Term
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Definition
| tissue that is transplanted btwn members of the same species |
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Term
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Definition
| transplantation of tissue from one part of a person's body to another |
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Term
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Definition
| transplantation of tissue between two different species |
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Term
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Definition
| transplantation of tissues btwn identical twins |
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Term
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Definition
| "when respiration and circulation are artificially maintained and there is total and irreversible cessation of all brain function including the brain stem" |
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Term
| what is the initial step in obtaining an organ? |
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Definition
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Term
| factors that must be known prior to announcing brain death? |
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Definition
-cause of unresponsiveness (not reversible cause)
-absence of metablic CNS depression (must have SBP >90 and temp over 90)
-absence of toxic CNS depressant (sedatives alch or other) |
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Term
clinical determination of brain death
examples |
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Definition
EEG- not definate
Perfusion scan- measures blood flow
Physical exams- 2 non transplant MD
GCS- 3
dolls negative and apnea test positive |
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Term
| clinical manifestations of brain death |
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Definition
no reflexes
-fixed pupils
-negative dolls
-negative ice water calorics
-no conrneals, gag or cough
-positive apnea test |
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Term
clinical determination of brain death
doll's eyes test |
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Definition
evaluation of brain stem function. Oculocephalic reflex
-elevate HOB to 30
-rapid rotation of the head
Positive: eyes roll opposite of rotation
Negative: eye roll to same side as rotation (brain death) |
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Term
| what are the physiological parameters for preforming the apnea test? |
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Definition
temp btwn 96.8-99 (WNL)
no sedatives or paralytics
normal PCo2- and preoxygenation
SBP >90 |
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Term
clinical determination of brain death
apnea test |
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Definition
place pt on CPAP at 100% Fio2
-watch for spont resps and chest excursion
-ABG's drawn at 5, 8 and 10 min
--- reconnect to machine after 10 min or if BP drops or arrythmias occur |
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Term
clinical determination of brain death
apnea test- positive results |
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Definition
PCo2 >60
pH < 7.30
and no spont breathing on CPAP
this indicates positive apnea test |
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Term
| Donor Evaluation Criteria |
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Definition
-age: depenant on health of organ, usually cut off at 70
-blood type compatibility
-serological testing: presence of disease hep b and c, cmv
-HLA matching: antigens
-no active infection ie HIV and Hep B
-no systemic cancers
-mild to no htn of hypo
-DM and risky behavior are possible no's
-also special dependent on organ |
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Term
| what are the special blood types for donation? |
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Definition
O- universal donor
AB- universal recipient |
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Term
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Definition
human leukocyte antigens:
human cell ptns that recognize foreign cells
used to determine the success rate of transplantation
6/6 is perfect match ie sibling |
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Term
| physiological parameters to keep Donor at during post donation |
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Definition
rule of 100's
-SBP >100
-P02 >100 (PEEP 5 and low Fio2)
-temp 96-100
-U/o: 50-100 cc/hr |
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Term
| how long can you wait to harvest with a non-beating (asystolic) heart? |
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Definition
golden hour!
