FLUTD, ELECTROLYTE and ACID - BASE BALANCE Chapter 52HOMEOSTASIS Execss potassium can cause death-ito ginagamit sa death penalty - if no potassium, this can cause muscle weakness, “potassium is good for the heart The regulators are kidney and hormones x From the Greek words for “same” and steady” refers to any process that living thing use to actively maintain fairly stable conditions necessary for survival. x Balance depends on several processes. x Diseases and daily factors can eate y imbalanceFLUID ELECTROLYTE HOMEOSTASIS ee Mceunmure heel melt Ure) electrolyte concentrations are maintained within strict homeostatic Panes ace te aM ateM cee elke AST=) (=e: organ systems ADH-lessenurineoutputWater overview *Water comprises about 60% -70% of the total body weight *Varies with age weight gender MAs medaling ma dehydrate ang infant because their body comprise of more water ‘Sa woman is more on fat and Kongo ang waterNormal Composition in Average Man PX y Ke > a3, *When a person loses more than 10% of his total body fluids,he can DIE!!!Functions of Water in the Body +-Transporting nutrients to cells and wastes from cells *-Transporting hormones, enzymes, mol = platelets, and red and white blood cells Facilitating cellular metabolism and proper cellular chemical functioning «Facilitating digestion and promoting elimination «Acting as a solvent for electrolytes and non-electrolytes --Acting as a tissue lubricant and cushion +-Helping maintain normal body temperature If baby is dehydrated, they have red lipsA v A Water Loss Aw ww! ROUTES OF WATER LOSS -SENSIBLE -INSENSIBLE Urine Lungs Feces Sweat Be ax Causes of Increased Causes of Increased Water Loss Water Gain “Fever ‘Increased sodium intake *Diarthea *Increased sodium *Diaphoresis retention “Vomiting *Excessive intake of water *Gastric suctioning *Excess secretion of ADH *Tachypnea ;Two Compartments of Fluid in the Body 1. Intracellular Fluid (ICF) 2. Extracellular Fluid (ECF)O Intracellular fluid (ICF) Interstitial fluid within cen Extracellular fluid (ECF) Outside the cellDistribution of Body Fluids (1 of 3) * Intracellular (ICF) * Within cell » About 2/3 adult body fluid * Vital to cell functioning * Medium for metabolic processes Copyright © Pearson EDistribution of Body Fluids (3 of 3) + Extracellular (ECF) * 2. Interstitial * Surrounds cells + 75% of ECF * Lymph and transcellular fluid * About 5% * Carries oxygen and nutrients to, and waste away, from cells Copyright © Pearson EdiEXTRACELLULAR FLUID 3. Transcellular Fluid + The transcellular fluid is the smallest component of the extracellular fluid. * tis largely made up of water.Copyright © Pearson Ed.cation Limited 2072. al Rignts ReservedSEE Composition of Body Fluid (1 of 2) a * Fluids contain oxygen, nutrients, waste products, and ions. * Electrolytes * Cations (Na*) , anions (CI) * (K*), (Ca*), (Mg*) *(Ch), (i CO" PO"), (SO*). jicarbonate ‘Sulfur dioxideComposition of Body Fluid (2 of 2} * Electrolytes - + Vary from one body compartment to another ° ECF * Mostly sodium, chloride, and bicarbonate *lCF * Potassium, ma phosphate, rela i Copyright © Pearson EducaticMovement of Body Fluids and Electrolytes (1 of 4) * Selectively permeable * Varying degrees of ease of movement * Solutes -substances dissolved in a liquid (electrolytes) * Crystalloids -salts that dissolve readily into true solutions Large protein- albumin * Colloids-substances such as large protein molecules that do not readily dissolve i into solutions * Solvent-component of a solution th solute (Water) * Osmolality -total solute concentrati Kiss compartment (milliosmoles per per kilo m mOsm/kg) Copyright © 2022. All RigiDifference between Sclute and Sctvent Salt Water re Salt Water Solute 2 — Solvent Solution |Movement of Body Fluids and Electrolytes (2 of 4) * Solutions Isotonic- same osmolality as ECF. (Ex. Normal saline, 0.9% sodium chloride) » Hypertonic-have a higher osmolality than ECF (Ex. 3% sodium chloride) » Hypotonic-have a lower osmolality than ECF (Ex. 0.45% sodium,chlorideType of Solutions Hypertonic lsotonic Hypotonic HO ® Shrunken Cells; Normal Cells =|QDY FLUIDS AND FLEETIOL 1. Diffusion - tendency of solutes to move freely from areas of high concentration to low concentration (down hill) 2. Osmosis - fluid passes from areas of low solute concentration to areas of high solute concentration 3. Filtration - passage of fluid eon 2 permeable 4 Active transport - requires energ a 1 cell membrane from area of lessefconce one of greater concentrationMovement of Body Fluids and Electrolytes (2 of 4) * Osmotic pressure-power of a solution to pull water across a semipermeable membrane * Colloid osmotic pressure (oncotic pressure) (holding water in plasma, and when necessary pulling water from the interstitial space) Higker ‘OSMOSISahead Filtration is melee of ing perticles Gon he hakActive transport... process ii is the movement Wee of molecules across a cell membrane, e Active TransportB. Regulating Body Fluids 1. Fluid Intake WA log /, ; £ How increawlour.| / X Average adult intake about . Fluid Intake: 1500 ml/day Additional 1000 ml volume Sanne is acquired from foods and Signa! from oxidation of these \ foods during metabolic po @ processes. Raveriags > 0 Wate tich Fruits A VeggiesB. Regulating Body Fluids Source: Amount (ml) XOral Fluids * 1200-1500 Water in foods * 1000 XWaterasby-productof ° 200 food mechanism Total * 2400 - 2700B. Regulating Body Fluids 2. Thirst Mechanism Xs the primary regulator of fluid intake XIs located in the hypothalamus of the brainB. Regulating Body Fluids 2.Fluid Output Fluid losses from the body counterbalance the intake of fluid. * Fluid Output A. Urine B. Feces C. Insensible lossesnec Becta ost mowrety bioed Oren Boerne Angoteran @ Stumuters Samutates PyDotnaiamic DPypotnatarsc osmoreceptors, oumoreceptors Sind SA proces 2 NE se saunvavon 7 Ory moun Tree v Sense of tnurst Ingeston of water Pe Coots ena Oratenas | Snor-weem - mostens mouth Momacn | nreberon and imesnnwal of turat f 7 ~ Long: teen Renyaratos wnrepwon en yerother blood }. of te FIGURE 24.3 Dehydreten, Vhivet, and Reitydretien. See ine text CONCermng ine uncertainty abOUl @ dry Mouth contnbuung toB, REGULATING BODY FLUIDSB. REGULATING BODY FLUIDS 3. Maintaining Homeostasis a Kidneys o Hormones - Antidiuretic Hormone - Renin - Angiotensin - Aldostergas -Atrial Natriuretic Factor AtriumC. REGULATING ELECTROLYTES Electrolytes Are charged ions capable of conducting electricity, are present in all body fluids and fluid compartments. % Maintaining fluid balance ScomnbuE acid - bee regulggen— % Facilitating enzyme reactions Ee X Transmitting neuromuscular reactions i. =Importance of Electrolytes + -Maintain voltages across cell membranes + -Carry electrical impulses to other cells + Found in blood or the human body in the form of acids, bases or salts (Sodium, calcium, potassium, chlorine, magnesium, bicarbonate) + -Conduct an electric current that transports eae — the body rev" we & 00,09 ogee P00 ! y 9 oO Nee ¢ Poets + pi 99705 8 og"Effects of Electrolytes eThe loss of electrolytes in the body can lead to an unbalance of fluids in the body and the pH, and a damage of the electric potential between the nerve cells that transmit the nerve signals (Encarta)Major Electrolytes/Chief Function Sodium — controls and regulates volume of body fluids Potassium — chief regulator of cellular enzyme activity and water content Calcium — nerve impulse, blood clotting, muscle contraction, B12 absorption Magnesium — metabolism of carbohydrates and proteins, vital actions involving oye Chloride — maintains osmotic p food, produces hydrochloric acid Ba Phosphate — involved in importa reactions in body, cell division and hereditary Bicarbonate — body's