Study GuideExam #3 - IV

1. . Review the ABO System and the Rh System: know the universal Donor and
Universal Recipient Table 11-1 and 11-2 Page 687.
Blood Groupings

Recipient Antigens on
RBCs

Antibodies Present in
Plasma

Anti-B

Anti-A

AB

A&B

None

None

Anti-A & Anti-B

Rh system:
- 2nd most important antigen is the D antigen
Presence of D antigen = Rh+
Absence of D antigen = Rh- 5 Principle antigens: D, C, E, c and e
Universal Donor = O-negative
Universal Receiver = AB-positive
What are the factors that we look at when we are typing and crossing patient?
- Donor blood
- Recipient blood
Look for the:
1) Rh and ABO factors (Type)
2) HLA Antigen = important in patients with transplants or
multiple infusions and paternity typing
2. The Components of Blood and their uses: Table 11-5 page 729-731
Whole Blood = RBCs, Plasma, WBCs and platelets
- 500 mL -------> 200 mL - RBCs & 300 mL - Plasma
Red Blood Cells (Packed Cells)
- 300 mL (Anemia = low hgb)
Look at Hematocrit (RBC%) Level = tells allergy significant level
- Want free of particular matter - FILTERED (Poll Blood filter)
= microfiber filter out LEUKOCYTES
(PREVENTS FEBRILE, NON-HEMOLYTIC TRANSFUSION RXNS)
Granulocytes = Neutropenic (low white blood count)
- Not reactive to new-last or neupogen
Plasma = replenish fluid and protein lost from injury/bleed

( < 14 M; <12 F = Thrombocytopenia)

Storage of blood:
1) Food source must be provided to maintain adequate nutrition to
the stored cells
2) Anticoagulation must be achieved to ensure that the blood
remains in its liquid cellular state for the duration of the
storage period
3. Blood Donor testing: Slide 5/6 Power Point
Specific Screening Test:
Hepatitis B surface antibent (HBxHg)
Hepatitis B core antibody (anti-HBc)
Hepatitis C virus antibody (anti-HCv)
HIV-1 and HIV-2 antibody (anti-HIV & anti-HTV-2)
Serology for syphilis
Nucleic aid amplification testing (NAT) for HIV-1 and HCV
NAT for West Nile Virus (WNV)
Recipients Tested for ABO and Rh
- Antibody screening and compatibility testing
- Blood bank has 2 objectives
1) Prevent antigen-antibody reactions in the body
2) Identify antibody that the recipient may have and to
supply blood that lacks the corresponding antigen
4. Steps in the administration of Blood components:
1) Verifying the Physicians Order
2) Blood typing and Crossmatching the Recipient
ABO & Type
3) Selecting and Preparing the Equipment
a. Catheters
b. Solution - hang with NS
c. Administration Set
d. Special Filters - Pall Blood filter
e. Fluid/Blood Warmers
4) Preparing the Patient
5) Obtaining blood product from the blood bank
** Blood out of refrigerator for 4 HOURS **
6) Preparing for Administration
7) Initiating Transfusion
8) Monitoring the Transfusion
9) D/C the Transfusion

5. Types of transfusion reactions: Table 11-8 Pages 736-740

Etiology

S/S

Key Interventions

Prevention

Hemolysis occurs when

antibodies in plasma attach to
antigens on the donors
RBCs
- C/b infusion of ABOincompatible RBCs

- Fever w/ or w/out
chills
- Tachycardia
- Abdominal,chest,
flank, back pain
- Hypotension
- SOB
- Red/dark urine
- Shock

- STOP TRANSFUSION!!!!
- Get help immediately
- Change administration set
and infuse NS
- Treat shock
- Maintain BP/renal
perfusion
- Administer diuretics to
maintain blood flow

Exercise extreme care

during the entire
identification process
- Start infusion slowly and
monitor for first 15
minutes

- Occurs as a result of
antibodies directed against
leukocytes or platelets
- Febrile reactions occur
immediately or 1-2hrs after
infusion in complete

- Fever rise of 1 C
(2 F) in
association w/
transfusion
- Chills
- Headache
- Vomiting

- STOP TRANSFUSION!!!!
- Change administration set
and infuse NS
-Notify the LIP
- Monitor VS
- Anticipate order for
antipyretic agents
- If ordered, restart
transfusion

- Use leukocyte-reduced
blood transfusion

- C/b recipient sensitivity to

allergens in the blood
component

- Itching
- Hives (local)
- Urticaria
- Facial Flushing
- Runny eyes
- Anxiety
- Angioedema

