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A. Types
1. Type A – A antigens, B antibodies. If received B or AB, the anti-B
antibodies will react with B-antigen present in B blood and cause
agglutination. Can receive A & O.
2. B – B antigens, A antibodies. Can get B & O.
3. AB – A & B antigens, no antibodies. Can get A, B, AB, & O. universal
recipient
4. O – does not have A or B antigens. Has A & B antibodies. Universal
donor, but can only get O blood.
B. Rh factor
1. Rh+ has D antigen & no anti-D antibody
2. Rd negative person does not have D antigen but if exposed to Rh+ will
form anti-D antibody which will act against the Rh antigens with future
exposure
B. acute hemolytic
1. life-threatening
2. occurs when donor blood incompatible w/ recipients. From
error in matching w/ patient id before giving. Antibodies in
recipient combine w/ antigens on donor erythrocytes causing
aggulation & hemolysis
3. chills, fever, low back pain, nausea, dyspnea, blood in urine;
hypotension, bronchospasm & anaphalaxis possible
4. must be prevented – must be recognized quickly &
transfusion stopped. Take down all tubing, hang new tuning
& infuse NS slowly. Thorough assessment, notify MD, obtain
required blood & urine specimen. Document!
C. Allergic
1. usually because of sensitivity to plasma protein in blood
2. itching, flushing
3. stop transfusion, infuse NS, notify MD. Administer
antihistamine (Benadryl) to resolve problem & blood can be
resumed
4. if severe, blood will not be restarted. Epinephrine & steroids
may be needed
5. Future – patient should get antihistamine before transfusion
D. circulatory overload
1. usually happens because client sensitive to overload, CHF,
or nurse infused too quickly
2. PRBC better than whole blood unless volume is needed
3. Diuretic may be given after transfusion or between 2 units
4. S&S: dyspnea, tachycardia, anxiety, crackles, pink frothy
sputum
5. Nurse should place client in upright position, feet down, stop
blood, infuse NS @ KVO, notify MD. May need oxygen,
diuretics
2. Radiologic tests
A. lymphangiography (dye)
B. scans (bone scan, liver/spleen)
3. biopsies
A. bone marrow aspiration & biopsy
1. PRE:
-anterior or posterior iliac crest: must empty bladder before, must
remain very still
-signed informed consent
-premeditate for pain – will be sore for several days
assess platelet count before
2. POST:
-hold pressure several minutes, 5-10 or longer
-patent needs to stay in bed for couple of hours at least 2 hours
B. lymph node aspiration & biopsy
1. local anesthetic
2. small dressing after
B. low RBCs – anemia – more rapid the onset the more sever symptoms
1. overall S&S with low RBCs
a. restlessness – if they weren’t before, in situation where they
might be bleeding, ex – post op
b. dyspnea – no hemoglobin carrying o2 (activity intolerance,
impaired gas exchange)
c. fatigue, malaise, lethargy, HA (activity intolerance)
d. dizziness, fainting (high risk for injury)
e. pallor – pale nail beds
f. tachycardia, palpitation, chest pain (b/c of increase o2), MI
g. depression – can’t keep up with ADLs
h. cheilosis/angular stomatitis – cracking in corner of mouth
i. glossitis – inflamed tongue
Vitamin B12 deficiency – also called megoblastic (large cell) anemia; cobalamin
deficiency; pernicious amemia when only problem is lack of intrinsic factor. S/S:
may take years to manifest due to fairly large stores of B12. B12 + folic acid =
DNA synthesis. Red sore tongue (glossitis), angular stomatitis/cheilosis, vitiligo
(white patchy spots on skin), neurological symptoms: parasthesias – numbness
& tingling, proprioception. Source for B12 same as iron; lethargic, tired
difference = impaired neurological functioning, see above neuro. Test specific for
B12 = schilling test. Schilling test – receive oral dose of radioactive B12. If
absorbed there will be radioactivity in urine, and small intestine is not problem. If
no radioactive B12 in urine – is it stomach or small intestine? Test is repeated
and given radioactive intrinsic factor. If radioactive urine comes thru –
stomach/intrinsic factor is problem, true pernicious anemia. Does not come thru
than small intestine is problem, if have plenty of intrinsic factor its just called B12
deficiency.
Specific care for B12 – neurological problems we need to prevent. Safety –
shoes their feet may not be getting adequate circulation. Temperature – check
with thermometer. Oral care – no acidic, or spicy foods. B12 – IM at first daily,
then weekly, may need to be on the rest of their life.
Folic acid deficiency – also called megaoblastic. Folic acid + B12 = RBCs. Lot
of same problems as iron & B12. Foods: dark leafy greens, *OJ, liver, *peanuts,
*whole grains breads. Drinking alcohol, oral contraceptives, anticonvulsants
impairs absorption of folic acid.
S/S: same as B12 except no neuro problems!!! Glossititis, angular stomatitis
(cracking of mouth), vitiligo, brittle ridged nails.
Dx: measuring folic acid w/I RBC
Nursing care for folic acid – diet, folic acid supplements, oral care.