NSG 321 FINAL EXAM STUDY GUIDE
ORGAN DONATION AND TRANSPLANTATION
REJECTION
• Tissue typing
o Recipient receives transplant from an ABO compatible doron
o Do NOT need to have same Rh factor
o Human leukocyte antigen (HLA) typing on donors and recipients
• Teach signs and symptoms of infection and when to contact HCP
• Hyperacute Rejection
o Antibody mediated (humoral)
o Minutes to hours after transplant
• Acute rejection
o Days to months after transplant
o New incisional pain
o Monitor BUN, Creatinine (Will be high)
▪ Normal BUN 8-23
▪ Normal Creatinine 0.51-0.95
• Chronic Rejection
o Months-years after transplant
o Irreversible
• Avoiding rejection
o Immunosuppressants for life
o Initially wear a mask in public, avoid
crowds
o Monitor for increased pain
o Report temps greater than 99.5
• Graft Vs. Host Disease (GVHD)
o Donor T-cells attach and destroy recipients’ cells
o 7-30 days after transplant
o Pruritis, shredding skin, liver disease, diarrhea, abdominal pain, GI bleed
MEDICATIONS
• Teach patient about lifelong need for immunosuppressants
• Goal of immunosuppressant drugs
o Suppress immune response without wiping out immune system
o Lifelong balance between rejection and infection
• Medications used to prevent rejection
o These medications inhibit T-cell production and prevent response from the body that causes organ
rejection
▪ Corticosteroids (initially but not for long term use)
▪ Calcineurin inhibitors
▪ Cytotoxic drugs
▪ Monoclonal antibodies
▪ Polyclonal antibodies
o Doses of drugs are reduced over time, will have to monitor T-cells
o Immunosuppressants increase risk for malignancies
▪ Teach patient to keep appointments and get regular screenings
o Corticosteroid related complications
▪ Increase blood sugars
▪ Aseptic necrosis of hips, knees, joints
, ▪ Peptic ulcer disease
▪ Cataracts
DISASTER PREPAREDNESS AND EMERGENCY/TRAUMA SYSTEMS
PRIMARY SURVEY VS. SECONDARY SURVEY WITH TRAUMA PATIENTS
Primary Survey: ABCDEF Secondary Survey
A: Alertness and Airway History and Head to toe
B: Breathing Head, Neck, and Face
C: Circulation Chest
D: Disability Abdomen and Flanks
E: Exposure and Environment Pelvis and Perineum
F: Facilitate adjuncts and Family Extremities
Inspect Posterior Surfaces
• Primary Survey
o Focuses on airway, breathing, circulation, disability, exposure, facilitation of adjuncts, and family
o If uncontrolled external hemorrhage is noted, format may be reprioritized with CABC for hemorrhage
o Primary survey aids to identify life-threatening conditions so appropriate interventions can be started
ORGAN DONATION AND TRANSPLANTATION
REJECTION
• Tissue typing
o Recipient receives transplant from an ABO compatible doron
o Do NOT need to have same Rh factor
o Human leukocyte antigen (HLA) typing on donors and recipients
• Teach signs and symptoms of infection and when to contact HCP
• Hyperacute Rejection
o Antibody mediated (humoral)
o Minutes to hours after transplant
• Acute rejection
o Days to months after transplant
o New incisional pain
o Monitor BUN, Creatinine (Will be high)
▪ Normal BUN 8-23
▪ Normal Creatinine 0.51-0.95
• Chronic Rejection
o Months-years after transplant
o Irreversible
• Avoiding rejection
o Immunosuppressants for life
o Initially wear a mask in public, avoid
crowds
o Monitor for increased pain
o Report temps greater than 99.5
• Graft Vs. Host Disease (GVHD)
o Donor T-cells attach and destroy recipients’ cells
o 7-30 days after transplant
o Pruritis, shredding skin, liver disease, diarrhea, abdominal pain, GI bleed
MEDICATIONS
• Teach patient about lifelong need for immunosuppressants
• Goal of immunosuppressant drugs
o Suppress immune response without wiping out immune system
o Lifelong balance between rejection and infection
• Medications used to prevent rejection
o These medications inhibit T-cell production and prevent response from the body that causes organ
rejection
▪ Corticosteroids (initially but not for long term use)
▪ Calcineurin inhibitors
▪ Cytotoxic drugs
▪ Monoclonal antibodies
▪ Polyclonal antibodies
o Doses of drugs are reduced over time, will have to monitor T-cells
o Immunosuppressants increase risk for malignancies
▪ Teach patient to keep appointments and get regular screenings
o Corticosteroid related complications
▪ Increase blood sugars
▪ Aseptic necrosis of hips, knees, joints
, ▪ Peptic ulcer disease
▪ Cataracts
DISASTER PREPAREDNESS AND EMERGENCY/TRAUMA SYSTEMS
PRIMARY SURVEY VS. SECONDARY SURVEY WITH TRAUMA PATIENTS
Primary Survey: ABCDEF Secondary Survey
A: Alertness and Airway History and Head to toe
B: Breathing Head, Neck, and Face
C: Circulation Chest
D: Disability Abdomen and Flanks
E: Exposure and Environment Pelvis and Perineum
F: Facilitate adjuncts and Family Extremities
Inspect Posterior Surfaces
• Primary Survey
o Focuses on airway, breathing, circulation, disability, exposure, facilitation of adjuncts, and family
o If uncontrolled external hemorrhage is noted, format may be reprioritized with CABC for hemorrhage
o Primary survey aids to identify life-threatening conditions so appropriate interventions can be started
