Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCM > Transplantation > Flashcards

Transplantation Flashcards

1
Q

major histocompatibility complex (MHC) what is it

A

a set of molecules on cell surfaces that are responsible for lymphocyte recognition - these set of molecules uniquely identify us as us
also known as HLA - human leukocyte antigen - set of molecules responsible for recognizing foreign antigens that come into contact with me as a person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

self cells recognize self cells, any protein that enters my organism of self gets recognized as a foreign antigen, the recognition of foreign antigen illicit’s an immune response which response

A

an inflammatory response which potentiates the risk for SIRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is an antigen

A

foreign substance/protein that illicit’s immune response (antibodies)
its what keeps us healthy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

identical twins have the same

A

HLA - human leukocyte antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

a transplant pt is at HIGH RISK for

A

organ REJECTION and INFECTION secondary to suppression of immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

in 1968 the UAGA (uniform anatomical gift act) stated

A

increased donation - framework when we donated an organ it was a gift - given upon death - donate tissue, skin, eyes - the 1st legal process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NOTA (national organ transplant act) stated

A

1984 - resulted in formation of an organ procurement organization network that provided professional education for a need for national coordinated organization for transplantation - beginnings of network - hospitals in charge of procurement of organ
phila gift of life 1 of the 1st organ procurement transplant centers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

UNOS - United Network for Organ Sharing

A

1986 - US government created this for organ procurement of organs - management of organ donation - national network - all regions in US required to have an organ procurement center by law - hospitals no longer in charge of managing organ procurement - outside source builds trust

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

difference between donation and transplantation

A

Donation - OPO (organ procurement organizations) “gift of life” is the one responsible for coordinating and managing donation process. OPO provides support to families prior to, during and after donation
Transplant - OPO will help coordinate with hospitals transplant coordinators - interdisciplinary approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a nurses responsibility when a family shows interest in organ donation of a loved one

A

notify charge nurse - contact OPO invite them to talk to family - we don’t directly discuss donation with patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

**what is best practice in organ donation process

A

the earlier we identify potential donors the better - OPO gets involved early on and builds relationships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

strategies to increase organ donation

A

All hospitals must have an agreement with an OPO
The hospital must notify the OPO in a timely manner
The OPO determines medical suitability for donation
The hospital and the OPO must collaborate in family notification and education services
The hospital and the OPO must collaborate in educating hospital staff
Hospitals must review death records analysis of identification of potential donors and maintain fxn of donors
Responsible for recovery of organ from deceased
box 21-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

categories of organ donor/sources

A
  • **living relatives or unrelated (kidneys,liver) - must meet certain criteria - HLA most closely matches relatives (except liver)
  • **deceased donor (meets brain death criteria) best transplant donor - still perfusing
  • **deceased after cardiac/circulatory death (DCD) - heart has stopped beating and pt stopped breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

living donor is at risk for this post-op/assess for

A

LIVER (infection - decreased immune response
bleeding problems)
KIDNEYS (urine output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what criteria must be met to become a donor

A

overall good health
free from: diabetes, cancer, heart disease, kidney disease
compatible blood type (HLA testing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

***in liver transplant what is different for appropriate donation

A

don’t need to match HLA

ONLY BLOOD TYPE and BODY SIZE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

brain death is determined by

A

complete cessation of brain function that is irreversible

2 physicians determinant (neurologist and intensivist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

3 elements of cessation of brain functioning

A

pt is in a coma
pt is apnic
absence of brain-stem reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

***criteria for the physician exam to determine brain death

A

complete entire physical exam
pt must be normothermic (can’t be hypothermic)
pt must be oxygenated (can’t be hypoxemic) as e/b ABG
pt cannot be on medications that suppress the CNS (no sedation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

federal and state laws require physician notification of the OPO following determination of brain death, t or f

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

clinical criteria for brain death determination

A

pt will have absent corneal reflexes
pt will have absent light reflexes - pupils unresponsive pt must be w/o sedation
pt will have absent dolls eyes - eyes turn opposite direction of the turned eyes
pt does not have a gag reflex (when suctioned no gag reflex)
apnea testing - PaC02 >60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

**what is apnea testing when determining brain death

A

pg 661 chart 21-3
pt on ventilator - Take baseline ABG - take pt off vent for 8 min draw ABG
pre apnea ABG PaC02 is normal (35-45)
post apnea ABG Pa02 decreases - PaC02 is increased; greater than 60 indicates brain death - not exhaling C02,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

can a DCD pt still be a donor

A

yes - (kidneys within 8hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

hypo-perfusion/re-perfusion injury is at increased risk for

A

SIRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how do we obtain consent for donors

A

informed consent
family consent for donation - (donor designation - drivers license is the consent)
presumed consent - if i don’t mark on license everyone is considered as a donor - must identify NOT wanting to donate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

**what are some myths and fears assoc w/consent to donate

A

think they might not be dead yet
inferior care - personnel will not care as much
disfiguring - cant do open casket funeral
religious beliefs
costs - fear of fees for those uninsured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

***once pt is identified as brain dead the focus of care shifts to

A

promoting optimal physiologic status to preserve organ fxn (maint norm ABG’s, glucose reg, hemodynamic stability, electrolytes, clotting fxrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

