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Med Surg IV > HLA Crap > Flashcards

HLA Crap Flashcards

1
Q

How many HLA antigens are looked at for a match?

A

6

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2
Q

The ________ the match, the less likely for _________.

A

HIgher

Rejection

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3
Q

Which two organs require an exact match?

A

Kidneys and bone marrow

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4
Q

What organ requires no HLA match? Why not?

A

Corneas

Corneas are avascular

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5
Q

What is a Positive (+) crossmatch?

A 
Blood from donor 
\+
Blood from recipient
= 
BAD reaction
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6
Q

What is a Negative (-) crossmatch?

A 
Blood from donor 
\+
Blood from recipient
= 
No reaction
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7
Q

What type of crossmatch is necessary for a transplant?

A

Negative (-)

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8
Q

What are the 3 MAIN components for transplant?

A
  1. Negative crossmatch
  2. ABO compatibility
  3. HLA match
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9
Q

How many types of rejection are there?

A

3; hyperacute, acute, chronic

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10
Q

Hyperacute reaction

When does it occur?
Why is it rejecting?
What organ is more susceptible to this type of reaction?
Treatment?

A

Almost immediately! Occurs in minutes to hours!

Requires immediate removal of the organ

Rejects due to pre-existing antibodies
- Most likely there was a FALSE negative crossmatch

Most susceptible organ - kidneys

No treatment

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11
Q

Acute reaction

When does it occur?
Is it reversible?
Treatments?

A

Occurs - Usually within 6 months post transplant (can happen up to a year)

The ONLY rejection that is REVERSIBLE

Meds: Immunosuppressants (for life) and corticosteroids

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12
Q

Chronic reaction

When does it occur?
Is it reversible?
What are treatments?

A

Occurs - when the patient has repeated acute rejections. Repeated rejections cause scarring making the organ unable to work.

Non-reversible, organ is scarred (dead) which means no perfusion

TX: Pt will need to be placed back on a transplant list for another transplant - If kidneys, the patient will need to go back on dialysis and most likely need new venous access.
Pt can stop taking immunosuppressants

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13
Q

Why don’t we use immunosuppressants for a chronic reaction?

A

Because the organ is already dead therefore the body cannot reject it

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14
Q

Graft Vs. Host Disease

How soon does it occur?
Treatment?

A

The transplanted ORGAN REJECTS the recipient’s BODY

Happens in 1 - 4 weeks

NO adequate treatment
Focus on prevention:
- Irradiated blood products
- Immunosuppressants
- Corticosteroids
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15
Q

3 clinical manifestations of Graft Vs Host

A

Skin issues (rash)

Liver issues

GI issues

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16
Q

What do corticosteroids do?

A

Suppress the inflammatory response

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17
Q

What do calcineurin inhibitors do?

A

Inhibit B & T cells (WBC)

18
Q

What do cytotoxic drugs do?

A

Suppress B & T cells

19
Q

What do monoclonal antibodies do?

A

inhibit T cell function

20
Q

What do polyclonal antibodies do?

A

Deplete T cells

21
Q

Can a patient with uncontrolled diabetes receive a transplant?

A

NO

Why? The patient is UNSTABLE

22
Q

Can a patient with managed HIV receive a transplant?

A

YES

Why? More recently, if HIV is managed PROPERLY the patient is considered STABLE

23
Q

Can a patient with managed Hep C donate and organ to a recipient with managed Hep C?

A

YES

Why? Both patients are STABLE

24
Q

Can a patient with chronic respiratory infections receive a transplant?

A

NO

Why, patient is UNSTABLE

25
Q

During the live donor, kidney transplant process, is the procedure more difficult for the donor or the recipient?

A

The donor

Why? When harvesting the kidney it is very invasive for the donor because of where the kidneys are located. For the recipient, the kidney is not transplanted in the same place at it originates. It is placed in a much lower position, and access is easier.

26
Q

What are complications of kidney transplantation?

A 
Rejection (most common)
Infection
Cardiovascular disease
Malignancies (cancer)
Recurrence of original renal disease
Long term corticosteroid-related complications
27
Q

Kidneys need a MAP of _____ to fully perfuse

A

65 or >

28
Q

A patient with end-stage renal disease is being evaluated for possible kidney transplant. The nurse prepares this patient for which testing for this procedure? Select all that apply.

  	ABO typing
  	Electrolytes
  	Cross-matching
  	BUN and creatinine
  	Tissue typing
A

Tissue typing

ABO typing

Cross-matching

29
Q

After teaching a patient on immunosuppressant therapy after a kidney transplant about the post transplant drug regimen, the nurse determines that additional teaching is needed when the patient says:

a. “If I develop an acute rejection episode, I will need to have other types of drugs given IV.”
b. “I need to be monitored closely because I have a greater chance of developing malignant tumors.”
c. “After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor.”
d. “The drugs are given in combination because they inhibit different aspects of transplant rejection.”

