adult health nursing ii block 7.0

Adult Health Nursing IIBlock 7.0

Blood Products and Blood Transfusions

Adult Health II Block 7.0University of Southern Nevada

Block 7.0 Module 1.3

Learning Outcomes• Discuss various blood components• Distinguish between various blood types• Compare and contrast indications for various

types of blood transfusions• Describe nursing responsibilities prior, during,

and post blood transfusion• Prioritize plan of care for clients experiencing

transfusion reactions and complications


Blood Components• Packed Red Cells- Anemia, Hg <6-10g/dl• Platelets- Thrombocytopenia, Plt count < 80,000• Fresh Frozen Plasma- Deficiency in coagulation

factors, PT or PTT 1.5 times normal• Cryoprecipitate- Sepsis, neutropenic infection not

responding to antibiotic therapy, clotting problems, usually given IV push over a few minutes

• Albumin- Replace for low albumin• Whole Blood-Traumatic injuries, extensive burns,

dehydration, shock


Albumin• Expands circulating volume• Used to Treat:• Hypovolemia• Burns• Adult Respiratory Distress• Severe Nephrosis• Cirrhosis


Albumin and Nursing Considerations

• Monitor Vital Signs• Monitor Central Venous Pressure• Assess Respiratory Status for Overload• Must be given IV• Assess Lab Values- Look for an increase in the

albumin level after transfusion• Assess edema


Blood Types-ABO System• Blood Type is based on the presence of

antigens• Must check for compatibility to prevent any

reaction• A antigen= Type A blood type• B antigen=Type B blood type• Both A and B antigens=Type AB blood type• Neither A nor B antigen = Type O blood type


Blood Types• Within the first few years of life circulating antibodies

develop against the blood type antigens that person did not inherit

• EX: A person born with/inherited Type A blood forms antibodies against Type B blood, a person born with/inherited

• Type O blood has not ‘inherited’ either A or B antigens and will form antibodies against RBCs with either A or B antigens.

• If RBCs that have an antigen are infused in a person who does not share that antigen a reaction can occur.


Blood Types and CompatibilityBlood Type Antigen Antibody Compatible

With:

A A B A,O

B B A B,O

AB AB O A, B, AB, O

O O A,B O


Rh Factor• Rh system is different than ABO system• An Rh negative person is born without the Rh antigen, and does

not form antibodies unless exposed to the antigen• Exposure can occur if the person receives Rh positive blood or

exposure during pregnancy/birth• Once an Rh negative person is exposed, any contact with Rh

positive blood will trigger a reaction• NOTE: An Rh+ person can receive blood from a Rh negative

donor, but Rh negative people should not receive Rh+ blood• Therefore: O- is the universal donor and AB+ is the universal

recipient


Blood Transfusions• Types:• Transfusions from blood donors• Autologous- Client’s own blood is collected and

used for an elective surgery. Only can be used by the client.

• Intra-operative- Blood loss during surgery is collected through a “cell saver” machine and re-transfused to client during procedure or for a set # of hours after a procedure.


Indications for Transfusions• Excessive blood loss- Trauma, Surgeries• Anemia• Chronic Renal Failure• Coagulation Deficiencies• Thrombocytopenia


Transfusion Procedure• Nursing Considerations and Actions for

transfusions are pre-transfusion, during the transfusion, and post-transfusion

• I would know this if I were you


Pre –Transfusion (Prior)• Assess lab values- Hg, Hct, Albumin, PT, PTT• Verify order for blood transfusion• Obtain Type and Crossmatch (ABO/Rh)• Obtain patient consent• Initiate IV (large bore usually #20 minimum or larger)• Always use Y-connector tubing (comes with a filter)• Always use Normal Saline (.9NS) for transfusion• Always use a pump for controlled infusion time


Pre-Transfusion (Prior)• Obtain baseline vital signs- Especially temp.• Assess patient history to see if patient has

ever had a reaction to blood• Obtain blood from blood bank- Check bag• 2 nurse verification- Match patient ID band to

blood bag and slip for name, record number, blood type, blood unit number, expiration date and DOCUMENT on the blood slip


During the Transfusion• Remain with patient during the first 15-30

minutes of the transfusion- Hemolysis• Infuse at prescribed rate- Assess for overload• Monitor vital signs (per agency policy)• Notify primary care provider immediately for

any signs of reaction


Post Transfusion• Obtain vital signs and chart them on the blood

slip• Dispose of the blood administration bag and

tubing per agency protocol…usually in biohazard waste.

