РефератыИностранный языкHeHealthcare Essay Research Paper In today

Healthcare Essay Research Paper In today

Healthcare Essay, Research Paper


In today’s fast-paced world where technology rules, the medical profession is


also advancing. In 1991, 2,900 liver transplants were performed in the United


States while there were 30,000 canidates for the procedure in the United States


alone (Heffron, T. G., 1993). Due to shortages of available organs for


donation/transplantation, specifically livers, once again science has come to


the rescue. Although the procedure is fairly new in the United States, the


concept of living organ donation is fast growing. Living related liver


transplantion was first proposed as a theoretical entity in 1969 but it was not


until almost twenty years later that the procedure became a clinical reality (Heffron,


T. G., 1993). Living related liver transplants have mainly been performed in the


United States and Japan until recently. In 1991 Europe began trying to institute


the procedure. The first transplant of this type took place in 1989 (Broelsch,


C. E., Burdelski, M., Rogiers, X., Gundlach, M., Knoefel, W. T., Langwieler, T.,


Fischer, L., Latta, A., Hellwege, H., Schulte, F., Schmiegel, W., Sterneck, M.,


Greten, H., Kuechler, T., Krupski, G., Loeliger, D., Kuehnl, P., Pothmann, W.,


& Schulte Am Esch, J., 1994). This concept still has many areas that have


not yet been explored in depth and there are sensitive issues involved that need


to be addressed. Live organ donation came about as a means to solve the problem


of the absence of a donor. Many people die every year while waiting for a donor


organ and many others suffer because of complications linked to finding a


suitable donor. Before live organ donation most available organs were


harvested/transplanted from cadavers. This procedure has problems of its own.


Complications include(a) suitable match, (b) legalities, (c) family not wanting


to donate organs, and (d) time. With live organ donation a suitable match should


be easier to obtain and time should be able to be controlled to some extent.


With live organ donor transplantation, "…the organ-damaging hemodynamic


instabiility associated with the death of the donor is avoided, and the


coordinated scheduling of operations in the donor and recipient holds ex vivo


organ ischemia to a minimum" (Singer, P. A., Siegler, M., Whitington, P.


F., Lantos, J. D., Emond, J. C., Thistlethwaite, J. R., & Broelsch, C. E.,


1989, p. 620). Prior to receiving a donor organ, recipients may be experiencing


a variety of signs and symptoms related to their disease process. These can


include(a) jaundice, (b) ascites, (c) GI bleed, (d) ECG changes, (e) malaise,


(f) encephalopathy, (g) body image changes, and (h) fluid and electrolyte


imbalances. Disease process is specific to the individual. Once the need for


transplant has been established the search for a donor can begin. There are a


multitude of steps involved in the procedure. Some of these include(a)


evaluation to determine the need for transplant, (b) search for a suitable donor


who is willing to donate, (c) evaluation of the donor, (d) obtaining the proper


consent, and (e) mapping out the plan of care for both donor and recipient. Due


to legalities and ethical conflicts, the acceptance of live organ donor


transplantation is questionable. Those families and volunteer participants must


meet several criteria in order to be considered for a live liver donor. Once


someone decides that they want to be a donor they must first under go a medical


and psychiatric evaluation. The medical portion of the evaluation includes(a)


compatible blood type, (b) no history of liver disease, (c) normal results of


liver function tests, (d) appropriate size of left liver lobe on CT scan, (e) no


vascular anomalies on hepatic arteriography, and (f) low operative risk. The


psychiatric portion of the evaluation must find that the donor is at low risk


for psychological decompensation and involves obtaining informed consent.


