NUR-214 UNIT 19 & 20

UAGA (Uniform Anatomical Gift Act)

Individuals can authorize one's own tissues, organ, and eyes following death. Prohibited trafficking of human organs.

NOTA (National Organ Transplant Act)

Required a nationwide organ procurement and transplantation network be established. United Network for Organ Sharing was awarded the contract by the federal government in 1986.

notify within 1 hour, GCS 5 or less, absence of 2 or more brain stem reflexes, withdrawal of vent support convo

What are nursing considerations regarding NJ regulation for organ sharing and procurement?

flat EEG, coma, apnea, fixed/dilated pupils, absent brain stem reflexes

What characteristics can qualify as brain death?

decreased donor

Patient has suffered brain death or circulatory death.

living donor

Donor is alive and agrees to donate an organ (or part) and/or tissue.

recipient

The person receiving the donation.

syngeneic

Genetically identical members of same species; genetically identical twins.

allogenic

From another of the same species.

autologous

Originating from one's self.

xenogenic

Type of transplant in which tissue is used from a different species.

granulocytes, macrophages

What is Phagocytic immune Response?

B lymphocytes

What is Humoral Immune Response?

T lymphocytes

What is Cellular Immune Response?

age, ABO compatibility, social risks, mechanism of brain death, med/surg Hx, HLA histocompatibility, HIV, EBV, Hep, CMV

What are donor evaluation factors?

pre-transplant complication s/s

Hypotension - Dysrhythmias/Bradycardia - Loss of Temperature Regulation - DI - Thyroid Hormone Depletion - Poor Gas Exchange/Acid Base Imbalance - Low insulin levels or insulin resistance

monitor for infection, organ rejection, complications, I&O, F&E, post op care

What are post-transplant care nursing interventions?

within minutes to hours

Graft Rejection: Hyperacute

first weeks to several months

Graft Rejection: Acute

months to years

Graft Rejection: Chronic

Hyperacute Rejection

Caused by pre-existing anti-donor antibodies in the recipient's blood; recognition of the donor's antibodies starts the complement system.

Hyperacute Rejection s/s

General Malaise - Elevated Temperature - Thromboses

tissue removal

What is the treatment of a Hyperacute Rejection?

Acute Rejection

It is caused by a mismatch of polymorphic HLA, which is mediated by T cells. The person will show manifestations of particular organ damage.

control w immunosuppressive therapy

What is the treatment of Acute Rejection?

Chronic Rejection

T-cell, antibody mediated vascular damage. Months to years after. Irreversible.

antirejection medications may slow

What is the treatment of Chronic Rejection?

Liver, Kidneys

Where are Glucocorticoids/Corticosteroids metabolized & excreted?

Corticosteroid short term s/e

Psychosis - Mania - Depression - Agitation - Insomnia

DVT, PUD, infection, edema, Bone Fx, hyperglycemia

What are Corticosteroid s/e?

Antimetabolite

What is the classification of Azathioprine?

Antimetabolite

What is the classification of Mycophenolate?

liver, kidneys

Where are Antimetabolites metabolized and excreted?

monitor CBC, AVOID azathioprine & allopurinol, increased infection risk

What are Antimetabolite nursing considerations?

Antimetabolite s/e

Bone Marrow Suppression - Infection - Anemia - Leukopenia - Thrombocytopenia - Hepatotoxicity

CNI (Calcineurin Inhibitor)

What is the classification of Cyclosporine?

CNI (Calcineurin Inhibitors)

What is the classification of Tacrolimus?

liver, bile

Where are CNIs metabolized and excreted?

CNI s/e

Gingival Hyperplasia - Infection - Anaphylaxis - Hyperkalemia - Hypomagnesemia - Renal Impairment - HTN - D - Convulsions

Proliferation Inhibitor

What is the classification of Sirolimus?

liver, GI tract

Where are Proliferation Inhibitors metabolized and excreted?

Proliferation Inhibitor s/e

Thrombocytopenia - Leukopenia - Anemia - Elevated Triglycerides - D/V/N - Peripheral Edema - Pain

monitor CBC, lower incidence of nephrotoxicity, hepatoxicity, neurotoxicity

What are nursing considerations regarding Sirolimus?

Biologic Agents (Orthoclone)

What is the classification of Muromonab-CD3?

cytokine release syndrome

What are s/e of Orthoclone?

Cytokine Release Syndrome s/s

Fever - Diarrhea - Myalgia - SOB - Pulmonary Edema - Respiratory Distress

monitor CBC, F&E, hemodynamics, infection s/s, organ rejection s/s, report UO <30 mL/hr (0.5 mL/kg/hr)

What is the post-op management of a Kidney Transplant?

kidney acute rejection s/s

Fever - Edema - Gross Hematuria - Pain - Weight Gain - HTN - decreased UO - increased BUN/Cr

monitor I&O, daily weight, LABs, infection s/s, organ rejection s/s, bleeding

What is the post-op management of a Heart Transplant?

heart acute rejection s/s

Weight Gain - SOB - fatigue - ABG bloating - Fever

heart chronic rejection s/s

Ischemia - Infarction - Heart Failure - Ventricular Dysrhythmias - Death

<55 y/o, <20 pack year, no active infection, no previous cardiothoracic surgery

What is the donor criteria for a Lung Transplant?

