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192 Cards in this Set
- Front
- Back
What are the things you want to cover in assessing bleeding disorders?
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Timing, Quality, Quantity, Severity, Location, Precipitating Factors, and Aggravating Factors.
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What is meant by "Timing" in Assessment of Bleeding Disorders?
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Was it something acute or abrupt or is it a chroonic problem that has been developing over a period of time.
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What is meant by "Quality" in Assessment of Bleeding Disorders?
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Is it sanguineous or serous sanguineous with blood mixed in, bright red or dark red?
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What is meant by "Severity" in Assessment of Bleeding Disorders?
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Does it ooze or does it gush?
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What is meant by "Precipitating Factors" in Assessment of Bleeding Disorders?
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What are the conditions that could cause bleeding problems like liver problems, spleen problems, and meds.
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What is meant by "Aggravating Factors, in Assessment of Bleeding Disorders?"
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OTC. Examples are Aspirin and Ibuprofen.
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If it is bright red blood in stools where is it coming from?
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The rectum.
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If it is burgundy colored blood in the stool, what is it?
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Melena from the colon.
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Vomiting blood is going to be from where?
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Stomach or above.
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Shock will develop when?
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When you lose 1/3 of your blood which is 5 liters.
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How much blood does an individual have in liters?
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5 liters normally.
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When the body is unable to compensate for blood loss, what happens?
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Acute signs and symptoms appear.
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What do you want to do if it is an external bleed?
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Apply pressure, if that isn't working, then use and arterial pressure point proximal to the bleed, elevate and monitor distal pulses.
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Do you want to occlude the blood flow?
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NO!
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What is the #1 cause of GI bleed?
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Local trauma or irritation, like erosion and ulcerations.
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What are other causes of GI bleed?
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75% of upper GI bleeds are related to esophageal varices (a complication of alcoholism), Hemorrhagic gastritis (an irritation of the gastric mucosa), peptic ulcers (gastric ulcers, duodenal ulcers, and anastamotic ulcer).
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What do you want to do with multiple test abnormalities?
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Consider them all.
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What do you want to do with squential test results?
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Monitor them.
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What can a tight turniquet cause?
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Pseudo-hyperkalemia.
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What is the most frequently ordered lab?
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CBC
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What is a CBC?
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The number, the variety, the percentage, the concentration, and the quality of the blood cell.
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What are the three components of a CBC?
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RBC, platelets, and white blood cells.
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What does a CBC show the healthcare provider?
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Disease processes, either progression of or complication of.
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What's another name for RBC's?
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Eurythrocytes
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Where are RBC's produced?
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In the bone marrow.
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How long do RBC's remain in circulation?
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About 120 days.
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What happens to RBC's at the end of their 120 day cycle?
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They are destroyed by the spleen.
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Who's RBC count is lower, a man's or a woman's?
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A Woman's
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What can cause decreased RBC's?
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Abnormal erythrocytes like hemmorhage, insufficiency of iron, B12, folate, abnormal destruction of erythrocytes like seen with anemias. Lack of needed elements for production and Bone Marrow Suppression like in aplastic anemia and chemo.
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What tells the bone marrow to produce RBC's?
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Erythropoetin, secreted by the kidneys like in hypoxia.
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What is the main purpose of RBC's
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Deliver oxygen throughout the body.
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Kidney failure would do what to the production of RBC's?
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Decrease RBC production due to decreased erythropoetin.
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Bone Marrow failure, Leukemia, and hemmorhage, all decrease what?
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RBC's
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What happens in Leukemia?
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White blood cells are mutated and crowd out the red blood cells.
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What can cause increased RBC's?
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Polycythemia Vera, a condition where the bone marrow is over producing and has also been called a cancer of the red blood cells, chronic hypoxic states, and high altitudes.
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What type of conditions are where the body is needing more oxygen so the kidneys stimulate a higher production of RBC's for this to be carried out.
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Chronic hypoxic states.
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How does high altitude increase RBC's?
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The air is thinner so your body wants more oxygen and the kidneys produce mor erythropoetin just like in physical training or body stressing.
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What is the characteristic of pulmonary fibrosis?
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Scarring of the lung tissue which sends a message of hypoxia.
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What is Cor Pulmonale?
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Right sided heart failure.
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If a person is dehydrated, what does it do to their numbers?
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Raises them.
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What can a high RBC count indicate?
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Renal failure, Cor pulmonale, and pulmonary fibrosis.
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What is Hematocrit (Hct)?
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The percentage of RBC's in the plasma.
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What is the normal range of Hematocrit (Hct)?
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36-49
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What can happen if Hct is <20%?
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Cadiac failure and death.
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What can happen if Hct is >60%?
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Spontaneous blood clotting.
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What are reasons for increased Hct?
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Polycythemia and dehydration.
