Question

V.V. is a 40 year old African American male who was diagnosed with sickle cell disease at the age of 8. His anemia has been managed with multiple transfusions and recently he has shown signs of chronic renal failure. He is receiving two units of packed RBCs this morning as an outpatient. He has A- Blood type What blood type can he receive? What are your key nursing considerations for the procedural transfusion of blood? What are three potential current complications with s/s and interventions that you need to monitor for? What are three potential delayed complications with s/s and intervention that you need to teach V.V. to monitor for at home?

Answer 1

1.He can recieve A+,AB+,O+,O-

2 Nursing considerations are

• Maintain standard and transmission-based precautions and surgical asepsis as necessary.
• Insert an intravenous line and infuse normal saline;maintain the infusion at a keep-vein -open rate.
• Always check the bag for the volume of the blood component.
• Blood products should be infused through administration sets designed specifically for blood;using a Y tubing or straight tubing blood administration set that contains a filter designed to trap fibrin clots and other debris that accumulate during blood storage..
• Premedicate the client with acetaminophen as prescribed,if the client has a history of adverse reactions;if prescribed ,oral medications should be administered 30 minutes before the transfusion is started,and intravenously administered medications may be given immediately before the transfusion is started.

3 Current complications of blood transfusion are

Transfusion reactions,Circulatory overload and Hyperkalemia.

Signs of Transfusion reactions are

• Weak pulse
• Fever
• Tachycardia
• Hypotension
• Visible hemoglobinuria
• Oliguria

Nursing intervention

• Stop the transfusion
• Keep the intravenous line open with 0.9% saline.
• Notify the physician and blood bank.
• Remain with the client,observing signs and symptoms and monitoring vital signs as often as every 5 minutes.
• Prepare to administer emergency medications such as antihistamines, vasopressors, fluids and corticosteroids as prescribed.
• Obtain a urine specimen for laboratory studies .
• Return blood bag,tubing,attached labels and transfusion record to the blood bank.

Circulatory overload-it is caused by the infusion of blood at a rate too rapid for the client to tolerate.

• dyspnea,chest pain ,wheezing on auscultation of the lungs.
• Headache
• Hypertension
• Tachycardia
• Distended neck veins.

Interventions

• Slow the rate of infusion.
• Place the client in an upright positon,with the feet in a dependent position.
• Notify the physician.
• Administer oxygen,diuretics and morphine sulphate as prescribed.

Hyperkalemia

• Stored blood liberates potassium through hemolysis.
• The older the blod,the greater the risk of hyperkalaemia;therefore clients at risk for hyperkalaemia,such as those with renal insufficiency or renal failure,should recieve fresh blood.
• Assess the date on the blood and the serum potassium level before and after the transfusion.
• Monitor the potassium level and for signs of hyperkalaemia.
• Slow the transfusion and notify the physician if signs of hyperkalemia occur.

4 Delayed complications of blood transfusion are Iron overload,Disease transmission, Septicaemia

Iron overload- A delayed transfusion complication that occurs in clients who recieve multiple blood transfusions,such as clients with anaemia or thrombocytopenia..

Assessment

• Vomiting
• Diarrhea
• Hypotension
• Altered hematological values

Interventions

• Deforaxmine ,administered intravenously or subcutaneously ,removes accumulated iron via the kidneys.
• Urine turns red as iron is excreted after the administration of deferoxamine;treatment is discontinued when serum iron levels return to normal.

Disease transmission

• A disease most commonly transmitted is hepatitis C ,which is manifested by anorexia,nausea,vomiting,dark urine and jaundice;the symptoms usually occur within 4 to 6 weeks after the transfusion.
• Other infectious agents and diseases transmitted by blood transfusion include hepatitis B virus,human immunodeficiency virus,human herpes -virus type ,Epstein -Barr virus,human T-cell leukemia,cytomegalovirus and malaria.
• Donor screening has greatly reduced the risk of transmission of infectious agents;additionally,antibody testing of donors for human immunodeficiency virus has greatly the risk of transmission.

Septicaemia-It occurs with the transfusion of blood that is contaminated with microrganisms.

Assessment

• Rapid onset of chills and a high fever.
• Vomiting
• Diarrhea
• Hypotension
• Shock.

Interventions

• Notify the physician.
• Obtain blood cultures and cultures of the blood bag.
• Administer oxygen,intravenous fluids,antibiotics,vaspressors and corticosteroids prescribed