Health promotion in patients with organ transplants

1. Health promotion in patients with organ transplants Bigya Nepal SurakshyaShrestha

2. A story… • http://video.google.com/videoplay?docid=9036065053199156338&hl=en#

3. 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

4. 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

5. Assumption contd… Generalpeople • 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.

6. 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

7. 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.

8. 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

9. 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

10. 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 

11. 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)

12. Consequences contd… Positive • Learn to cope with stress in a healthy way • Healthy body • Feeling of hope of survival and healthy life • Prolonged life

14. 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.

15. 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)

16. 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).

17. 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

18. 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)

19. 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

20. 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

21. Interventions contd… • Lifestyle changes: • Alcohol and smoking cessation • Regular exercise • Balanced diet • Immunizations • Regular check up: dental & ophthalmologic

22. Case study John’s case study: • John 27 years old has developed ESRF and has been supported by hemodialysis 3 times a week, 3-5 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.

23. 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.

24. Discussion

25. Discussion contd… • What psychosocial care should be offered to John? • 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?

26. Discussion contd… • Does John have an obligation to comply with his post transplant self care?

27. 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/erectile-dysfunction/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.

28. 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.

29. Thank you !!!