With current advances in technology and knowledge of immune responses at the molecular level, organ and tissue transplantation is becoming more commonplace. The most frequently transplanted organs are the kidney, liver, and heart. The major problem to be overcome is the immunologic response of the patient to donor tissues. The ability of the immune system to distinguish self from nonself is crucial to its proper functioning; therefore, in the process of transplantation, the donor/nonself can be rejected. The three forms of rejection are (1) hyperactive or hyperacute (within 48 hr), (2) acute (usually within 3–6 mo), and (3) chronic (occurring months or years after transplant). General postoperative care is similar to that for any other major abdominal or cardiothoracic surgery; however, special considerations necessitate meticulous measures to prevent infection and identify early signs of rejection.
CARE SETTING
Post-ICU plan of care addresses early recovery and long-term postdischarge community/clinic follow-up phases.
RELATED CONCERNS
Refer to (1) specific surgical plans of care for general considerations (e.g., cardiac surgery), and (2) organ-specific plans (e.g., heart failure, renal failure, cirrhosis, hepatitis), relative to issues of target organ problems following transplantation.
Peritonitis
Psychosocial aspects of care
Sepsis/septicemia
Surgical intervention
Thrombophlebitis: deep vein thrombosis
Patient Assessment Database
Refer to specific plans of care for data reflecting specific organ failure necessitating transplantation.
EGO INTEGRITY
May report: Feelings of anxiety, fearfulness
Multiple stressors: Impact of condition on personal relationships, ability to perform expected/ needed roles, loss of control, required lifestyle changes; financial concerns, cost of procedure/ future treatment needs; uncertainty of outcomes/personal mortality, spiritual conflicts; waiting period for suitable donation
Concerns about changes in appearance (e.g., bloating, jaundice, major scars), aesthetic side effects of immunosuppressant medications
Spiritual questioning (e.g., “Why me?” “Why should I benefit from someone else’s
death?”)
May exhibit: Anxiety, delirium, depression; cognitive and emotional behavior changes
SEXUALITY
May report: Loss of libido
Concerns regarding sexual activity
SOCIAL INTERACTIONS
May report: Reactions of family members
Conflicts regarding family member(s) ability/willingness to participate, e.g., financial, organ/bone marrow donation, postprocedure support
Concern about benefiting from other person’s death
Concern for family member who must take on new responsibilities as roles shift
TEACHING/LEARNING
May report: Previous illnesses, hospitalizations, surgeries
Lack of improvement/deterioration in condition
Beliefs about transplantation
History of alcohol/drug abuse, disease resulting in organ failure
Discharge plan
DRG projected mean length of inpatient stay: Dependent on organ transplanted
May need assistance with ADLs; shopping, transportation, ambulation; managing
medication regimen
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES (DEPENDENT ON SPECIFIC ORGAN INVOLVEMENT)
General preoperative screening studies include:
Chest x-ray: Provides information about status of lungs and heart.
CT/MRI scan: Reveals status of body systems and organs, including size, shape, and general function of major blood vessels; organ size for best match with donor organ; and potential sources of postoperative complications. Rules out presence of cancer, which would contraindicate transplantation.
Total-body bone scan: Evaluates status of skeletal system to determine presence/absence of bone cancer.
Specific blood and tissue typing: As may be required for donor-recipient matching.
Dental evaluation: To rule out oral infection or abscessed teeth.
Ear, nose, and throat evaluation: To rule out sinus infection.
Renal function studies (e.g., IV pyelogram, creatinine clearance): Determines functional status of kidneys.
Pulmonary function studies: Determines lung function and/or limitations that may complicate recovery.
CBC: Identifies anemia, which can reduce oxygen-carrying capacity, and other blood factors that may affect recovery.
Biochemical studies: Various tests done as indicated in addition to electrolytes, immune status.
Screening tests: To detect presence/type of hepatitis; HIV, viral titer (e.g., CMV, herpes).
ECG: Screens cardiac status, e.g., electrical conduction/dysrhythmias, signs of infarcts/hypertrophy.
