N304 Exam 1

Front 1

What is type screening?

Back 1

ABO typing and screening for antibodies in recipient’s blood

Front 2

What is type and cross-match?

Back 2

ABO typing, screen for recipient’s antibodies, mix donor’s serum with recipient’s. If agglutination occurs, no match. Blood is physically held for the recipient.

Front 3

What determines the blood group?

Back 3

Red blood cell surface proteins

Front 4

What are the blood types?

Back 4

1. Type A
2. Type B
3. Type AB
4. Type O

Front 5

What RBC antigen is found in Type A blood?

Back 5

A

Front 6

What plasma antibody is found in Type A blood?

Back 6

Anti-B

Front 7

What RBC antigen is found in Type B blood?

Back 7

B

Front 8

What plasma antibody is found in Type B blood?

Back 8

Anti-A

Front 9

What RBC antigen is found in Type AB blood?

Back 9

A & B

Front 10

What plasma antibody is found in Type AB blood?

Back 10

No antibodies

Front 11

What RBC antigen is found in Type O blood?

Back 11

No antigens

Front 12

What plasma antibody is found in Type O blood?

Back 12

Anti-A & Anti-B

Front 13

What donor type can Type A blood receive?

Back 13

A or O

Front 14

What donor type can Type B blood receive?

Back 14

B or O

Front 15

What donor type can Type AB blood receive?

Back 15

A, B, AB, or O

Front 16

What donor type can Type O blood receive?

Back 16

O only

Front 17

Which blood type is the universal recipient?

Back 17

AB

Front 18

Which blood type is the universal donor?

Back 18

O

Front 19

What is the second major blood grouping system?

Back 19

The Rhesus (Rh) system

Front 20

What is the Rh factor?

Back 20

1. Like the ABO blood types, the Rh factor is an inherited blood protein, or antigen, on red blood cells

2. The Rh factor is connected to the ABO blood type

Front 21

What are the classifications of Rh factor?

Back 21

People who have it are "Rh positive"; those who don't are "Rh negative"

Front 22

What is the reaction of Rh incompatibility?

Back 22

A person with Rh negative blood can develop antibodies in the blood plasma if he/she receives blood from an Rh positive person whose Rh antigens trigger the production of Rh antibodies, which is usually fatal

Front 23

What happens if an Rh negative recipient receives Rh positive donor blood?

Back 23

The recipient will produce anti-Rh antibodies

Front 24

What happens if an Rh positive recipient receives Rh negative donor blood?

Back 24

Nothing, the recipient will not produce anti-Rh antibodies

Front 25

What is the most common blood type in the U.S.?

Back 25

O+ at 38% of population

(close second is A+ at 34%)

Front 26

What is the least common blood type in the U.S.?

Back 26

AB- at 1% of population

(B- is at 2%)

Front 27

What is whole blood?

Back 27

Contains packed cells, leukocytes, platelets and plasma

Front 28

What are the indications for whole blood?

Back 28

1. Treatment of acute, massive hemorrhage and loss of > 25-30% of blood

2. Cardiac surgeries, burns, trauma

**Not routinely used; can result in fluid overload

Front 29

What is the outcome of whole blood infusion?

Back 29

Expect a 1 gram increase in Hg and 3-4% rise in Hct for each unit of whole blood infused

Front 30

What are formed elements?

Back 30

1. Leukocytes & thrombocytes

2. Erythrocytes

Front 31

What are the layers of centrifuged blood?

Back 31

1. Top layer = Plasma

2. Middle layer = Leukocytes & thrombocytes

3. Bottom layer = Erythrocytes

Front 32

What is packed red blood cells?

Back 32

Prepared from whole blood with some plasma, WBCs and platelets are still present

Front 33

What is the precaution regarding packed red blood cell (PRBC)?

Back 33

Platelets and leukocytes are not viable but can cause problems in that they contain HLAs

Front 34

What are the indications of PRBC?

Back 34

1. Improve O2 carrying-capacity in clients with symptomatic anemia

2. To restore blood loss as a result of hemorrhage or surgical blood loss

Front 35

What is the outcome of PRBC infusion?

Back 35

One unit of PRBC can raise Hg 1 gram; Hct 3%

Front 36

What is Washed Red Cell or Leukocyte-Poor Cells (Leukopoor; Leuko-reduced)?

Back 36

Red cells are washed with normal saline to remove most of the plasma. Must be used within 24 hours.

Front 37

What are the indications for Washed Red Cell or Leukocyte-Poor Cells (Leukopoor; Leuko-reduced)?

Back 37

Indicated for patients with repeated hypersensitivity reactions to blood and blood products despite administration of antihistamines prior to transfusion

Front 38

What are the precautions regarding Washed Red Cell or Leukocyte-Poor Cells (Leukopoor; Leuko-reduced)?

Back 38

1. Does not prevent transfusion graft vs host disease (may not reduce the proteins enough to prevent hypersensitivity).

2. May eliminate CMV

Front 39

What is alloimmunity?

Back 39

Lack of immune response to antigens on blood or tissue cells received from a donor of the same species

Front 40

What is a transfusion graft versus host disease (TGVHD)?

Back 40

Donor T cells (lymphocytes) attack host tissues

Front 41

What are the signs and symptoms of transfusion graft versus host disease (TGVHD)?

Back 41

S/sx occur within 1-2 weeks—thrombocytopenia, anorexia, n/v, chronic hepatitis, recurrent infection

**TGVHD has 90% mortality rate

Front 42

How is a transfusion graft versus host disease (TGVHD) prevented?

Back 42

Prevented by using irradiated blood products which destroy the T cells and their cytokine products

Front 43

What is irradiated PRBC?