with in one hour |
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Term
| Evaluation of transplant recipients! |
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Definition
-end stage organ failure (6-12 months to live)
-clinical status (see table 26-6)
-nutritional status (mal could inc complications)
-social services and support
-psychosocial readiness
-financial readiness |
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Term
| heterotrophic hear transplant (def) |
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Definition
| patient receives donor organ IN ADDITION to his own heart |
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Term
| orthotopic hear transplant (def) |
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Definition
patient receives donor organ IN PLACE of his own heart
this is more common than adding on top of original organ, |
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Term
| how will an EKG differ after heart transplantation |
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Definition
patient retains its P wave as well donor heart p wave
-two P waves on EKG but only donor will continue conduction through heart. |
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Term
denervated heart for transplantation
def |
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Definition
| when nerves and blood supply are severed to ready organfor transplantation. |
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Term
| manifestations of implanted denervated hearts |
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Definition
no SNS v PNS innervation
-unable to respond to SNS to inc HR
-resting tachy (>100 bpm)
-no valvasa or varotid to dec HR and NO ATROPINE
-NO PAIN with MI |
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Term
| Sx of heart transplant REJECTION |
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Definition
-fatigue/weakness- flu like pain
-fever (>101.5)
-dysrhythmia
-SOB
-tachycardia or dysrhythmia
-hand/ foot swelling
-sudden wt gain
-hypotension
----patients should feel a lot better right when they wake up any other feelings indicate rejection. |
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Term
Sx of heart transplant REJECTION
dysrhythmia with interventions
IMPORTANT |
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Definition
indication of rejection (possible prolonged ischmia)
-take biopsy
-sinus brady: pacing and Isuprel
-PVC: check electrolytes
-atrial dys: caused by biopsy? |
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Term
| Sx of lung transplant rejection |
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Definition
-fever and malaise
-dyspnea
-NON productive cough
-dec SpO2 stats |
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Term
| how much liver function is needed to sustain life? |
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Definition
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Term
MELD scoring system
-model end stage liver dsease |
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Definition
based on probability of death in 3 months
-bilirubin
-INR
-creatinine
-cancer
---high score is more likely to die |
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Term
| Sx liver transplant rejection |
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Definition
-fever and flu sx
-dec loc, rec resp function
-hemodynamic instability
-jaundice, itching
-abdominal pain: RUQ and back
-inc AST, ALT, LDH and bili
-inc PT/PTT and dec plts and fibroeningen |
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Term
| Sx kidney transplant rejection |
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Definition
-fever >100 and malaise
-pain over kidney
-sudden wt gain 2-3 lbs in 24 hrs
-edema
-htn (also common s/e)
-inc cr and BUN |
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Term
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Definition
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Term
kidney-pancreas transplantation
indicated for? |
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Definition
type one DM
-will try to do both at the same time |
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Term
| common transplant complications |
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Definition
surgical- bleed or DVT
graft rejection- chronic--acute
infection
organ dysfunction
malignancy |
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Term
transplant complications
medication related |
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Definition
HTN
neph-hepato tox
osteoporosis
DM
wt gain
bone marrow suppression |
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Term
| what organ transplantation can be moved to floor not ICU? |
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Definition
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Term
| post op nursing considerations |
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Definition
-Hemodynamic Stability
--Pressure, gtts, CVP monitoring, hypothermia, bleeding, EKG readings, drains, strict I & O
-Monitor for signs and symptoms of infection
--Meticulous hand washing! (scrub)
--Look to remove tubes and drains as soon as possible
-Monitor for signs & symptoms of rejection
-Start immunosuppressive meds
-Start patient and family teaching |
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Term
graft rejection
Hyperacute Rejection |
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Definition
immediately post op, immediate graft failure
-need re transplant or life support
-activation of humoral B lymphocytes (antibody)
---previous blood transfusion, pregnancy, organs and wrong blood type |
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Term
graft rejection
acute rejection
bckg |
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Definition
3-6 months post op in 40-50% of ppl
-cell mediated response to T lymphocytes
--- need biopsy to determine |
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Term
graft rejection
acute rejection
treatment |
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Definition
dependant on person and organ
-IV Solumedrol
-OKT3 (antibody monocolal)
-antithymocyte globulin (attack T cells)
-plasmapheresis (like dialysis for plasma) |
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Term
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Definition
occurs at varying times and slow progression
-humoral and cellular mediated response
-chronic inflammation: scaring and stenosis
-lack of blood: ischemia |
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Term
| what is a MAJOR cause of morbidity and mortality for transplantations, causing most death in 1st year? |
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Definition
INFECTION!!
-immunosuppressive Rx in use!