Monitor for ARDS, bleeding, infection, rejection s/s, LABs, VS, immunosuppressive therapy

What is the post-op management of a Lung Transplant?

lung acute rejection s/s

Fatigue - Dyspnea - Fever - Hypoxemia - Pulmonary Infiltrates - Pleural Effusions

lung chronic rejection s/s

SOB - Decreased Exercise Tolerance - Airflow Limitation - Decline in Pulmonary Function

Islet Cell Transplant

Experimental tx for Type I diabetes; matched donor's (↓) pancreatic cells are infused into the pts liver through the portal vein.

Hep C can donate liver to Hep C patients

What are nursing considerations regarding Hepatitis C and liver transplants?

monitor LABs, VS, complications like infections, bleeding, acute/chronic rejection s/s, immunosuppressive therapy

What is the post-op management of Liver Transplants?

liver acute/chronic rejection s/s

increased AST/ALT, Bilirubin - ABD Discomfort - Ascites - Jaundice - Dark Urine - Fever - Fatigue - Loss of Appetite

Stem Cells

Blood forming cells that mostly liver in the bone marrow; make RBCs, WBCs, and platelets.

Autologous HSCT

No rejection, but possible recontamination with cancer; used in multiple myeloma and advanced testicular cancer.

Allogenic HSCT

Graft versus cancer effect donor cells attack the cancer, but the stem cells could be destroyed before ever reaching the bone. Infection from the donor can occur.

Marrow, Blood, Umbilical Cord

Through what methods are Stem Cells obtained?

monitor for infusion s/e, avoid infection private room, infusion does not hurt

What are nursing considerations regarding HSCT?

prostate, lung/bronchus, colon/rectum, urinary bladder, melanoma

What are the top 5 cancers in men?

breast, lung/bronchus, colon/rectum, uterine corpus, melanoma

What are the top 5 cancers in females?

G0

A resting stage of the cell cycle in which DNA replication and cell division stop.

G1

Cell growth.

susceptible, antimetabolites work on this phase

What are nursing considerations regarding the S phase of Cell kinetics?

G2

Cell prepares to divide.

Neoplasm

An abnormal mass of tissues, which can be benign or malignant in nature.

Benign

Mild, not cancerous; they do not demonstrate uncontrolled cell growth that follows no physiologic demand.

Cancer

Any malignant growth or tumor caused by abnormal and uncontrolled cell division.

Carcinogen

A cancer-causing substance.

Doubling Time

Time it takes cells to double in size (tumor)

Tumor Suppressor Gene

A gene whose protein products inhibit cell division, thereby preventing uncontrolled cell growth (cancer).

Nadir

Lowest activity of Bone Marrow.

<500 ANC (normal >2000)

What ANC requires standard precautions in a patients room?

Initiation

The process by which a carcinogenic agent interacts with DNA to produce damage that, if not repaired before the cell division, could lead to error-prone DNA replication.

Promotion

Involves the clonal expansion of the initiated cell, in which the initiated cell divides into other cells that now have the same alterations in DNA if not repaired in time.

Progression

The stage in which benign lesions acquire the ability to proliferate and invade adjacent tissue and establish distant sites of metastasis through the acquisition of additional mutations.

Metastasis

The spread of cancer cells to locations distant from their original site.

Paraneoplastic Syndrome

Unexpected pathological disorder provoked by the presence of cancer in the body, example includes small cell carcinoma of the lungs.

Pleomorphism

Cells vary in size and shape.

Hyperchromatism

Intensely stained nuclei (seen in stratified squamous epithelium that indicated potential malignant change)

Aneuploidy

Abnormal number of chromosomes.

hormonal, chemical, viral, radiation, genetics, immunologic

What factors are included as theories of Carcinogenesis?

AVOID red meat, high fatty & processed foods, smoking, maintain a healthy weight, regular exercise, HPV vaccine, removal of at-risk tissues (education is key)

What are nursing considerations regarding Primary Prevention for Cancer?

early detection and Rx

What are nursing considerations regarding Secondary Prevention for Cancer?

Pap Test Q3 years

Cervical Cancer Screening: 21-29 years old

HPV Test/PAP Test or PAP Test only, Q5 years or Q3 years

Cervical Cancer Screening: 30-65 years old

may stop based on previous results

Cervical Cancer Screening: 66+ years old

Mammogram, should begin annually

Breast Cancer Screening: 40-44 years old

Mammogram, annually

Breast Cancer Screening: 45-54 years old

Mammogram, should become Q2 years or can stay yearly, continues as long as expected to live at least 10 more years

Breast Cancer Screening: 55 years and older

PSA/DRE begin at age 50 w life expectancy of 10 years, African American and family Hx can start at age 45

Prostate Cancer Screening: Men

LDCT, current/former smokers ages 55-74 with at least 30 pack year (formers quit within last 15 years)

Lung Cancer Screening: Men & Women

begin age 45, until 75, 76-85 should decide with HCP on continuation, over 85 should no longer be screened

Colorectal Cancer Screening: Average Risk

before age 45, strong family Hx, Hx of UC or Crohns, FAP or Lynch Syndrome, abdominal or pelvic radiation Hx

Colorectal Cancer Screening: Highest Risk

Qannual

Colon Cancer Stool-Based Test: FIT