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Gen Med > transplant patient > Flashcards

transplant patient Flashcards

1
Q

criteria

A

end stage disease
conventional rx failed
no untreatable malignancy/infection
no disease process leading to attack of transplanted organ/itssue
demonstrates emotional and psych stability
good support system
good compliance w/ medical regimen

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2
Q

cadaveric donors

A

transplant source
suffered severe nero trauma w/ resulting brain death
organs remain viable w/ meds and mechanical means
no sepsis, malignancy, communicable disease

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3
Q

living donors

A

kidney, liver, lung, pancreas, bone marrow
more time to be evaluated by transplant team
newborn –> 65yo
no hx of drug/ETOH abuse, chronic disease, malignancy, communicable diseases

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4
Q

compatibility issues

A

ABO blood type
histocompatibility typing
size

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5
Q

histocompatibility typing

A

HLA (human leukocyte antigens)
white cell crossmatch
due to short organ ischemic times, may bot have time to perform typing

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6
Q

UNOS

A

united network for organ sharing

responsible for procurement and distribution of organs
sets standards for MD, transplant facilities, labs, organ procurement organizations

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7
Q

UNOS distributes organs based on

A

illness severity, blood type, weight match, recipient eating time

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8
Q

transplant rejection

A

normal immune repsonse

immunosuppressive drugs

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9
Q

immunosuppressive drugs

A

usually double or triple drug regimen
prevent total rejection
decrease body response to fighting infection
balance is key

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10
Q

hyper acute graft rejection

A 
occurs w/in first 48 hrs of transplant
usually due to ABO incompatibility or cytotoxic antibodies in recipient
presents w/ high fever and malaise
unresponsive to tx
only option is to remove transplant
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11
Q

acute graft rejection

A

occurs during first year
small vessel damage due to T lymphocyte repsonse
if not detected, whole organ becomes ischemic
treatable and reversible

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12
Q

acute graft rejection presents w/

A 
sudden weight gain
peripheral edema
malaise
dyspnea
decreased urine output
electrolyte imbalance
elevated BP
swelling/tenderness at graft site
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13
Q

chronic graft rejection

A

occurs after first year of transplant
due to immunoglobulin M complexes and compliment formed in organ vessels
deterioration is gradual and progressive
drugs may slow process down, but will not stop it
eventual need of re-transplant
presentation depends on organ involved

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14
Q

infection

A

immunosuppressants increase chance
if present, decrease drugs and start Antibiotics
proper hand washing before and after pt care

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15
Q

highest risk of infection is

A

within 3 months of transplant

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16
Q

signs of infection

A 
temp > 100.5
fatigue
chills
sweating
diarrhea > 2 days
dyspnea
cough 
c/o sore throat
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17
Q

transplant types

A 
kidney
liver
pancreas
heart
lung
bone marrow
double transplants
18
Q

cadaveric kidney may be viable for 72 hours

A

72 hours

last organ usually harvested
30-40% chance of acute tubular necrosis

19
Q

type of donor preferred for renal transplant

A

increase graft and recipient survival
more time for match eval
decrease chance of damage during procurement
decreased risk of ATN

20
Q

recipient kindly remains unless

A

infected or uncontrolled HTN

21
Q

donor kidney placed in

A

iliac fossa

extraperitoneal
low ab incision
advantages

renal artery/vein of donor connected to iliac artery/vein or recipient

ureter sutured to bladder

22
Q

renal post op

A

dialysis may be needed first few weeks

strict I and O

23
Q

signs of rejection

A 
decreased urine output
increased BUN and serum creatinine
increased BP
wt gain (>1kg/24 hr)
ankle edema
24
Q

BP w/ renal treatment

A

systolic maintained > 110 mm Hg
ensure adequate rental perfusion

increase is higher than normal w/ acitivity

25
Q

orthotopic cadaveric (liver)

A

disease liver removed
new liver placed in anatomical position
incision-midline sternotomy and continuous laparotomy

26
Q

living adult donor (liver)

A

single lobe transplanted

liver regulates to normal size in donor and recipient w/in several months

27
Q

split liver

A

adult cadaveric liver is divided into two in situ
usually left lobe given to child due to small size
right lobe given to adult

28
Q

domino (liver)

A

pt w/ FAP
involves 3 people
pt w/ FAP recieves donor liver
FAP liver goes to another recipeient

29
Q

symptoms from FAP manifest

A

40-60 years

30
Q

liver post op

A

three JP suction drains

biliary T tube

31
Q

liver rejection

A

prolonged PT/PTT, abnormal liver panel, oliguria, metabolic acidosis, hyperkalemia, kypoglecemia, coma

32
Q

tx for liver rejection

A

immediate retransplant

33
Q

liver therapy - post op ascites

A

increased abdominal girth
LE edema
increased lumbar lordosis
COG shifts leading to possible balance

34
Q

pancreas transplant

A

not live saving procedure
pt w/ metabolic implant, Type I DM, severe brittle diabetes
may prohibit neuropathy progression
performed before severe diabetic complications occur

35
Q

pancreas transplant procedure

A

lower oblique abdominal incision
bladder drainage technique
BW monitored
some pts insulin indep 5 yrs

36
Q

pancreas - bladder drainage technique

A

donor duodenum attached to urinary bladder

loss of fluids needs to be monitored

37
Q

pancreas transplant post op

A

strict bed rest for a few days

loss of fluids monitored

38
Q

pancreas transplant post op - signs of rejection

A 
ab pain
fever
tenderness at graft site
hematuria
hyperglycemia
39
Q

pancreas transplant therapy

A

remind pt to stay hydrated esp w/ avitivieis

record I and O on record sheet

40
Q

pancreas and kidney transplants in diabetic pts

A

MDs may prefer to perform simultaneously due to potent immunosuppressive drugs

41
Q

orthotopic heart transplant

A

most common
median sternotomy incision
medial sternotomy incision
heart is removed except for post right atrium w/ SA node, left atrium, aorta, pulmonary artery
new heart is placed in anatomical position
EKG shows two P waves, but only new heart has ventricular contraction

42
Q

hetertopic heart transplant

A

rare
diseased heart is left in place
donor heart placed to right side of existing
donor L vent supports systemic circulation
native R ven supports pulm circulation
EKG shows 2 rhythms/rates

Gen Med (20 decks)

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