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Nursing 4 Exam 4 > Unit 19 Organ Transplant/Donation > Flashcards

Unit 19 Organ Transplant/Donation Flashcards

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1
Q

What is the basic criteria for Transplantation?

Ppl who can receive

A

End-stage disease in a transplantable organ

Failure of conventional methods to treat condition successfully

Progression of problems associated with organ failure which may be fatal

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2
Q

1 What is the Uniform Anatomical Gift Act?

2 What is the National Organ Transplant Act?

3 What is the Uniform Determination of Death Act?

A

1 Guidelines that authorized donation of organs

2 Organ registry

3 Determined what brain death was, cessation of all function including brain stem.

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3
Q

What does syngeneic mean? allogenic/allograft? autologous? xenogenic?

A

Syngeneic: Genetically identical member of same species
“identical twins”

Allogenic: Between members of same species (typical transplant)

Autologous: To self (blood and skin)

Xenogenic: Different species (ex: use during heart valves, skin)

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4
Q

Who is the recipient?

How is the living donor process done?

Cadaver process?

A

Person receiving organ

OR to OR

Person who died, organs taken from PT on vent - absolute brain death.
Organs kept in electrolyte solution.

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5
Q

What are the 3 processes of the immune system recognizing something that is non-self?

A

Inflammation (edema, redness, warmth, vessels constricting)

Anti-body mediated immunity (B-lymphocytes produce antibodies against antigens)

Cell-mediated immunity (T-lymphocytes regulate activity of other WBCs)

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6
Q

What is involved in compatibility/tissue typing?

A

Look for comparable weight

ABO/Rh antigens on RBCs (crossmatching by mixing blood in petry dish to see how they react)

Histocompatibility antigens-Human Leukocyte antigen. (HLA) which makes more compatible -looking for 3-5 HLA matches.

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7
Q

What is graft rejection?

A
  • Normal response to any foreign substance (B and T cells activated, inflammation)
  • Describes immune system response to a donated tissue/organ
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8
Q

What is a Hyperacute Rejection?

What are the manifestations?

A
  • Rare rejection, involves wrong blood type
  • Not treatable, organ needs to be removed
  • Seen within 48 hours

Manifestations: general malaise, elevated temperature, thromboses

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9
Q

What is Acute Rejection? describe.
How is it treated?
What is the dx by?

A
  • Rejection occurs within 3 months to 2 years
  • Tissue is vascularized
  • Becomes sensitive to donor’s antigens
  • Repeated episodes lead to organ damage and necrosis
  • Cell mediated response

Treatable w/ immunosuppressants therapy
Dx: w/ biopsy

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10
Q

What is Chronic Rejection?

A
  • Gradual deterioration over months to years (> 2 years)
  • May be asymptomatic or show s and s’s of failure in transplanted organ (weight gain, increased BUN/CR)
  • Treatment not usually successful, anti-rejection medications may slow process
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11
Q

What are lifetime immunosuppression therapy Rx’s?

Describe them.

A

cyclosporine:
-inhibits action of t-cells
-major immunosuppressant agent for prevention of allograft rejection.
-high degree of specificity
SE: nephrotoxic, hepatotoxic, neurotixic

tacrolimus:
-100x more potent than cyclosporine
-Useful for rescue therapy as well
SE: GI, liver, and renal dysfunction

azathioprine:

  • anti metabolic
  • reduces inflammation
  • decreased bone marrow and B and T cells
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12
Q

Describe the rescue therapy drug mycophenolate mofetil and corticosteroids.

A

mycophenolate mofetil:

  • common in kidney transplants and combo w/other Rx’s
  • less toxic, newer.
  • effective in rejection and rescue therapies.

corticosterioids ex: prednisone

  • anti-inflammatory anf immunosuppressant
  • decreases lymphocytes
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13
Q

What do you want to give all immunosuppressant drugs with?

A

Food

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14
Q

What is the primary cause of death following an organ transplant?

A

Infection because of bone marrow suppression

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15
Q

What is the nursing management pre-transplant?

A

Maintain recipient’s health

Treat chronic problems and infections

Psychiatric evaluation - is client capable of compliance?

Education: pulmonary exercise, meds, financial impact

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16
Q

If PT has infection before transplant, what happens?

A

They are temporarily taken off list.

17
Q

What is the nursing management post-transplant?

A

Infection control (most important)

Early recognition and treatment (of infection) improves chance that rejection can be reversed

Monitor toxic effects of meds

F/E balance and I and O’s

18
Q

What is Hematopoietic Stem Cell Transplant (HSCT) used for?

What is the objective regarding this?

