Shared Flashcard Set

Details

Unit 3-Blood, TPN, and Chest Tubes
Karen Morrison
90
Nursing
Not Applicable
03/06/2011

Additional Nursing Flashcards

 


 

Cards

Term

Blood

 

What are the reasons for infusing blood?

Definition

Massive blood loss

  Improve Oxygen carrying capacity

  Active bleeding

  Correction of coagulation defects

  Replace plasma proteins

Term

Blood

Planning to Infuse Blood

 

What must be included in the order for blood products?

 

 

Definition

    

     Must include Type & Cross match,

Must include specific type of blood product

and number of units

Term

Blood

Planning to Infuse Blood

 

Must consent be obtained from

the patient before administration?

Definition

 

 

Yes, the patient must sign

a consent form before

administration of

blood or blood products.

Term

Blood

Planning to Infuse Blood

 

What size guage must

be in place at the IV site?

 

 

 

Definition

20 guage or larger.

It is OK to use 22 guage at SHMC

 

Internal diameters are now larger,

outside diameter is the same.

Term

Blood

Planning to Infuse Blood

 

Should you select a larger or smaller

vein for administration?

Definition

 

 

Try to select a larger vein,

Stay away from the hand

Term

Blood

Planning to Infuse

 

What supplies are needed?

 

Definition

 

 

 A pump

 Appropriate tubing/filter 

 Consent

Patent IV site

 

Term

Blood

Receiving the blood product

 

Why is it so important to coordinate

care before you receive the

blood product?

Definition

 

 

  once the blood arrives on the floor, the clock is ticking, you must be ready to double check per protocol and hang the blood ASAP

 

At Riverbend it must be hung within 15 minutes.

Term

Blood

Receiving the blood product

 

What 5 things must be checked

with another approved person?

 

Definition

 

 

1. Name & MRUN on transfusion record (TR) and chart match

2. Donor # on bag & TR match

3. Blood type & Rh on bag & TR match

4. If autologous, SS# match

5. Dr. order

 

Term

Blood

Infusion of Blood Product

 

What equipment is

needed for hanging blood?

(besides the pump)

Definition

 

         Tubing/Filter

       0.9% Normal Saline (250cc bag)

 

Term

Blood

Infusing of blood products

 

How many approved people are needed to

do the in patinet room check?

Definition

 

 

Two

Term

Blood

Infusion of blood products

 

What must be checked in

the patient's room by both

approved staff members?

 

Definition

 

 

Patient’s armband for name & birth date

This must be checked by two

staff members.

Term

Blood

Infusion of blood products

 

What must also be checked before

infusion of blood products?

Definition

 

 

A set of patient vital signs prior

to infusion.

Term

Blood

Evaluating the Infusion of Blood

 

What must be routinely

monitored during infusion of blood.

 

 

 

Definition

   

 

  Vital Signs:  every 5 minutes for first 15 minutes.

  Volume in first 15 min. ~ 30ml, then adjust rate for appropriate time.

 After first 15 min., observe hourly.

 Change in VS,  increase in temp, Pt. unstable,

 then stop transfusion

 

Term

Blood

Evaluating the Infusion of Blood

 

 

What must be routinely

monitored after infusion of blood?

 

Definition

 

 

 Effectiveness of infusion:

 Activity level

 Color

 Lab values

 

Term

Blood

Transfusion Reaction

 

What are acute

transfusion reactions?

Definition

 

  Acute Hemolytic Reaction

ABO incompatibility

 

Term

Blood

Transfusion Reaction

 

What are acute

transfusion reactions?

Definition

 

Febrile Reactions

Term

Blood

Transfusion Reaction

 

What are acute

transfusion reactions?

Definition

   Allergic reactions

Mild – urticaria, itching, flushing

 

Severe /Anaphylactic  - Anxiety, urticaria, wheezing, progressing to cyanosis, shock, possible cardiac arrest.

Term

Blood

Transfusion Reaction

 

What are acute

transfusion reactions?

Definition

 

 

Circulatory Overload

and

Sepsis

Term

Blood

Transfusion Reactions

 

What are Delayed blood

transfusion reactions?

Definition

 

Infections (Hep B, C, HIV, EBV, CMV

Term

Blood

Transfusion Reactions

 

What are Delayed blood

transfusion reactions?

Definition

 

Iron Overload

Term

Blood

Transfusion Reactions

 

What are Delayed blood

transfusion reactions?

Definition

 

 

Graft vs. Host Disease

Term

Blood Transfusion Products

 

What are RBSs?

Definition

 

Whole blood minus plasma

Term

Blood Transfusion Products

 

What are the indications that

RBCs will be prescribed?