primary bufter sysD.Acid — Base Balance X Acid —is a substance that releases hydrogen ions (H+) in solution. % Bases or Alkalis — have a low hydrogen ion concentrate and can accept hydrogen ions in solution. %pH — measures the acidity or alkalinity of a solution. PH of 6.8 is fatal Ucan check acidosis on ABG testRESPIRATORY REGULATION x Respiratory Regulation of Carbon Dioxide in Extracellular Fluid x Increased carbon dioxide levels in extracellular fluid increase rate and depth of respirations so that more carbon dioxide is exhaled. x Decreased carbon dioxid respirations to maintain ca» Renal Control of Hydrogen lon Concentration * The kidneys control extracellular fluid pH by removing hydrogen or bicarbonate ions from body fluids. - When the kidneys excrete more bicarbonate ions, the urine becomes more alkaline. - When the kidneys excrete more hydrogen ions, the urine becomes more acidic. Copyngtt2004 by Delmar Leaming, adivision of Thomson Leaming, Inc. sarE. Factors Affecting Body Fluid, Electrolytes, and Acid — Base Balance XAge %Sex and Body Size X Environmental Temperature X Lifestyle Fluid ImbalancesFluid Imbalances + 2 basic type: isotonic & osmolar + Isotonic imbalance: water & electrolyte are lost or gained in equal proportion, osmolarity remain constant Osmolar imbalance: when water is lost or gained alone, osmolarity altered 4 categories: Fluid volume deficit - Isotonic loss (FVD, or hypovolemia) Isotonic gain (FVE, or hypervolemia) Hyperosmolar loss ( dehydration) Hypo- osmolar gain ( over hydration, or water intoxication) ohFour Categories of Fluid Imbalances 1. An |sotonic loss of water and electrolytes — Fluid volume deficit 2. An |sotonic gain of water and electrolytes — Fluid volume excess 3. A Hyperosmolar loss of only water— Dehydration 4. Ahypo-osmolar gain of only water - overhydrationFluid Volume Deficit + Occurs when the body loses both water and electrolytes. +Hypovolemia— initially lost from the intravascular compartment. *Third-space fluid shift — fluid shifts from the vascular space into an area where it is not readily accessible as extracellular fluid.ae Disturbances in Fluid , Electrolyte, and Acid-Base Balance . * Fluid volume deficit (hypovolemia or \ isotonic fluid loss) * Caused by a loss of both water and \ solutes in the = \ same proportion from the ECF spaceFluid Volume Excess Occurs when the body retains both water and sodium Hypervolemia — excessive retention of water and sodium in ECF Edema — excess interstitial fluid, accumulates in tissue spaces like around the eyes Pitting Edema — leaves a small depression or pit after finger pressure is applied in swollen area.Figure 52-10 . Evaluation of edema. A, Palpate for here and behind the medial malleolus, and over the do scale for grading edema.Electrolyte Imbalances SODIUM (Na+) > 135-145 mEq/L Functions Hypernatrimia or hyponatrimia *Maintains. osmolality «Participates in active transport *Helps regulate body fluids “Participates in the action potentialHYPONATREMIA “ALL RIGHT_.WHERE DID ALL THE SODIUM 60?~ Hyponatremia occurs when serum sodium is less than 135 mEq/L. L Na is caused by dilution as a result of excess HO or 7 Na loss. These are some of the situations. AF > hypertonic solutions, which eads tc dilutiona:Electrolyte Imbalances SODIUM Hypematremia: + Serum sodium is more than 150 mEq/L + Loss of water - insensible water loss (hyperventilation or fever) - Diarthea - Water deprivationElectrolyte Imbalances POTASSIUM +3.5-5 mEq/L Hypokalemia Loss of Potasstum - Vomiting and gastric suction - Diarthea - Heavy perspiration - Use of potassium — wasting drugs (e:2. diuretics)Electrolyte Imbalances POTASSIUM Hyperkalemia - Decreased Potassium Excretion - Can lead to cardiac arrest - Serum potassium level greater than 5.0 mEq/L - Renal FailureElectrolyte Imbalances CALCIUM :85-105 mgidlor 45.5.8 meg Functions +Formation