Check out this overview of organ transplant inservice
October 1, 1997 3 minutes read
Check out this overview of organ transplant inservice
Latricia Tolefree, RN, BSN, home care nurse and case manager at Loma Linda (CA) University Medical Center, has developed the following outline for teaching home care nurses about transplant patients:
An Overview of the Organ Transplant Recipient
I. Introduction
A. Solid organ transplant is an option given to individuals with life-threatening illnesses. It offers those individuals a new lease on life.
B. Organ transplantation is very successful.
C. Today, I would like to give you a brief overview of the organ transplant recipient.
II. Disease indications requiring solid organ transplant
A. End Stage Renal Disease and Kidney Disorders
1. Diabetes Mellitus (Juvenile Onset)
2. Genetic disorders
3. Viral disorders
B. End Stage Liver Disease and Liver Disorders
1. Viral illness (Hepatitis)
2. Metabolic disorders (A1AT)
3. Autoimmune disorders
4. Alcoholic liver disease
III. Current Trends in Immunosuppressive Therapy
A. Neoral (Cyclosporine)
1. Indications: Used to prevent solid organ transplant rejection
2. Special precautions: Watch for hypertension
3. Monitor kidney function for nephrotoxicity
4. Patient instructions: tremors, excessive hair growth
B. Prograf (FK 506)
1. Indications: Used to prevent liver transplant rejection
2. Special precaution: GI dysfunction, neurotoxicity, nephrotoxicity, and glucose tolerance
3. This drug has a high tendency to produce insulin dependent diabetes (usually temporarily)
C. Cellcept
1. Indications: Used to prevent organ transplant rejection
2. Special precautions: GI disturbance, headache
D. Steroids (Prednisone)
1. Indications: Used in prevention and treatment of solid organ rejection
2. Special precaution: Watch for ulcer disease, impaired wound healing, may induce diabetes, cataracts over long- term use; bone necrosis may occur
E. Other medications (antivirals)
1. Antivirals: Ganciclovir and Acyclovir (oral) special precautions: Nausea/vomiting, rash, or hives, contraindicated in pregnant women
IV. Organ Transplant Rejection and Infection
A. Rejection: This commonly occurs with transplantation. The immunosuppressive medications cause your body to fool itself. These patients are more susceptible to infections and other illnesses. All patients usually experience some type of rejection during their transplant life, but this doesn’t mean that the graft function is lost. Rejection depends a lot on an individual’s immune system, medication management, monitoring of lab values, and patient response to medications.
B. Infection: This commonly occurs with transplantation. These patients are taught to avoid exposure to large crowds and people with colds and illnesses during the first two to three months. They are expected to wear a mask if they are around people of this nature. You will find many patients taking antibiotics and antivirals for prophylaxis. They are maintained on these drugs at least the first three-to-six months of their new transplant life.
V. Multidisciplinary Care of the Transplant Recipient
There are many ways to manage these patients, from physical therapy to home care nursing and other disciplines.
A. Nursing: Monitor vital signs, including temperature with skilled nursing visit. Report any temperature greater than 100. These patients should have their own blood pressure machine and electronic thermometers. It’s a good idea to allow the patient to demonstrate usage of this equipment. Teaching of signs and symp- toms of rejection and infection also are important.
Nursing management of medications ensures that the patient is on a regimen and is complying with treatment. Management of side effects also is important.
B. Physical therapy: There are a lot of issues involved with these patients because they take a lot of medications that cause bone weakness. The organ disease indicating transplant has caused much muscle and bone loss. The medications also cause weight gain over a period of time. You can offer these patients gait training, strengthening, and placement on a home exercise program to manage these issues.
C. Occupational therapy: As indicated per individual patient.
D. Dietary: These patients (liver transplant recipients) are placed on low bacteria diets for the first 5 weeks post organ transplant. This is used to help decrease the incidence of infection. This diet is to avoid all uncooked foods. These patients are taught low cholesterol, low-fat diet, unless otherwise indicated. This patient population has the transplant dietitian follow them throughout their care.
E. Social worker: These patients require much support throughout their illness. Dealing with a chronic illness affects the entire family. When these patients have a transplant, it also affects the entire family. There is a great need for emotional sup- port and development of coping skills for dealing with these issues. Referral to community resources is helpful for job rehabilitation. The primary goal is for an individual to be a productive member of society.
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