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Name some patient education for avoiding infection after transplant
- avoid fresh fruit, veggies, flowers - in hospital
- avoid anyone with cold or infection
- avoid large crowds for 3 months
- thoroughly was fruits and veggies
- avoid RAW oysters, shellfish or fish
- fully cook Eggs, chicken, pork
- avoid mowing lawn, digging in garden, etc.
- use caution if fishing (hooks, fins, knives)
- avoid cat litter, birdcages...
- TAKE MEDS! - don't run out
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What is important to know about vaccinations for organ transplant patients?
- No LIVE vax's
- Get vaccinated and those around you should be vaccinated too
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What are the goals of INDUCTION THERAPY of immunosuppressants?
Prevent ACUTE rejection
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Name the Calcineurin Inhibitors to prevent transplant rejection
- Tacroliums (Prograf)
- Cyclosporine (Sandimmune)
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Name the Antiproliferative drugs that inhibit elements needed for DNA synthesis - to prevent transplant rejection
- Azathioprine (Imuran)
- Mycophenolate (Cellcept)
- Sirolimus
- Everolimus
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What is a steroid medication used to prevent transplant rejection that suppresses immune response?
Prednisone
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This type of rejection rarely occurs, but it happens when the body has been exposed previously to the same or similar antigens found in the donor organ.
Hyperacute rejection
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This type of rejection usually does not occur until several days after transplant. The anti-rejection drugs (immunosuppressant drugs) help.
Acute rejection
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This type of rejection occurs months to years after transplant. It may be the result of repeated episodes of acute rejection and/or infection.
Chronic rejection
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What are the S/S of rejection for all solid organ transplants?
- Fever > 100 (remember steroids may blunt temperature effect)
- Malaise/ flu-like symptoms
- Edema
- Weight gain
*Direct pt to call provider IF they have any of these symptoms!
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For specific organ rejection S/S - think of the specific organ and what it is for...
Heart - tachy, dysrhythmia, hypotension
Lung - SOB, decreased SaO2, pulm function...
Kidney - elevated BUN/Creat, HTN, pain over kidney
Liver - Jaundice, itching, abd/back pain, elevated liver enzymes
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Name some antimicrobial and antiviral meds used for organ transplant
- Co-trimoxazole
- Valcyte
- Acylovir
- Septra/Bactrim
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Name some Antifungal meds for prophylaxis in organ transplant?
- Itraconazole
- Nystatin
- Clotrimazole
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Transplant meds can lead to which vitamin/mineral deficiencies?
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What does NODAT stand for?
new-onset diabetes after transplantation
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Many patients develop other comorbid conditions after transplant, name some common ones
- Diabetes
- Obesity
- Dyslipidemia
- Bone metabolism/disease
- Hematologic issues (leukopenia, anemia, thrombocytopenia)
- Malignancies (skin CA, lymphomas)
- CKD
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Post-transplant care is intense - name some of the monitoring after transplant
- annual H&P
- annual dental + reg cleanings
- HTN - weekly BP at home / Monthly in office
- DM and cholesterol
- cardio / renal
- Dexa bone scan every year
- malignancy screening
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Name the criteria for Heart transplant:
- Life expectancy less than 1 year
- Age generally less that 65 years
- New York Heart Association (NYHA) class III or IV heart failure
- Normal or slightly increased pulmonary vascular resistance
- Absence or active infection
- Stable psychosocial stats
- No evidence of current drug or alcohol abuse
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What are some things that result from heart transplant?
- Heart rate usually higher (90-110)
- no fight or flight response
- electrolyte imbalances (K, Ca, Mg)
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Nursing interventions after Heart transplant
- Daily weight
- Assessments – lungs/heart sounds, abg
- I/O, EKGs, O2 sat
- SOB, monitor for change in breathing patterns
- Left vs Right side failure
- Meds are lifelong – immunosuppressants
- Orthostatic Hypotension
- Monitor for A-fib/flutter
- Labs – K, Na, Ca, Mag
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Lung transplant criteria
- Severity of underlying lung disorder
- Likelihood of benefit from lung transplantation
- Presence of comorbid disease processes
- Age of candidate
- Ability to participate in an exercise program
- Nutritional status
- Psychosocial support
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Nursing interventions for liver transplant
- Monitor LOC, abd bloating, VS, fever, tachy, Flank pain. Skin for jaundice
- Monitor for clotting issues, petechiae, eccyhmosis
- Asepsis, H/W, pulm toilet
- Labs – ALT, AST, bili, ALP, and PT/INR for elevations. WBC and H&H
- Neutropenic precautions
- Daily weight and I/O
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Nursing interventions for Kidney and Pancreas transplant
- 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, Flank pain
- Pulmonary Toilet, prevent infections
- Fluid replacement protocol.
- Bladder scans if minimal U/O Goal for foley is to D/C asap
- Monitor VS, I/O, labs, cardiac rhythm
- Fluid replacement
- Isolation initially x kidney
- Monitor for rejection
- Monitor for infection: Most common URI & UTI
- Opportunistic infections
- Education, Education, Education
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What kind of In-hospital infection precautions after transplant?
- visitors wash hands and mask prior to entry
- No visitors or staff with s/s of virus or infection
- Pt to wear mask when out of room
- bottled distilled water is given to all transplant patient after initial surgery
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