N434 Exam 3 Flashcards

What are the 3 criteria for transplantation?
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What are the 3 criteria for transplantation?
1. Presence of end-stage disease in a transplantable organ; DON'T respond to conventional therapy

2. Absence of untreatable malignancy, irreversible infection, or disease that would attack the transplanted tissue

3. Ability of client to survive the surgical procedure
Which organ is the most commonly transplanted?
Kidney
What are 2 criteria for receiving a kidney transplant?
1. Patient must be on dialysis
2. GFR < 20
What is the one criteria for receiving a pancreas transplant?
Must have type 1 diabetes
What are 2 criteria for receiving a liver transplant?
1. Must be in end-stage liver disease OR liver failure OR have certain type of cancer only in liver (usually bile duct cancer)

2. Must be free of alcohol intake for AT LEAST 6 months to even be considered
What is the one criteria for receiving heart and lung transplants?
Must have end-stage disease
Describe the process of a stem cell transplant.
Chemotherapy
--> Patient's remaining bone marrow & cancer cells are destroyed
--> Stem cells "home" to bone marrow & produce new blood cells
--> IV injection of purified stem cells
--> Treat stem cells or bone marrow with agents that destroy malignant cells without harming normal cells
--> Harvest stem cells or bone marrow
What are specific criteria for the client being able to survive the surgical procedure?
- Must undergo extensive testing
- No severe cardiac or lung disease (if not having heart or lung transplant)
- Must be compliant
What is the Uniform Anatomical Gift Act?
Sets rules surrounding donations
--> Hospitals risk losing Medicare/Medicaid reimbursements if they don't follow UAGA
What is the role of Lifesource?
Determines if patient can be an organ donor & talks to family to get consent or to get a patient to be a donor
What are roles of UNOS?- Set guidelines for regional centers & states - Keep track of patients on waiting list for organ transplant - Have algorithm & database to determine/allocate where organs go when they become availableWhat are brain death criteria?- Complete & irreversible loss of brain function - Body temp > 90 degrees F - Pupils non-reactive to light - No spontaneous mov't or posturing in response to external stimuli, no facial response, no gag reflex - Doll's eyes (oculocephalic reflex) - Oculovestibular reflex - Apnea in presence of hypercapniaWhat should MAP, Urinary output, and EF be kept at in "donor maintenance"?MAP > 60 mmHg UOP > 1 mL/kg/hour EF > 45%How lung do the heart & lungs last after cardiac death?4 hoursHow long does the liver last after cardiac death?12 hoursHow long do the kidneys last after cardiac death?Up to 36 hours (but preferrably 24 hours)Are the existing kidneys removed during a kidney transplant?No - existing kidneys are NOT removedIf the donor reaches cardiac death within ______ of ventilator removal, then they can be an organ donor.30 minutesWhich organ transplants are based on how long the patient has been on the list? Which are based on how sick the patient is?How long -- pancreas How sick -- liver, heart, lungsWhat must be drawn every month while waiting on the transplant list?Panel reactive antibody -- the higher the number, the higher the chance of rejection < 20% is considered lower riskWhen does a hyperacute rejection take place? Is it treatable?Within 24 hours (usually rejects immediately, before end of surgery) No treatmentWhen does an acute rejection take place? Is it reversible?Within first 6 months Typically reversible if caught earlyWhen does a chronic rejection take place? Is it reversible?Over months or years IrreversibleWhat are the most common infections observed in the first month after a transplant?Pneumonia, wound infections, IV line & drain infections, UTIsWhat is the leading cause of death after a renal transplant?Cardiovascular diseaseWhat is the difference between induction immunosuppression and maintenance immunosuppression?Induction = temporary high dose in peri-operative period Maintenance = lifelong; cannot miss dosesWhat medications are used in immunosuppressant therapy?- Corticosteroids (prednisone, deltason) - Calcineurin inhibitors (cyclosporin) - Cytotoxic drugs - Polyclonal antibodies (Thymoglobulin) or monoclonal antibodies (OKT3)What immunosuppressant needs troughs drawn in the morning before dosage?Calcineurin inhibitors (Cyclosporin)What are benefits of early kidney transplantation?