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Post-op HEART Transplant Care and Nursing Interventions.
- Immunosuppressants for life – to suppress natural defense mechanisms such as T and B cells.
- Monitor for Heart rejection (Chart 35-10 pg 703)
- Hand hygiene and Asepsis
- Regular check up (exercise tolerance tests and angiography)
- Calcium channel blocker (diltiazem) Cardizem to prevent coronary spasm and closure
- Teaching – e.g. exercise and diet
- NURSING INTERVENTIONS
- Daily weights
- Assessments – lungs/heart sounds, ABG's
- I/O, O2 sat
- SOB, monitor for changeS in breathing
- Left vs Right side failure
- Meds are lifelong!!! immunopsuppressants.
- Orthostatic Hypotension
- Monitor EKG's for A-fib/flutter
- Labs – K, Na, Ca, Mag
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Post-Op LUNG care and nursing interventions
- Thoracotomy (pp 577 Chest tube)
- Monitoring for Respiratory problems
- Bronchodilators and mucolytic therapies
- Pulmonary hygiene (I.S. 10x when awake)
- PAIN management – Opioids by epidural limits pain, sedation, and cognitive dysfunction while allowing patient to participate in pulmonary hygiene measures.
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LUNG TRANSPLANT COMPLICATIONS
- Primary graft dysfunctionL(leading cause of death in first 30 days
- Chronic lung allograft dysfunction(Leading cause of mortality after first year)
- Infectious complications
- Malignancy
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What is the most common cause of liver transplant?
Cirrhosis caused by hepatitis C is the most common reason for liver transplants
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Post =-Op LIVER TRANSPLANT care and Nursing interventions?
- Monitor temp
- monitor for abdominal pain, distention, and rigidity (peritonitis).
- Neurologic status – change could indicate encephalopathy from a non-functioning liver
- Clotting issues – look for blood in catheters, petechiae, and ecchymosis Immunosuppressants – e.g. Cyclosporine A Monitor for S&S of rejection – like tachycardia, fever, right upper quadrant pain or flank pain, increasing jaundice.
- Labs-monitor for elevations in bilirubin, ALT, AST, alkaline phosphatase levels, and PT/INR
- More LIVER Treatment NURSING INTERVENTIONS.....
- Monitor LOC, abd bloating, VS, fever, tachy, Flank pain, skin for jaundice,
- Asepsis, H/W, pulm toilet
- Monitor WBC and H&H
- Neutropenic precautions
- Daily weight and I/O
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KIDNEY & PANCREAS Interventions
- Monitor Urine output Q/hour for color, amount high or low, and clarity.
- Blood sugar Q/hour
- Labs – H&H, CBC, lytes K, Ca, Mag. BUN, Cr
- Monitor for Abdominal girth and flank pain
- Pulmonary Toilet, prevent infections
- Fluid replacement as prescribed.
- Bladder scans if minimal U/O
- Goal for foley is to D/C ASAP!!!
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What are some instructions to your patients to avoid getting an infection?
- Avoid fresh fruit, vegetables, and fresh flowers while in the hospital.
- Avoid anyone who had a cold or active infection.
- During the first three months avoid large crowds
- Wash fruits/veggies
- Avoid eating raw oysters, raw shellfish, or raw fish.
- Thoroughly cook eggs
- chicken and pork should be well done.
- Avoid mowing the lawn, digging in the garden and being near construction sites. These activities increase your exposure to fungal infections
- DO NOT clean kitty litter or birdcage.
- Do not let your medications run out!!!! Some pharmacies need to special order your immunosuppression medicines ahead of time.
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What are the 3 types of organ transplant rejections? When and how do they occur?
Hyperacute Rejection - This rarely occurs, but it happens when the body has been exposed previously to the same or similar antigens found in the donor organ. Previous exposure to these antigens may have resulted from blood transfusion, pregnancy, or previous organ transplants.
Acute Rejection - Acute rejection usually does not occur until several days after transplant. The anti-rejection drugs (immunosuppressant drugs) help.
Chronic Rejection - Chronic rejection occurs months to years after transplant. It may be the result of repeated episodes of acute rejection and/or infection.
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What are some supplements recommended for organ transplant patients?
- MVI
- Calcium- transplant medications such as prednisone, cyclosporine, and diuretics lead to calcium loss
- Magnesium - medications cause depletion
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ETHICAL ISSUES related to organ donation....
- Supply versus demand
- Appropriate allocation of available organs Risks and benefits of organ donation from living donors
- Appropriate and acceptable methods to increase organ donation from the deceased through the adoption of the principle of 'presumed consent'
- Right methods of providing acceptable appreciation and compensation for the family of the deceased as well as volunteer and altruistic donors
- Duties and responsibilities of the medical profession and society to help fellow humans
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What are some S/S of all solid organ transplants?
- Fever > 100 (remember steroids may blunt temperature effect)
- Malaise/ flu like symptoms
- Edema
- Weight gain
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What the specific s/s to look for after a HEART TRANSPLANT?
- “not feeling right"
- SOB
- Tachycardia
- Dysrhythmias
- HYPOtension
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What are some s/s to look for following a LUNG TRANSPLANT rejection?
- SOB
- Non productive cough
- Decreased O2 sat
- Abnormal pulmonary function
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What are some s/s related to KIDNEY TRANSPLANTS rejection?
- Hypertension (HIGH BP!)
- Pain over kidney
- Elevated creatinine/BUN
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What are some s/s related to LIVER TRANSPLANT rejection?
- Jaundice
- Itching
- Abdominal/back pain
- Elevated liver enzymes
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