-most from lung and blood infection (surgical cite)
-CMV most common
-fungal: yeast treat with Nystatin swish and swallow
----GOOD HANDWASHING |
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Term
| malignancy related to what? |
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Definition
immunosuppressive therapy
-100% higher than general population
ie non hodgkin lymphoma ect.. even skin |
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Term
| why use immunosuppressive therapy? |
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Definition
to suppress activity of helper and cytotoxic t cells
-immunocomp enough to not reject but not so much that they develop infection or neoplasm |
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Term
immunosuppressive therapy
Cyclosporine
background |
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Definition
calcineurin inhibitor
-suppress T cells without B cell suppression
--immune system has some function
---- not same as Sandimmune! |
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Term
immunosuppressive therapy
Cyclosporine
monitoring |
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Definition
-monitor CSA levels, only tx MD to adjust
s/e: acute and chronic nephrotoxicity, HTN, hyper lip, abnormal hair growth, GI, edema, bleeding gums
-----must take for LIFE! |
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Term
immunosuppressive therapy
prograf |
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Definition
tacrolimus BID
-first for liver tx now all thoracic pts
-attacks T lymphocytes
-NOT TAKEN WITH CSA and other Rx
-take on EMPTY stomach
no hyperlip, hair growth, bleeding gums or inc appetite |
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Term
immunosuppressive therapy
prograf
S/e |
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Definition
taken for life
-nephrotox -hyperKalemia
-HYPERGLYCEMIA |
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Term
immunosuppressive therapy
Sirolimus |
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Definition
inhibition of T cells and antibody formation
- good for renal insufficieny with prograf or if hypergly
-lots of interactions possible
-can combine with other immunosup
--- 4hrs post calcineurin inhib. |
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Term
immunosuppressive therapy
Sirolimus
s/e |
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Definition
-hyperlip, infection, leukopenia, acne, HTN and poor wound healing
-not for immediate post op |
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Term
immunosuppressive therapy
Corticosteroids |
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Definition
initially solumedrol then prednisone for life
-anti inflammatory and impairs t cell sensitivity
-titrate to low dose
s/e: hypergly, wt gain, bone disorder, moon face, dec wound healing inc in infection |
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Term
immunosuppressive therapy
corticosteriods
prednisone |
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Definition
dec immune response
-inc infection risk, inc appetite
-GI irritation, bone softening, emotional changes and Na retention |
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Term
immunosuppressive therapy
Imuran |
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Definition
antiproliferative agent
-inhibition of DNA/RNA synthesis of T cels and some B
-daily dose with prograf
s/e: bone suppression: thrombocyt and leukopenia |
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Term
immunosuppressive therapy
Cellcept |
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Definition
Purine synthesis inhibitor
-works on t and b cells
-monitor CBC
-use with caution in renal and liver illnesses |
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Term
immunosuppressive therapy
Thymoglobulin or antithymocyte globulin |
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Definition
polyclonal antibody
-when animals are injected with human thymocytes
-suppresses T lymphocytes
-used post transplatation for 3 days |
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Term
immunosuppressive therapy
OKT3
muromonab-CD3 |
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Definition
monoclonal antibody
-suppression of T lymphocytes
-two wks post trans and if there is rejection
---dc after 14 days |
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Term
immunosuppressive therapy
LIFE LONG triple therapy |
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Definition
1. tacrolimus/rapaune/CSA
2. prednisone
3. immuran or Cellcept
working to eliminate prednisone |
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Term
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Definition
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Term
CMV post transplantation
treatments |
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Definition
-valcyte: prophylaxis and treatment
-ganciclovir: treatment
-foscarnet: IV rx for CMV that is resistant |
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Term
common fungal infections
coccidiodiomycosus |
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Definition
valley fever
pathogen from soil |
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Term
common fungal infections
aspergillus |
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Definition
| mold or fungus in soil, manure, peanuts, grain and corn! |
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Term
common fungal infections
canadida albicans |
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Definition
| yeast that is normal to the body |
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Term
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Definition
productive cough- possible change in color
fever
infiltrates in chest |
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Term
common fungal infections
treatmetns |
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Definition
-___+conazole
-nystatin
ect |
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Term
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Definition