A
  • Standard treatment for someone with leukemia: lymphoma, aplastic anemia
  • Can be autologous (your own stored) or allogenic (another person’s) stem cells

The objective is to get rid of all malignant cells w/chemo and radiation then give stem cells to replace and restore marrow function.

19
Q

Describe the Hematopoietic Stem Cell Transplant (HSCT) procedure.

A

Obtain donor-HLA match

Obtain cells from iliac crest: OR procedure

500-1000ml aspirated

Peripheral cells are obtained in outpatient

Filtered, to deplete T cells

IV transfusion (takes body 2-4 weeks to make cells from these stem cells)

20
Q

What is the donor care post-op management?

A

Hydrate

Pain management

Monitor complications of anesthesia

Site dry and intact

21
Q

What are steps to the transplantation of Stem Cells?

A
  1. Condition PT 5-10 days by getting rid of all malignant cells w/radiation and chemo
    SE: n and v, diarrhea, mucositis
  2. Transplant and transfuse over 30 min
    SE: fever, hypertension
  3. Engraftment - key to process, cells survive and grow in PT’s bone borrow sites ~2-5 weeks

(during this time PT is thombocytopenic and susceptible to infection)

22
Q

Describe Graft versus Host Disease.

A
  • Rejection of stem cells
  • Inflammation throughout whole body
  • Major organs affected: skin, liver, GI tract
  • The T cells from donated marrow cause the problem (graft causes issue)

Occurs in 30-70% of all BMT recipients

Can occur or persists after 100 days

23
Q

What are signs and symptoms of GVHD? (graft versus host disease)

A

Erythematous rash

Severe sloughing

Pruritus

RUQ pain

N/V

Diarrhea

24
Q

What is the most common transplant?

What are complications with this transplant?

A

Kidney transplant

Complications: 
Thrombosis
Acute rejection (within two weeks)
Acute tubular necrosis
Oliguria
Polyuria
Increased BUN/CR
25
Q

What is the post-op management of a kidney transplant?

A

IVF

I/Os

Diuretic therapy

Daily weights

Labs

Prophylactic antibiotics

Monitor for s and s’s of infection

26
Q

What are a couple conditions for heart transplant?

When is the initial rejection?

A

< 1 year to live
< 65 years old

Initial rejection usually 3 months after transplant,
Symptoms: dysrhythmias, weakness, fatigue

27
Q

What definitively indicates rejection in heart transplant?

A

Biopsy 1 week post transplant

28
Q

Describe Lung transplant.

A

May be single lobe or lung

PT’s receiving have severe or irreversible problems (CF, etc) while well enough to survive sx

Usually for <55 yo

29
Q

What is the post-op management of lung transplant?

A

Early ventilator weaning

Fluid restrictions

Bronchodilators

Early ambulation/Pulmonary exercises

Biopsy after 1 week

30
Q

Describe conditions when a pancreas transplant would be appropriate.

What are complications of pancreas transplant?

A

CF- pancreas and lung

Diabetes- pancreas and kidneys

Complications:

  • Venous thrombosis
  • Drop in urine amylase
  • Increased blood glucose
  • Acute rejection
31
Q

What is success if pancreas transplant measured by?

A

Measured by not excreting extra insulin

32
Q

When could a liver transplant be appropriate?
Who are liver transplants most common for?
What are the signs and symptoms of acute rejection in 1-2 weeks?

A

ESLD

Liver transplants most common for children

S and S’s of Acu. Rejection in 1-2 weeks:

  • Tachycardia
  • Fever
  • RUQ or flank pain
  • Jaundice
  • Elevated ALK phos
33
Q

What is seen elevated in liver rejection?

What is needed for diagnosis?

A

Labs will be elevated

Biopsy is needed for definitive dx

34
Q

What tissues can be donated?

A 
Corneas 
Skin
Bone
Heart valve
Saphenous veins
Tendon
35
Q

Describe Imminent Death referrals.

When are other instances when we would call the sharing network?

A

Must refer all ventilator dependent PT’s w/in 1 hour to the sharing network to allow proper evaluation of potential donor, if patient meets any of the following criteria:

  • GCS 5 or <
  • Loss of two or more cranial nerve reflexes
  • If end of life discussions are proposed.
  • Family initiates interest in donation.
36
Q

What are the steps in Organ Donation Process?

A

1) Referral
2) Evaluation
3) Consent
4) Maintenance
5) Recovery
6) Follow-up

37
Q

Describe the rescue therapy drug muromonab-CD3.

A

muromonab-CD3:
-Has monoclonal and polyclonal antibodies

-Selectively attacks lymphocytes /WBCs

-Most effective in 1st episode (choose different Rx on
another episode)

-Causes sensitization of PT along with serum sickness “flu-like symptoms” or anaphylactic reaction

Nursing 4 Exam 4 (6 decks)

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