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What are reasons for decreased Hct?
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True decrease in the RBC and overhydration.
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What is the normal range for hgb?
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12-18
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What is the transport vehicle for O2 and CO2?
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hgb
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What is a reticulocyte?
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An immature RBC.
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How long does it take for a reticulocyte to mature into an RBC?
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2-3 days
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What are they looking for in a erythrocyte count?
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The number of reticulocytes.
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An increase in reticulocyte numbers is caused by?
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Anything that decreases RBC's.
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What are erythrocyte indices used for?
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To identify types of anemia.
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What does the Mean Corpuscular Volume (MCV) show?
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The size of the RBC.
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What does the Mean Corpuscular Hgb Concentration (MCHC) show?
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Proportion of each cell occupied by Hgb.
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What does the Mean Corpuscular Hemoglobin (MCH) show?
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The amount of Hgb in one cell.
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Macrocytic is?
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Increased RBC size.
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Microcytic is?
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Decreased RBC size.
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Normocytic is?
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Normal RBC size.
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What is the second part of the CBC?
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WBC (leukocyte)
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What is the primary function of the WBC (leukocyte)?
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To fight infection.
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What's the other name for WBC?
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Leukocyte
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White blood cells are _________ and ___________?
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bigger and fewer.
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What can cause leukocytosis?
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Leukemia, infections, trauma, stress, and tissue damage.
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What are the two variant categories of WBC's?
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Granulocytes and non-granulocytes?
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What are the granulocytes?
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Neutrophils, Eosinophils, and Basophils.
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What are the non-granulocytes?
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Lymphocytes and Monocytes.
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What causes an increase in neutrophils?
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Bacterial infections.
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What are immature neutrophils called?
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Bands or Segs.
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What is a shift to the left?
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An increase in bands (segs) or immature neutrophils.
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When will there be an increase in bands and segs?
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When there is a severe bacterial infection or severe inflammatory response.
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What type of infection is related to decreased neutrophils?
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Viral
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An increase in eosinophils is in response to?
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Asthma, hayfever.
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A decrease in eosinophils is in respone to?
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Stress
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What causes an increase in lymphocytes?
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Mononucleosis, mumps, and measles.
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A decrease in lymphocytes is caused by?
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HIV, Sepsis
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An increase in monocytes is caused by?
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TB
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Decreased monocytes is caused by?
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Bone Marrow depression
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An increase in basophils is caused by?
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Polycythemia
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A decrease in basophils is caused by?
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Acute allergic reactions.
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If you have a decrease in one you will have what in the WBC's?
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An increase in another because WBC counts are based on percentages.
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What is the third component of the CBC?
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Platelets
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Platelets are necessary for what?
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Blood clotting
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What is the normal range for platelets?
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150,000 - 350,000
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What is the other term for Platelets?
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Thromobytes
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What are the causes of thrombocytosis?
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Polycythemia, Malignant tumors, temporary rise after a splenectomy (rebound thrombocytosis)
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What is an increase in thrombocytes called?
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Thrombocytosis
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What is an decrease in thrombocytes called?
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Thrombocytopenia
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What causes thrombocytopenia?
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Viral infections, HIV, SLE (systemic lupous erythrymytosis), Hemolytic disorders, bone marrow depression (aplastic anemia), and Heparin.
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What is the most common type of coagulation test (bleeding time)?
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Ivy method
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Why are bleeding times performed?
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For disorders of platelets or vascular defects in the clotting process.
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What is the normal range for the Ivy method coagulation test?
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3-7 minutes.
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What is the normal range for the Duke method coagulation test?
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1-3 minutes.
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When do you have an increase in bleeding time?
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Bleeding time is increased with thrombocytopenic pupura, platelet function abnormalities, vascular abnormalities, severe liver disease, DIC, aplastic anemia, heparin, ASA, NSAIDS.
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Prothromibin Time measures what?
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The effectiveness of Coumadin.
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Does a PT monitor the level of Coumadin?
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No, just effectiveness.
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What is Coumadin?
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An anti-coagulent.
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What is Coumadin not?
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A blood thinner.
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What is the normal range for PT?
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12-15 seconds.
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What is the "basic anticoagulation" range?
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1.2 - 1.5 times normal.
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What is the "sustained risk of thromboembolism" range for PT?
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1.5 - 2.0 times normal.
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What is the "Cardiac" range for PT?
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2.0 - 2.5 times normal.
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What are some of the causes of increased PT level?
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Liver disease, factor deficiencies: II, V, VII, and X; leukemia's, and CHF.
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What are increased PT levels treated with?
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Phytonadione (aquamephyton)
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What are causes of decreased PT level?
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Thrombophlebitis, MI, and PE.
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What is vitamin K?
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Phytomadione (aquamephyton)
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What is the standardized PT test?
