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41 Cards in this Set
- Front
- Back
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3 MAJOR complications of transplants
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Infection
Bleeding Rejection |
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What cndx created by transplant promote infection
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1) Altered integrity of mucosal barriers
2) Nuetropenia secodondary to immunosuppression |
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When is highest risk for infection s/p transplant
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W/in 3 months secondary to immunosupression
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Acute rejection (most common form of rejection) occurs when?
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W/in 3 months of transplant
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What mediates rejection response in acute rejection i.e. what is that pathophys
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Antigens of donor organ trigger lymphocytes to mature into helper T cells
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Best Tx for acute rejection
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Responds best to immunosuppresion
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How is chronic rejection usually discovered
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Decreased organ function
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How is chronic rejection usually Tx'd
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Alter drug doses
Abx |
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What might hematuria s/p kidney transplant be indic of
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Nothing-normal for several days
7-10 days or longer=problem |
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S&S indic of urinary drainage probs s/p kidney transplant
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C/o abd pain or urgency to void
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Preferred way of dislodging urinary clots s/p kidney transplant
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Milk-
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Freq Lyte disturbance occuring s/p kidney transplant
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HyperK
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Earliest and most common indicators of acute rejection s/p kidney transplant
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Changes in labs:
BUN/Cr, Cr clear, UO Tx with inc immunosuppression |
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S&S of chronic kidney rejection
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May be similar to renal failure
Tx with immunosupression and can always go on dialysis |
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Nursing consieration s/p liver transplant
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Fluid volume:
PA, art line and CVP Abdominal girth Vasopressors and fluid volume as ordered Bleed: Labs Drains Be prepared to transfuse |
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Labs that might prompt suspiscion of rejection s/p liver transplant
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PT/INR
T Bili LFT rising (initially elev then should dec) Tx=biopsy=prescence of lymphocytes |
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Cahracterstics of drainage from biliary drain s/p liver transplant should be
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Motor oil in appearance
Bad=??? |
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Why might pacing be require for heart transplant pt
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Denervation>lack of ANS stim>decrease automaticity
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Why is an alternative to atropine s/p heart transplant since it is inneffective?
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Isoproteronerol:
Synthetic sympathomimetic acting on beta receptors |
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What may slow s/p heart ransplant from recognizing MI?
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Denervation>prevents transmission of pain.
Also at higher risk as compensatory mechanism delayed by denervation. Must rely on slower mechnism of catecholamine release |
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Why is RHF most common cause of ventric failure
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Old hear was working real hard and now new heart thrust into that environment.
Thus pt's with inc PVR/SVR may be C/I to heart transplant |
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How is potential for RVHF Tx'd s/p heart transplant
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Decrease afterload:
inotropes milronin nitrates |
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What are some subtle S&S of heart rejection (cause remember acute rejection is often asymptomatic)
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Worsening exercise intolerance
Increase WBC's Low grade fever Decreased CO |
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Why is it impt to extubate s/p lung transplant pt w/in 24-36 hrs
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Prevent VAD
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Why can a s/p lung transplant pt not cough?
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Denervation
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Why is it impt to limit suctioning to only when needed in s/p lung transplant pt
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Cath can press on anastamosis
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What helps to differentiate between infection and rejection in lung transplant pt's
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Biopsy
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DM2 assoc with what transplant?
DM1 asoc with what transplant? |
DM2=kidney
DM1=pancreas |
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Increased blood glucose in pancreatic transplant pt
-late or early sign? |
Late
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Preferred source of harvested stem cells
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Apheresis (autotransplant)
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Why may male pt's sperm bank prior to stem cell transplant
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Procedure can make one sterile
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Mobilization of stem cells occurs __ days prior to harvesting procedure
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4-5 days
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Recipients of HSCT must be preconditioned meaning...
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Chemo/radiation
Myeloablative vs non-myeloablative Infection risk!! |
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Best way to defend graft vs host disease
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HLA matching
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Graft vs host disease is an immunologic response manifested by
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Severe rash
Enteritis Inc LFT's` |
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Why is it impt to wean prednisone as part of immunosuppression therapy ASAp
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SE:
GI bleed PUD, bowel perf, etc |
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Why will a transplant pt have LFT's monitored for life?
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Imuran (immunosuppresion)
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What immunosuppressive Rx are nephrotoxic or hepatotoxic
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Heapatoxic:
Imuran (on for life, mon LFT's) Cyclosporine Nephrotoxic: Tacrolimus Cyclosporine |
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Why might transplant pt's eventually require BP Rx
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Cyclosporine may induce HTN
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Does a living donor need to be related?
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No
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2 ways to determine donor death
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1) absebnce of cardiopulm fxn
2) brain death |
