Transcript Health promotion in patients with organ transplants

HEALTH PROMOTION IN PATIENTS
WITH ORGAN TRANSPLANTS
Bigya Nepal
Surakshya Shrestha
A story…

http://video.google.com/videoplay?docid=90360
65053199156338&hl=en#
Assumptions:
Living Donor
 Emotional disturbances
 Fear of losing organ, death
 Feeling of being helpful
Recipient
 Emotional disturbance
 Feeling of being completely
cured
 Feeling of guilt
 Fear of new organ rejection
Assumptions contd…
Nurses
 Feeling of personal loss of donor’s death/ feeling of
happiness for recipient
 Ethical dilemma whether to treat cadaver as a donor or
to follow end of life care.
Family
 Threat of losing a loved one
 Uncertainty about the procedure
 Stressful to be in the organ list
 Fear of organ rejection
Assumption contd…
General people
 Emotional attachment: People might think that their
bodies (after death) is not only important to them, but
also to their families because there is emotional
attachment. Thus, they might reject organ donation.

Gift of life: People also might think that they are
giving gift of life to somebody, thus they support
organ donation.
Definitions



Health promotion: Is the science and art of helping
people change their lifestyles to move towards state of
optimal health.
Organ transplant: It is a surgical procedure where
damaged or failing organ is replaced with functioning
one.
Organ rejection:
Organ: Structural and functional part of the body which is
composed of tissues and cells that can perform particular
function.
 Rejection: An immunological attack against organisms or
substances that the immune system recognizes as foreign

Definitions contd…




Ethics: The science or study of moral values or
principles, including ideals of autonomy, beneficence,
and justice.
Dysfunction: State or condition of not meeting a
desirable or intended objective.
Quality of life: Measure of optimum energy that
gives a person with the power to cope successfully.
Compliance/ adherence : Is fulfillment by a patient of
a caregiver’s prescribed course of treatment.
Defining criteria

Health promotion
 Balance
of physical, emotional, social, spiritual, and
intellectual health
 Enhances awareness
 Changes behavior and attitudes
 Creates environment that support good health
practices
 Types: Primary, secondary, and tertiary prevention
 Recognition of risk factors or signs and symptoms
Defining criteria contd…

Organ transplant
 Needed when an organ is irreversible, diseased, or
injured
 Provides a chance to live longer and overcome
complicating conditions
 Complications include organ rejection, infections,
and malignancies
 Raises ethical issues
 National Organ Transplant Act of 1984 prohibits
buying and selling of human organs
Antecedents







Organ failure
Drug abuse
Infection
Surgery
Stress
Lack of positive lifestyle
changes
Malignancy






Excess alcohol
Side effects of medication
Noncompliance
Lack of social support
Lack of finances to pay
for follow up care
Pain
Consequences
Negative
 Cost



Ethical concerns

Safety

Hospitalization

Sexual dysfunction
Medication side effects
(facial hair, acne, stomach
problem, fluid retention,
hypertension, headache
Complications (rejection,
infection, malignancies,
electrolytes imbalance)
Consequences contd…
Positive
 Learn to cope with stress in a healthy way
 Healthy body
 Feeling of hope of survival and healthy life
 Prolonged life
Literature Review



Among 90% of post transplant recipients, infection rate
is very high particularly bacterial and candidal
infections (Wade, C. R., et al.).
In addition to infection , they have increased risk of
developing complications, such as, malignancies and
rejections (Williams, 2009).
A study done by Gross, C.R. et al., stated that medical
complications such as hypertension, diabetes
hypercholesterolemia, and osteoporosis were also the
common problems faced by this population.
Literature review contd…



28 % of the women reported to have negative
consequences after transplants such as fear of
pregnancy, lack of energy, body image, and
reduced sexual desire.
Some women were also afraid to have sex because
of having UTI.
67% of the respondents indicated that they had
never received information or instruction about
possible sexual changes related to transplant.
(Muehrer, R. J., et al., 2006)
Literature review contd…



Study done by Wong, J.A., et al., stated that erectile
dysfunction was one of the problems faced by51 % renal
transplant recipients participating in the study. The major
cause for this problem was stated to be multi-factorial
including increasing age, Diabetes Mellitus, and depression.
Patients experienced several negative affects such as anger,
frustration, boredom, anxiety, difficulty sleeping, and
depression, and suicidal thoughts (Ouellette, A., et al.,
2009).
Non-adherence was a leading cause of late graft organ
failure especially among adolescents. (Zelikovsky, N., et al.,
2008).
Nursing Interventions
Infections:
 Education- Medication, signs and symptoms of
infection, wound care
 Regular health check up
 Frequent hand-washing
 Personal hygiene
 Early ambulation
 Avoid crowded places and people with known
infections or illnesses
Intervention contd…


