Term
| What does bone marrow make? |
|
Definition
| RBC, WBC, and Platelets. Also involved in immune responses |
|
|
Term
| In adults - what bones have bone marrow? |
|
Definition
| sternum, skull, pelvic & shoulder girdles & the end of long bones |
|
|
Term
| What happens to bone marrow with aging? |
|
Definition
| fatty tissue slowly replaces active bone marrow |
|
|
Term
Where is erythopoietin made?
What is it important for? |
|
Definition
In the kidneys
growth factor for RBC |
|
|
Term
| What are the three major types of plasma proteins? |
|
Definition
Albumin
Globulins
Fibrinogen |
|
|
Term
| What is the main function of albumin? |
|
Definition
| maintaining osmotic pressure of the blood, preventing leakage into tissues |
|
|
Term
| What are some functions of globulins? |
|
Definition
| transporting other substances, protecting body againstinfection (immunoglobulins) |
|
|
Term
| What is the function of fibrinogen? |
|
Definition
| inactive protein that is activated to form fibrin |
|
|
Term
| What is the pargest proportion of blood cells? |
|
Definition
|
|
Term
| What is the lifespan of a health mature RBC? |
|
Definition
| 120 days after being released into the blood |
|
|
Term
| what produces hemoglobin? How much? |
|
Definition
| RBC's produce hemoglobin. each normal mature RBC contains hundres of thousands of hemoglobin modules. |
|
|
Term
| What is an essential part of hemoglobin? |
|
Definition
|
|
Term
| What carries carbon dioxide? |
|
Definition
| The globin portion of hemoglobin |
|
|
Term
| Are RBC considered a buffer ? |
|
Definition
|
|
Term
| What would happen if we had too many RBCs |
|
Definition
| Blood would thicken and slow its flow |
|
|
Term
| What is the trigger for RBC production? |
|
Definition
| increase in the need for tissue oxygenation |
|
|
Term
| What happens when tissue oxygenation is less than normal? |
|
Definition
| Kidneys release erythopoietin |
|
|
Term
| Substances needed to form hemoglobin |
|
Definition
| iron. B12. folic acid. copper. pyridoxine, cobalt, and nickel. |
|
|
Term
| what are the smallest blood cells? |
|
Definition
|
|
Term
|
Definition
| precursor cell in bone marrow responsible for platelets. |
|
|
Term
| What happens to the tounge in perniciousanemia andiron deficient anemia? |
|
Definition
|
|
Term
| what would a beefy red tounge indicate? |
|
Definition
|
|
Term
|
Definition
| The number of RBCs in the blood is greater than normal |
|
|
Term
| What is different about the blood of a person with polycythemia? |
|
Definition
| It is hyperviscous (thicker than normal blood) |
|
|
Term
|
Definition
A cancer of the RBCS
Massive production of RBCs, excessive leukocyte production, and excessive platelet production.
sustained increase in blood
hemoglobin levels to 18g/dL, a RBC count of 6million/mm, or a hct of 55% or greater |
|
|
Term
|
Definition
| cell excess. This is seen in extremes in the peripheral blood of people with PV |
|
|
Term
|
Definition
|
|
Term
| What do teh facial skin and mucous membranes of a patient with PV look like? |
|
Definition
| Dark, flushed appearance. Purplish or cyanotic because blood in tissues is poorly oxygenated. |
|
|
Term
| What causes intense itching in patients with PV? |
|
Definition
| dilated blood vessels and poor tissue oxygenation |
|
|
Term
| What causes hypertension in patients with PV? |
|
Definition
| thick blood moving slowly through tissues placing greater demands on the heart |
|
|
Term
| what will superficial veins look like on the patient with PV? |
|
Definition
|
|
Term
| What is vascular statis called? |
|
Definition
| thrombosis (clot formation) |
|
|
Term
| What causes infarction & necrosis in patients with PV? |
|
Definition
| clot formation within the smaller vessels occluseds blood vessles causing hypoxia |
|
|
Term
| What tissues are at most risk for infarction & necrosis in a patient with PV? |
|
Definition
|
|
Term
| Why are gouut and hyperkalemia problems for patients with PV? |
|
Definition
| cell life is shorter, so there is great cell turnover. when blood cells are destroyed their contents are released, including uric acid and potassium. |
|
|
Term
| Do patients with PV have bleeding problems? |
|
Definition
| Yes. platelet impairment causes bleeding problems |
|
|
Term
| Since there are so many RBCs in PV, are patients well oxygenated? |