A

c. “After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor.”

The calcineurin inhibitor will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.

DIF: Cognitive Level: Application REF: 230-232

30
Q

A patient who received a bone marrow transplant for treatment of leukemia develops a skin rash 10 days after the transplant. The nurse recognizes this reaction as an indication that the:

a. donor T cells are attacking the patient’s skin cells.
b. patient’s antibodies are rejecting the donor bone marrow.
c. patient is experiencing a delayed hypersensitivity reaction.
d. patient will need treatment to prevent hyperacute rejection.

A

a. donor T cells are attacking the patient’s skin cells.

The patient’s history and symptoms indicate that the patient is experiencing graft-versus-host disease, in which the donated T cells attack the patient’s tissues. The history and symptoms are not consistent with rejection or delayed hypersensitivity.

DIF: Cognitive Level: Comprehension REF: 232

** I want to say this question or one very similar to it, is on her test ***

31
Q

A patient is admitted to the hospital with acute rejection of a kidney transplant. The nurse will anticipate:

a. administration of immunosuppressant medications.
b. insertion of an arteriovenous graft for hemodialysis.
c. placement of the patient on the transplant waiting list.
d. drawing blood for human leukocyte antigen (HLA) and ABO compatibility matching.

A

a. administration of immunosuppressant medications
ANS: A

Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is reversible, there is no indication that the patient will require another transplant, hemodialysis, or HLA/ABO testing.
DIF: Cognitive Level: Application REF: 229-230

32
Q

Which information about patient and donor tissue typing results for a patient who needs a kidney transplant is most important for the nurse to communicate to the health care provider?

a. Patient is Rh positive and donor is Rh negative.
b. Six antigen matches are present in HLA typing.
c. Results of patient-donor cross matching are positive.
d. Panel of reactive antibodies (PRA) percentage is low.

A

Results of patient-donor cross matching are positive.
ANS: C
Positive cross matching is an absolute contraindication to kidney transplantation, since hyperacute rejection will occur after the transplant. The other information indicates that the tissue match between the patient and potential donor is acceptable.
DIF: Cognitive Level: Application REF: 229

33
Q

When assessing a patient who had a liver transplant a week previously, the nurse obtains the following data. Which finding is most important to communicate to the health care provider?

a. Dry lips and oral mucous
b. Crackles at both lung bases
c. Temperature 100.8° F (38.2° C)
d. No bowel movement for 4 days

A

c. Temperature 100.8° F (38.2° C)
ANS: C
Infection risk is high in the first few months after liver transplant and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions, but do not indicate a need for urgent action.
DIF: Cognitive Level: Application REF: 1088

34
Q

The decision to donate one’s organs or tissues can be made by the patient __________ death or by the patient’s _________ after death.

A

BEFORE death

FAMILY after death

35
Q

Patients with a heart transplantation are at rick for which of the following complication in the first year after transplantation? (select all that apply)

a. Cancer
b. Infection
c. Rejection
d. Vasculopathy
e. Sudden Cardiac Death

A

Correct answers: b, c, e

b. Infection
c. Rejection
e. Sudden Cardiac Death

Rationale: A variety of complications can occur after heart transplantation. In the first year after transplantation, the major causes of death are acute rejection and infection. Heart transplant recipients also are at risk for sudden cardiac death. Later, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) are major causes of death.

36
Q

The nurse plans long-term goals for the patient who has had a heart transplant with the knowledge that a common cause of death in heart transplant patients during the first year is:

a. infection
b. heart failure.
c. embolization
d. malignant conditions

A

a. infection
Because of the need for long-term immunosuppressant therapy to prevent rejection, the patient with a transplant is at high risk for infection, a leading cause of death in transplant patients. Acute rejection episodes may also cause death in patients with transplants, but can be successfully treated with augmented immunosuppressive therapy. Malignancies occur in patients with organ transplants after taking immunosuppressants for a number of years.

37
Q

This type of transplant rejection which most commonly occurs with kidney transplant.

A

Hyperacute

38
Q

Organ must be removed when this type of transplant rejection occurs.

A

Hyperacute

39
Q

A transplant rejection which Infiltration of the organ with B and T lymphocytes occur.

A

Chronic

40
Q

A transplant rejection which usually reversible with additional or increased immunosuppressant therapy.

A

Acute

Med Surg IV (12 decks)

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