What is the primary nursing diagnosis for a 4th to 10th-day postoperative liver transplant patient?
A. Excess Fluid Volume
B. Risk for Rejection
C. Impaired Skin Integrity
D. Decreased Cardiac Output
Correct Answer: B. Risk for Rejection
Risk for rejection is always a possibility, especially during the 4th to 10th day postoperatively. LT patients are at risk for several complications. The primary care NP should be aware of these complications and needs to know when referral back to a transplant center or hepatologist is appropriate. The most serious issues are problems with the vasculature of the liver, biliary issues, rejection, and infection. Lab abnormalities—specifically elevation in alkaline phosphatase, alanine aminotransferase (ALT), and serum bilirubin levels—are usually the first indication of a problem in one or more of these areas.
Option A: Post-transplant acute kidney injury (AKI) has been reported to occur in 9-78% of cases with 10% progressing to end-stage renal failure. Early identification of potential AKI is crucial to improving patient outcomes as evidence shows that even small increases in serum creatinine are associated with a decline in overall mortality.
Option C: Patients are also at risk for specific opportunistic infections in the early postoperative period. Herpes simplex virus (HSV) reactivation disease is the most common opportunistic viral infection and can quickly progress to disseminated multi-organ infection and failure.
Option D: In the first month postoperatively patients are most likely to develop infections related to the surgical procedure and hospitalization, such as bacterial and fungal wound infections, urinary tract infections, bloodstream infections, pneumonia, and Clostridium difficile colitis.
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