● Rejection of the donated pancreas Following a pancreas transplant the patient must take medications for the rest of his life to help prevent rejection of the donor pancreas. Such medications have several side effects
with a kidney transplant or after successful kidney transplantation in persons whose kidneys have been damaged by diabetes. The average waiting time for a pancreas transplant is about 23 months. The average wait for a simultaneous kidney-pancreas transplant is about 13 months (Mayo Clinic, 2019; MedlinePlus, 20121b). Candidates for a pancreas transplant typically have type 1 diabetes, along with kidney damage, nerve damage, or eye problems, or other complications. Transplant candidates usually have diabetes that is out of control despite medical treatment. Some people who have type 2 diabetes may be candidates for transplant if they have both low insulin resistance and low insulin production (Johns Hopkins Medicine, 2021). About 10% of all pancreas transplants are performed in people with type 2 diabetes. This is generally because of the patients’ having both low insulin resistance and low insulin production (Mayo Clinic, 2019). Surgical pancreatic transplant takes about three hours. If done in conjunction with a kidney transplant, the combined surgery takes about six hours. The patient’s diseased pancreas is not removed during the surgery. The donor pancreas is usually placed in the right lower part of the abdomen, and blood vessels from the new pancreas are attached to the patient’s blood vessels. The donor duodenum is attached to the patient’s intestine or bladder (MedlinePlus, 2019). ● The following are complications associated with the transplant surgery (Mayo Clinic, 2019). Case study: Jeremy Wilson Jeremy is a 16-year-old high-school student who has a history of hard-to-control type1 diabetes. Jeremy is struggling to live what he calls “a normal life like my friends.” Because of the seriousness of his condition he, his parents, and his healthcare providers agree that he is a candidate for pancreas transplant. Question 1: How long will it take to obtain a pancreas for transplantation? Discussion: The average wait time for a pancreas transplant is about 23 months. The pancreas must be meticulously matched to the recipient and is transported in a cooled solution that preserves the organ for up to approximately 15 to 20 hours. Once a pancreas becomes available, it must be transplanted into a recipient within 18-24 hours. Jeremy needs to know about the waiting period for a pancreas. It may be a difficult waiting period as he is anxious to live “a normal life.” Jeremy, and his family, may benefit from counseling as they wait and in preparation for undergoing, and living with, transplantation. The possibility of complications must be addressed with patients and families. Healthcare professionals must not only monitor patients but also teach patients and families to recognize signs Smoking ● 21.6% were tobacco users based on self-report or levels of serum cotinine. ● 15.0% reported current cigarette smoking. ● Hemorrhage ● Blood clots ● Infection ● Hyperglycemia ● Urinary tract infections ● Failure of the donated pancreas Overweight and obesity ● 89.0% were overweight or had obesity, defined as a body mass index (BMI) of 25 kg/m2 or higher.
(Mayo Clinic, 2019): ● Thinning of bones ● Elevated cholesterol ● Hypertension ● Skin sensitivity ● Fluid retention ● Weight gain ● Swollen gums ● Acne ● Excessive hair growth
Before transplantation, patients are evaluated both physically and mentally. Patients must be able to cope with and adhere to lifelong medical follow-up, the need to take medications to help prevent organ rejection for the rest of their lives, and the ability to cope with side effects of medications needed after transplantation (Mayo Clinic, 2019; MedlinePlus, 2021b18b) Self-Assessment Quiz Question #8 All of the following immunization recommendations for adults who have diabetes mellitus are accurate EXCEPT: a. Administer influenza vaccine to all patients annually. b. The TDAP vaccine should not be administered to pregnant women. c. All persons 50 years of age or older should receive the two-dose Shingrix vaccine. d. The HPV vaccine should be given to persons 26 years old and under. Question 2: What happens during the transplant procedure? Discussion Surgical pancreatic transplant takes about three hours. If done in conjunction with a kidney transplant, the combined surgery takes about six hours. The patient’s diseased pancreas is not removed during the surgery. The donor pancreas is usually placed in the right lower part of the abdomen, and blood vessels from the new pancreas are attached to the patient’s blood vessels. The donor duodenum is attached to the patient’s intestine or bladder Question 3: Why is a mental health examination needed before transplant surgery? Discussion Before transplantation, patients are evaluated both physically and mentally. Patients must be able to cope with and adhere to lifelong medical follow-up, the need to take medications to help prevent organ rejection for the rest of their lives, and the ability to cope with side effects of medications needed after transplantation
PREVENTION AND MANAGEMENT OF COMPLICATIONS OF DIABETES
and symptoms of complications and how to adhere to treatment regimens for complications if they occur. The CDC identifies the following risk factors for diabetes-related complications (CDC, 2020c):
● 36.4% had quit smoking but had a history of smoking at least 100 cigarettes in their lifetime.
Specifically: ● 27.6% were overweight (BMI of 25.0 to 29.9 kg/m2 ) ● 45.8% had obesity (BMI of 30.0 to 39.9 kg/m2 ) ● 15.5% had extreme obesity (BMI of 40.0 kg/m2 or higher)
Book Code: ANCCUS2423
Page 69
EliteLearning.com/Nursing
Powered by FlippingBook