Posttransplant Coordinators Role

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The roles of the pre- and posttransplant coordinators are similar in that education is a key component. The most important skill a patient can learn is independence. Teaching independence is challenging. The decreased length of stay post-

TABLE 6.2. General Guidelines for Transplant Recipients

Healthy living guidelines

A. Vaccines: Patients must always receive killed virus vaccines after transplantation.

1. Patient must avoid children who have received the live polio vaccine for up to 1 month; the child will secrete this vims through the G1 tract. Do not come in contact with child's stools (i.e., changing diapers).

2. Examples of live or weakened vaccines:

a. Smallpox b. Yellow fever c. Measles d. Mumps e. Rubella f. Oral polio g. Bacillus Cal mette-Guerin (BCG)

h. TY 21a typhoid

3. Examples of killed virus vaccines a. Flu b. Diphtheria-tetanus (booster only)

c. Tuberculosis d. Pneumococcal e. Hepatitis B

Commonsense guidelines for patients

1. Wash hands frequently.

2. Avoid individuals who are ill.

3, Notify the transplant team if exposed to a communicable disease for the first lime.

4, Watch for shingles and thrush.

A. Cancer

1. Immunosuppressive medications increase the risk of skin cancer. Skin should be shielded from the sun; patients should use sun block with a sun protection factor of 15 or greater and wear a hat and protective clothing if possible.

2. Female patients should receive a Papanicolaou smear annually,

3. Report any changes in skin, such as a change in size, shape, or color of a wart or mole.

B. Dentist

1. Patient must see a dentist every 6 months.

2. Antiobiotic coverage is needed for teeth cleaning, dental work, or any invasive procedure.

C. Activity

1, Walking is the best exercise initially.

2, Driving is permitted as soon as the patient's strength has returned to normal.

1. Use of a diaphragm or condom, or a combination, is the safest method of contraception for transplantation patients.

2. Pregnancy is strongly discouraged for 1 year after transplantation.

E. Smoking

I. This is strongly discouraged because of the increased risk of these patients for cancer and infection.

F. Returning to Work

1, Patients may return to work when they feel ready.

2. No heavy lifting (> 25 lbs) for at least 6 weeks after transplantation.

transplant poses a problem in readying the patient for discharge. Anxiety surrounding discharge also contributes to this challenge. Family members and significant others are enlisted as interim care providers until the patient gains independence.

The wealth of information needed before discharge is intimidating to many recipients and requires constant reinforcement. Patients with low literacy skills or physical disabilities present a unique challenge to the transplant coordinator. Evaluation of a patient's current knowledge base and his or her ability to learn is vital to the success of the teaching plan. Plans are individualized for these patients and, when necessary, help is enlisted from significant others. Creativity is encouraged to facilitate the learning process. Visual aides such as printed information, slides, and movies can be helpful. Patient management issues are especially evident in the posttransplant period. Compliance with follow-up visits and medication is stressed. If indicated, the reason for noncompliance is assessed and solutions are sought.

Before discharge, signs and symptoms of rejection, adverse reactions to medications, recommended routine screening, vaccine recommendation, exercise, and healthy living guidelines are reviewed. Tables 6.1 and 6.2 outline a formal, posttransplant medication teaching plan for a renal transplant recipient. Additional reinforcement or new teaching methods can be instituted to avoid complications. Outpatient clinic visits present an excellent opportunity to assess the patient for changing needs. As the patient recovers, new information may be introduced.

Communication with the referring physician is encouraged. Transplant centers provide a summary of the patient's course and recovery at time of transfer. Some providers are reluctant or inexperienced in providing postoperative transplant follow-up. Guidelines for patient management from the transplant center are helpful and can aide in the transition process for both patient and physician. This may include information on immunosuppressive medications, their side effects, and suggestions for laboratory values to be monitored. The transplant coordinator is available 24 hours per day at most transplant centers for physician and patient communication.

Transplant coordinators have a diverse and challenging responsibility to provide continuous care to the transplant patient. They are an integral part of the transplant team. Many patient issues that are not evident to other team members come to the transplant coordinator's attention. For this reason the transplant coordinator serves a vital role and link in the success of the transplant process.

Part

Organ Procurement and Preservation

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