Definition

 

Severe or symptomatic anemia;

 

Acute blood loss

Term

Blood Transfusion Products

 

What is the Volume and Infusion Rate

of RBCs?

Definition

 

Volume: 330 ml

Rate: 1-3 hours (after 1st 15 minutes).

Slower if patient is fluid excessed.

Term

Blood Transfusion Products

 

What are Nursing Considerations

When Administering RBCs?

Definition

 

 

ABO and Rh compatability

required

Term

Blood Transfusion Products

 

What are Nursing Considerations

When Administering RBCs?

Definition

Handle gently;

cells break

Term

Blood Transfusion Products

 

What are Nursing Considerations

When Administering RBCs?

Definition

 

Expected outcome post infusion:

 

HCT increased by 2-3%

HGB increased by 1g.

 

Term

Blood Transfusion Products

 

What are Nursing Considerations

When Administering RBCs?

Definition

 

Use standard blood tubing

(Has inline filter)

Term

Blood Transfusion Products

 

What are Leukocyte-Poor

RBCs?

Definition

 

 

RBCs with 99% of

leukocytes removed.

Term

Blood Transfusion Products

 

What are the indications to

use Leukocyte-Poor RBCs?

Definition

 

Severe or asymptomatic anemia,

acute blood loss

 

The leukocyte-poor RBCs prevent febrile

reactions from leukocyte antibodies,

immunosuppressed patients

Term

Blood Transfusion Products

 

What are the Volume and Infusion

rate for Leukocyte-Poor RBCs?

 

Definition

 

Volume: 330 ml

Rate: 1-2 hours (after 1st 15 minutes).

Slower if patient is fluid excessed.

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administration of Leukocyte-Poor

RBCs?

Definition

 

The same as for RBCs, except add a leukocyte

removal filter (PALL filter).

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administration of Leukocyte-Poor

RBCs?

Definition

 

Unit can be yellow tinged.

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administration of Leukocyte-Poor

RBCs?

Definition

 

Agitate bag more often;

Platelets will tend to aggregate.

Term

Blood Transfusion Products

 

What is Plasma?

FFP (fresh frozen)

Definition

 

Clotting factors and serum

Term

Blood Transfusion Products

 

What are the indicaitons that

Plasma (FFP) will be administered?

 

Definition

 

Clotting deficiencies

especially factors V and VII.

Term

Blood Transfusion Products

 

What are the Volume and Rate of

Plasma (FFP)?

Definition

 

Volume: 200 - 250ml

Rate: Infuse rapidly;

as fast as patient tolerates.

Term

Blood Transfusion Products

 

What are the Nursing Considerations

for administration of Plasma (FFP)?

 

Definition

 

ABO compatability required.

Term

Blood Transfusion Products

 

What are the Nursing Considerations

for administration of Plasma (FFP)?

Definition

 

Use within 24 hours after thawing.

Term

Blood Transfusion Products

 

What are the Nursing Considerations

for administration of Plasma (FFP)?

Definition

 

Contains no platelets or RBCs.

Term

Blood Transfusion Products

 

What are the Nursing Considerations

for administration of Plasma (FFP)?

Definition

 

Use standard blood filter.

Term

Blood Transfusion Products

 

What are Platelets (PLT)?

 

 

 

Definition

 

Platelet-rich plasma separated

from fresh blood

(Leukocyte-poor PLTs available)

Term

Blood Transfusion Products

 

What are the indications that

Platelets (PLTs) will be prescribed?

Definition

 

Thrombocytopenia

Acute Leukemia

 

Replaces inadequate number of PLTs

or dysfunctional PLTs.

Term

Blood Transfusion Products

 

What are the Volume and Rate

of Platelets (PLTs)?

Definition

 

Volume: 40ml/unit;

Several units per bag.

 

Rate: infuse rapidly

5 minutes/unit

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administering Platelets (PLTs)?

 

Definition

 

ABO compatability not necessary,

but highly recommended for repeated units.

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administering Platelets (PLTs)?

Definition

 

Each unit raises PLT count by 5000

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administering Platelets (PLTs)?

Definition

 

Patients with a history of platelet transfusion

reactions require premedication with

anithistamine and antipyretics,

or use leukocyte-poor platelets.

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administering Platelets (PLTs)?

Definition

 

Avoid giving to patients with a fever.

Term

Blood Transfusion Products

 

What are Nursing Considerations

for administering Platelets (PLTs)?

Definition

 

Use PALL filter with leukocyte-poor

platelets

Term

Blood Transfusion Products

 

What is Cryoprecipitate?

