Teach staff transplant patients’ special needs
People who need a kidney or liver transplant live daily with the threat of death and the hope of a new lease on life when a donor organ becomes available.
Home care professionals often are needed to help those patients recover after transplant surgery, and education managers can help by holding an inservice on transplantation.
"These are a very special type of patients, and they require a lot of care because of the type of medications they have to take post-transplant surgery," says Latricia Tolefree, RN, BSN, home care nurse and case manager of Loma Linda (CA) University Medical Center, Home Health Care. The home care agency serves a 60-mile radius in southern-central California.
Tolefree had been a transplant coordinator, working with kidney, kidney-pancreas, and liver transplants, for the Loma Linda hospital and has taught seminars about transplant patients for home care professionals and others.
"I tried to educate all of the home care staff about what they could provide for post-transplant as far as their care; what the physical therapist could offer them; what the occupational therapist could offer them, and the dietitian and others," she explains.
She offers this advice on how to teach nurses, aides, physical therapists, and other home care staff about transplant patients:
• Give staff an overview.
Kidney transplants are very successful and have been done for years, with success rates up to 98%, Tolefree says. (See overview on transplants, p. 159.)
Typically, 75% to 80% of the kidneys transplanted from deceased donors are working one year after surgery, according to the National Kidney and Urologic Diseases Information Clearinghouse of Bethesda, MD. (See resource guide to transplants, p. 157.)
Tolefree says transplant patients who receive kidneys from someone who is on life support have an 85% success rate after one year, and those who receive a kidney from a living relative have a 98% success rate.
Simply put, the surgery places a healthy kidney into the patient’s body between the upper thigh and abdomen, below the failing kidneys. The surgery takes three to six hours, and the usual hospital stay is 10 to 14 days.
The surgeon connects the artery and vein of the new kidney to the patient’s artery and vein, and the patient’s blood begins to flow through the kidney and make urine.
The patient’s transplant success depends on a close blood and tissue match with the donor kidney. The new kidney may take up to a few weeks to make urine.
If successful, the new kidney will do all of the work that the patient’s failed kidneys cannot do.
• Diseases that cause organ failure.
Healthy kidneys clean the blood by filtering out extra water and wastes and by making hormones that keep bones strong.
Kidney disease or renal failure can be caused by juvenile diabetes, viral diseases, and genetic disorders, Tolefree says.
When the kidneys fail to work, the condition is called end-stage renal disease.
Liver failure primarily is caused by viral infections, including hepatitis; metabolic disorders, including enzyme deficiencies; and sometimes by alcoholic liver disease, especially when the individual also has a viral infection, Tolefree says.
Another cause is an auto-immune liver disease, which results from a reaction when the person’s own body will produce antibodies that damage the organs and surrounding tissues, she adds.
• Immunosuppressive therapy trends.
Tolefree recommends education managers talk about Neoral, an immuno-suppressant medication that has the following side effects: hair growth on the face and arms and hand tremors.
Prograf is another drug that prevents the patient’s body from rejecting the organ.
"Prograf or FK506 is mainly used for liver transplant rejection," Tolefree explains. It can cause nausea, vomiting, gastrointestinal problems, and it has a tendency to make people become temporarily insulin-dependent diabetics.
Prograf also can cause neurotoxicity headaches and migraines, she adds.
Cellcept, a third anti-rejection medication, has some of the same side effects as Prograf.
A fourth form of treatment is the use of steroids. These are given in combination with other drugs, Tolefree says. Steroids can increase appetite, which can result in a significant weight gain. Also, when steroids are used over the long-term, they can cause complications related to diabetes and cataracts.
Tolefree says that since the anti-suppression drugs lower patients’ immune systems, the transplant patients are more susceptible to viruses. So they’re given antiviral drugs for three to six months after surgery. The anti-rejection drugs have to be taken for the patient’s lifetime because there’s always a risk the body will reject the organ.
• The nurse’s role.
"The nurses mainly make sure they place the patients on a good regimen for taking their medications, and they make sure they understand what the side-effects are," Tolefree says.
Compliance is a big issue with transplant patients, she adds. "They were so sick before the transplant operation, and then they get this new organ, and they don’t feel sick anymore, so they might stop taking their pills."
Nurses need to monitor the patient’s temperature and make sure patients understand they cannot be around people who have colds or sniffles or infectious diseases.
• The roles of other therapists.
Transplant patients have a lot of muscle and bone loss with organ disease, in addition to weight gain, Tolefree says.
"So the physical therapist should place them on a home exercise program with weight training to rebuild bone loss," she adds.
Liver transplant patients typically are placed on a low-bacteria diet for the first five weeks because of the high doses of anti-rejection medication.
A dietitian could explain how the patient needs to avoid raw vegetables and eat only fruits he or she can peel. The lifetime diet includes low cholesterol and low-fat foods.
Social workers can help provide patients and their families with emotional support. Tolefree adds, "If the goal of transplant patients is to help them become productive members of society again, then a social worker can set them up with job rehabilitation classes."
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