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
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
What are the goals of INDUCTION THERAPY of immunosuppressants?
Prevent ACUTE rejection
Name the Calcineurin Inhibitors to prevent transplant rejection
- Tacroliums (Prograf)
- Cyclosporine (Sandimmune)
Name the Antiproliferative drugs that inhibit elements needed for DNA synthesis - to prevent transplant rejection
- Azathioprine (Imuran)
- Mycophenolate (Cellcept)
What is a steroid medication used to prevent transplant rejection that suppresses immune response?
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.
This type of rejection usually does not occur until several days after transplant. The anti-rejection drugs (immunosuppressant drugs) help.
This type of rejection occurs months to years after transplant. It may be the result of repeated episodes of acute rejection and/or infection.
What are the S/S of rejection for all solid organ transplants?
- Fever > 100 (remember steroids may blunt temperature effect)
- Malaise/ flu-like symptoms
- Weight gain
*Direct pt to call provider IF they have any of these symptoms!
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
Name some antimicrobial and antiviral meds used for organ transplant
Name some Antifungal meds for prophylaxis in organ transplant?
Transplant meds can lead to which vitamin/mineral deficiencies?
What does NODAT stand for?
new-onset diabetes after transplantation
Many patients develop other comorbid conditions after transplant, name some common ones
- Bone metabolism/disease
- Hematologic issues (leukopenia, anemia, thrombocytopenia)
- Malignancies (skin CA, lymphomas)
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
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
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)
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
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
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
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
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