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International Normalized Ratio (INR)
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What is the normal range for PT/INR?
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0.7-1.8
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What is the normal range for PT/INR in Oral Anticoagulation therapy?
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2.0 - 3.0
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What is the normal range for PT/INR in Cardiac therapy?
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3.0 - 4.5
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What is Partial Thromboplastin Time (PTT) used for?
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PTT is used to detect deficiencies in all clotting factors except VII and XIII and to detect platelet variations.
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What is PTT used to monitor?
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Heparin therapy.
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What is the normal range for PTT?
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22.1 - 34.1
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What is used when PTT is critically high?
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Protamine Sulfate
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What are some causes of increased PTT?
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Factor deficiencies, cirrhosis of the liver, vitamin K deficiency, leukemia's, and DIC.
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Which medication has the longest half-life, Coumadin or Heparin?
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Coumadin
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Why are bone marrow aspirations done?
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To check what type of anemia a patient has.
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What are the steps for patient preparation in bone marrow aspiration?
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Consent form and baseline vitals.
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Who performs the patient preparation for bone marrow aspirations?
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The physician performs the patient preparation and the nurse is there to assist.
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Who will collect the specimens in bone marrow aspiration prep?
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The lab.
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What is the follow up care in bone marrow aspiration?
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Band aid and check every 2 hours for hematoma formation.
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Anemia
Iron deficiency Vitamin B12 Folic Acid are? |
Nutritional Anemias
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Nutritional Anemia
Dietary deficiencies, decreased absorption, increased metabolic needs, blood loss are reasons for? |
Nutritional Anemia
Iron deficiency |
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Nutritional Anemia
Lack of intrinsic factor, malabsorption conditions, dietary deficiencies, short gut, short bowel, they have had surgery, stomach removed? |
Nutritional Anemia
Vitamin B12 |
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Nutritional Anemia
Inadequate dietary intake, increased metabolic needs, malabsorption and impaired metabolism? |
Nutritional Anemia
Folic Acid |
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Sickle Cell, Thalassemia, Glucose-6-phosphate dehydrogenase, and Acquired hemolytic are the?
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4 major anemias (Hemolytic)
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Hemolytic Anemias
Genetic condition where RBC's become crescent shaped? |
Hemolytic Anemias
Sickle cell Anemia |
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Hemolytic Anemias
Genetic disorder of Hgb synthesis? |
Hemolytic Anemias
Thalassemia |
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Hemolytic Anemias
Also known as Cooley's Anemia? |
Hemolytic Anemias
Thalassemia |
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Hereditary defect of RBC metabolism, lack of enzyme in the RBC, affects the metabolism of the RBC's?
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Hemolytic Anemias
Glucose-6-phosphate dehydrogenase anemia |
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Hemolytic Anemias
Hemolysis of the RBC usually caused by blood transfusions? |
Hemolytic Anemias
Acquired Hemolytic Anemia |
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Bone marrow fails to produce RBC's?
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Aplastic Anemia
Bone Marrow Depression |
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To improve oxygen transport
Volume expansion Provision of proteins Provision of platelets Provision of coagulation factors are? |
Purpose of Blood Transfusions
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Some cultures will not accept?
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Blood transfusions (or any type of "human" fluid)
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When can you give human fluids to a pt if it is against their religion?
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If they consent (change their mind)
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What type of Collection Method is a blood drive?
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Homologous
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What type of Collection Method is self-donation, pre-operative (pre-deposit), Hgb must be over 11 and no more than 1 unit a week?
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Autologous
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This Collection Method is usually done in the holding area and when a unit is extracted they give a bolus of normal saline
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Acute normovolemic hemodilution
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This blood has been collected and filtered from blood lost during a procedure and put back into the pt?
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Intra-operative salvage
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This blood has been collected during a procedure and if the pt has lost at least a unit of blood during the procedure, the blood is filtered and infused back into the pt after the procedure is completed?
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Post-operative salvage
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What type of Collection Method is when someone decides who is going to donate blood for them?
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Designated
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Which Collection Methods are tested?
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Homologous and Designated
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Which Collection Method does not get tested?
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Autologous
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Which collection method has the donator pay to donate blood?
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Designated
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Where blood is drawn and they determine what type the blood is and it's Rh factor?
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Type and Screen
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If they have blood in the facility that matches what is needed?
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Type and Crossmatch
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What type of blood does a donor have that can be used in anyone?
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O-
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What kind of Rh blood can a person receive if they are Rh+?
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They can receive Rh+ and Rh- blood.
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What type of Rh blood can a person with Rh- blood receive?
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They can receive Rh- only.
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Which type of blood type person can receive any type of blood (universal recipient)?
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A person with AB+ blood.
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Whole blood can be used as a?
(but not usually) |
Volume expander
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Where are the main places that you would see whole blood used?