of bone and teeth *Contraction of muscle *Blood coagulation *Blocks sodium transport into the cell “Transmission of nervous impulses*Hypocalcemia *<8.5 mg/dL +< 4 5mEqjL ionized Calcium «Nervous System + Paraesthesia «Muscular System + Tetany, Laryngeal * spasms «Cardiovascular System + decreased cardiac * output «cardiac dysrhythmias *Hypercalcemia >10.5 mg/dL total Calcium or >5.5 mEq/L ionized Calcium «Neurological Manifestation * lethargy, confusion, coma *Skeletal Manifestations + deep bone pain; fractures «Renal Manifestations. stones Gastrointestinal Manifestations + Constipation;anorexia + Nausea and Vomiting «Cardiovascular Manifestations + Shortened QT interval, *Bradycardia + Cardiac arfestMagnesium (1.5-2.5 mEq/L or 1.6 - 2.5 mg/dl) Hypomagnesemia - Chronic alcoholism - Pancreatitis - Bums S/S Neuromuscular irritability with tremors Increased reflexes, tremors, convulsions Positive Chvostek’s and - Trousseau’s signs Hy i - Renal failure / - Adrenal Insufficiency _Chloride (95 - 108 mEq/L} * — Hypochloremia - excess loss of chloride through the Gl tract, kidneys, or sweating. - may experience muscle twitching, tremors, or tetany * Hyperchloremia - acidosis - weakness - lethargy - may risk of dysrhythmias or comma:Phosphate ( 1.8-2.6 mEq/L)/ 2.5-4.5 mg/dL Hypophosphatemia - Alcohol withdrawal - use of antacids that bind in the Gl tract - paresthesia - muscle weakness and pain - mental changes - possible seizures * Hyperphosphatemia - due to tissue trauma - infants who are fed cow’s milk - numbness and tingling around the mouth and in fingertips, muscle spasm and tetanyAcid — Base Imbalances Are usually classified as respiratory or metabolic by the general or underlying cause of the disorderA.B.G. Oxygen iced) Og Normal Value 7.35-7.45 Ree Sulla pele BPA O11) 40) 0 >95%-98 Eee aT aTo interpret A.B.G. results, start with the pH. It high (alkolosis) or low (acidosis)? Then go to the pco? Low High Normal High Low Normal Low Normal LowAcid — Base Imbalances Respiratory Acidosis a condition that causes carbon dioxide retention, either due to hypoventilation or impaired lung function, causes carbonic levels to increase and pH level to fall below.7.35 :Respirations , Disorientation RESPIRATORY ACIDOSIS * Drowsiness, Dizziness,Acid — Base Imbalances Respiratory Alkalosis when a person hyperventilate, more carbon dioxide than normal when exhaled, carbonic acid levels fall and pH rises to greater than 7.45.RESPIRATORY ALKALOSIS * Hyper Reflexes & Muscle Cramping Gare * Hyperventilation * Seizures tRate & Deoth) wchycardia 4 * Lor Normal 5 # TAmxiety, a) Tirritablity * Causes: - ypervestaatcn * Hypokalemia eae Amcety, PE, Fear Mechamcai \ertlator * Numbness & Tingling of ExtremitiesAcid — Base Imbalances Metabolic Acidosis when bicarbonate levels are low in relation to the amount of carbonic acid in the body, pH level fall.METABOLIC ACIDOSIS © $Muscle Tone,Acid — Base Imbalances Metabolic Alkalosis the amount of bicarbonate in the body exceeds the normal 20 - to - | ratio. - respiratory center is depressed.“METABOLIC ALKALOSIS ’ I can’t control the pHi \ / There is just too much bese, | and I have lest my H™ concentration! I’m alkelotic!METABOLIC ALKALOSIS * Confusion ° Dizzy, Tirritability Dysrhyth . iti : \ from&K:) Nausea, Vomiting, «Compensatory : e Andety, . Seizures © Causes: ines * Tremors, Muscle Cra bicarbonate) ( of Fingera & Sir (NG Suctioning, (tserum Ca™) Prolonged Vomiting Hypercortisofiem)1. Nursing Management 1.1 Assessment 1.2 Planning 1.3 Diagnosing 1.4 Implementation 1.5 Evaluation1.1 Assessment Nursing History * Current and past medical history * Functional, developmental, socioeconomic factors * Medications + AgePhysical Assessment * Skin, oral cavity, mucous membranes, eyes, cardiovascular and resp. system, neurologic and muscular statusClinical Measurements * Daily Weights: +-semsne sus