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G270 > Transplant and Transfusion Reaction > Flashcards

Transplant and Transfusion Reaction Flashcards

1
Q

Success of liver transplantation

A

successful immunosuppression

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2
Q

Complications of liver transplant

A
  • Bleeding
  • Infection
  • Rejection
  • Obstruction of the biliary anastomosis
  • Impaired biliary drainage
  • Vascular thrombosis & stenosis
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3
Q

Contraindications for kidney transplant

A

• Recent malignancy, active or chronic infection
• Severe irreversible disease (cardiac disease, chronic lung disease, severe peripheral
vascular disease)
• Active infection (HIV, hepatitis B and C)
• Class II obesity (body mass index >35 kg/m2)
• Current substance abuse
• Inability to give informed consent, Hx of non adherence to treatment regimens

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4
Q

Hyperacute rejection- kidney

A

in 24 hr
• Fever, malaise, tenderness,
• Immediate removal of the transplanted organ

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5
Q

Acute rejection- kidney

A

3 -14 days or after many years
• tenderness at the transplant site, ↑ creatinine, ↑ temp,
malaise, and oliguria
• Early recognition & immunosuppressant therapy

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6
Q

Assessing rejection

A 
• Oliguria
• Edema
• Fever
• ↑ BP
• Weight gain
• Swelling or tenderness over the transplanted kidney or graft
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7
Q

Monitor Urinary Function- living donor

A

Living donor
• Function immediately returns after surgery
• May produce large quantities of dilute urine

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8
Q

Monitor Urinary Function- cadaver donor

A
  • May not function for 2 or 3 weeks
  • anuria, oliguria, or polyuria
  • Significant changes in fluid and electrolyte status
  • May require hemodialysis
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9
Q

All Immunosuppressant Meds

A

Increased Risk for Infection

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10
Q

blood components- serum proteins

A

o Coagulation
o Healing
o Transport
o Osmotic pressure

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11
Q

PRBC’s

A

Hgb ↑ 1 g/dL per unit, Hct 2-3% per unit

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12
Q

Platelets

A

↑ 5K-10K per unit

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13
Q

Transfusion Pre-Procedure

A
  • Confirm order, confirm type & crossmatch done by lab (verifying RN)
  • Consent and patient ID (verifying RN)
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14
Q

Transfusion Procedure

A
  • Obtain blood (initiate within 30 minutes)
  • Dual check with another RN
  • Vitals Q 15min (30min)→ Q 30min (1h) → Q 1 h
  • Close monitoring for 15-30 minutes
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15
Q

Reaction Symptoms

A
  • Fever
  • Chills
  • Respiratory distress
  • Low back pain
  • Nausea
  • Pain at the IV site
  • Anything “unusual.”
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16
Q

Febrile Nonhemolytic Reaction (within 2h) S&S

A

S/Sx’s
• Chills (minimal to severe)
• Followed by fever that begins within 2 hours after transfusion
• Muscle stiffness

Antipyretics can be given to prevent fever

17
Q

Acute Hemolytic Reaction S&S

A 
Most dangerous and life threatening
• Reaction with as little as 10 mL of PRBCs
• Errors in blood component labeling & identification
S&Sxs
• Fever, chills
• Low back pain
• Nausea
• Chest tightness
• Dyspnea
• Anxiety
18
Q

Allergic Reaction

A 
S/Sx’s
• Urticaria
• Itching
• Flushing
• Resolve after administration of an antihistamine
19
Q

Transfusion-Associated Circulatory Overload (TACO) S&S

A
  • Dyspnea, orthopnea, crackles
  • Tachycardia
  • ↑ Blood pressure
  • Sudden anxiety
  • JVD
20
Q

Transfusion-Associated Circulatory Overload (TACO)

A
  • Hypervolemia: too much blood volume too fast
  • Condition aggravated in patients with ↑circulatory volume (or↓CO)
  • Assess for signs of circulatory overload
  • As late as 6 hours after transfusion
21
Q

Transfusion-Related Acute Lung Injury (TRALI) S&S

A
  • Acute SOB
  • Hypoxia
  • Hypotension
  • Fever
  • Eventual but acute pulmonary edema
22
Q

TRALI

A
  • Potentially fatal, idiosyncratic reaction: abrupt onset
  • Acute lung injury within 6 hours after blood transfusion
  • Most common cause of transfusion-related death
  • Pulmonary edema with decrease of oxygenation
23
Q

Nursing Management- blood transfusion reaction

A
  • Stop transfusion immediately if suspected reaction
  • Notify provider
  • Patient assessment
  • Determine the type and severity
  • Initiate slow infusion of NS IV through new IV tubing, same IV access
  • Compare vital signs with baseline, including O2 saturation
  • Assess patient’s respiratory status
  • Notify provider of assessment findings & implement treatments
  • Notify blood bank of suspected transfusion reaction
  • Send blood container & tubing to blood bank for repeat typing & culture

G270 (6 decks)

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