HUC 122 Quizlet "Organ Transplant"

HUC 122: Quizlet is due on or before JULY 10TH, @ 8:00 am you need 40 points or more to pass.

Instructions: using the resources listed ,answer the following questions at the end of this article.

Organ transplantation is not a new medical concept used to cure organ disease. The first successful kidney transplant from a live donor occurred in Boston in 1954 from one twin to another.  Since that date, major improvements have led to transplanting eyes, middle ears, hearts, lungs, the pancreas, livers, skin and bones. According to the Department of Health and Human Services, in 2013 over 25,000 organs were transplanted in the United States. The number of individuals needing an organ transplant far outnumber the amount of available organs. The need for additional organs has prompted organ procurement groups to lobby Congress to pass legislation requiring hospitals to approach patients and families regarding organ donation. It is now a requirement for an organ procurement group to be notified by hospital personnel (possibly the Health Unit Coordinator) at the time of a patient’s impending death. 

Caring for the organ transplantation patient presents challenges for the entire multidisciplinary healthcare team. Goals for the patient include infection prevention, monitoring for complications associated with the transplant, prevention of acute and long term rejection and returning the patient to activities of daily living.

A major concern is the prevention of infections. Transplant patients receive immunosuppressive medications to help stop rejection of the new organ. This group of patients also remain in the hospital for long periods after the transplant occurs. A weakened immune system and exposure to the hospital environment places this patient at risk of developing infections. Common infections during this post-operative time include (not limited to) urinary tract infections (UTI) pneumonia, wound and bloodstream infections and viral infections such as herpes simplex. Transplantation patients are especially vulnerable to viral infections such as hepatitis B and C, Cytomegalo virus (CMV), Epstein Barr (mononucleosis) and Varicella Zoster (chicken pox and shingles). The patient may be placed in isolation with limited visitors to protect the patient from the hospital and outside environment.

Additional infection prevention strategies include the ordering of prophylactic antibiotics, removal of catheters and IV/PICC lines as soon as possible and educating the family to stay home if they are feeling ill. The dietician may need notified to wash and/or peel any fruits on the meal tray to decrease exposure to infectious agents. This patient also requires an annual seasonal intramuscular flu vaccine (not the nasal mist live virus) and a pneumococcal vaccine every 5 years. Upon discharge, any transplantation patient depending upon a well or cistern for water supply should be advised to boil water for 1 full minute prior to drinking. Water from public water suppliers is chlorinated and safe for the transplantation patient.

Another main concern is observing for and preventing rejection of the new organ or tissue. There are three types of rejection:

1. Hyper acute rejection occurs a few minutes after the transplant and organ must be removed right away so the recipient does not die. This type of rejection is seen when a recipient is given the wrong type of blood.
2. Acute rejection may occur any time from the first week after the transplant to 3 months afterward. Everyone has some amount of acute rejection.
3. Chronic rejection takes place over many years. The body's constant immune response against the new organ slowly damages the transplanted tissues or organ.

Monitoring for signs and symptoms of rejection rely upon both clinical symptoms and laboratory results. Careful monitoring of the WBC count could alert the physician to adjust the immunosuppressive medications. A tissue biopsy may be ordered to observe for signs of rejection in the new organ or tissue.

Rejection is impacted by the source of the donated organ or tissue. An autograft takes tissue from the individual and transplants the tissue on the same individual (take skin from the abdomen or buttocks and transplants to a burn on the arm). And isograft occurs between individuals with identical genetic makeup such as identical twins. An allograft uses organs or tissue from a donor of the same species (human to human but not identical genetics) while a xenograft crosses species (a pig valve placed in a human heart). The autograft and isograph have less risk of rejection than the allograft and heterograft.

Signs of rejection may include flu-like symptoms, pain at the sight of transplant and general malaise. A fever is rare as the inflammatory reaction is suppressed due to the immunosuppressive medications. Organ specific rejection is demonstrated by abnormal finding associated with the function of that organ (high blood sugars in a pancreas transplant, shortness of breath after a lung transplant, decreased urine with a kidney transplant, etc).

 Immunosuppressive medications also present with risks for the organ transplantation patient. Along with the increased risk of infection, additional risks include heart disease, cancer, osteoporosis and diabetes. A key factor in preventing chronic illnesses such as these is a healthy immune system. In the organ transplantation patient, the immune system is severely depleted and cannot protect the body against many chronic long term illnesses. Immunosuppressive medications also may interact with other prescribed medications and the patient may not get the full benefit of other required medications. Examples of immunosuppressive medications include Imuran, Prednisone, Prograft and Cellcept. Research is continually occurring in search of new and improved medications for the transplant patient.

 In order to help control for the development of long term chronic illnesses in the organ transplant patient, physician orders may include regular blood glucose measurement, a low fat low cholesterol diet, smoking cessation classes and frequent complete blood count (CBC) without differential and metabolic panels. If signs and symptoms of infection are present, culture and sensitivity (C & S) tests may be ordered. Additional orders include accurate intake and output (I & O), daily weights and consults with primary care physicians or transplant specialists. Encouraging exercise as tolerated is key to aid in preventing heart disease and weight gain.

Routine laboratory tests are necessary to monitor for the following: drug toxicity, graft rejection, infection secondary to immunosuppression, and the response of liver enzymes after treatment for graft rejection or after a change in the immunosuppressive regimen. Infection and graft rejection most often occur within six months following transplantation. In the event that one or both of these situations occurs, the frequency for laboratory testing will increase in order to closely monitor the patient's overall response.

The care of the organ transplantation patient requires a multidisciplinary team approach. At the core of the team is the role of the Health Unit Coordinator as he/she views and is responsible for placing and monitoring vital orders for the patient’s well-being for quality patient outcomes.

Resources:

• Infections in solid organ transplants. www.lahey.org/infectiousdiseases
• Long term cancer risks in immunosuppressive regimens after transplantation: www.tornado.com/long-term-cancer-risks-of-immunisuppressive-regimens
• Long term management after transplants. http://www.inova.org/healthcare-services/kidney-transplant/index.jsp
• Organ transplant-after the transplant. www.nih.gov/medline/article/000815.htm
• Prevent infection after the transplant. www.methodisthealth.org