*nursing mgmt goals for donor care - 4

A

oxygenate the organs - ABG
maintain hemodynamic stability - determined by BP
maintain fluid/electrolyte balance (K, Na)
maintain temp regulation

29
Q

recovery of organs - role of the critical care nurses

A

emotional support for family - OPO
physiological support for pt
communication/collaboration

30
Q

transplant rejection - we expect every pt to have some type of rejection, t or f

A

true - assess for rejection and complications r/t infection because we expect an immune response, mostly cell-mediated rejection response

31
Q

which immunity would come from an antibody response

A

humoral immunity

32
Q

transplanted organ will have different antigens (proteins) than the recipient, t or f

A

true - we anticipate an antigen mediated immune response that is cell-mediated

33
Q

a cell-mediated antigen response occurs because

A

cytotoxic T cells are capable of killing foreign cells from foreign organ

34
Q

what do helper T Cells do

A

help regulate the immune response and send proliferative cells to destroy the foreign invader

35
Q

what do suppressor T cells

A

helps down regulate up-regulators

36
Q

normal immune response wants to get rid of the foreign organ, t or f

A

true

37
Q

trt for patients receiving an organ is about

A

regulating the cell mediated immune response - we want to suppress cytotoxic T cells, stop helper T cells to up-regulate an immune response

38
Q

what drugs do we give to try and regulate the immune response

A

immuno-suppressants, steroids, anti-inflammatory

suppression of the immune response

39
Q

** 3 types of rejection **

A

hyper-acute
acute
chronic

40
Q

what is hyper-acute rejection

A

antibody (humoral) mediated response - the person who received the organ had already had a memory of that antigen (blood transfusion w/bld type, mother with incompatibility RH pregnancy)

41
Q

what is acute rejection

A

cell-mediated immune response - happens to everybody

42
Q

what is chronic rejection

A

a combination of cell mediated and antibody mediated long term rejection response

43
Q

a hyper-acute rejection happens when

A

as soon as the organ is reperfused, in the OR or ICU

44
Q

how do we trt acute rejection

A

anticipate it give immune-suppression meds in OR to help decrease effects after surgery

45
Q

when does a chronic rejection occur

A

years after transplant - long term antibody development/chronic which induces organ to be rejected after a long period of time

46
Q

when does acute rejection occur

A

weeks to months after transplant - we balance and coordinate immune-suppressant therapies

47
Q

treatment after chronic rejection

A

pt would need another transplant

48
Q

which renal transplant pt being cared for in the ICU is showing s/s of acute rejection

A

pt with tenderness over the graft site and a 15lb 3-day weight gain

49
Q

tenderness over a graft site is indicative of

A

rejection

50
Q

***what is the purpose of induction therapy

A

to induce tolerance of transplanted graft - can be given

pre, intra or post-op

51
Q

goal of immunosuppression

A

decrease activity of the helper T cells

52
Q

immunosuppression therapy is given 2 ways

A

induction therapy - pre-inta-post operatively

maintenance therapy - long-term combination therapy

53
Q

immunosuppressant meds cause increased risk for

A

infection, malignancies, glucose intolerance, rejection - down-regulating immune response

54
Q

most definitively determine rejection by doing this

A

biopsy the organ - EXCEPT THE LIVER

55
Q

why not do liver biopsy to determine rejection

A

bleeding and infection

56
Q

pt with end stage liver disease and are in need of a transplant are at high risk for

A

bleeding, infection, hepatic encephalopathy

57
Q

contraindications for receiving a liver transplant

A

metastatic cancer, alcohol cirrhosis, AIDS, advanced cardiovascular disease

58
Q

donor criteria for a liver transplant

A

blood type and body size - NO HLA required

good for non-relative donor

59
Q

MELD (model end-stage liver disease) criteria formula that calculates

A

risk for mortality - used to classify severity of liver disease
the sicker pt is w/liver disease the less likely to survive transplation

60
Q

MELD score parameters

A 
assess for increased
serum creat levels
INR
Bilirubin 
if increased, increased risk for death
61
Q

mgmt of pre-transplantation phase

A 
q 1hr neuro assessments
HOB elevated 30-40 degrees (avoid aspiration w/declining mental status and oxygen)
1:1
bed in low position
do paracentesis for ascites
62
Q

post-op mgmt for liver transplant pt

A

maintain BP, electrolyte status
watch for coagulopathy problems
carefully measure t-tube drainage (biliary drainage)
monitor liver fxn tests - elevated = possible rejection
monitor PT and INR times
monitor temp - chg with tachycardia be suspicious of infection - call the DR!

63
Q

any decrease in t-tube drainage would indicate

A

the liver is starting to not work

64
Q

pain and tenderness at the site, other than post-op would warrant suspicion of

A

rejection

65
Q

the most common complication of liver transplant is

A

hepatic artery thrombosis or HAT

66
Q

HAT (hepatic artery thrombosis) happens because of and includes these s/s

A

a graft dysfunction - causing increased bleeding, infection, decreased drainage from t-tube and increased liver enzymes

67
Q

dx of HAT (hepatic artery thrombosis)

A

Doppler ultrasound

68
Q

family education upon discharge of liver transplant

A

continued surveillance of infection and rejection

weekly visits to PCP

CCM (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions