What did you learn?? Organ transplant
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Even a perfect match does not guarantee organ success." "The doctor may decide to delay the use of immunosuppressant drugs." "Immunosuppressive drugs guarantee organ success." "Let's wait until after the surgery to discuss your treatment plan."
"Even a perfect match does not guarantee organ success."
The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse? "You've waited years for this transplant, you need to think positively." "If your body rejects the kidney, you can go back on dialysis; you are not going to die." "I understand your concerns, let's talk about them." "Don't think like that; I'm certain you will be fine."
"I understand your concerns, let's talk about them." The nurse must address the client's concerns and encourage the client to express any concerns. The rejection of a transplanted kidney is of great concern to the client, the family, and the health care team for many months. An important nursing function is the assessment of the client's stress and coping. The nurse uses each visit with the client to determine if the client and family are coping effectively and if the client is adhering to the prescribed medication regimen. If indicated or requested, the nurse refers the client for counseling. The other responses are non-therapeutic. Reference:
Which statement indicates that a client understands immunosuppressant therapy following a solid organ transplant? "This medication will be necessary for at least a few months." "I'll be so glad when this medication therapy is no longer needed." "I will need to stay on this medication for the rest of my life." "I know I'll have to take a dose of this medication if I get an infection."
"I will need to stay on this medication for the rest of my life." Infection is a major cause of morbidity and mortality, especially in clients who are neutropenic or who have had bone marrow or solid organ transplantation. For those with solid organ transplantation, who must continue lifelong immunosuppression to avoid graft rejection, serious infection is a constant hazard. If efforts to prevent infections are unsuccessful, infections may be fatal unless recognized promptly and treated aggressively. This information makes all the
When explaining the risks of pretransplant immunosuppression, the nurse demonstrates understanding of the process when making which statement? "Serious complications can occur if you are not monitored carefully while you are immunosuppressed." "Inadequate immunosuppression increases your risk of developing an infection." "Excessive immunosuppression can be corrected fairly easily with other medications." "Once the transplant is completed, complications associated with immunosuppression are no longer a concern."
"Serious complications can occur if you are not monitored carefully while you are immunosuppressed." For an organ transplant to be successful, the client's immune system must be artificially suppressed after transplant. If immunosuppression is excessive, the client develops serious infections and other adverse effects, such as cancer, because the drug's actions that slow the proliferation of activated lymphocytes also affect any rapidly dividing nonimmune cells. Inadequate immunosuppression increases the risk of organ rejection.
A client who waiting for an organ transplant asks the nurse why the donor organ must be matched. Which response by the nurse would be most appropriate? "Matching is required by law before any transplant." "Matching prevents you from having a reaction." "Matching helps ensure that the proper organ is prepared." "The closer the match, the less risk there is of rejection."
"The closer the match, the less risk there is of rejection." All transplants, except autotransplantation, produce an immune response. Therefore, matching a donor's HLA markers as closely as possible to those of the recipient for histocompatibility is essential. The more closely the foreign cells can be matched, the less aggressive the immune reaction will be to the donated tissue.
A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be: "Kidney transplantation is 100% successful, and there is no need for you to worry." "You will be given medication to decrease the likelihood of your immune system attacking your new kidney." "Your new kidney will continue to work fine as long as you do not drink any alcohol." "There is no need to worry about rejection because the occurrence of rejection is low with kidney transplant."
"You will be given medication to decrease the likelihood of your immune system attacking your new kidney." The success of transplantation depends primarily on the degree of histocompatibility, adequate organ preservation, and immunologic management. Maintenance immunosuppressive therapy plays an essential role in controlling T- and B-cell activation. Kidney rejection is managed by the maintenance of immunosuppressive therapy medications. It is important to give factual information to the clients and not dismiss or overlook their concerns.
Which type of graft utilizes the client's own skin for wound coverage? Heterograft Allograft Autograft Slit graft
Allograft An autograft uses the client's own skin, which is transplanted from one part of the body to another. A heterograft is obtained from animals, principally pigs. An allograft is human skin obtained from a cadaver. A slit graft is used when the area available as a donor site is limited, as in clients with extensive burns.
You are working on a transplant unit and you know to carefully monitor your clients. What is the rationale for closely monitoring clients taking immunosuppressive drugs? Because of an increased risk of blood-related complications Because of an increased risk of heart failure Because of an increased risk of skin and hair problems Because of an increased risk of respiratory or urinary system infection
Because of an increased risk of respiratory or urinary system infection After organ transplantation, the client's immune system may attack the new organ's cells because it recognizes them as 'nonself.' Therefore, drugs are used to intentionally suppress the immune system. For example, azathioprine (Imuran), cyclosporine (Sandimmune), and muromonab-CD3 (Orthoclone OKT3) are immunosuppressive drugs. The nurse should follow agency guidelines for controlling infectious diseases or protecting the client who is immunosuppressed. The nurse should observe such clients for signs and symptoms of infection such as fever, sore throat, productive cough, and dysuria. Immunosuppressive drugs do not cause skin or hair problems or any blood-related complications. Heart failure, infusion reactions, and life-threatening infections are associated with taking infliximab.
The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use? Sprinkle the contents of the capsule on food. Administer medication following breakfast daily. Contact the health care provider at first signs of an infection. Administer the medication with an antacid to prevent stomach upset.
Contact the health care provider at first signs of an infection. Mofetil is an organ rejection medication that diminishes the body's ability to identify and eliminate pathogens (immunosuppressant). Identifying symptoms of infection at an early state is helpful in treating the infection. This medication is administered on an empty stomach. Typically, capsules would not be opened dispensing medication at one time. Antacids may decrease the absorption of the medication.
The family of a client awaiting heart transplantation is concerned about the financial cost of lifelong antirejection medications following the procedure. Which intervention by the nurse is most appropriate? Discuss how the family might consider fund raising efforts to pay for the costs. Contact the social worker to discuss the client and family's financial concerns. Explain that all costs are covered if the client is unable to pay. Suggest the family discuss the cost with the health insurance provider.
Contact the social worker to discuss the client and family's financial concerns. Transplantation requires a multidisciplinary team approach. A social worker is always included as part of that team. The nurse should contact the social worker to discuss the client's and family's financial concerns. The social worker would contact the health insurance provider to discuss the cost of the transplant. It is unlikely that the costs will be covered if the client is unable to pay. Although fund raisers have been used through social media to secure finances to pay for medical expenses, this suggestion is inappropriate for the nurse to make.
The medication reconciliation of a newly admitted resident of a nursing home indicates that the patient takes cyclosporine. The nurse should initially suspect that this resident may have: a previous organ transplant. diabetes mellitus. AIDS. a history of multiple myeloma.
Cyclosporine is used as an adjunct treatment to prevent rejection in solid organ transplantation and to prevent graft-versus-host disease in allogeneic bone marrow or stem cell transplants. It is not used in the treatment of multiple myeloma, diabetes, or AIDS. Reference:
A nurse is caring for a client following an organ transplant procedure. The client reports that oral cyclosporine tastes awful and that the client is unable to swallow it. The nurse tells the client that it is possible to make the medication more palatable by mixing it with: orange juice. grapefruit juice. ice cream. oatmeal.
Cyclosporine may be added to orange juice to make it more palatable. Grapefruit juice should not be used because it affects metabolism of the drug.
You are a nurse working on a bone marrow transplant (BMT) unit. Your patient is scheduled to receive a bone marrow transplant. What information will you provide to the patient's visitors? Take the patient to the cafeteria for meals. Bring plants to improve air quality. Wear hospital scrubs when entering the patient's room. Do not visit if they've had a recent infection.
Do not visit if they've had a recent infection Before engraftment, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they've had a recent illness or vaccination. Plants should not be brought to the BMT patient. The patient cannot go to the cafeteria for meals. Disposable hospital gowns are worn when entering the patient's room.
A home care nurse is caring for a client who has received a liver transplant. The nurse is reinforcing earlier teaching about the client's immunosuppressant therapy and the need for appropriate self-care. Which client statement suggests that the client understands? "I'm at risk for infection until my body accepts my new liver." "I need to take these drugs until my prescription runs out." "I will always be at risk for serious infection." "I should stop taking these drugs if I get sick."
I will always be at risk for serious infection." Explanation: Solid organ transplantation requires a lifelong regimen of immunosuppressant drugs to prevent graft rejection. The client receiving such a transplant will always be at risk for serious infection.
A staff nurse is caring for a client who is a potential heart donor. The client's family is concerned that the recipient will have access to personal donor information. Which response by the nurse demonstrates knowledge of the organ donation process? "There is never contact between the donor's family and the recipient." "I will have the transplant coordinator speak with you to answer your questions." "It is important that the recipient knows how to reach the family of the donor if health problems arise after the transplant." "The recipient is allowed to ask questions about the donor and have them answered."
I will have the transplant coordinator speak with you to answer your questions." The transplant coordinator, a specially trained person with knowledge of the donation, procurement, and transplantation processes, typically speaks to family members about organ donation and answers their questions. Contact is permitted after the procedure with consent from the donor's family and the recipient. Typically, the transplant organization coordinates the communication. Confidentiality of the potential donor is always maintained unless the recipient and donor families both sign confidentiality waivers.
Which is the most likely indication for the use of immunosuppressant agents? Increased intracranial pressure Intractable seizure disorders Organ transplantation HIV/AIDS with multiple drug resistance
Organ transplantation
An adult client experienced a kidney transplant 2 days ago, and the regimen of antirejection drugs began just prior to surgery. What nursing action should be integrated into this client's plan of care? Wash the client's skin with chlorhexidine twice daily. Have the client wear a gown and gloves when outside the room. Place the client in a single, protective isolation room. Arrange for the client to receive a raw-food, organic diet.
Place the client in a single, protective isolation room. Clients receiving antirejection therapy are at a greatly heightened risk of infection; protective isolation is warranted. Raw foods are normally contraindicated, and the use of a gown and gloves does not protect the client sufficiently from infectious microorganisms. It is not necessary to perform twice-daily antiseptic washes.
The nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function? Surgical removal of the appendix Surgical history of a partial gastrectomy Negative history for radiation therapy Previous organ transplantation
Previous organ transplantation
A client is receiving mycophenolate after undergoing a liver transplant. What would be a priority nursing diagnosis? Risk for infection Imbalanced nutrition Deficient knowledge Acute pain
Risk for infection Mycophenolate is a T- and B-cell suppressor that is used in clients having transplants to reduce the risk of rejection. Subsequently, the client is at high risk for infection. Acute pain, imbalanced nutrition, and deficient knowledge may be appropriate, but the risk for infection would be the priority.
Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant? Deficient fluid volume related to fluid intake restrictions postoperatively Pain related to tissue rejection Risk for infection related to immunocompromised state Constipation related to effects of administered drugs
Risk for infection related to immunocompromised state Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant. As a result, this leaves them susceptible to infection. The child may have pain from the surgical procedure but it does not occur from the rejection of the organ. Constipation may occur from the opioids used for pain management but it is not the priority nursing diagnosis. The fluid volume should return to normal once the transplanted kidney is functioning properly.
A female client has completed immunosuppressive therapy in preparation for transplantation. When explaining the risks of immunosuppression, the nurse would state: Once the transplant is completed, complications with immunosuppression are no longer a concern. Taking both of the medications together will make her periods lighter and shorter duration. Excessive immunosuppression can be corrected easily with other medications. Serious complications can occur if you are not monitored carefully.
Serious complications can occur if you are not monitored carefully. For an organ transplant to be successful, the client's immune system must be artificially suppressed after transplant. If immunosuppression is excessive, the patient develops serious infections and other adverse effects, such as cancer, because the drug actions that slow the proliferation of activated lymphocytes also affect any rapidly dividing nonimmune cells.
The home care nurse is caring for a female client who underwent renal transplantation 8 weeks ago and is self-administering immunosuppressant drugs. What situation in the client's life is the greatest cause for concern? She is a vegetarian. She likes to walk ½ mile a day. She runs a secretarial business from home. She runs a sick child day care.
She runs a sick child day care. With clients who are taking immunosuppressant drugs, a major role of the home care nurse is to assess the environment for potential sources of infection, assist clients and other members of the household to understand the client's susceptibility to infection, and teach ways to decrease risks of infection. Although infections often develop from the client's own body flora, other potential sources include people with infections, caregivers, water or soil around live plants, and raw fruits and vegetables.
A female client is prescribed cyclosporine after her bone marrow transplant. What is the mechanism of action of cyclosporine that makes this an ideal drug for this patient? Suppression of the normal effects of the immune system in the body Increased stimulation of the normal effects of the immune system in the body Targeting of various receptor sites of cells Targeting of specific receptor sites of cells
Suppression of the normal effects of the immune system in the body Cyclosporine acts as an immune suppressant, which blocks the normal effects of the immune system in the body. This action is beneficial in organ transplantation, in which the body destroys foreign tissue, and in autoimmune diseases, in which the body destroys its own cells.
A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function? Surgical history of a splenectomy History of radiation therapy Surgical removal of the appendix Previous organ transplantation
Surgical removal of the appendix Removal of the appendix would have no direct effect on the immune system. Organ transplantation requires immunosuppressive drugs, which cause impaired immune function. Radiation therapy destroys lymphocytes. The spleen is an important part of the immune system, and removal of it increases the client's risk for poor immune function.
Which type of lymphocyte is responsible for cellular immunity? T lymphocyte Plasma cell Basophil B lymphocyte
T lymphocyte T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensitivity reactions.
Question 15 of 34 A client with diabetic nephropathy has received a kidney transplant and the care team believes that the client's cells may not be recognizing the new organ's histocompatibility antigens. The nurse should recognize what implication of this finding? The client's risk for nosocomial infection is increased. The client's healing may be delayed. The client's transplant is proceeding as intended. The client may experience transplant rejection.
The client may experience transplant rejection. When an organ is transplanted from one person to another, a great effort is made to match as many histocompatibility antigens as possible to reduce the chance that the "new" body will reject the transplanted organ. This is not directly related to healing or infection risk.
A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient? Need Compatible blood and tissue types Blood relationship Sex and size
The donor and recipient must have compatible blood and tissue types. They should be fairly close in size and age, but these factors aren't as important as compatible blood and tissue types. When a living donor is considered, it's preferable to have a blood relative donate the organ. Need is important but it can't be the critical factor if a compatible donor isn't available.
A client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client? "The problem of rejection is not as common in liver transplants as in other organ transplants." "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." "It is easier to get a good tissue match with liver transplants than with other types of transplants." "You would not be scheduled for a transplant if there was a concern about rejection."
You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." Rejection is a primary concern. A transplanted liver is perceived by the immune system as a foreign antigen. This triggers an immune response, leading to the activation of T lymphocytes that attack and destroy the transplanted liver. Immunosuppressive agents are used as long-term therapy to prevent this response and rejection of the transplanted liver. These agents inhibit the activation of immunocompetent T lymphocytes to prevent the production of effector T cells. Although the 1- and 5-year survival rates have increased dramatically with the use of new immunosuppressive therapies, these advances are not without major side effects. The other statements are inaccurate or will not decrease the client's anxiety.
The nurse is caring for a diverse group of clients. Which client is most likely to require education about the role of histocompatibility antigens? client with non-small cell lung cancer who is scheduled for chemotherapy client who has developed drug-induced parkinsonism from antipsychotic therapy client with chronic renal failure who will soon receive a kidney transplant client who has just been diagnosed with multiple sclerosis
client with chronic renal failure who will soon receive a kidney transplant
A client who has undergone an organ transplant is at a greatly heightened risk of health problems because of what impaired ability? differentiate between its own cells and antigens on foreign cells synthesization of the proteins that differentiate into T cells and B cells the immune system's ability to sequester T cells in the thymus the bone marrow's ability to initiate hematopoiesis
differentiate between its own cells and antigens on foreign cells In healthy people, the immune system's ability to inherently differentiate between cell surface proteins on its own cells (called self-antigens or autoantigens) and antigens on foreign cells provides protection against disease. However, in people who have received an organ transplant, this protective mechanism must be altered to avoid damage to the transplant and organ rejection. None of the other options are risks associated with organ transplantation. Reference:
Which cellular structure would be most likely involve which organ transplantation? ribosomes histocompatibility antigens lysosomes receptor sites
histocompatibility antigens Histocompatibility antigens are used by the body to identify a cell as a self-cell, protecting them and destroying non-self-cells. They are important in transplantation to prevent rejection. Receptor sites do not play a role in organ transplants. Ribosomes are the site of protein synthesis and are not involved with organ transplantation. Lysosomes contain digestive enzymes and aid in digesting worn or damaged sections of a cell when the membrane ruptures and the cell dies.
A 22-year-old woman has received an organ transplant and is on cyclosporine therapy. The nurse will encourage her to avoid crowds and limit social activities while on the medication due to: episodes of extreme dizziness. increased risk of infections. frequent migraine headaches. increased sedation.
increased risk of infections Cyclosporine therapy suppresses the immune system to limit immune reactions directed toward the new organ; however, the suppression also causes a generalized increased susceptibility to infection. Patients taking cyclosporine should avoid exposure to infections by avoiding crowds and promptly reporting injuries or signs of infection. The drug is not known to cause sedation, extreme dizziness, or migraine headaches
A nurse is caring for a 9-year-old child who has a grave prognosis after receiving a closed injury from being struck by a car. Which health team member should approach the family about organ donation? transplant coordinator pastoral care staff member emergency department nurse nurse-manager
transplant coordinator The transplant coordinator is the best health team member to approach the family about organ donation. The transplant coordinator is typically available to hospitals that routinely perform organ transplants. When the coordinator isn't available, the attending physician or another physician not directly involved in determining brain death should approach the family. Although the emergency department nurse may have admitted the child, she and the nurse-manager aren't directly involved with the child's care or with the family. Pastoral care staff members provide emotional and religious support and aren't involved with approaching the family about organ donation; they may, however, be present in a supportive capacity if the family wishes.
A nurse receives her client care assignment. Following the report, she should give priority assessment to the client: who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. who is experiencing mild pain from urolithiasis. with pinkish mucus discharge in the appliance bag 2 days after an ileal conduit. who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant.
who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. A sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L in a client immediately following dialysis should be the priority assessment. Pinkish mucus discharge in the appliance bag is a normal finding for a client who's had an ileal conduit, as are a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L in a client who's had a kidney transplant. Although the nurse should further assess mild pain from urolithiasis, this is an expected finding and not a priority in relation to the client with abnormal sodium and potassium levels.