- STOP TRANSFUSION!!!!
- Keep the vein open w/ NS
- Notify the LIP
- Monitor VS
- Anticipate antihistamine
order
- If ordered, restart
transfusion slowly
- Mild reactions can precede
severe allergic rxn,

- If known mild allergic

reaction occurs w/ blood
transfusion, may
premedicate with
diphenhydramine 30
minutes before the
transfusion

- Antibodies to donor blood

plasma

- Hypotension
- Urticaria
- Bronchospasm
- Anxiety
- Shock

- STOP TRANSFUSION!!!!
- Keep the vein open w/ NS
- Administer CPR if
necessary
- Anticipate order for
steroids
- Maintain BP

- Use autologous blood

- Use blood from donors
who are IgA deficient or
administer only wellwashed RBCs in which
all plasma has been
extracted

- Fever (continual,
low grade)
- Malaise
- Jaundice (mild)
- Decreased
hematocrit and
hemoglobin
- Increased bilirubin

- NO acute tx required
- Monitor hematocrit level
- Renal function
- Coagulation profile
- Notify LIP and transfusion
services

- Exercise extreme care

during the entire
identification process

Delayed Transfusion
Reactions

- Result of RBC antigen

incomptability other than
the ABO group
- Occur due to destruction of
transfused RBCs by
alloantibodies not
discovered during the
crossmatch procedures

TRANSFUSION
ASSOCIATED GRAFTVERSUS-HOST
DISEASE
(TA-GVHD)

- Rare and fatal

- Viable t-lymphocytes in
transfusion component
engraft in recipient and react
against recipient tissue
antigens
- Highest risk in the
immunocompromised pt

- Fever
- Maculopapular
rash
- ^ levels on hepatic
function tests
- Watery diarrhea
- Pancytopenia

- No effective therapy
- Tx of symptoms

- Adminster irradiated
blood products in
immunocompromised
pts.

Acute hemolytic
transfusion reaction

FEBRILE
NONHEMOLYTIC
REACTION

Allergic Reactions
(Mild)

Severe Allergic
Reactions; Anaphylaxis

Check when giving a Unit of blood

1) ABO and Type of blood (Rh)
2) Unit number = number on recipients armband; on anything the pt. is receiving
3) Expiration date
6. What are the goals of parenteral nutrition - Slides 4 & 5
Goals:
- Provide all essential nutrients in adequate amounts to sustain
nutritional balance during periods when oral or enteral
routes of feedings are not possible or are insufficient to
meet the patients caloric needs
- Preserve or restore the bodys protein metabolism and prevent the
development of protein or caloric malnutrition
- Diminish the rate of weigh loss and to maintain or increase body
weight
- Promote wound health (^ protein)
- Replace nutritional deficits
7. What are the components of Total Parental Nutrition
TPN = HYPERTONIC Solution
1) Carbohydrates: Provide energy
= 10-20% Dextrose
2) Protein: body-building nutrient, functions to promote tissue growth and
repair and replacement of body cells
= 8 essential Amino Acids
3) Lipids (Fats): primary source of heat and energy
= Essential for the structural integrity of ALL cell membranes
- Fewer problems with glucose homeostasis
- carbon dioxide production is lower
- Hepatic tolerance may improve
= fatty acids ---> repair the body
Others Additives:
Eletrolytes: infused as a component already contained in the amino acid
solution or as an additive
Vitamins: necessary for growth and maintenance, multiple metabolic
processes
- both fat and water soluble are needed
- Vitamin K can be given IM
Heparin,
Regular Insulin
Histamine 2 (H2) Inhibitors

8. How is TPN administered: ie Line, filter. Pages 796-797; 814

TPN delivered via a CVAD (any type = nontunneled, PICC, subQ
tunneled, or VAP) is the I.V. administration of HYPERTONIC
glucose (20%-70%) and amino acids (3.5%-15%), along with
all additional components required for complete support.
(Caller hyperalmentation or 2-in-1)
Lipids, Carbs & Proteins (TNAs) = 3-in-1
Filters:
- Use of a 0.22-micron filter = remove microoganisms
- Use of a 1.2-micron filter = formulas with lipids
*(Lipid solution = Watch for calcium precipitating out)*
- = get rid of w/ 70% ethonal (dissolves fat)
Sensible Loss = aware fluid floss = wound drainage, GI tract losses, & urination
INsensible loss = occurs daily through the skin (sweat & oil) and respiration
Tx: *Manage I/Os *
9. What patients are candidates for Nutritional support. p. 814
Candidates for nutritional support include those with:
- Altered catabolic states
- Chronic weight loss
- Conditions requiring bowel rest - Short bowel syndrome
- Excessive nitrogen loss
- Hepatic or renal failure
- Hypermetabolic states
- Malabsorption states
- Malnutrition = look at what the pt. is lacking
- unable to intake nutrients > 3-5 days = parenteral feed
= MC in ICU patients (comatose pts = mixed nutr.)
- Multiple trauma
- Serum albumin levels below 3.5 g/dL
Nutritional Assessment includes:
- Hx (medical, social, dietary)
- Anthropometeric measurements (height, weight, skinfold tests, midarm
circumference)
Skinfold test = uses a capiller
- Laboratory testsing (serum albumin, serum transferrin, prealbumin and
retinal-binding protein, total lymphocyte counts, serum electrolytes)
- Energy requirements
- Physical examination

10. Review complications of Total Parenteral Nutrition: Table 12-8 Pages

801-803
- VAD-related complications
- Metabolic complications
- Nutritional complications
11. In chapters 3,and 6 read the information on peds and geriatrics
Pediatric Infusion Therapy
- Physiological changes must be kept in mind:
= total body weight (85%-90% water)
- heat production
- immature renal and integumentary systems (reg F&E needs)
- Physical assessment: - measuring the head circumference ( 1yo)
- checking height/length
- VS
- Skin turgor
- Presence of tears
- moistness and color of membranes
- urinary output
- characteristics of fontanelles
- level of childs activity
- Peripheral routes include :
- four scalp veins,
- dorusm of the hand and forearm,
- lower extremities prior to walking age
- Selection of PIV equipment must keep in mind the pts safety, activity,
age and size
- Needle selection depends on the age of the child = 22- to 26-gauge
- Use small volumes of solution (250-500 mL); use a VSS and, when
indicated infusion pumps
- Always have extra help when starting an IV in a child
- Perform venipuncture in a seperate room, use a pacifier for neonates and
infants, warm your hands before applying gloves, and use stickers
or drawing as rewards
- Delivery of medications to children can be by intermittent infusion,
retrograde infusion, or syringe pump
Geriatric Infusion Therapy
- Physiological changes include:
- decreased renal function
- decreased drug clearance
- increased rx for infection as a result of immunosuppression
- cardiovascular changes = alt. electric thinning of the vein walls

- skin losses (THINing)

- subcutaneous support ----> look for sensory deficit
- thinning of skin
- Assessment includes:
- skin turgor
- temp
- rate and filling of vein in hand or foot
- daiy weight
- I/O
- postural blood pressure
- swallowing ability
- functional assessment of pts ability to obtain fluids if not NPO
- Venipuncture techniques should take into consideration the skin and vein
changes of elderly persons.
= USE SMALL-GAUGE CATHETERS,
BLOOD PRESSURE CUFF, OR
PLACE A LOOSE TURNIQUET OVER CLOTHING
- Use WARM COMPRESSES to visualize veins
- Consider microdrip adminstration sets
12. Read the chapter on TPN and Blood transfusions.
Draw blood = Turn TPN off 3-5 mins prior to draw blood
- flush vigorously prior w/ 5mL NS
- done flush 20mL NS
* TPN can be around-the-clock ---> flush vigorously w/20mL NS b/w bags*
= hang for 24 hours (Tx: hang new bag after 24hrs.)
13. Chemo therapy from the hand out focus on the last 4 slides.
SHORT TERM COMPLICATIONS OF Antineoplastics (CHEMO)
- Venous Fragility
- Alopecia
- Diarrhea
- Constipation
- Altered Nutritional Status
- Anorexia and Alteration in Taste
- Fatigue
ACUTE REACTION
- Hypersensitivity and Anaphylaxis
- Extravasation
- Stomatitis and Mucositis
- Myelosuppression
- Neutropenia

- Thrombocytopenia
- Anemia
TOXICITIES
- Neurotoxicity
- Cardiac Toxicity
- Pulmonary Toxicity
- Renal Toxicity
ROUTES OF ADMINISTRATION FOR CHEMOTHERAPY
- IV
- Intrathecal
- Regional
- Intra-arterial
- Intraperitoneal
- Cerebrospinal Fluid Reservoirs
- Infusion Pumps
14. Power point on Pain and Information on Pain in the book. Check the index
Patient-controlled analgesia (PCA) = a philosophy of treatment rathter
than a single method of drug administration
- Anticipating pain that is severe but intermittent
- Constant pain that gets worse with activity
- Old and young who can use it
- Ability to manipulate the dose button
- Pt. MUST be motivated to control pain
- Not already sedated from other medications