NURSING PRIORITIES
1. Prevent infection.
2. Maximize organ function.
3. Promote independent functioning.
4. Support family involvement and coping.
DISCHARGE GOALS
1. Free of signs of infection.
2. Signs of rejection absent/minimized.
3. New organ function adequate.
4. Usual activities resumed.
5. Patient/family education plan established.
6. Plan in place to meet individual needs following discharge.
CARE SETTING
Post-ICU plan of care addresses early recovery and long-term postdischarge community/clinic follow-up phases.
RELATED CONCERNS
Refer to (1) specific surgical plans of care for general considerations (e.g., cardiac surgery), and (2) organ-specific plans (e.g., heart failure, renal failure, cirrhosis, hepatitis), relative to issues of target organ problems following transplantation.
Peritonitis
Psychosocial aspects of care
Sepsis/septicemia
Surgical intervention
Thrombophlebitis: deep vein thrombosis
Patient Assessment Database
Refer to specific plans of care for data reflecting specific organ failure necessitating transplantation.
EGO INTEGRITY
May report: Feelings of anxiety, fearfulness
Multiple stressors: Impact of condition on personal relationships, ability to perform expected/ needed roles, loss of control, required lifestyle changes; financial concerns, cost of procedure/ future treatment needs; uncertainty of outcomes/personal mortality, spiritual conflicts; waiting period for suitable donation
Concerns about changes in appearance (e.g., bloating, jaundice, major scars), aesthetic side effects of immunosuppressant medications
Spiritual questioning (e.g., “Why me?” “Why should I benefit from someone else’s
death?”)
May exhibit: Anxiety, delirium, depression; cognitive and emotional behavior changes
SEXUALITY
May report: Loss of libido
Concerns regarding sexual activity
SOCIAL INTERACTIONS
May report: Reactions of family members
Conflicts regarding family member(s) ability/willingness to participate, e.g., financial, organ/bone marrow donation, postprocedure support
Concern about benefiting from other person’s death
Concern for family member who must take on new responsibilities as roles shift
TEACHING/LEARNING
May report: Previous illnesses, hospitalizations, surgeries
Lack of improvement/deterioration in condition
Beliefs about transplantation
History of alcohol/drug abuse, disease resulting in organ failure
Discharge plan
DRG projected mean length of inpatient stay: Dependent on organ transplanted
May need assistance with ADLs; shopping, transportation, ambulation; managing
medication regimen
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES (DEPENDENT ON SPECIFIC ORGAN INVOLVEMENT)
General preoperative screening studies include:
Chest x-ray: Provides information about status of lungs and heart.
CT/MRI scan: Reveals status of body systems and organs, including size, shape, and general function of major blood vessels; organ size for best match with donor organ; and potential sources of postoperative complications. Rules out presence of cancer, which would contraindicate transplantation.
Total-body bone scan: Evaluates status of skeletal system to determine presence/absence of bone cancer.
Specific blood and tissue typing: As may be required for donor-recipient matching.
Dental evaluation: To rule out oral infection or abscessed teeth.
Ear, nose, and throat evaluation: To rule out sinus infection.
Renal function studies (e.g., IV pyelogram, creatinine clearance): Determines functional status of kidneys.
Pulmonary function studies: Determines lung function and/or limitations that may complicate recovery.
CBC: Identifies anemia, which can reduce oxygen-carrying capacity, and other blood factors that may affect recovery.
Biochemical studies: Various tests done as indicated in addition to electrolytes, immune status.
Screening tests: To detect presence/type of hepatitis; HIV, viral titer (e.g., CMV, herpes).
ECG: Screens cardiac status, e.g., electrical conduction/dysrhythmias, signs of infarcts/hypertrophy.
NURSING PRIORITIES
1. Prevent infection.
2. Maximize organ function.
3. Promote independent functioning.
4. Support family involvement and coping.
DISCHARGE GOALS
1. Free of signs of infection.
2. Signs of rejection absent/minimized.
3. New organ function adequate.
4. Usual activities resumed.
5. Patient/family education plan established.
6. Plan in place to meet individual needs following discharge.
Chinese
French
German
Italian
Japanese
Korean
Russian
Spanish
