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TRANSPLANTATION (POSTOPERATIVE AND LIFELONG) 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
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Beliefs about transplantation History of alcohol/drug abuse, disease resulting in organ failure Discharge plan
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