Transfusion Obtain vital signs upon completion of the transfusion Dispose of the blood-administration set appropriately (biohazard bags) Monitor blood values as prescribed (CBC, hemoglobin, hematocrit) Complete paperwork and file in the appropriate places Document the client’s response 10 10 1/18/2019 BLOOD TRANSFUSION Types of reaction Onset Sign and symptoms Acute hemolytic Immediate This reaction may be mild or life-threatening. Symptoms in lower back pain, tachycardia, tachypnea, hypotension, c tightening or pain, flushing, anxiety and hemoglobinuria. This reaction may cause: cardiovascular collapse, acute r disseminated intravascular coagulation, shock and death Febrile 30 mins to 6 hr after transfusion Symptoms include: chills, fever, flushing, headache and a Use white blood cell filter. Administer antipyretics. Mild allergic During or up to 24 hr after transfusion Symptoms include: itching , urticaria, and flushing. Administer antihistamines, such as diphenhydramine (Bena 11 11 1/18/2019 BLOOD TRANSFUSION Complication and Nursing Implications Stop the transformation immediately If a reaction is suspected. Initiate a saline infusion. The saline infusion should be initiated with a separate line, so as not to give more blood from the transfusion tubing. Save the blood bag with the remaining blood and the blood tubing for testing. 12 12 1/18/2019 BLOOD TRANSFUSION Circulatory Overload Symptoms include: dyspnea, chest tightness, tachycardia, tachypnea, headache, hypertension, jugular‐vein distention, peripheral edema, orthopnea, sudden anxiety and crackles in the base of the lungs. Administer oxygen, monitor vital signs, slow the infusion rate and administer diuretics as ordered. Notify the primary care provider immediately. 13 13 1/18/2019 BLOOD TRANSFUSION Sepsis and Septic Shock Symptoms include: fever, nausea, vomiting, abdominal pain, chills, hypotension. Maintain patent airway and administer oxygen. Administer antibiotic therapy as ordered. Obtain samples for blood cultures. Administer vasopressors, such as dopamine, to combat vasodilation in the late phase. 14 14 1/18/2019 BLOOD TRANSFUSION Elevate the client’s feet. If disseminated intravascular coagulation (DIC) occurs: 1. Administer anticoagulants, such as heparin, in the early phase. 2. Administer clotting factors and blood products during the late phase (clotting factors are used up in the early stage). 3. Administer activated protein C to control inflammatory response. 15 15