- Avoid long-term dialysis - Better overall candidate - Younger ageHow does recipient surgery differ from donor surgery?Donor: - Small laparoscopic incision - Surgery starts 1-2 hours earlier - Worse pain Recipient: - Larger incisionWhat typically causes death in the first year after transplant? Later death?Early death = acute rejection & infections Later death = malignancies or cardiac vasculopathyDifferentiate between the left side brain and right side brain.Left = ANALYTICAL Right = CREATIVEWhat are the 5 different types of TBIs?1. Scalp lacerations 2. Skull fractures 3. Concussions 4. Contusions 5. HematomasDifferentiate between acquired brain injury (ABI) and traumatic brain injury (TBI).ABI = ALL types of traumatic brain injuries (e.g. stroke, seizure disorders, electric shock, tumor) TBI = alteration in brain function caused by EXTERNAL FORCE (e..g falls, assaults, MVAs, sports injuries)TBIs occur most often in which age group?65+ years oldWhat are characteristics of basilar skull fractures?- Battle's sign (behind ear) - Raccoon eyes - "Halo" from CSF leakingWhat is the most common type of TBI?ConcussionWhat happens during a concussion?TBI injury --> bruising & swelling of brain, tearing of blood vessels & injury to nerves --> concussion (changes the way the brain functions)What are s/s of a concussion?Dizziness, nausea, headaches, light sensitivity, confusionWhen does post-concussion syndrome (PCS) occur?2 weeks to 2 months after injuryWhat is a contusion?Bruising of brain tissueWhat are s/s of hematomas?Unconscious or decreased LOC, headache, N/VWhat is involved in emergency management of ICP?- Ensure patent airway - Stabilize cervical spine - IV access & fluids - Control bleeding - Assess LOC (use GCS) - Monitor VS & heart rhythm - Keep patient warm - Assess for wounds & CSF leakingWhat is decorticate posturing?Arms flexed inward and bent in toward the body and the legs are extendedWhat is decerebrate posturing?Neck is extended with jaw clenched; arms are extended; legs are extended straight outWhich is more severe -- decorticate or decerebrate posturing?Decerebrate -- more severe damageWhat is the Ranchos Los Amigos scale?Level of cognitive functioning scale -- more detailed assessment for LOCWhat are nursing actions to lower intracranial pressure?- Raise HOB to 30 degrees - Activity management - ROM when calm - Airway management - Stool softeners, high fiber & fluids - Decrease metabolic demand (no fever, agitation, pain, shivering) - Avoid hyperglycemia - Monitor I&Os (NS is preferred IV fluid) - Control painWhat are the 5 types of surgical interventions for ICP?1. Burr hole -- remove fluid or blood 2. Craniotomy -- temporarily remove bone flap for access to brain 3. Craniectomy -- cut away bone flap to relieve pressure 4. Cranioplasty -- reconstruction of bone 5. Shunt proceduresWhat is the most important part of pre-op teaching?Provide emotional support with a focus on post-op expectations (e.g. hair removal, ICU monitoring)What electrolyte should be strictly monitored in patients with increased ICP? Why?Sodium -- risk of hyponatremia Can present with SIADH (decreased urine output) -- if untreated, can cause severe convulsions, seizure, coma, deathWhat is a ventriculostomy? What is a major consideration for its use?Drain placed into ventricles in brain to drain off excess CSF Must be kept at same level -- should be readjusted any time patient changes position!What is the biggest risk with CSF draining devices?Infection -- can drain CSF off too quicklyHow often should I&Os be taken in a patient with increased ICP? When should nutrition supplements be initiated?I&Os = hourly Nutrition = within 24 hoursWhat is the first line treatment for increased ICP?MannitolWhat are clinical manifestations of meningitis?1. Fever 2. Headache 3. N/V 4. Nuchal rigidity (severe pain when putting chin to chest) 5. Cranial nerve dysfunctionWhat is the most common & accurate diagnostic test for meningitis?Lumbar punctureDoes meningitis require any isolation precautions?Yes - contact isolationWhat are the most concerning assessment findings for increasing ICP?1. LOC change -- most sensitive indicator to increased ICP 2. Cushing's Triad (systolic HTN, bradycardia, irreg respiration) 3. Pupils fixed & dilated 4. Decerebrate posturingWhat is the most common cause of pancreatitis? The second most common?1st = alcohol 2nd = gallstonesWhat occurs in the early stage of acute pancreatitis?Gallstones block cystic duct, then block pancreatic duct --> pancreatic enzymes become stuck in pancreas --> enzymes digest in pancreas instead of sm intestine --> autodigestion of pancreas --> inflammation --> injury to pancreatic cellsWhat occurs in the late stage of acute pancreatitis?Necrosis, fluid accumulations, pseudocyst, infection, organ failureWhat are s/s of pancreatitis?