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NURS 470 > Organ Transplant > Flashcards

Organ Transplant Flashcards

1
Q

allograft

A

tissue that is transplanted between members of the same species

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2
Q

autograft

A

transplantation of tissue from one part of a person’s body to another

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3
Q

heterograft

A

transplantation of tissue between two different species

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4
Q

isograft

A

transplantation of tissues between identical twins

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5
Q

brain death definition

A

when respiration and circulation are artificially maintained and there is total and irreversible cessation of all brain function including the brain stem

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6
Q

clinical determinants of brain death

A

EEG
cerebral blood flow/perfusion scan
physical exam (by 2 non-transplant MDs)
GCS of 3
no reflexes with fixed pupils, negative dolls eyes, negative ice water calorics, no corneal reflex, no gag reflex, no cough, positive apnea test

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7
Q

apnea test

A

normal temp, no sedatives/paralytics, normal PCO2, pre-oxygenated, SBP >90
CPAP with 100% FiO2
observe for spontaneous respirations/chest excursions
after 5, 8, & 10 min draw ABG and reconnect

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8
Q

positive apnea test findings

A

PCO2 >/= 60 with no respirations AND
pH < 7.3

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9
Q

donor evaluation criteria

A

age
blood typing - ABO compatibility
serological testing for diseases so NONE
HLA antigen matching
tests done on the specific organ
no active systemic cancers
no high risk behaviors
absence of hyper/hypotension

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10
Q

5 major goals for physiologic management of the donor

A

maintain hemodynamic stability
maintain optimal oxygenation
maintain normothermia
maintain fluid & electrolyte balance
prevent infections

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11
Q

physiologic management rule of 100s

A

SBP > 100
PO2 > 100
PEEP of 5
lowest FiO2
temp 96-100*F
urine output 50-100cc/hr

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12
Q

asystolic or non-heart beating donor

A

surgical recovery of organs of CV death
severe neurological injury but doesn’t meet brain death criteria
withdraw from support in PACU with family
have 1 hr to procure organs

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13
Q

evaluation for all transplant recipients

A

end stage organ failure (6-12 months with severe functional disability)
clinical status: tests specific to organ, blood test
nutritional status
social services: family support, spiritual
psychological readiness: psych history, response to stress, compliance
financial: insurance

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14
Q

ways to increase kidney transplants

A

living related donors
non-living related donors
paired kidney transplant
re-transplant of decreased transplant recipients (death not transplant related)

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15
Q

conditions that indicate heart transplant

A

cardiomyopathy, aneurysms, malformations, ASHD, refractory dysrhythmias/angina
NYHA class III or IV (marked limitation of activities, mostly stay at rest or complete rest)

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16
Q

heart cold time

A

4-6 hrs

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17
Q

heart orthotopic transplant

A

receives donor heart in place of own heart

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18
Q

physiology of denervated heart

A

donor heart completely denervated at time of transplant
2 p-waves b/c donor heart retains own sinus node
only donor sinus nodes conducts to ventricles

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19
Q

effects of denervated heart

A

no SNS or PNS innervation
rapid resting heart rate
orthostatic hypotension
doesn’t respond to valsalva or carotid massage
atropine doesn’t work (isuprel should)
may not feel angina

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20
Q

s/s of heart transplant rejection

A

fatigue/weakness, flu-like aches and pain
fever of 100.5 or higher
just not feeling right
shortness of breath
tachycardia or dysrhythmia
swelling of the hands or feet
sudden weight gain
hypotension

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21
Q

dysrhythmias in transplant heart

A

usually indicates rejection (so biopsy)
can be due to prolonged ischemia or pre-op meds
sinus bradycardia (pacer or isuprel)
PVCs (K and Mg)
atrial dysrhythmias

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22
Q

lung transplant clinical indications

A

irreversible end stage lung disease, expected to die in 1-2 years
single lung: COPD, alpha 1 antitrypsin deficiency
double lung: CF, bronchiectasis
heart-lung: pulmonary HTN, eisenmenger’s

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23
Q

lung cold time

A

4-6 hrs

24
Q

how often are patients on lung transplant list seen and assessed?

