N434 Cellular regulation

N434 Cellular regulation

Organ transplant

Stem cell tx

GVH

Multiple Choice

Six days after kidney transplantation from a deceased donor, a patient develops a temperature of 101.2º F (38.5º C), tenderness at the transplant site, and oliguria. The nurse recognizes that these findings indicate

• Acute rejection, which is not uncommon and is usually reversible.

• Hyperacute rejection, which will necessitate removal of the transplanted kidney.

• An infection of the kidney, which can be treated with IV antibiotics.

• The onset of chronic rejection of the kidney with eventual failure of the kidney.

Emily was diagnosed with polycystic kidney disease (PKD) at the age of 25.

Over the years, her kidney function gradually declined, and she started experiencing symptoms of end-stage renal disease (ESRD), including fatigue, nausea, and difficulty concentrating.

Transplant case study

​Emily has been on the waiting list for a kidney transplant for the past year. Despite dietary restrictions and medication management, her symptoms have continued to worsen, affecting her ability to work effectively and enjoy daily activities. She is anxiously awaiting news of a potential donor match.

Open Ended

Day 1:

Emily receives a call from her transplant coordinator informing her that a deceased donor kidney has become available, and she is the next eligible candidate on the transplant list. She is asked to come to the hospital immediately for evaluation and preparation for surgery.

What assessments should you perform to ensure Emily is prepared for the transplant surgery physically and emotionally?

Multiple Choice

What preoperative tests should be conducted before proceeding with the transplant surgery?

• Blood tests, imaging tests, ECG, pulmonary function tests, and other specific tests based on medical history.
• Dental exams
• Eye tests
• Hearing tests

Multiple Select

What factors should be considered when determining the suitability of the deceased donor kidney for Emily?

• Blood type compatibility

• Tissue match

• Hair length of the donor
• Potential infections or diseases

• kidney function

Human leukocyte antigen system - both HLA typing and cross-matching for HLA antibodies are performed in histocompatibility studies

Other tests may include tissue compatibility, CBC, CMP, LFTs, Renal function tests, phosphate levels, etc. 

In addition to extensive testing, the patient will have a behavioral health assessment and meet with a social worker to ensure they have support when they are discharged.



THIS IS A LIFE-ALTERING AND SUSTAINING EVENT!

​Day 2:
Emily undergoes a series of preoperative assessments, including laboratory tests, imaging studies, and a psychological evaluation. The deceased donor kidney is determined to be a suitable match for Emily based on compatibility testing and organ quality assessment.

Open Ended

What are the potential challenges associated with using a deceased donor kidney?

Multiple Choice

How can Emily's care team ensure effective communication and coordination among the various healthcare professionals involved in her transplant care?

• Implement regular team meetings, utilize a centralized communication platform, assign a care coordinator, establish clear roles and responsibilities, and maintain open lines of communication.
• Limit the frequency of team meetings
• Ignore the need for a centralized communication platform
• Have multiple care coordinators with overlapping responsibilities

​Day 3: Emily undergoes the transplant surgery successfully. The surgical team closely monitors her in the immediate postoperative period for signs of complications such as bleeding, infection, or rejection.

Match

Match the following

• Hyperacute

• Acute rejection

• Chronic

immediately upto a few minutes after tx

first week after the transplant to 3 mos

over many years

• immediately upto a few minutes after tx

• first week after the transplant to 3 mos

• over many years

Open Ended

What are some signs or symptoms of rejection?

​Day 4-7:
Emily's kidney function gradually improves in the days following the transplant surgery. She experiences some pain and discomfort at the surgical site but is otherwise recovering well.

Multiple Choice

How should Emily's care team assess her progress and adjust her postoperative care plan accordingly?

• Ignore vital signs and pain levels, focus only on wound healing
• Disregard overall recovery progress, only adjust medication dosages
• Stop physical therapy routines and increase dietary restrictions
• Monitor vital signs, pain levels, wound healing, and overall recovery. Adjust medication dosages, physical therapy routines, dietary restrictions, and follow-up appointments.

​Week 2:
Emily is discharged from the hospital and instructed to follow up regularly with her transplant team for ongoing monitoring and medication management.

​Emily's kidney transplant represents a significant milestone in her journey to manage her PKD and improve her quality of life. With comprehensive preoperative evaluation, meticulous surgical technique, and attentive postoperative care, she has a good prognosis for long-term kidney function and overall well-being. However, ongoing monitoring and support from her transplant team will be essential to ensure the success of her transplant and optimize her long-term outcomes.

Dropdown

Which ​ healthcare members would be associated with the kidney transplant team?​ ​

Select answer

​

Select answer

​

Select answer

​

Select answer

​

Select answer

Multiple Choice

An adult client has been placed on cyclosporine (Gengraf) following a kidney transplant. What are some side effects to monitor for?

• Side effects to monitor for include hypertension, nephrotoxicity, tremors, and hyperglycemia. Avoid grapefruit.
• Muscle weakness, tachycardia, hypokalemia, hypocalcemia
• Nausea, constipation, insomnia, weight gain
• Hypotension, ototoxicity, bradycardia, hypoglycemia