Unit 19 Organ Transplant/Donation Flashcards Preview

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Flashcards in Unit 19 Organ Transplant/Donation Deck (37):
1

What is the basic criteria for Transplantation?
(Ppl who can receive)

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

2

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?

1 Guidelines that authorized donation of organs

2 Organ registry

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

3

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

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)

4

Who is the recipient?

How is the living donor process done?

Cadaver process?

Person receiving organ

OR to OR

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

5

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

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)

6

What is involved in compatibility/tissue typing?

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.

7

What is graft rejection?

-Normal response to any foreign substance (B and T cells activated, inflammation)

-Describes immune system response to a donated tissue/organ

8

What is a Hyperacute Rejection?
What are the manifestations?

-Rare rejection, involves wrong blood type

-Not treatable, organ needs to be removed

-Seen within 48 hours

Manifestations: general malaise, elevated temperature, thromboses

9

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

-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

10

What is Chronic Rejection?

-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

11

What are lifetime immunosuppression therapy Rx's?
Describe them.

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

12

Describe the rescue therapy drug mycophenolate mofetil and corticosteroids.


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

13

What do you want to give all immunosuppressant drugs with?

Food

14

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

Infection because of bone marrow suppression

15

What is the nursing management pre-transplant?

Maintain recipient's health

Treat chronic problems and infections

Psychiatric evaluation - is client capable of compliance?

Education: pulmonary exercise, meds, financial impact

16

If PT has infection before transplant, what happens?

They are temporarily taken off list.

17

What is the nursing management post-transplant?

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

What is Hematopoietic Stem Cell Transplant (HSCT) used for?
What is the objective regarding this?

-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

Describe the Hematopoietic Stem Cell Transplant (HSCT) procedure.

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

What is the donor care post-op management?

Hydrate

Pain management

Monitor complications of anesthesia

Site dry and intact

21

What are steps to the transplantation of Stem Cells?

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

Describe Graft versus Host Disease.

-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

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

Erythematous rash

Severe sloughing

Pruritus

RUQ pain

N/V

Diarrhea

24

What is the most common transplant?
What are complications with this transplant?

Kidney transplant

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

25

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

IVF

I/Os

Diuretic therapy

Daily weights

Labs

Prophylactic antibiotics

Monitor for s and s's of infection

26

What are a couple conditions for heart transplant?
When is the initial rejection?

< 1 year to live
< 65 years old

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

27

What definitively indicates rejection in heart transplant?

Biopsy 1 week post transplant

28

Describe Lung transplant.

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

What is the post-op management of lung transplant?

Early ventilator weaning

Fluid restrictions

Bronchodilators

Early ambulation/Pulmonary exercises

Biopsy after 1 week

30

Describe conditions when a pancreas transplant would be appropriate.

What are complications of pancreas transplant?

CF- pancreas and lung

Diabetes- pancreas and kidneys

Complications:
-Venous thrombosis
-Drop in urine amylase
-Increased blood glucose
-Acute rejection

31

What is success if pancreas transplant measured by?

Measured by not excreting extra insulin

32

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?

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

What is seen elevated in liver rejection?
What is needed for diagnosis?

Labs will be elevated

Biopsy is needed for definitive dx

34

What tissues can be donated?

Corneas
Skin
Bone
Heart valve
Saphenous veins
Tendon

35

Describe Imminent Death referrals.
When are other instances when we would call the sharing network?

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

What are the steps in Organ Donation Process?

1) Referral

2) Evaluation

3) Consent

4) Maintenance

5) Recovery

6) Follow-up

37

Describe the rescue therapy drug muromonab-CD3.

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