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Nursing 3 Test 3

Transplantation

QuestionAnswer
Transplantation transfer a section of tissue or a complete or partial organ from its original prosition to anothers
Types of transplants xenograft, allograft(autograft & isograft)
xenograft across species
allograft within the same species
autograft self
isograft from identical twins
organ donors cadavers(80-85% of donors,usually brain dead) Living(related:twins,siblings,parents & unrelated)
organ transplant waiting list 4/12/11-all organs(110,734) Kidneys(88,290)
transplants performed 2010 28,664
Donation Laws 1971-Uniform Anatomical Gift Act, 1986-87-Required Request Law, 1999-HCFA mandates that all hosp report imminent death to OPO's, 2008-NJ Hero Act
Transplantation Organizations OPTN(Organ Procurement & Transplant Network), UNOS(United Network of Organ Sharing), OPO(Organ Procurement Organization),Transplant Center
Donation Process ID donor,OPO notified,Donor evaluated,Brain death determined,family informed/options ID'd,consent obtained,organs surgically recovered,organs/tissue shared w/recipients
donor criteria age,no transmittable diseases,no high risk behavior for infectious disease,no active malignancy,no overwhelming sepsis,specific organ evaluated for suitability and function
brain death criteria deep coma(GCS-5),no spontaneous movement or respirations(vent dependent),no purposeful response to pain, no brain stem reflexes(pupil,cough,gag),confimatory tests(EEG,brain blood flow)
Lab tests done routine lab tests, histocompatability testing, serology testing for transmittable diseases
ABO typing matching or compatible blood type, ABO incompatibility(contraindication to solid organ transplantation),research ongoing for ABO incompatible donation
HLA Human Leukocyte Antigen
Human Leukocyte Antigen Genetic "Barcode"
HLA matching tests donor and recipient compatability(6 most common)**IMPORTANT**-in kidney & bone marrow transplantation
crossmatching determines if recipient has produced antibodies to the potential doneor
A positive crossmatch is a... contraindication for organ transplant due to risk of hyperacute rejection
Hyperacute rejection antibody mediated response, occurs in minutes-hours, usually occurs in kidney transplants, pt's have pre-existing antibodies(ABO mismatch,previous blood transfusions,previous transplant),irreversible(organ need to be removed)
Acute rejection cell mediated response,most common type(reversible),occurs few days/months after transplant,inflammation at graft site??,impaired organ function,confirmed w/bx
treatment of acute rejection short course steroids,anti-T cell antibodies
Chronic rejection possibly antibody-mediated response, gradual deterioration of organ(months/years after), Confirm w/bx, wait list for new organ
graft vs host disease(GVHD) bone marrow transplant complication,occurs w/in 7-30 days, occurs if no close match of HLA,donor cells attack host tissue(esp skin,liver,GI,cell mediated response),prognosis poor
immunosuppressive therapy begun pre and intra op, helps minimize & prevent rejection, high risk for malignancy & infection, to be taken REST OF LIFE
Corticosteroids general immunosuppression, anti-inflammatory
corticosteroids side effects wt gain, GI upset, muscle weakness, hyperglycemia, mood swings, impaired wound healing(minimal use now b/c of above)
Cyclosporine(sandimmune) inhibits T-lymphocyte cells
Adverse effects of Cyclosporine(Sandimmune) hyperglycemia, increases facial and body hair, gingival(gum) hyperplasia, nephrotoxic, neurotoxic, and hepatotoxic
Tacrolimus(Prograf) Inhibits T-cells(Do not admin w/Cyclosporin)
Adverse effeccts of Tacrolimus(Prograf) tremor,h/a,HTN, nausea, hyperglycemia, nephrotoxic and neurotoxic
Mycophenolate mofetil(Cellacept) Inhibits T-cell and B-cell proliferation, effective as part of triple therapy in kidney transplant
adverse effects of Mycophenolate mofetil(Cellacept) diarrhea, n/v, leukopenia
Other medications for transplantation anti-virals, anti-infectives, anti-fungals, anti-ulcer(to prevent side effects of steroids)
pre-op nursing for transplantation determination of physical health, psychosocial evaluation, preop teaching
post transplant nursing care of the immunosuppressed patient, assessment of graft function, timely detections of complications post transplant
renal transplant complications fluid imbalance: intra-op formation of urine w/massive diuresis(LRD),strict I&O, replace urine output, monitor serum electroylytes, monitor vitals
urine output for kidney transplant pt catheter patency, replace urinary output ml/ml Q 1 hr, monitor color of urine, abrupt decrease is significant, CBI, catheter care, monitor output after catheter d/c
renal transplant complications delayed graft function, transplant renal artery stenosis, urinary tract obstruction
risk for infection of renal transplant pt usually opportunistic infections, may not present w/typical s/s(low grade fevers, malaise & general discomfort), monitor possible sites for infection
education needs for renal transplant pt:self needs temp,BP,wt,I&O, long term f/u care, prevention of infection, regular eye & dental check ups, contraception, avoid contact sports, medic-alert bracelet,a/s rejection
Teaching:Medications for renal transplant pt name,dosage,strength,side effects,take on schedule,don't miss dose DO NOT STOP, do not take with grapefruit juice, contraception(females should avoid pregnancy for 2yrs)
Discharge Teaching:Report to physician... Temp >99F, boil,abscess,infected wound, foul drainage(anywhere), peristent cough, cloudy,foul smelling urine, organ specific s/s
Created by: jbittner