A

seen every 2-3 months
diagnostic tests updated every 6 months

25
Q

s/s of lung transplant rejection

A

fever/malaise
dyspnea
non-productive cough
decreased oxygen saturation
abnormal pulmonary function tests

26
Q

indications for liver transplant

A

primary biliary cirrhosis
non-alcoholic cirrhosis: post-necrotic, cryptogenic, TPN induced, laennec’s
alcoholic liver disease
chronic active hepatitis
hepatocellular cancer
biliary atresia

27
Q

liver cold time

A

less than 12 hrs

28
Q

s/s of liver transplant rejection

A

fever/flu like symptoms
deterioration of mental, hemodynamic, renal, & respiratory function
jaundice and itching
abdominal pain: RUQ and back pain
increase in liver enzymes (AST, ALT, LDH, bilirubin)
increase in PT/PTT
decrease in platelets and fibrinogen
decrease in bile output or change in color

29
Q

indications for kidney transplant

A

ERSD caused by HTN, DM, polycystic and glomerulonephritis

30
Q

kidney cold time

A

< 30 hrs

31
Q

s/s of kidney transplant rejection

A

fever greater than 100f
general malaise
pain or tenderness over grafted kidney
sudden weight gain
edema
HTN
elevated serum creatinine and BUN
decreased creatinine clearance

32
Q

how to test for rejection

A

ultrasound
biopsy

33
Q

kidney pancreas transplant indication

A

for type 1 diabetes

34
Q

kidney pancreas transplant cold time

A

less than 24 hrs

35
Q

surgical transplant compllications

A

bleeding
vascular thrombosis
anastomosis leakage

36
Q

types of graft rejection

A

hyperactute
acute
chronic

37
Q

medication related transplant complications

A

HTN
nephrotoxicity
hepatotoxicity
osteoporosis
diabetes
weight gain
bone marrow suppression

38
Q

transplant complications

A

surgical
graft rejection
infection
organ dysfunction
malignancy
med related

39
Q

post-op nursing considerations

A

recover in ICU (kidneys medsurg)
hemodynamic stability: pressure, drips, CVP monitoring, hypothermia, bleeding, EKG, drains, strict I&O
monitor for s/s of infection
meticulous hand washing
remove tubes/drains asap
start immunosuppressive meds
pt and family teaching of meds/care

40
Q

hyperacute rejection

A

immediate post-op period
immediate graft failure
re-transplant or life-sustaining treatment
caused by preformed reactive antibodies from exposure to antigens

41
Q

acute rejection

A

occurs 1st 3-6 months
caused by cell mediated response activated by T-lymphocytes
biopsy

42
Q

chronic rejection

A

after 6months
both humoral and cellular mediated immune response
chronic inflammation = diffuse scarring and stenosis of vasculature of organ
lack of blood supply = ischemia to organ

43
Q

common infections

A

leading cause of death
Lund and blood borne infections: bacterial, disruption in skin integrity
CMV: viral, from recipient or reactive disease, mild or severe
fungal: yeast in mouth and vagina, nystatin tx

44
Q

transplant associated malignancies d/t immunosuppression

A

NHL
Laposi’a sarcoma
hepatobiliary and renal malignancies
skin tumors
gout

45
Q

goals of immunosuppressive therapy

A

suppress activity of helper and cytotoxic T cells

46
Q

types of calcineurin inhibitors

A

cyclosporin
tacrolimus
sirolimus (rapamune)

47
Q

action of cyclosporin

A

suppresses T cells without affecting B cells

48
Q

tacrolimus action

A

inhibits interleukin release and attacks t-lymphocytes

49
Q

sirolimus (rapamune) action

A

inhibits T cell and antibody formation
3rd choice med

50
Q

which corticosteroids are prescribed

A

solumedrol initially
prednisone for life

51
Q

why corticosteroids

A

anti-inflammatory actions protect against transplanted organ and impair sensitivity of T cells to antigen

52
Q

imuran (azathioprine) action

A

inhibits DNA/RNA synthesis causing suppression of T-cell and some B-cells

53
Q

cellcept(mycophenolate mofetil) action

A

affects T and B cells
(so monitor WBCs)
excreted into bile

54
Q

lifelong triple therapy

A
  1. CSA, tacrolimus, or rapamune
  2. prednisone
  3. imuran or cellcept

work towards dual theray and eliminate prednisone

55
Q

additional transplant meds: prophylaxis and treatment

A

antibiotics
antivirals for CMV
antifungals for valley fever, aspergillus, yeast

56
Q

recipient self care for life

A

strict med regimen
routine visits with MD and compliance with testing
close contract with transplant coordinator
support group
strict infection control
NOT A CURE

NURS 470 (28 decks)

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