|
Definition
| No. There are lots of cells but they don't work good. patients are hypoxic |
|
|
Term
| Left untreated how long do patients with PV live? |
|
Definition
|
|
Term
| How long may patients with PV live with treatment? |
|
Definition
| 10 to 15 years longer than the 2 years they would have lived without treatment |
|
|
Term
| What is treatment for PV? |
|
Definition
| Pheresis, hydration, promoting venous return, and anticoagulatn therapy |
|
|
Term
|
Definition
Treatment for PV
Withdrawl of whole blood and removal of the patient's RBCs to decrease the number of RBCs and reduce blood viscosity. plasma is then reinfused |
|
|
Term
|
Definition
drink at least 3 litres of liquids per day
Avoid tight or restrictive clothing
Wear gloves outdoors in cool/cold temps
Keep all health related appointments
contact your MD at first sign of infection
Take anticoagulants as prescribed
Wear support hose or stockings when you are awake and up
Elevate your feet when seated
Exersize slowly and on the advice of your MD
Stop activity at the first sign of chest pain
Use an electric shaver
Soft bristled toothbrush
Do not floss |
|
|
Term
| Why isn't agressive chemo used to treat PV? |
|
Definition
|
|
Term
|
Definition
Hemophilia A (Classic hemophilia)
deficiency of factor VIII. 80% cases
Hemophilia B (Christmas disease)
Deficiency of factor IX 20% of cases |
|
|
Term
|
Definition
|
|
Term
| What percentage of patients with hemophilia have no family history? Where did the disease come from? |
|
Definition
| 30%. It is thought to be a new mutation |
|
|
Term
| How is hemophilia transmitted? |
|
Definition
| Genetically from mothers to 50% of her offspring. |
|
|
Term
| What percentage of sons of a woman carrying the hemophilia gene will be affected by the disease? |
|
Definition
|
|
Term
| What percentage of daughters of a woman carrying the hemophilia gene will be affected by the disease? |
|
Definition
|
|
Term
| What percentage of daughters of a woman carrying the hemophilia gene will be carriers of the disease? |
|
Definition
|
|
Term
| What percentage of sons of hemophilliacs will be affected by the disease? |
|
Definition
|
|
Term
| What percentage of daughters of hemophiliacs will be carriers of the gene? |
|
Definition
|
|
Term
| What is the clinical presentation of a patient with hemophilia? |
|
Definition
| Abnormal bleeding in response to any trauma. Do not bleed more often or more rapidly, but for a longer period. Clotting factor deficiency impairs the formation of stable fibrin clots which allows excessive bleeding. |
|
|
Term
| Assessment of a patient with hemophilia |
|
Definition
Excessive bleeding form minor cuts, bruises, or abrasions
Joint and muscle hemmorrhages that lead to disabilitating long term problems requiring joint replacement
Tendency to bruise easily
Prolonged and potentially fatal hemorrhage after surgery |
|
|
Term
What will the lab results for a patient with hemophilia show?
Ptt
Pt |
|
Definition
Prolonged partial thromboplastin time
Normal bleeding time
Normal prothombin time |
|
|
Term
| How is hemophilia A treated? |
|
Definition
| either regularly scheduled infusions of synthetic factor VIII or factor VIII cryoprecipitate or intermittent infusions ans needed |
|
|
Term
| Why is factor VIII replacement prohibitive for many patients with hemophilia? |
|
Definition
|
|
Term
| Where does factor VIII replacement come from? |
|
Definition
| pooled human blood and some animal sources |
|
|
Term
| What is the volume of packed red blood cells (PRBCs) and what is the infusion time? |
|
Definition
| 200-250ml infused over 2-4 hours |
|
|
Term
| Indications for infusion of packed red blood cells? |
|
Definition
Anemia;
Hemoglobin < 6g/dl or 6-10g/dl dependent on symptoms |
|
|
Term
| What is the volume of washed red blood cells (WBC-poor PRBCs) and what is the infusion time? |
|
Definition
| 200ml infused over 2-4 hours |
|
|
Term
| What is the indication for infusion of washed red blood cells? |
|
Definition
history of allergic transfusions reactions
hematopoietic stem cell transplant patients |
|
|
Term
| Volume and infusion time for pooled platelets |
|
Definition
| about 300 ml infused over 15-30 mins |
|
|
Term
| indications for infusion of pooled platelets |
|
Definition
thromocytopenia.
