Organ Transplant PPT PDF

ORGAN TRANSPLANTATION I TY UN M IM SED S P RE P SU Replacement of diseased/damaged organ with a healt...

ORGAN TRANSPLANTATION I TY UN M IM SED S P RE P SU Replacement of diseased/damaged organ with a healthy organ from a donor. Organs that may be transplanted include:  Kidney  Heart  Liver  Lungs  Pancreas  Stomach & intestines RISK FACTORS Acute or chronic infections History or indicators of cancer Factors that increase risk for infection or cancer: Poor nutrition Smoking ALLOGRAFT Most common organ transplant Organ from genetically non-identical human donor:  Cadaveric  Living related (but not identical twin)  Living unrelated  ORGAN MATCHING Tissue typing done to assess donor- recipient compatibility Tissue matching does not completely prevent organ rejection Human Leukocyte antigens (HLAs) Cross-matching & % reactive antibodies KIDNEY TRANSPLANT LIVER TRANSPLANT HEART TRANSPLANT LUNG TRANSPLANT PANCREAS TRANSPLANT INTESTINAL TRANSPLANT NURSING DIAGNOSES 1. Ineffective therapeutic regimen management related to lack of knowledge about complex post- transplant care 2. Risk for infection related to immunosuppression 3. Risk for injury related to organ rejection or adverse drug effects 4. Social isolation related to need to avoid exposure to infections CONCEPT-BASED NURSING CARE How can the nurse use a concept-based approach to plan post-operative care for the transplant patient?  Acid-base?  Comfort?  Fluid & electrolyte?  Infection?  Oxygenation?  Perfusion? NURSING CARE Priority nursing actions include: Correct administration of immunosuppressant drugs Monitoring for signs of rejection Monitoring for adverse drug effects Preventing infections PREVENTING INFECTIONS Avoid exposure to infection Maintain a healthy lifestyle Take prophylactic antibiotics Report infections immediately HCAI - PREVENTION Care of intravenous catheters (central and peripheral) Urinary catheter care Neutropenia precautions ANC CALCULATION WBC 1.6 Neutrophils %Bands 5 %Segs 48 Lymphocytes % 10 Monocytes % 15 Platelet 210 Hemoglobin 13 Hematocrit 40 WBCs (1.6) x 1000 = 1600 %Bands + %Segs = 53% = 0.53 ANC = 1600 x 0.53 = 848 (Neutropenic precautions needed?)  NURSING CARE CONT. Correct administration of immunosuppressant drugs Consistent administration No OTC or herbals without approval IMMUNOSUPPRESSION The success of allogeneic organ tranplantation is also dependent upon immunosuppressant drug therapy to prevent organ rejection. The goal of drug therapy is to suppress the antecedents, attributes, & positive consequences of normal immunity  IMMUNOSUPPRESSANT DRUGS Calcineurin inhibitors (cyclosporine, tacrolimus) Rapamycin (mTOR) inhibitors (sirolimus) Antiproliferative agents (azothiaprim, mycophenolate) Antibodies (moromonab-CD3, baxiliximab) Corticosteroids (prednisone) IMMUNOSUPPRESSANT DRUGS CONT. May use more than one drug for therapy: Ability to block multiple immune responses Lower dosages can be used thus reducing the risk of adverse effects  ADVERSE EFFECTS Major complications of immunosuppression are: inability of the immune system to respond to infections the development of melanomas, lymphomas, and other cancers MONITORING FOR ADVERSE DRUG EFFECTS  Patient teaching (verbal & written) Common adverse effects and how to monitor Contraception Drug-drug or drug-food interactions Importance of carrying drug information LONG-TERM IMPLICATIONS Adherence to complex drug therapy Increased risk for cancer  Routine screening  Sun screen and protective clothing ORGAN REJECTION Occurs due to the genetic difference between the donated organ and the recipient Involves both humoral and cell mediated immunity  Inflammatory response  Damage to blood vessels of transplanted organ  Failure of transplanted organ TYPES OF REJECTION Hyperacute rejection Acute rejection Chronic rejection MONITORING FOR SIGNS OF REJECTION Early signs of rejection Not feeling well Flu-like symptoms Pain or swelling at transplant site Organ function decline Keep appointment for lab tests