Transplant Flashcards
brain death criteria
no central pain response & no protectives
apnea testing
pop off vent & monitor for resp effort, brain dead if none & CO2 raised by 20
confirmatory brain death testing
EEG, angio, isotope
what to check before declaring brain dead
normoglycemic, normothermic, no intox/poisoning, normal BP (with/without pressors)
care of brain dead donor
highest SaO2 with lowest FiO2, maintain temp, reduce pressors, map > 60, temp >36.5, UO > 1mL/kg/hr
hyper acute rejection
occurs minutes-hours after donation, organ must be emergently removed
acute rejection
occurs within 1 year, usually reversible with rescue meds
chronic rejection
gradual loss of organ function, must stay on immunosuppressants for life
short term side effects of corticosteroids
hyperglycemia, cushingoid appearance, mood swings, infection risk
long term side effects of corticosteroids
weight gain, osteoporosis, infection risk, cataracts, thin skin, gastric ulcers
cyclosporin
maintenance anti-rejection med
cyclosporin side effects
hirsutism, nephrotoxicity, HTN; monitor weight & renal fx
tacrolimus side effects
DM, diarrhea, vomiting, headache, renal toxicity
first month after transplantation
neutropenic - no crowds, no flowers, no vax, no fresh fruits/veggies, no kids, etc.
months 2-6 after transplantation
opportunistic infections, can get severe
6+ months after transplantation
community acquired infections, some get chronic illnesses
post-op kidney reception
strict I&O, should work immediately, may be oliguric for up to 7 days –> hyperK, dialyze
isoproterenol
decreases SA node dysfunction
post op heart reception
not innervated - no atropine, no chest pain w MI/dysrhythmia
post op liver reception
monitor coags, PT/INR & PTT
hypergly good postop
post op lung reception
extubated within 24-36, kept hypovolemic & freq bronchs to clear secretions –> no cough reflex; freq oral care