neni netiney mii stnae * vital signs * fluid intake & outputLABORATORY TESTS a. Serum electrolytes b.CBC xHematocrit - measures the volume of whole blood that is composed of RBC (40-54% men; 37-47% womeg-— wd1.2 DIAGNOSING 1. Fluid Volume Deficit 2. Fluid Volume Excess 3. Risk for Imbalanced Fluid Volume 4. Risk for Fluid Volume Deficit 5. Impaired Gas Exchange 6. Impaired Oral Mucous Me) 7. Impaired Skin Integrity ¥ 8. Ineffective Tissue PerfusidLaboratory Tests ¢. Osmolality * Serum osmolality ~ measure of solute concentration of the blood * Urine osmolality - measure of solute onLABORATORY TESTS d.Unne pH Urine specific gravity (1 005 to 1.030 e Arterial Blood Gases pH 7.35- 7.45 PaC02 35-45mmH¢g Pa02 © 80-100mmHg oy HCO3 =. 22-26mEy BaseExcess -2to +2 MEQ/L Q2 saturation 95-98"1.3 PLANNING x Goals: 4. Maintain or restore normal fluid balance 2. Maintain or restore normal1.3 PLANNING x Goals: 3. Maintain or restore pulmonary ventilation and oxygenation 4. Prevent associated risk - tissue breakdown, decreased, ardia signs1.4 |MPLEMENTATION 1. Promoting wellness 2. Enteral fluid & electrolyte replacement 3. Fluid intake modifications 4. Dietary ChaNgeS -vscaunse 5. Oral electrolytes supplemenG. PARENTERAL FLUID & ELECTROLYTES REPLACEMENTS 1. Intravenous Solutions 1.1. Isotonic - 0.9%NaCl or NSS (normal saline solution) - Lactated Ringer's 5% dextrose water| | G. PARENTERAL FLUID & ELECTROLYTES REPLACEMENTS 1. Intravenous Solutions 1.2 Hypotonic 0.45%NaCI 0.33%NaCI 1.3 Hypertonic D5NS D5 1/2NS D5LRG. PARENTERAL FLUID & ELECTROLYTES REPLACEMENTS Intravenous Solutions Volume Expanders - are used to increase blood volume Ex. Dextran, plasma, albumigzgelaPeripheral Venipuncture Sites * client’s age * length of time the infusion is to run * type of solution used * conditions of veinsCommon Sites: 1. Inner arm - cephalic vein - basilic vein - median cubital vein - medial antebrachial vein & radial vein on2. Dorsal surface of hand - cephalic vein - basilica vein - dorsal venous network - dorsal metacarpal veinsFigure 52-15 * Commonly used venipuncture sites: 4, army 8, hand, Abo sous he sie wad br apaphaaly rested onfal ohekr FIC.H. Intravenous Infusion Equipment a. lV Catheters b. Catheter Stabilization Devices c. Solution Containers d. Infusion Administration sets e. IV Filters f. IV PolesFlash back chamber > Needle grid I Injection port capbutterfly catheter i \ CF f $ \V.catheter butterfly type with port LV. catheter_H. Intravenous Infusion Equipment a. Intravenous Catheters 1. Peripheral—short catheter 2. Peripheral — midline catheter 3. Peripherally Inserted Central Venous (PICC) eae 4. Central Venous Access D = == 5. Implanted Vascular AccessDevice (IVADs)CATHETER PLAGEMENT / ; Subclavian a Uy catheter Basilic vein / PICCCentral Venous Access DeviceImplanted Vascular Access Devices (IVADs)H. Intravenous Infusion Equipment b. Catheter Stabilization Devices ~ helps decrease movement of catheter at the insertion site, which helps prevent infection from being dislodged.H. Intravenous Infusion Equipment c. Solution Containers - Plastic bag - Glass bottle - Sizes (50ml, 100ml, 250ml, 500ml or 1000mld. Infusion Administration sets - also called administration infusion set - consist of a insertion spike, drip chamber, a roller valve or screw clamp, tubing with secondary ports and a protective cap over connector to the lV catheter —Infusion set spikes and drip chambers: A, nonvented macrodrip andH. Intravenous Infusion Equipment e. IV Filters - are used to remove air and particulate matter from IV infusions and to reduce the risk of complications. - consist of membrane Problem associated with filt - Clogging which may stop onslow - binding of some drugsf. Intravenous Poles are used to hang the solution container|. Starting an Intravenous Infusion The Primary provider is responsible for ordering \V Therapy for clients. The Nurse determines the following; 1. The type and amount of solution to be infused 2. The exact amount (dose) of any medications to be added to a compatible sgiutic 3. The rate of flow or the time infusion is to be completedRegulating and Monitoring Intravenous Infusions The Nurse initiating the IV calculates the correct flow rate, regulates the infusion, and monitors the client's responses. The Nurse must the volume of fluid to be infused and the specific time for the infusion. 