Platelet count <20,000
Patients who are actively bleeding with a platelet count <50,000 |
|
|
Term
| Volume and infusion time for single donor platelets |
|
Definition
| 200 ml infused over 30 minutes |
|
|
Term
| Indications for single donor platelet transfusion |
|
Definition
| history of febrile or allergic reactions |
|
|
Term
| Volume and infusion time for fresh frozen plasma |
|
Definition
| 200ml infused over 15-30 minutes |
|
|
Term
| Indications for infusion with fresh frozen plasma |
|
Definition
Deficiency in plasma coagulation factors
Prothombin or partial thromboplastin time 1.5 times normal |
|
|
Term
| Volume & infusion time for cryoprecipitate |
|
Definition
| 10-20ml/unit infused over 15-30 minutes |
|
|
Term
| Indications for infusion of cryoprecipitate |
|
Definition
Hemophilia VIII or von willebrand's disease
Firbinogen levels < 100mg/dl |
|
|
Term
| Volume & infusion time for WBC |
|
Definition
|
|
Term
| Indications for infusion of WBC |
|
Definition
| Sepsis, neutropenic infection not responding to antibiotic therapy |
|
|
Term
| Legally, a physician's prescription is required for transfusions. What should the prescription state? |
|
Definition
type of product
dose
transfusion time |
|
|
Term
| How soon must a red blood cell transfusion be completed after removal from refrigeration? |
|
Definition
|
|
Term
| What is the most common cause of ABO incompatibility reactions? |
|
Definition
|
|
Term
| 6 steps to take before infusing blood |
|
Definition
Assess lab values
Verify the order
Assess patients VS, urine output, skin color, and history of transfusion reactions
Obtain venous access. Use a central catheter or at least a 20 gauge needle if possible
Obtain products from blodo bank.
Perform all required safety checks
with another registered nurse, verify the patient name and number, check blood compatibility, and note expiration time |
|
|
Term
| Why are filtered tubings needed to administer blood products? |
|
Definition
| to remove aggregates and possible contaminants |
|
|
Term
| What would happen if you diluted blood products with something other than normal saline? |
|
Definition
|
|
Term
| How long should you stay with the patient when delivering a blood infusion |
|
Definition
| the first 15 to 30 minutes |
|
|
Term
| 5 steps during blood administration |
|
Definition
Administer blood using appropriate filtered tubing
dilute blood with only normal saline
remain with the patient for the first 15 to 30 mins
infuse the product at the prescribed rate
monitor VS |
|
|
Term
| why is it important to propery dispose of bag and tubing after blood transfusion? |
|
Definition
| bloodbourne pathogens may be spread inadvertantly through improper disposal |
|
|
Term
| Two steps after blood transfusion |
|
Definition
Discontinue infusion and properly dispose of bag and tubing
Document type of pruduct, product number, volume infused, time of infusion, and any adverse effects |
|
|
Term
| What gauge needle must be used to adminiter blood componants? why? |
|
Definition
| at least 20-gauge because blood is thick |
|
|
Term
| What kind of tubing sets are used for blood infusions? |
|
Definition
| Y tubing and straight tubing sets |
|
|
Term
| What products can be given with blood infusions? |
|
Definition
| None. they may clot the blood during infusion |
|
|
Term
| What is the priority action prior to giving a blood transfusion? |
|
Definition
| Determine that the blood component delivered is correct ant that the identification of the patient is correct |
|
|
Term
| IS the patient's room number an acceptable form of identification for blood transfusions? |
|
Definition
|
|
Term
| Who must be one of the nurses comparing the patient's identification with the information on the blood component bag? |
|
Definition
| The nurse who will actually be administering the blood products |
|
|
Term
| What visible signs are signs of bacterial growth or hemolysis in bags of blood products? |
|
Definition
| discoloration, gas bubbles, or cloudiness |
|
|
Term
| When will a severe reaction to a blood transfusion typically occur? |
|
Definition
| within the first 50mL of blood |
|
|
Term
| After the initial 50mL, how often must vital signs be checked while a blood transfusion is being given? |
|
Definition
| every hour or per hospital policy |
|
|
Term
| What are signs that the patient needs to report immediutely if felt during a blood transfusion? |
|
Definition
| chills, SOB, hives, itching. |
|
|
Term
| What is the electrolyte imbalance concern when transufsing RBCs or whole blood? |
|
Definition
Hyperkalemia.
Potassium is the main electrolyte inside cells. during transfusion, some cells are damaged, releasing potassium and raising the patient's erum potassium level. This problem is more likley when the blood was frozen or is several weeks old |
|
|
Term
| when are patients given RBC's |
|
Definition
| hemoglobin level of less than 8g/dl or who are hypoxemic or otherwise symptomatic |
|
|
Term
| whare platelets given to? |
|
Definition
| patients with platelet counts below 10,000/mm3 ant to patients with thrombocytopenia who are actively bleeding or are scheduled for an invasive procedure |
|
|
Term
| How many people are usually pooled into one platelet transfusion? |
|
Definition
|
|
Term
| Do platelet donors need to have the same blood type as the recepient? |
|
Definition
|
|
Term
| what kind of tubing is used to administer platelets? |
|
Definition
| a special set with smaller filter and shorter tubing. Additional filters can be used to remove WBC for patients who have a history of febrile reactions. |
|
|
Term
| Why aren't standard blood administration sets used for platelets? |
|
Definition
| because the filter traps the platelets and the longer tubing increases platelet adherence to the lumen |
|
|
Term
| A patient who has had a previous transfusion reaction would be given what before the administration of platelets? |
|
Definition
| benadryl and acetaminophen |
|
|
Term
|
Definition
|
|
Term
| Are fever and rigors during transfusions signs of a true transfusion reaction? |
|
Definition
|
|
Term
| What can fresh plasma be used to treat? |
|
Definition
| given to replace blood volume |
|
|
Term
| What is fresh frozen plasma used for? |
|
Definition
| patients with clotting disorders. |
|
|
Term
| What patients are candidates for a FFP infusion? |
|
Definition
| patients who are actively bleeding with a PT or PTT greater than 1.5 times normal |
|
|
Term
| Is ABO compatibility required for transfusion of plasma products? |
|
Definition
|
|
Term
| How fast should plasma transfusions be given? |
|
Definition
| As fast as patient can tolorate, generally over 30-60 minutes through regular Y set or straight filtered tubing |
|
|
Term
|
Definition
| a product derived from plasma. Clotting factors VIII and XIII, von willebrand's factor, and fibrinogen are precipitated from pooled plasma to produce cryoprecipitate. |
|
|
Term
| What patients are candidates for a cryoprecipitate infusion? |
|
Definition
| patients with a fibrinogen level of less than 100mg/dl |
|
|
Term
| Acute transfusion reactions |
|
Definition
| febrile, hemolytic, allergic or bacterial reactions, circulatory overload, or transfusion related graft versus host disase. |
|
|
Term
| Signs and symptoms of febrile transfusion reactions |
|
Definition
| chills, tachycardia, fever, hypotension, and tachypnea. |
|
|
Term
| When are hemolytic transfusion reactions caused? |
|
Definition
| by blood type or Rh incompatibility. |
|
|
Term
| What causes DIC with blood transfusions? |
|
Definition
| Wrong blood type or Rh incompatibility |
|
|
Term
| Manifestations of hemolytic transfusion reactions |
|
Definition
apprehension
headache
chest pain
low back pain
tachycardia
tachypnea
hypotension
hemoglobinuria
sense of impending doom |
|
|
Term
| what patients are most at risk for alergic transfusion reactions? |
|
Definition
| patients with a history of allergy |
|
|
Term
| signs and symptoms of allergic transfusion reaction |
|
Definition
| urticaria, itching, bronchospasm, or anaphylaxix |
|
|
Term
| When is the onset of allergic transfusion reaction? |
|
Definition
| up to 24 hours after the transfusion |
|
|
Term
| What will patients with a history of blood transfusion allergy be given? |
|
Definition
| leukocyte reduced or washed RBCs in which the WBCs, plasma, and immunoglobulin A have been removed. This reduces the possibility of allergic reaction |
|
|
Term
| What is the cause of bacterial transfusion reactions? |
|
Definition
| Contaminated blood products |
|
|
Term
| what kind of organism is usually the source of contamination for blood products. Why? |
|
Definition
| gram negative organisms because they grow rapidly in blood stored under refrigeration. |
|
|
Term
| Symptoms of bacterial transfusion reactions |
|
Definition
| tachycardia, hypotension, fever, chills, and shock. |
|
|
Term
| What causes circulatory overload? when is it most common? |
|
Definition
| when blood product is infused too quickly. Most common with whole blood transfusions or when the patient receives multiple transfusions. Older adults are more at risk. |
|
|
Term
| Symptoms of circulatory overload with blood products |
|
Definition
hypertension
bounding pulse
distended jugular veins
dyspnea
restlessness
confusion |
|
|
Term
| How can circulatory overload be managed? |
|
Definition
monitoring I&O
Infusing blood slowly
giving diuretics |
|
|
Term