-medication regimine
-routine MD visit and testing
-support group
-infection control
NOT A CURE: replaces one disease with another |
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Term
| autologous human stem cell transplant (HSCT) (def) |
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Definition
patient's own stem cells
stored with cord cells through freezing or DMSO
DMSO- causes bad taste and possible heart block and tachy |
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Term
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Definition
| stem cells from identical twin |
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Term
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Definition
stem cells from matched donor (human)
-sibling unrelated donor and unmatched sibling
-umbilical cord that is related or unrelated
not stored or frozen- 48hrs post collection |
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Term
HSCT indications
peds
adult |
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Definition
treatment of aggressive malignancies
peds: leukemia (allogenic) and solid tumors (autologous)
adults: lymphomas and leukemias |
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Term
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Definition
-eradication and ablation: kills all bone marrow and opens space for new, healthy cells
-immunosuppression: to prevent graft rejection |
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Term
Collection of peripherial stem cells
goal |
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Definition
| obtain enough CD34 cells/kg to replace what the patient lost through ablation |
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Term
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Definition
glycoptn
mediates attachment of stem cells to bone marrow
found in umbilical cord and bone marrow |
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Term
| do pts have to be the same blood type? |
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Definition
| no, but must remove all RBC prior to transplantation |
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Term
S/e Stem cell transfusion
allogenic |
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Definition
anaphylaxis, hemolysis and infection
no heart effect
micro pulmonary emboli
FVO (kidney)
no GI effect |
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Term
S/e stem cell transfusion
autologous |
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Definition
anaphylaxis, flushing and infection
bradycardia
micro pulmonary emboli
renal!: HTN, FVO, ARF, hemoglobin in urine
GI: bad taste and n/v |
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Term
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Definition
pt/family understanding
VS q15min x4, q30 x4 q1hr x4
cardiac and pulse ox monitoring
pre meds: corticosteroids and benadryl
watch for blood in urine |
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Term
engraftment
med and diagnostic |
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Definition
sargramostin: promotes engraftment
WBC and RBC before plts
ANC > 500
plts >20,000 w/o transfusion |
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Term
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Definition
GI: similar to chemo,
administer anti emetic and TPN
oral care
opioids for mucositis
I and O and BID weights |
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Term
HSCT complications
capillary leak syndrome |
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Definition
7-14 days post transplant
tissue damage from cytokines
inc capillary permeability: ascities, pulmonary edema, wt gain and fluid retention
--DIURETICS |
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Term
HSCT complications
Hemorrhagic Cystitis |
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Definition
hematuria with out clots
dysuria, urgency and spasm
HYDRATE! and CBI
pain management and plts |
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Term
HSCT complications
Veno-occulsive Disease (VOD) |
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Definition
7-12 days post transplant
hepatic obstruction
---ascities, inc bilirubin, RUQ pain
---10% wt gain
diuretics and fluid restriction
"actigall" inc bile flow
"defibrotide" non systemic anticoagulant |
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Term
HSCT complications
infection |
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Definition
source of death in +100 days
from neutropeina and no donor immunoglobins
several meds on slide 22 |
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Term
HSCT complications
graft failure |
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Definition
primary: first two months
secondary: first year
cause: low cell dose, non complete ablation, myelosuppressive meds, infection
---must have another HSCT |
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Term
HSCT complications
GVHD
acute |
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Definition
<100 days post transplant
damage to SKIN (rash), GI (grn watery) and LIVER (pain)
prevent: steriods CSA and methotrexate
management: gut rest, steriods and Octreotide
---administer immunosuppressives |
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Term
HSCT complications
HVGD
chronic |
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Definition
>100 days post transplant up to two years
-systemic multi organ
Sx: dry eyes and skin and mouth. hair loss, contractures. malabsorption and thrombocytopenia
----immunosuppressive Rx: prednisone/CSA
watch for infection: causes death |
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Term
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Definition
ANC > 500 for two days
no fever
48 hrs post antibiotics
able to take oral meds at home |
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Term
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Definition
when to cell
central line management
follow up appt
medications
and diet/exercise |
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