Donor’s consent can be influenced by three areas, these include(a) internal


pressure, (b) external pressure, and (c) urgency of medical situation. All


institutions have their own individual protocols for obtaining consent but many


do require a wait period between consent and procedure. This provides the donor


with time to change their decision, and after all these areas have been


addressed the donor and recipient are prepared for surgery. The procedure


involves donation of the left lateral lobe, which is the safest anatomical


resection (Jones, J., Payne, W. D., & Matas, A. J., 1993). The surgeries are


performed simultaneously and may take several hours depending upon the


experience of the transplant team and the possibility of complications. Common


complications include(a) arterial thrombosis, (b) bile leaks, (c) infection, and


(d) stricture at the biliary enteric anastomosis (Wise, B. V., 1994). During the


post-operative stage all normal nursing duties apply but there are also specific


things that nurses need to be aware of and look for. Because of the location of


the liver some patients may experience some degree of pulmonary compromise


post-operatively. Liver function needs to be monitored by assessing lab results,


liver enzymes, bilirubin, and bile production. All drains should be assessed for


quantity and color. Fluid volume status and intake and output also need to be


carefully monitored. PT/PTT coagulation factors are also a sensitive indicator


of graft function and can be expected to normalize in the first few days after


transplant (Wise, B. V., 1994). The transplanted segment of the liver will


regenerate to a standard liver volume, regardless of size at transplantation,


within four to six months following the procedure. Normal liver enzymes have


been documented within six weeks of the procedure (Wise, B. V., 1994). Organ


donation alone is an area where the nurse plays an important role but with the


advances of living organ donation the role has expanded and many nurses are not


prepared to play the part. When comparing living donor organ transplantation to


the age old means of organ harvesting/transplantation from cadavers, the


differences are many. Cadaver organs are usually shipped out , this meant that


there was one nurse and support system with the grieving family while there was


another nurse and support system with the recipient and family. The role is far


from being black and white and now with living organ donors it weaves an even


greater web. Now the nurse is dealing with a patient who may be facing eminent


death without a transplant, a concerned family who may be experiencing


anticipatory grieving stages and a living organ donor who may or may not be


related who also faces possible complications and maybe even death. Then add in


all the legalities and rules and you have one big mess. Support systems will be


a key factor in this web. All those involved will be facing challenges and


questions unique to them. Nurses must remember that when caring for the


patient’s condition, they must not forget to also care for the patient and


family. Isn’t that what holistic nursing care is all about? We must care for the


patient as a whole and this would include the patient’s family. Nur

ses need to


assess: (a) psychosocial needs, (b) functional outcomes, (c) quality of life,


(d) daily living, (e) psychiatric outcome, and (f) financial needs. The nurse


must use skills in crisis intervention to help ease the disequilibrium of the


family. Nurses need to be sensitive to patient and family needs. Nurses must


help the patients and their families to cope with(a) disease chronicity, (b)


waiting period, (c) role reversal, (d) hospitalization, and (e) complicated


medical regimen as well as take into consideration the demands on(a) time, (b)


energy, (c) finances, and (d) relationships that the disease has placed on


patients and their families. The burdens and challenges that this crisis places


on patients and their families are many. These can also include(a) the


uncertantity of rejection, (b) the uncertantity of future health and well-being,


(c) social isolation, (d) financial burdens, (e) possible organ failure, (f)


increased risk of two family members undergoing surgery, and (g) feelings of


guilt from non-donating persons or family members (Ganley, P. P., 1995). As


transplant moves into the critical care setting, nurses are going to have to be


prepared for optimal management of donors, canidates, and recipients. They need


to optimize patient outcomes through extended knowledge bases and education


about:: (a) the procedure, (b) the human immune response, (c) the pharmacology


of immunosuppression, and (d) physiological and psychologic and behavior


responses to transplantation (Smith, S. L., 1993). Nurses need to continue to be


patient advocates. We need to encourage communication, allow families to


ventilate anger, fear, and guilt and to educate patients and families about what


to expect. Nurses need to remember when designing care paths and nursing


diagnosis that it is important to include the necessary ones related to the


patients condition such as, potential for infection related to interrupted skin


integrity, which is the nursing diagnosis that the current nursing research is


focused on; but we also need to include nursing diagnoses that focus on the


patient and family as a whole. A key nursing diagnosis would be anxiety


secondary to knowledge deficit about liver donation/transplantation. We need to


educate patients and their families and take the time to answer their questions


and listen to their fears and concerns. All too often nurses get caught up in


the machines that are taking care of the patient’s condition but we must


remember that there is no machine that can care for the patient and family, only


the human response and caring of a nurse can preserve the "person".