| When does GVHD occur with transfusions? |
|
Definition
rare. life threatening. immunosuppressed and immunocompetent patients
manifestations occur within 1-2 weeks. |
|
|
Term
| Signs and symptoms of Transfusion associated GVHD |
|
Definition
| thrombocytopenia, anorexia, nausea, vomiting, chronic hepatits, weight loss, and recurrent infection. |
|
|
Term
| Mortality rate with TA-GVHD |
|
Definition
|
|
Term
| how can TA GVHD be prevented? |
|
Definition
| by using irradiated blood products. irradiation reduces T cells and their cytokine products |
|
|
Term
| What is an autologus blood transfusion? |
|
Definition
| collection and infusion of the patient's own blood. |
|
|
Term
| What is the purpose of an autologus blood transfusion? |
|
Definition
| reduces the risk for transmitting bloodborne diseases. |
|
|
Term
| four types of autologus blood donation |
|
Definition
Pre-op donation
acute normovolemic hemodilution
intraoperative autologus transfusion
post-op blood salvage |
|
|
Term
| How long can fresh packed RBC's be stored? |
|
Definition
|
|
Term
| For patient with rare blood types, how long can blood be frozen for? |
|
Definition
|
|
Term
| What is acute normovolemic hemodilution? |
|
Definition
| withdrawl of a patient's RBCs and volume replacement just before a surgical procedure. Goal is to decrease RBC loss during the surgery. Blood is stored at room temp and reinfused after surgery. Not used for anemic patients or those with poor kidney function |
|
|
Term
| What is intraoperative autologous transfusion and blood salvage after surgery? |
|
Definition
| recover and reinfusion of a patients own blood from an operative field or a bleeding wound. Special devices collect, filter, and drain the blood into a transfusion bag. must be reinfused within 6 hours |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| reduction in either the number of RBCs, the amount of hemoglobin, or the hematocrit (percentage of RBCs per DL of blood) |
|
|
Term
| What is the most common cause of anemia in adults? |
|
Definition
|
|
Term
|
Definition
| Gi bleeding, bone marrow disease, dietary problems, genetic disorders, excessive bleeding |
|
|
Term
|
Definition
| prolonged penile erection that can occur with men who have SCD. Painful. Can last for hours. Cannot urinate |
|
|
Term
| What percentage of SCD patients have open sores on lower legs caused by poor tissue perfusion? |
|
Definition
|
|
Term
| Are patients with CSD iron deficient? |
|
Definition
|
|
Term
| What organs are likely to be damaged by SCD |
|
Definition
|
|
Term
| What would a rapidly enlarging spleen or liver with increasing jaundice in a patient with SCD indicate? |
|
Definition
|
|
Term
| What is the WBC count of a patient with SCD? |
|
Definition
|
|
Term
| Priority problems for patients with SCD |
|
Definition
Acute pain r/t poor oxygenation
Chronic pain r/t joint destruction
Potential for sepsis
Potential for multiple organ dysfunction and death |
|
|
Term
|
Definition
|
|
Term
| How often should periperal circulation be assessed in a patient with SCD? |
|
Definition
|
|
Term
| What does drug therapy for patients in acute sickle cell crisis start with? |
|
Definition
| 48 hours of IV analgesics Morphine and hydromorphone (dilaudid)using pump or PCA |
|
|
Term
| how should PRN meds be used for patients in sickle cell crisis? |
|
Definition
| Avoided. They are not adequate to provide pain releif |
|
|
Term
| Why should IM injections be avoided for SCD patients? |
|
Definition
| absorbtion is impaired by poor perfusion and sclerosed skin |
|
|
Term
| How is hydroxyurea (droxia) used to reduce the number of sickling episodes? |
|
Definition
| stimulates fetal hemoglobin production. Incresing this level reduces sickling of red blood cells. This drug is associated with increased instance of leukemia. Hydroxurea supresses bone marrow function. Also causes birth defects |
|
|
Term
| What patient teaching is important for women taking hydroxyurea? |
|
Definition
| Sexually active women of childbearing age should use at least two methods of birth control while taking this drug and for one month after it is discontinued because it can cause serious birth defects |
|
|
Term
| Why are hypotonic fluids infused for SCD patients in crisis? |
|
Definition
| D5 in water or D4 in 1/2 NS infused at 250 over 4 hrs. Patients blood volume is usually hypertonic as a result of dehydration. Using hypotonic fluids can help bring down the blood osmolarity to the noraml range. |
|
|
Term
| Why are patients with SCD at greater risk for bacterial infection? |
|
Definition
| because of decreased spleen function. |
|
|
Term
| Any person entering the room of a person with a SCD crisis who has an URI should wear what? |
|
Definition
|
|
Term
| How often shoudl patients with SCD crisis be assessed for mouth lesions indicating fungal or viral infections? |
|
Definition
|
|