Back 43

Blood is treated with radiation that kills donor cells that may attack the immunocompromised clients (BMT recipient, clients with Hodgkins disease, leukemia, or in clients being aggressively treated with chemotherapy)

Front 44

What is the goal of irradiated PRBC infusion?

Back 44

To prevent the transmission of TGVHD

Front 45

What is CMV Negative PRBC used for?

Back 45

For immunocompromised clients including AIDS clients

Front 46

What are the characteristics of CMV Negative PRBC?

Back 46

1. CMV remains in a latent state in donor’s leukocytes if previously infected with the virus

2. Transfer of leukocytes to immunocompromised recipients could cause severe illness

Front 47

What are the characteristics of platelet transfusions?

Back 47

1. Does not require ABO typing- platelets don’t carry any antigen; erythrocytes do

2. Can be random donor (pooled, 6 –10 different donors), or a single donor.

3. Stored at room temperature for up to 5 days with frequent gentle agitation of bags to keep platelets viable

Front 48

What are the indications for platelet transfusions?

Back 48

1. If platelet count count is <20,000 and/or client is experiencing bleeding, platelets may be needed

2. Thrombocytopenia resulting from decreased platelet production (aplastic anemia, leukemia, post chemotx)

3. Increased platelet loss from bleeding

4. Increased platelet destruction (hypersplenism in cirrhosis, transfusion reaction).

5. Increased use or consumption as in DIC

Front 49

What is the outcome of platelet transfusions?

Back 49

1. One platelet concentrate (1 unit) should increase platelet count by approximately 5,000-10,000.

2. Infuse each single donor unit over 30 mins (tends to clump); pooled platelets 15-30 mins

Front 50

What is fresh frozen plasma (FFP)?

Back 50

Derived from 1 unit of whole blood whereby plasma is separated from the RBCs and then frozen

Front 51

What are the indicaitons for fresh frozen plasma (FFP)?

Back 51

1. Replaces plasma volume in hemorrhage and/or hypovolemic shock

2. Replaces clotting factors for the client with a known or unknown deficiency

3. Liver disease with significantly impaired clotting factor synthesis

4. DIC with active bleeding

5. Prolonged PT/INR with active bleeding or when immediate surgery is needed

6. Dilutional coagulopathy (substantial volume overload)

7. Use as soon as possible after it is thawed or within 2 hours

8. Administer as rapidly as possible. Most units are completed in 30-60 mins

9. Must be ABO compatible; may be given without regard to Rh type

Front 52

What is cryoprecipitate?

Back 52

1. Derived from 1 unit of FFP and contains Factor VIII (antihemophilia factor), Factor IX, and fibrinogen

2. ABO/Rh compatibility testing is not required

Front 53

What are the indications of cryoprecipitate?

Back 53

1. Hemophilia
2. Von Willebrand disease
3. Hypofibrinogenemia
4. DIC and massive transfusion with hemodilution

Front 54

What is the administration of cryoprecipitate?

Back 54

1. Use within 6 hours once thawed. Usual dose is 6-10 units.

2. Administer as rapidly as tolerated- 15-30 mins

Front 55

What is albumin?

Back 55

1. Major plasma protein available in 2 forms: 5% (isotonic) and 25% (hypertonic)

2. Derived from donor plasma and is heat treated for viral inactivation

Front 56

What is the administration of albumin?

Back 56

1. Should be used within a 4 hour time frame as there are no preservatives

2. Requires a dedicated line for infusion

Front 57

What are the indications for albumin?

Back 57

1. Primary use is as volume expander when treating hypovolemic shock from trauma or surgery

2. Used to support BP during a hypotensive episode

3. Create a diuresis in fluid volume excess

4. Facilitates mobilization of fluid from third space fluid shifts

5. Burns, acute liver failure, hypoproteinemia, to prevent/treat cerebral edema

Front 58

What is Autologous Blood Transfusion?

Back 58

1. Collection and transfusion of the patient’s own blood

2. Preoperative autologous blood donation

3. Intraoperative autologous transfusion

4. Post-operative blood salvage (must be reinfused within 6 hours)

Front 59

What are the pre-transfusion nursing responsibilities?

Back 59

1. Verify order

2. Ensure client has received informed consent and has signed the consent form

3. Verify client has received info regarding Paul Gann’s Act

4. Verify Hg and Hct

5. Start IV if not already in place

6. Use 18-20 g. Angiocath (preferred)

7. Administer blood with NS

8. Pre-med as ordered: Acetaminophen, Benadryl, Solu Cortef or Solu Medrol, Decadron

9. Obtain blood from Blood Bank following hospital procedure

10. Two RNs must verify ID of blood unit information—type, RH, expiration date, unit number, pt’s medical record number

11. Vital signs per hospital policy

Front 60

What information must be verified pre-blood-transfusion?

Back 60

Two RNs must verify ID of blood unit information—type, RH, expiration date, unit number, pt’s medical record number

Front 61

What are the immediate transfusion reactions?

Back 61

1. Hemolytic reaction
2. Allergic reaction
3. Febrile nonhemolytic reaction
4. Pyrogenic/Bacterial reaction
5. Circulatory overload
6. Air embolism

Front 62

What are the nurse's responsibilities regarding transfusion reactions?

Back 62

1. Stop blood immediately

2. Keep IV access with NS (switch tubing)

3. Monitor vital signs & O2 prn

4. Notify MD and Blood Bank for follow up blood draws

5. Medicate as ordered

6. Insert Foley cath to monitor urine output

7. Give old tubing and remaining blood product to Blood Bank