Definition

 

Coagulation Factors

VIII and XIII

Term

Blood Transfusion Products

 

What are the indications that

Cryoprecipitate will be prescribed?

Definition

 

Hemophilia A

Fibrinogen defeciency

Von Willebrand's disease

Term

Blood Transfusion Products

 

What are the Volume and Rate for

Cryoprecipitate?

Definition

 

Volume: 10 units per bag=

110 - 150 ml total.

 

Rate: Infuse within 20 minutes.

Term

Blood Transfusion Products

 

What are Nursing Consideration

when administering Cryoprecipitate?

Definition

 

ABO compatability necessary,

not Rh

Term

Blood Transfusion Products

 

What are Nursing Consideration

when administering Cryoprecipitate?

Definition

 

Use within 3 hours

Term

Blood Transfusion Products

 

What are Nursing Consideration

when administering Cryoprecipitate?

Definition

 

Can be given thru 20-22 guage IV needle

 

Term

Blood Transfusion Products

 

What are Nursing Consideration

when administering Cryoprecipitate?

Definition

 

Short half life - may need repeated doses.

 

Requires use of a blood filter.

Term

Blood Transfusion Products

 

What are the features of Albumin?

Definition

 

25% (25g/100ml)

 

Hyperosmolar

(100ml osmotically =

500 ml of plasma)

Term

Blood Transfusion Products

 

What are the indications that

Albumin will be prescribed?

Definition

 

Volume expansion,

Hypoproteinemia,

reduce 3rd space shift

(Increased colloidal osmotic pressure and causes

a significant ICF which leads to ECF shift)

Term

Blood Transfusion Products

 

What are the Volume and Rate of

Albumin?

Definition

 

Volume: 50 or 100ml bottles

 

Rate: 1-2 ml/minute

Term

Blood Transfusion Products

 

What are Nursing Considerations

when administering Albumin?

Definition

 

No ABO compatability issue,

pasteurized

Term

Blood Transfusion Products

 

What are Nursing Considerations

when administering Albumin?

Definition

 

Watch for pulmonary edema or other

signs and symptoms of fluid overload

Term

Blood Transfusion Products

 

What are Nursing Considerations

when administering Albumin?

Definition

 

Use vented tubing that comes with

the bottle; drip rate usually 20gtt/ml.

 

Need 15 micron filter

Term

Blood Transfusion Products

 

What are Nursing Considerations

when administering Albumin?

Definition

 

For treatment of shock give rapidly

For normal plasma volume give 1-2 ml/minute

Term

TPN

 

Total Parenteral Nutrition

 

Why would a patient get TPN?

Definition

 

The patient is nutritionally depleted,

administered via central line in SVC due

to the high percentage of Dextrose,

which is irritating to veins.

Term

TPN

 

Peripheral Parenteral Nutrition (PPN)

 

When would a patient receive PPN?

Definition

 

When the patient is not nutritionally depleted.

PPN provides a complete source of nutrition

which may be given via a PIV,

percentage of 10% or less of Dextrose in solution

It is not used very often.

Term

Assessment for Hanging TPN

 

When does a patient need TPN?

Definition

 

Inadequate nutrition

(decreased serum albumin esp. post-op

surgical patients)

 

Impaired intestinal absorption

Term

Assessment for Hanging TPN

 

When does a patient need TPN?

Definition

Increased Nutritional need

-bowel surgery

-malnutrition (supplement at a slow rate)

-excessive Na+ loss (sepsis, burns, need a

balanced electrolyte solution

 

Hepatic/Renal Failure

(difficult to metabolize proteins)

Term

Assessment for Hanging TPN

 

When does a patient need TPN?

Definition

Chronic weight loss that can't be controlled

-cancer

-surgery

-GI disease

-can't tolerate enteral tube

feedings

Term

TPN

 

What are the basics of TPN

knowledge?

Definition

TPN custom made for patient each day

TPN orders based on daily needs and lab values

TPN order good for one day only

(requires and order q daily)

TPN prepared in 2-3 liter bags;

volume for 24 hours in one bag.

 

TUBING CHANGED EVERY 48 HOURS

Term

TPN Ingredients

 

What is the base or standard

solution for TPN?

Definition

 

Electrolytes, Amino Acids and Dextrose

Term

TPN Ingredients

 

What is the standard

percentage of Dextrose

and why?

Definition

 

Standard solution is 20% (gives 1 cal/ml)

increased dextrose = increased calories and

increased hypertonicity which leads to

irritated veins.

 

Term

TPN Ingedients

 

What else does TPN

contain and why?

Definition

 

Crystalline Amino Acids, (they may be increased

if not healling well, breaking down more nitrogen

than taking in).