• Reassess lab values- Hg should rise 1gm/dl with every unit transfused.


Blood Transfusion Absolutes!!!

• Must ALWAYS be administered with Normal Saline (NS)

• NEVER mix blood with any medications or administer medications through blood line

• As a nursing student you may NOT be a co-signer for blood transfusion administration

• Infusion time (1 unit) should not exceed 4 hours


• Explain procedure and process• Explain indication for transfusion• Explain complications• Allow client time to ask questions• Assess understanding• Obtain consent

Client Education


Cultural Considerations• Some clients of certain faiths or cultures will

not accept blood transfusions.

• Autologous transfusions may be an alternative

• Must respect and accept these clients’ wishes


Older Populations• Assess circulatory, renal, fluid status• Higher risk for circulatory overload and CHF• Use no larger than a 19 gauge needle• Monitor vital signs paying particular attention

to heart rate, BP, and respirations• Lower rates of transfusion- Normal transfusion

time is 2 hours but may need to transfuse over 4 hours


Transfusion Reactions• Acute Hemolytic• Febrile• Mild Allergic• Anaphylactic• Circulatory Overload


Acute Hemolytic• Onset

IMMEDIATE!!

• EtiologyBlood Type or Rh

incompatibility

• Signs and Symptoms:• Chills, Fever, • Low Back Pain• Tachycardia, Tachypnea• Chest Tightening or Pain• Anxiety, “Impending Doom”• Complications:• Cardiovascular Collapse• Renal Failure• DIC, Shock, and Death


Febrile• Onset:• 30 minutes- 6 hours

after transfusion• Etiology:

Most often in clients with anti-WBC antibodies usually developed after multiple transfusions

• Signs and Symptoms:• Chills, Fever, Flushing• Headache• Anxiety


Mild Allergic• Onset:• During or up to 24

hours after transfusion

• Signs and Symptoms:• Itching• Urticaria• Flushing


Anaphylactic• Onset:

IMMEDIATE!!!!• Signs and Symptoms:• Wheezing• Dyspnea• Chest Tightness• Cyanosis• Hypotension• Feeling of Throat

Closing


Nursing Care of Transfusion Reactions

• Acute Hemolyic nurse• STOP TRANSFUSION

IMMEDIATELY• Start a saline infusion

using a separate IV line

nurse• Save the blood bag

with the remaining blood and IV tubing

• Notify primary care provider

nurse• Monitor Vital Signs, I &

O• Oxygen PRN



• Febrile Nurse • STOP TRANSFUSION• Administer antipyretics

Nurse • Use white blood cell filters• Notify primary care provider

Nurse• Complete transfusion

reaction form per policy• May resume transfusion if

symptoms resolve



• Mild Allergic nurse •Administer Antihistamines•Administer leukocyte reduced or “washed” RBCs

nurse •Symptomatic- Stop transfusion•Asymptomatic- may slow down and continue transfusion

nurse



Anaphylactic

STOP TRANSFUSION IMMEDIATELY!!!AND CALL PCP

MAINTAIN AIRWAYADMINISTER O2

IV FLUIDS

ANTIHISTAMINESCORTICOSTEROIDS

VASOPRESSORS


Circulatory Overload• Signs and Symptoms• Dyspnea• Chest Tightness• Tachycardia• Tachypnea• JVD• Peripheral Edema• Sudden Anxiety• Crackles at lung bases

• Nursing Care• SLOW THE RATE• Administer O2• Monitor Vital Signs• Notify PCP


adult health nursing ii block 7.0

Documents

blood products

various blood typescompare

blood transfusionsadult

complications block

contrast indications

transfusion reactions