ORGAN TRANSPLANT and RECOVERY K. BROOKS, RN, MSNEd
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Transcript of ORGAN TRANSPLANT and RECOVERY K. BROOKS, RN, MSNEd
ORGAN TRANSPLANT and
RECOVERY
K. BROOKS, RN, MSNEd
The First Successful Transplant Dates Back To 1954!
• 28,000 transplants performed nationally
• Transplants can include liver, intestine, kidney, heart, liver, intestine, kidney, heart, and lungand lung
• Organs fail D/T progressive disease, abuse, or congenital malformations/dysfunction
• Donors: “living” or “deceased”. Who are living donors?
• Amazing facts …………..
# of organ
donors has
gone down!
# of pts waiting transplant has gone up!
19,621 donors in 2005
91,000 patients awaiting transplant in 2005
It’s up to US!!! NURSES!!!
Assess the Situation and Refer Early!
“One Legacy” comes in …
More To Be Covered By The Guest Speaker
Post Operative Care Needsof the Organ Recipient
• Vigilant routine assessments
• Careful planning
• Individualized interventions
• Infection control
• Anti - Rejection Treatment
Transplant Care: “Rejection and Infection”
Review: the Immune System (normal response)
What is Rejection?
When is the high risk period?
For how long do you need to monitor for rejection?
Immunosuppressant Medication
Advances in immunosuppressant medications have greatly improved the
success rate with deceased donors.
Induction
IV Route
Maintenance
PO route
Let Me Think …
What
immunosuppressants
am I already
familiar with?
Corticosteroids “OG Fighters”
Methylprednisone/prednisone
Solumedrol / Deltasone
Calcineurin Inhibitors*Cyclosporine
*Tacrolimus (Prograf)
Sandimmune
Antiproliferative
Cellcept
Striking a Balance
1) Combination Therapy
3) Low doses of each (to reduce the adverse side effects)
2) One drug ONLY from each of the (3) families
“Maintenance Immunosuppression”
4) Monitor therapeutic levels with troughs and monitor adverse SE
What does Rejection Look Like?
Key Nursing Assessments of Transplant Patients
All PatientsI. Vital SignsII. WeightsIII. Strict I / OIV. S/Sx infection
Specific OrgansI. HeartII. LiverIII. Renal
HEART
“30 – 40% of heart transplants experience a
rejection during the first year after
transplantation.“
Signs and Symptoms
Diagnosing rejection
LIVER
“Rejection occurs in up to 60% of all liver transplant recipients”
Signs and symptoms
Labs to monitor
Diagnosing rejection
RENAL
“Rejection rates in the first year after
transplantation have decreased to 15%”
More cost effective than dialysis over a ten year period
The most commonly performed type of solid organ transplant
Renal Transplant Procedure
Nursing Management - Post OpNursing Management - Post Op Infection precaution ***Adequate perfusion – hemodynamics /
CVP monitoring ***Fluid replacementBleeding Pain ManagementDrains
RENAL
Nursing Assessment“Rejection”
Nurses Educate!
Education Keys:
• Immunosuppressant Therapy
• S/Sx Organ Rejection
• Organ specific risks
Additional Resources
Barone, C., Martin-Watson, A., Barone, G. (2004, October). The postoperative care of the renal transplant recipient. MedSurg Nursing, 13 (5), pp. 296-303.
Good, E., RN, MSN. (2000). Caring for patients with donor. Nursing 2000, 30 (6), pp. 34-39.