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Adult Health Test 5
blood components, DIC, aneurysm
42
Nursing
Undergraduate 3
05/04/2012

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Term
Purpose of Blood Component Therapy
Definition
Increase H&H:carry oxygen to cells, replace loss during active bleeding
Increase Intravascular volume
Replace deficiencies: Platelets, clotting factors
Term
Whole Blood Replacement
Definition
Used in hemorrhage or shock
-repalces volume and components (RBCs, plasma proteins, clotting factors, palsma)
-Large risk for incompatibility, overload, blood-born pathogens
Term
Packed Red Blood Cells
Definition
Used for severe or symptomatic anemia-specifically boosts H&H
-usually if hemoglobin is <8.0
-1 unit should increase Hgb by 1g/dl in a 70kg adult
-no clotting factors
-Risk for Blood born pathogens
Term
Platelets
Definition
Used for thrombocytopenia and continued hemorrhage
-one unit (30-60 ml) raises it 30k-50k
NO compatibility testing needed, but do NEED Rh factor
--Risk of blood born pathogens
Term
Fresh Frozen Plasma
Definition
Restores clotting factor and plasma protein
-Need cross matching but not Rh- should be ABO compatible
-One unit = 200-250 mls
Thawed in water bath
--Risk for blood born pathogens
Term
Albumin
Definition
Hypovolemic shock and trauma, hypoalbuminemia (ascites, 3rd spacing)
-Moves water from extravascular to intravascular space
-5% to 25% solution
--risk of hypersensitivity and blood born pathogens
Term
Cryoprecipitate
Definition
Replacement of clotting factors VIII and fibrinogen
-Rh compatibility not needed
-10-20mls/bag
Contains hemagglutinins
Risk of hemolysis
Term
Donor for Blood type A
Definition
A and O
Term
Donor for Blood type B
Definition
B and O
Term
Donor for Blood type AB
Definition
universal recipient--A, B, AB, O
Term
Donor for Blood type O
Definition
Universal donor--O
Term
Rh Factor
Definition
Presence of D antigen
--Should not be exposed to Rh+ blood
May cause severe hemolytic reaction
Term
Administration Procedure for Blood Products
Definition
-Physicians order
-discuss religious/cultural beliefs about transfusion
-patient consent
-Type and Crossmatch
-Blood band on patient
-18 gauge or larger IV access
-Special Y-tubing and filter
--only with normal saline, blood can not be on the floor for more than 20 minutes
-Must have 2 RN's
-Invert bag
-Establish baseline vitals
-remain with pt for first 15 minutes
-Take vitals q15 minutes for first hr., maximum infusion time=4hrs.
Term
Febrile Reaction
Definition
Most common reaction to blood
-symptoms may often occur in the first 15 min. or delayed
s/s: chills, fever, headache, muscle pain
-WBC incompatibility
-often occurs with hx of multiple transfusions: need filter, washed cells, antipyretic
Term
Allergy/Hypersensitivity Reactions
Definition
Sensitivity to blood donor's plasma proteins
-may be mild or anaphylactic
s/s: wheezing, reddened wheal on skin, itching, dyspnea, edema, shock, anaphylaxis
-occur during or after transfusion
TX: antihistamines for prevention, epinephrine and/or steroids for severe reaction
Term
Acute Hemolytic Reaction
Definition
Caused by infusion of incompatible blood
-clotting RBCs may cause organ damage
-Free Hgb may block renal tubules causing renal failure
-Often after 100-200mls of incompatible blood
s/s: initial burning along IV site, flushing face, chills, fever, SOB, lower back pain, chest pain, tachycardia, hypotension, dark urine, jaundice
TX: prevention by careful checking of id to blood
-obtain specimens
-treat shock, maintain urine output (possible foley)
-need new type and crossmatch prior to next transfusion
Term
Circulatory Overload
Definition

Identify patients at risk s/s: crackles, SOB, JVD transfuse slowly lasix may be fiven between units

 

(like fluid overload)

Term
Massive Transfusion Reaction
Definition
Caused by infusing large volumes of blood too quickly
--imbalance blood factors (clotting factor, albumin, platelets not in RBCs)
-hypothermia, hyperkalemia, citrate toxicity causing hypocalcemia
--monitor electrolytes and use blood warmers
Term
Delayed Transfusion Reactions
Definition

Infections:(blood born/transmitted infections)

 Hepatitis B and C Human herpes virus type 6 HIV HTLV-1 CMV Malaria West Nile Virus