Rejection: Strict adherence to medical regimen,
immunosuppressive agents, and follow up care
Malignancies: Regular cancer screening
(gynecological exam, mammogram, PAP smear,
Prostate Specific Antigen test(PSA), regular physical
examination, routine use of sunscreen lotion,
sunglasses)
Interventions contd…

Improving Sexual function:




Women: Using vaginal lubrication (KY jelly, astroglides)
Providing information on sexual and fertility issues after transplants and
medications
Men: Medications, mechanical devices, surgeries, psychosocial counseling
Compliance





Assess the cause of noncompliance
Reinforce client treatment
Referral (social worker, case manager)
Parental involvement in the follow up care and medication regimen
(adolescents)
Use of medication reminder systems
Interventions contd…
Psychosocial enhancement:
 Mindfulness Based Stress Reduction (MBSR)
exercises - reducer for emotional disturbances
especially depression and anxiety; improve quality
of life
 Support group
 Family support
 Providing opportunity to talk about their disease
process
Interventions contd…

Lifestyle changes:
 Alcohol and smoking cessation
 Regular exercise
 Balanced diet
 Immunizations
 Regular check up: dental & ophthalmologic
Case study
John’s case study:
 John 27 years old has developed ESRF and has
been supported by hemodialysis 3 times a week, 35 hours per session. John had a series of transplant
tests (physical, psychological, and practicality
evaluation) to assess his suitability as an organ
recipient. He had a history of smoking for 6 years,
and he admits to drink occasionally.
Case study contd…



John undergoes kidney transplantation, unfortunately
the transplanted kidney develops acute tubular
necrosis; John requires temporary dialysis during the
first post-surgical week.
He was lucky enough to find one more donor shortly
thereafter and went for re-transplantation.
John celebrated the first anniversary of his kidney
transplant. He has been compliant with his medication
regimen and has been fit and active.
Discussion
Discussion contd…





What psychosocial care should be offered?
Because of the risk of bacterial and fungal infection is greatest
during first few weeks after surgery, John was advised to take
appropriate precautions to prevent infections. What will be the
infection prevention precautions for John?
How will his quality of life be maintained? Any life style changes?
What kind of complications can he develop after the transplant
beside acute tubular necrosis?
What are some of the possible nursing diagnoses for John?
Discussion contd…

Does John have an obligation to comply with
his post transplant self care?
References






Chang, E., Daly, J., Elliott, D. (2006). Pathophysiology: Applied to nursing practice.
370-376. Mosby Elsevier, Australia.
Gross, C.R, Kreitzer, M.J, Russas, V., Treesak, C., Frazier, P.A., Hertz, M.I. (2004).
Mindfullness meditation to reduce symptoms after organ transplant: A pilot
study. Alternative Therapies in Health and Medicine, 10(3), 58-66. Retrieved
September 8, 2009, from Pro Quest Nursing & Allied Health Source.
Mayo staff (2008). Erectile dysfunction. Retrieved September 15, 2009 from
http://www.mayoclinic.com/health/erectiledysfunction/DS00162/DSECTION=treatments-and-drugs
Mayo clinic (2009). Kidney transplant: When your kidneys fail. Retrieved
September 8, 2009, from
http://www.mayoclinic.com/health/kidney-transplant/DA00094
Mayo clinic (2008). Liver transplant. Retrieved September 8, 2009, from
http://www.mayoclinic.com/health/liver-transplant/MY00349
Muehrer, R. J., Keller, M.L, Powwattana, A., Pornchaikate, A. (2006). Sexuality
among women recipients of a pancreas and kidney transplant. Western Journal of
Nursing Research, 28(2), 137-161. Retrieved September 8, 2009, from SAGE.
References contd…





Oulette, A., Achille, M., & Paquet, M. (2009). The experience of kidney graft
failure: Patient’s perspectives. Qualitative Health Research, 19(8), 1131-1138.
Retrieved September 8, 2009, from SAGE publications.
Wade, C.R., Reith, K.K., Sikora, J.H., & Augustine, S. M. (2004). Postoperative
nursing care of the cardiac transplant recipient. Critical Care Nursing, 27(1), 17-28.
Retrieved September 8, 2009, from EBSCO host
Williams, C. W. (2009). Management of clients requiring transplantation. In Black,
J.M. and Hawks, J. H. (Eds), Medical surgical nursing: Clinical management for
positive outcomes (8th ed.). 2137-2153. Saunders Elsevier: St Louis, MO: Mosby
Wong, J. A., Lawen, J., Kiberd, B. N., Alkhudair, W.A. (2007). Prevalance and
prognostic factors for erectile dysfunction in renal transplant recipients. Canadian
Urological Association. 1(4), 383-387. Retrieved September 10, 2009 form
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2422997
Zelikovsky N, Schast A.P, Palmer J.A, Meyers K.E.C (2008). Perceived barriers to
adherence among adolescent renal transplant candidates. Pediatric transplantation.
8 (12), 300–308. Retrieved September 8, 2009, from EBSCO host.