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ER and OR
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Contains RBC, WBC, platelets, plama (plasma proteins, antibodies, H2O and waste), and electrolytes, volume expander, source of proteins for coagulation.
Patients who need rapid, massive replacement of blood and who have symptoms of hypoxia, or who need an exchange transfusion? |
Whole Blood
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The most frequently ordered blood product, seen a lot for pt in post-operative blood loss, it increases the oxygen carrying capacity of blood in anemic patients?
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Reb Blood Cells
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What is FFP?
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Fresh Frozen Plasma
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Contains all normal components of blood plasma
Removed from whole blood and frozen Benefits pt's with clotting deficiencies? |
Fresh Frozen Plasma
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Transfused to control bleeding or prevent bleeding associated with deficiencies in platelet number or function and to aid in the coagulation process.
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Platelets
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This blood product is used with hemophilia?
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Cryoprecipitates
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Are pooled (mixed into one bag), some pt's require single donor placements (single donor)?
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Platelets
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Volume Expanders
Growth Factors (like eurythropoeitin) Blood Substitutes |
Alternatives to Blood Transfusions
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Have there been any blood substitutes that have been approved by the FDA?
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No
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Verify physician's order (must say infuse, give or something like that)
Obtain or verify patien'ts consent Blood typing and crossmatching (hospitals use types of banding to match pt to blood bag) Preparing the patient by obtaining transfusion hx of pt to see if they have had a problem before, by instructing pt about signs and symptoms of transfusion reactions, and you need to have baseline VS before you go down to get the blood. You need to have an 18 gauge needle or larger patent IV site, needs to be given with NS, you also need a filter on the blood tubing. Obtain the blood from the blood bank and then have 2 RN's go in to the room and verify the blood bag, the paper from the blood bank and the pt's info. You need to stay with the patient for the first 15 minutes and it will be infused slowly because most reactions happen within the first 15 minutes? |
Nursing Care for Blood Product Administration
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A Paul filter can be used in addition to the filter on the tubing that filters out the what in the blood.
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Leukocytes
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Why have hospitals gone to leukocyte poor blood?
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It reduces the chances for a reaction in blood transfusion.
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How long do you stay with the pt when infusing blood?
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For the first fifteen minutes.
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How often do you monitor the transfusion?
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It's based on facility.
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Physician's prescription, indication for transfusion (doctor does this), Informed client consent, client Identification checks, blood component issuance documentation, client monitoring during transfusion, assessment of client outcomes, applicable lab or clinical results before and after transfusion?
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Documentation concerning Transfusion
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What is the usual time frame for administration of whole blood?
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3 to 4 hours
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What is the usual time frame fo administration of RBC?
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2 to 4 hours
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What is the usual time frame for administration of FFP?
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As fast as you can.
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What is the usual time frame for administration of Platelets?
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As fast as you can.
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What is the usual time frame for administration of Cryoprecipitates?
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As fast as you can.
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What is the usual time frame for administration of Volume Expanders?
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50ml per hour
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When MUST transfusion be completed (starting from the time the blood leaves the blood bank)?
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Within 4 hours.
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If you can't administer the blood, you have gotten from the blood bank, right away, what do you do?
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Take it back to the blood bank.
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What are the pieces of equipment in the ER ICU to warm blood?
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Blood warmers
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How many ml's, roughly, is a unit of RBC's?
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250ml
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Blood pumps make transfusions much?
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Easier
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If a pt has had a prior Nonhemolytic Febrile reaction before, to stop the temp spike what can be done?
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Pre-medicate with Tylenol
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What is the transfusion reaction that causes a temperature spike?
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Nonhemolytic Febrile
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Transfusion reaction that includes mild itch to lines to anaphalactic reactions?
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Allergic reaction
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To prevent transfusion reactions what can be done?
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Pre-medicating.
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What happens when the wrong type of blood is administered?
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A Hemolytic reaction
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What can occur when there is a hemolytic reaction?
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Accute Renal Failure
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If a Hemolytic reaction occurs what must you monitor?
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BUN and Creatinin.
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To check for free hemoglobin in hemolytic reaction, what do you do?
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Collect a urine sample and send it down to the lab.
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Too large of an amount of fluid in too short of a time frame can lead to what transfusion reaction?
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Circulatory Overload
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The transfusion reaction you will most often see with autologous transfusion because of the way it was stored?
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Bacterial Contamination
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Most common transfusion reaction seen in pt's with renal failure?
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Hyperkalemia
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If blood sit on the shelf for awhile, the blood starts breaking down, what increases in the blood?
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Potassium
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Stop transfusion
Keep vein open with NS Notify physician and hospital blood bank Fill out form in triplicate All transfusion items need to be sent back down to the blood bank for examination The doctor will order what needs to be done for the transfusion reaction? |
Nursing Care for Transfusion Reactions
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