Term
Slow or Stopped Transfusion
Definition
Check bag height, check flow clamp
-make sure blood covers filters
-gently rock bag to agitate cells
-squeeze tubing or flash bulb
-untape dressing and check site
-dilute w 50-100cc normal saline
Term
Autotransfusion
Definition
Autologous donor
-pt. may donate their own blood prior to surgery, may be frozen
-good for rare blood types, reaction and disease may be avoided
AUTOTRANSFUSION
-collection device used to collect, filter and return blood lost in surgery or trauma
-clots may occur and prevent re-transfusion
-may lack coagulation factors
Term
Aortic Aneurysm
Definition
An out pouching or dilation of the arterial wall, frequently involving the aorta
-most are found in the abd. aorta below the renal arteries
but may also occur in the thoracic or popliteal or femoral artery
-occurs more in men
Term
Risk factors for Aortic Aneurysm
Definition
Risk increases with age, >65 y.o.
-smoking
-Atherosclerosis & arteriolsclerosis
-HTN
-Trauma
-Marfan syndrom: changes the structure of BVs
Term
True Aneurysm
Definition
Affects all the layers of the vessel wall
-Fusiform: uniform in shape (symmetrical dilation, regular shape)
-Circumferential: all the way around the diameter
Term
False Aneurysm
Definition
Trauma causes a disruption of all the layers of the arterial wall leading to a contained bleed
Saccular: out pouching of the vessel wall
Berry: congenital, often happens in the brain
Term
Dissecting Aneurysm
Definition
Aneurysm that has a break causing blood to leak out
--LIFE threatening emergency
Term
Symptoms of Aortic Aneurysm
Definition
Symptoms develop slowly and aneurysm may rupture without warning
Common ones: thoracic, abdominal, femoral, popliteal
Term
Abdominal Aneurysm Symptoms
Definition
pulsating mass, midabdominal or lumbar back pain, cool, cyanotic extremities, claudication
Term
Thoracic Aneurysm Symptoms
Definition
back, neck, chest pain, dyspnea, hoarseness, dysphagia, edema of the face and neck, JVD
Term
Popliteal and Femoral Aneurysms Symptoms
Definition
Intermittent claudication, pain at rest, numbness, pulsative mass in popliteal fossa
Term
Symptoms of Dissecting Aneurysm
Definition
Extremely sudden, excruciating pain (tearing or ripping sensation
syncope (pass out)
dyspnea
BP increases then drops out
Term
Complications of Aneurysm
Definition
Rupture: most common (mortality 50%), pt. may bleed to death, need emergency surgery, massive bleeding into abd cavity or retroperitoneal space
-weakness, paralysis
-ischemia/infarction of major organs
-aortic regurgitation
Term
Diagnostic Tests for Aneurysm
Definition
Often in physical exam or Chest X-ray done for other conditions
-CT scan most accurate test to determine the size
ABD, femoral, extremity US
EKG
Angiography- assess involvement of other vessels
Transesophogeal echo (TEE)
Term
TX of Aneurysm
Definition
Prevent rupture!
-assess size, location and surgical risk
-Keep BP under control: long term beta blockers, nipride, calcium channel blockers
Constant VS and UO monitoring
Term
Surgical Repair of Aneurysm
Definition
Only if: >5cm, growing rapidly, pt. is symptomatic
Endovascular stent graft: metal sheath with fabric covering placed through femoral artery, shorter hospital stay, lower cost, fewer complications
Open Sugery: remove aneurysm, insert synthetic fabric graft, requires about 6 day hospital stay, 8 week rehab
--need long term anticoagulant therapy
Term
Disseminated Intravascular Coagulation
Definition
DIC: a serious bleeding disorder including both clotting and bleeding
-always caused by an underlying condition
-Can be mild to life threatening
-Can affect one organ or can be widespread and eventually cause multiple organ failure
Term
Patho of DIC
Definition
Tissue damage or toxins activates clotting cascade
-excessive thrombin cause accelerated clotting
-thrombi and emboli cause ischemia and necrosis
-decrease in clotting factor and platelets
-clots break down
-leads to uncontrollable bleeding
Term
Causes of DIC
Definition
Trauma
Sepsis
OB complication
Cancer
Fat Embolism
Aortic Aneurysm
Acute glomerulonephritis
Term
Symptoms of DIC
Definition
Bleeding: oozing or bleeding from incisions and punctures sites
-bruising, purpura, petichea
-GI bleeding
-hemoptysis
-tachycardia, hypotension
-hematuria, renal failure
-increased ICP
Clotting
-cyanosis or extremities
-dyspnea, tachypnea
-Mental status change
Term
Diagnosis of DIC
Definition
clotting tests are prolonged (PT, PTT)
raw materials used for clotting are decreased
Fibrin degradation products are elevated, D-dimer elevated
CBC and Platelets
Term
Treatment of DIC
Definition
Diagnose quickly, resolve underlying problem
-blood products (platelets, FFP)
-Anticoagulant therapy
-symptomatic treatment
Term
Top Nursing Priorities for DIC patients
Definition
1. Ineffective tissue perfusion r/t decreased blood flow: assess extremities, cap refill, pulses
-do not elevate legs, minimize invasive procedures
2. Impaired gas exchange r/t clots: O2 sat. monitoring, bed rest in high fowlers
3. Pain r/t ischemia: handle gently, cool compresses
4. Fear r/t uncertain prognosis
-maintain calm environment, respond promptly to calls
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