1. The. number of milliliters to be adios istered in 1 hour (mL/h) 2. The number of drops to be gwen: (gtt/min) KVO - Keep vein openRegulating and Monitoring Intravenous Infusions Milhliters per hour 1000 total infusion volume = 125 ml/h 8 H total infusion time Nurses need to check infusions to ensure that the indicated milli infused and that IV patency isRegulating and Monitoring Intravenous Infusions Drops per minute Drops per minute = _total mfusion volume x drop factor total time of infusion in mmutes 1000ml in 8 hours and drip factor is 20 drops/ml, the drops per minute should be 100ml x_20 = 8H x 60 min (480 min) = 41 dropsfming" 20 ang adult drops 60 ang pedia dropsRegulating and Monitoring Intravenous Infusions Micro drops per minute Drops per minute = _total infusion volume x drop factor total time of infusion in minutes 500ml in 8 hours and dip factor is 60 microdrops/ml, the microdrops per minute should be 500ml x _60Total Volume/Time in Hours = Volume/hr. Eg. * 1000 ce/ 5 hours = 200 ce/hr. * 500 cc/ 10 hours = 50 ce/hr. How to calculate drops/min.: Volume/hr._X_Drip Factor* 60 mins. * Micro —(60 gtt/ml) * Macro —(20 gtt/ml)Run D.-LRS 1000 cc to run for 8 hours. Step 1.: Get volume/hour 1000ce_ = 125cc/hr Shrs. Step 2.: Get drops/min. Volume per hour _X drip factor 60 min.(1 hr.) 125 ce/hr X20 get/ec = 41.66 or 42ggts/min. 60 min.Devices to Control Infusions Manual Flow RegulatorDevices to Control Infusions Electronic Infusion DevicesComplications of Infusion Therapy 1, Infiltration 2. Extravasation 3. Phlebitis 3.4 Mechanical Phlebitis 3.2 Chemical Phlebitis 3.3 Bacterial PhlebitisComplications of Infusion Therapy 1. Infiltration-Infiltration can be caused by puncture of the vein during venipuncture, dislodgement of the catheter, or a poorly secured infusion device: MAs medaling mag baga if sa baby Hot and cold compress para Mawala ang bagaComplications of Infusion Therapy 2. Extravasation-unintended administration of - vesicant drugs or fluids into the subcutaneous - tissueComplications of Infusion Therapy 3. Phlebitis 3.4 Mechanical Phlebitis Inflammation and clot due to Seay, of vein 'Complications of Infusion Therapy 3. Phlebitis 3.2 Chemical Phlebitis Ang drug mismoComplications of Infusion Therapy 3. Phlebitis 3.3 Bacterial PhlebitisComplications of Infusion Therapy 04 (sun blanched, Sghteaking, bruited, swollen, edema, pitting, croulaten, pan BetweenMates.conBlood Transfusion request Blood Transfusion Consent Blood Transfusion form and. al Consent Sa ol wae1. Verify doctor's witten prescription: ] |> Blood products/s written and complete | > Any instruction during and after &T. > Pre-medications if ordered. | 2 Observed (12 rights) when preparing and administering any | Blood or blood components: ‘L Right Medication 7. Right Reason | 2 Right Patient 8. Right Documentation | 3. Right Time 9, Right Assessment and Evaluation | 4. Right Route 10. Right Client Education 5. Right Dose 11 Rightto Refuse Medication 6. Right Response 12 Right Expiration Date 4 3, Explainthe procedure/rationale tothe patient/relative.4 Baseline information taken and documented: History regarding previous transfusion. Vital Signs (TPR,BP}) Checked for pre-existing skin rasbes/allerges 4 6. Explain the importance of the benefits on Voluntary Blood Donation ( R.A 7719- National Blood Service Act of 1994). 