There are still many ethical issues that surround living donor organ


transplantation. Issues that arise include(a) risks versus benefits, (b)


selection of donor and recipient, and (c) informed consent. The largest risks to


recipients include(a) organ rejection, (b) organ failure, and (c) possible


death. Benefits to recipients include a normal life or closer to normal life.


Risks to donors include(a) partial hepatectomy, (b) complications, and (c)


possible death. Benefits to donors include psychological benefits and the degree


depends upon the relationship between donor and recipient (Singer, P. A. et.


al., 1989). Arguments for living donor organ transplantation include(a)


reduction of pre- transplant mortality, (b) provides a new source of livers for


transplantation, (c) allows the transplant to be performed before the


recipient’s condition deteriorates from complications, (d) immunologic


advantage, and (e) fulfills powerful motivation of parent/other to participate


(Lynch, S. V., Strong, R. W., & Ong, T. H., 1992). Arguments against living


donor organ transplantation include(a) may be uneccessary, (b) frequently


require retransplant from cadaver source, and (c) poses unknown risk to donor


(Lynch, S. V., et. al., 1992). But most medical decisions are based on the


question of whether or not the risks outweigh the benefits and in the case of


living donor organ transplantation, the decision should be made on an individual


basis but keep in mind that, "…when a donor is genetically and


emotionally related to the recipient, the intangible benefits of saving a life


are most rewarding, and the risk-benefit ratio is most favorable" (Singer,


P. A., et. al., 1989, p. 621). Although the procedure of living donor organ


transplantation is truly a controversial issue, the nursing care of these


patients and their families has not been well documented. The medical


documentation and research on the actual procedure has been minimal and the


little nursing research that is out there is out-dated and incomplete. Because


of the specialty of transplantation and the uniqueness of the procedure there is


a need for more research and detailed information in order for all nurses and


health care providers to provide optimal care to patients and their families who


are experiencing living donor organ transplantation. Since living donor organ


transplantation will probably become a more common procedure, research and


knowledge related to the topic will help nurses better function in their role as


caregiver and patient advocate. Therefore we need to continue searching for the


answers and better ways to optimize patient outcomes. Although I have not


experienced this clinical concept in my nursing practice, I am currently


experiencing it in my personal life. I have found that it is sometimes


complicated to separate one’s nursing skills and behaviors from one’s personal


feelings. I was disappointed in my search for information related to living


donor organ transplantation. It is also disheartening that nurses in this field


have not tried to educate their fellow nursing professionals in this area of


study.


Broelsch, C. E., Burdelski, M., Rogiers, X., Gundlach, M., Knoefel, W. T.,


Langwieler, T., Fischer, L., Latta, A., Hellwege, H., Schulte, F., Schmiegel,


W., Sterneck, M., Greten, H., Kuechler, T., Krupski, G., Loeliger, C., Kuehnl,


P., Pothmann, W., & Schulte Am Esch, J.. (1994). Living donor for liver


transplantation. Hepatology, 20 (1), 495-555. Ganley, P. P.. (1995). Living


related liver transplantation (LRLT) in childrenFocus on issues. Pediatric


Nursing, 21 (6), 523-525. Heffron, T. G.. (1993). Living-Related pediatric liver


transplantation. Seminars in Pediatric Surgery, 2 (4), 248-253. Jones, J.,


Payne, W. D., & Matas, A.. J.. (1993). The living donors- Risks, benefits,


and related concerns. Transplantation Reviews, 7 (3), 115-128. Lynch, S. V.,


Strong, R. W., & Ong, T. H.. (1992). Reduced-size liver transplantation in


children. Transplantation Reviews, 6 (89), 115-128. Singer, P. A., Siegler, M.,


Whitington, P. F., Lantos, J. D., Emond, J. C., Thistlewaite, J. R., &


Broelsch, C. E.. (1989). Ethics of liver transplantation with living donors. The


New England Journal of Medicine, 321 (9), 620-621. Smith, S. L. . (1993). The


cutting edge in organ transplantation. Critical Care Nurse, supp. June, 10-30.


Wise, B. V. . (1994). Advances in pediatric solid organ transplantation. Nursing


Clinics of North America, 29 (4), 615-629.

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