 

NaCl

 

Na Acetate (bicarb, can be increased for

acidotic patients).

Term

TPN Ingedients

 

What else does TPN

contain and why?

Definition

KCL (can be increased or

decreased r/t condition)

 

K Phosphate (renal patients don't excrete well,

may be decreased)

 

Calcium gluconate

Term

TPN Ingedients

 

What else does TPN

contain and why?

Definition

Magnesium Sulfate (same as K phosphate, also helps people heal, nerve transmissions)

 

Multi-vitamins

 

Trace elements (minerals)

 

 

Term

TPN Ingedients

 

What else does TPN

contain and why?

Definition

Fat Emulsions

3 methods of administering Fat emulsion

-added to bag of TPN = TNA (total nutritional admixture)

-infused along with TPN solution (Lipids)

-administered without TPN as a fat/calorie supplement

a) 10% & 20% available

b) can be given PIV

c)infuse for 12 hours/every 24 hours

Term

TPN Ingedients

 

What else does TPN

contain and why?

Definition

DO NOT GIVE IF LIPIDS IF ALLERGIC TO EGGS

Insulin  in solution and/or sub-Q per sliding scale

r/t high amount of glucose, even for non-diabetics

Check CBGs every 6 hours

 

PPN if glucose is < 10%

Term

Planning to administer TPN

 

What are the necessary checks?

Definition

Is the CL correctly placed?

current MD order

room temperature

check label against order

date and time bag hung

sticker on bag goes on charting record

want to make sure if MD ordered lipids as well

 

Term

Planning to administer TPN

 

What equipment is necessary to

administer TPN

 

Definition

 

TPN solution

IV pump

IV tubing

Micro filters

Saline flushes

If triple lumen CL, use median line

may need 2 pumps, one for lipids and one for TPN.

(lipids = fat emulsion in Sigma pump)

Term

Planning to administer TPN

 

Is strict aseptic technique required?

Definition

 

Yes, scrub the hub well.

Term

Implementing TPN

 

What do you check in the

patient's room?

Definition

 

Patient's name & birth date & armband

Term

Implementing TPN

 

What is the rate for TPN?

Definition

 

It should be started slowly, 50-75 ml/hour

for the first 24 hours and then increase.

Can be 30 ml/hour to start

 

Never go cold turkey, always wean off slowly,

ie. no new order

Term

Implementing TPN

 

Must TPN always be given

on a pump?

 

Definition

 

Yes

Term

Implementing TPN

 

What patient teaching should be done?

Definition

 

Purpose/rationale

rationale for frequency of CBGs

UOP may increase initially r/t high glucose

Term

Implementing Lipids

 

What should be assessed before giving lipids?

Definition

 

Assess for disturbance in fat metabolism,

egg allergy,

pancreatitis,

or risk of fat embolism

Term

Evaluating TPN

 

What may need troubleshooting?

Definition

1. For example, if the VTBI is 200ml and there is no new bag and no order for TPN you should decrease the rate by 10% (10 or 15ccs)

Want to wean off to try to avoid hypoglycemia.

 

2. Continue assessment of IV site

Term

Evaluating TPN

 

What labs are ordered for effectiveness

or ingredient adjustments?

Definition

Chem panel- Na+, K+, Cl (electrolytes), kidney/liver function

 

Triglycerides r/t lipids

 

CO2-acid base issues, indirect indication of base, bicarb

Term

Evaluating TPN

 

What labs are ordered for effectiveness

or ingredient adjustments?

Definition

Pre-albumin

 

Serum osmolality- TPN can create an osmolatity imbalance, TPN has hyperosmolality

 

24 hr UUN (urine urea nitrogen) measures amount

of nitrogenous waste excreted through the kidney

Term

Evaluating TPN

 

What assessments will you make after

while administering TPN?

Definition

I & O and weight, ex. fluid overload

 

Any S/S of infection (glucose medium for growth)

 

Is therapy promoting desired outcome?

Term

TPN

 

In my notes about tubing

 

Standard tubing except for filter-extension

tubing. Separate, attaches to end of IV tubing.

Lipids takes another tubing.

Joins TPN tubing BELOW the filter.

Definition

TPN line attaches to lipid line at lipids

lowest attachment.

No drugs should go through

TPN.

 

It is not in our scope of practice to push or

run even compatible drugs through a TPN line.

 

Term

Chest tubes

 

After looking at the Atrium University powerpoint

that Maggie posted under

Unit 3: Chest tube lab

I think that studying that is way better than

my flashcards could be unless I hear differently.

I will look at my Closed Chest Drainage Systems

handout tomorrow to see if I can make flashcards out of that but I have to get some shuteye.

 

Definition
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