4 7. Blood Request form completed: > Blood Request form (Al entries must be filled up. Accomplish in 2 copies) > Transfusion Administration Checklist (1 checklist per 1 unit of biogd) vvvy¥ & Request prescribed blood /blood components from blood bank ta include: blood typing and x-matchingand blood result of transmissible disease. 4 9. Once blood is available. Using a clean lined tray, get compatible blood from the hospital blood bank. ¥ 10. Wrap the blood bag with clean towel and keep it at room temperature.| iL. Have a doctor and two (2) nurses assess patient’s condition. Countercheck: > Recheck physician's order > Compatible blood to be transfused against the x-matching. » Noting ABO grouping and RH. » Serial number of each blood unit. > Expiration date with blood bag label and ather lab. | > Blood exam as required before transfusion ( Hgb&Hct). » Visual inspection: Bag intact-no leaks, no tampering No clots, unusual discoloration, hemolysis No significant blood color difference- tube and bag > Waccess: Vine patency \V. Administration set for BT 3 way stopcock12. Get the baseline vital signs- BP, RR, and Temperature before transfusion. Refer to M.D accordingly. 13. Give pre-med 30 minutes before transfusion as prescribed. ¢ 14. Do hand hygiene before and after BT15. Prepare materials needed for BT. | * |V injection tray | * Compatible BT set | ® Blood component to be transfused | * Plain NSS 500cc je WV hook * Plaster ® Gloves etc. 4 16. Main line is suggested to have Plain NSS during blood transfusion. 717. Open compatible blood set aseptically and close roller clamp. > Spike the blood bag carefully; > fill the drip chamber at least half full; > prime tubing and remove air bubbles > Use 3 way stopcock. ¥ | MAAN la i ag SAS ta a a 9 18. Close roller clamp of IV fluid of Plain NSS and regulateto keep vein open while transfusion is going on.ee : 19. Final Identity Check (Bedside) > Patient state full name and date of birth (if able). If not, responsible person is to respond. | > Patient and name matched with the patients armband | > Serial number in the blood bank form match with the blood product container. | » Recheck VS > If all verifications are in agreement, sign and write the date and time started before puncturing, to the provided checklist and other document. Compare ihe name & number on the patent's wratpend wath Soe on the piood beg labelBedside Checking & identify the correct patient! BLOOD BAG Compatibility label PATIENT PAPERWORK Verbal ID Compatibility form Wristband Prescription charteee, 20. Transfuse the prescribed blood. Transfuse the blood via injection port and regulate at 10-15 gtts. initially for 15 minutes,then ot prescribed rate (usually an the parieat’s conditian). | During the blood transfusion: Close monitoring for the first 15 minutes. Close monitoring for the next 30 minutes { Hourly Monitoringwhile ongoingtransfusion. bd | 21 For immediate management of suspected transfusion reaction: Fever Hypotension Resperatory Distress Gills Hypertensan Beedrg Urtcanal Pan (V ute, chest back) f blood transfusion reaction ocours: ‘Stoo transfusion immediately (leave! in place} Check VS auscultate heart and bresth sounds Check bhood bag and venfy phyacan Nouly Resdent/attendingPhyscan Nocty Laboratory and Murve Supervisor tum rematreng blood product and BT form to the laboratory. . Filup * Suspected Adverse Reschan Reporting Form” \4 ’22. If suddenly blood transfusion stops/delayed: > check V site. > Cose the roller damp. > Find another site immediately. | > Notify the AP a 23. Swirl the bag hourly ta mix the solid withthe plasma. N.B one 81 set should be used for 1-2 units of blood. s 24. End of Transfusion: > When blood is consumed, close the roller clamp of BT, and disconnect from IV lines then regulate the |VF of Plain NSS as prescribed. Monitor Vital signs Return remaining blood product and BT form tothe laboratory. w w