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Nursing 3 Test 3
Transplantation
| Question | Answer |
|---|---|
| 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
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