- Abdominal pain (LUQ or epigastric) - Decreased bowel sounds - Abdominal distention - Abdominal pain NOT relieved by vomiting - Light colored, foul-smelling stool - Amber colored urine - Red/flushed or yellow/jaundiced - Fever, tachy, high WBCs - Crackles - Difficulty breathing, increased RR - Low BPWhat are 2 classic signs of a more severe state of disease of pancreatitis?1. Cullen's sign -- edema/bruising in tissue around UMBILICUS 2. Grey Turner's sign -- bruising of FLANKSWhat are diagnostics of pancreatitis?- Typical abdominal pain - Serum lipase or amylase > 3x upper limit - Characteristic CT findingsWhat labs are elevated in pancreatitis? What labs are lowered?Elevated = liver enzymes, bilirubin, triglycerides, glucose, WBC Lowered = calciumWhat test is used to diagnose pancreatitis but is also a risk factor for pancreatitis?Endoscopic retrograde cholangiopancreatography (ERCP) --> endoscope inserted through mouth into duodenum & dye injected into pancreatic or billiary ductsWhat are nursing interventions for pancreatitis?- Pain management - Antispasmodics - NPO/NGT (prevents stomach acid from entering duodenum) - Administer calcium supplements - Replace fluids & electrolytes - Antibiotics (if fever) - Steroids (for inflammation)What are 2 signs of hypocalcemia?1. Chvostek's sign -- twitches when cheek is tapped 2. Trousseau's sign -- wrist flexes with inflation of BP cuff on armWhat patient education should be given for pancreatitis?- D/c alcohol - Low fat diet - Quit smoking ASAP - Exercise regularly - Cut out sugar - Drink lots of water - Lose weight - Use olive oil for cooking - Eat fresh fruits, veggies, lean protein foods, & whole grainsHow is chronic pancreatitis managed?1. Pancreatic enzyme replacement --> give with H2 blockers 2. Insulin/hypoglycemic agents 3. AntidepressantsWhat is a pancreatic pseudocyst? What are s/s?Encased bubble of pancreatic enzymes, fluid, & tissue - Abdom pain, palpable mass, N/V, anorexia, increased amylaseWhat is the most common cause of hyperthyroidism?Grave's diseaseWhat is the primary cause of hypothyroidism? Secondary cause?1st = damage to thyroid gland (increased TSH) 2nd = hypothalamic/pituitary dysfunction (decreased TSH)What are s/s of myxedema? Does it occur in hypo or hyperthyroidism?Hypoventilation, bradycardia, hypotension, hypothermia, skin changes, edema HypothyroidismIn hyperthyroidism, what are TSH levels? T3 & T4 levels?TSH = initially increased but eventually DECREASED T3 & T4 = INCREASEDWhat are 2 medications for hyperthyroidism treatment?1. Anti-thyroid meds (PTU) --> blocks conversion of T4 to T3 2. Iodine --> inhibits synthesis/release of T3 & T4, blocks blood flow to thyroidWhat are teaching points for radioactive iodine treatment?- May lead to dry mouth - Do not use if pregnant or if a child - Hypothyroid common following tx - Use separate bathroom or flush toilet 2-3 times - Sit down on toilet (don't stand) - Separate laundering - Don't prepare food for others with bare hands - Avoid being around pregnant women & children for 7 days after tx - Avoid public transportation - Push fluidsWhat is a last resort treatment for hyperthyroidism?ThyroidectomyWhat are post-op considerations for a thyroidectomy?- Bleeding - Open airway - Whisper (limit talking & decrease stress on area) - Trach set - Support head, don't put strain on incision - Monitor for hypocalcemia!!What is the first line treatment for hypothyroidism?Levothyroxine - Dose based upon T3/T4 levels - Lifelong dosing required - Cardiac complications may occur with first doses - Interacts with anticoagulants & digoxinWhat are calcium & phosphorus levels in hypoparathyroidism?Decreased calcium Increased phosphorusWhat treatment is done for hypoparathyroidism?Balance of calcium - Calcium supplement (fortified with Vit D & Mg) - Dark greens, milk, tofuWhat causes hyperparathyroidism?Benign parathyroid adenomaWhat are calcium & phosphorus levels in hyperparathyroidism?Increased calcium Decreased phosphorusWhat are nursing interventions for hypercalcemic crisis?- Monitor cardiac, neuro, renal, pulmonary - IV sodium chloride - Loop diuretics (excrete excess calcium) - Phosphate therapy - Calcitonin