You’re developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this patient is to:
A. Remain afebrile and have negative cultures.
B. Resume normal fluid intake within 2 to 3 days.
C. Resume the patient’s normal job within 2 to 3 weeks.
D. Try to discontinue cyclosporine (Neoral) as quickly as possible.
Correct Answer: A. Remain afebrile and have negative cultures.
The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection. The patient’s BUN creatinine ratio, magnesium levels, and blood pressure require monitoring while on therapy. Uric acid monitoring is debatable. Therapeutic monitoring of cyclosporine in transplant patients is a valuable tool in adjusting drug dosage to prevent acute rejection, nephrotoxicity, and predictable dose-dependent adverse reactions.
Option B: The patient may not be able to resume normal fluid intake or return to work for an extended period of time and the patient may need cyclosporine therapy for life. The range between effective cyclosporine concentrations and the concentrations associated with serious toxicity is fairly narrow. Sub-optimal doses or concentrations can lead to therapeutic failure or severe toxicity.
Option C: Patients on cyclosporine are at a slight risk of lymphoproliferative malignancies and infections; thus, a thorough history and physical exam are vital at each clinic visit. Cyclosporine therapy has a much higher opportunity for patient success with the communication and collaboration of an interprofessional healthcare team.
Option D: In solid organ transplantation, it has clinical use for the treatment of organ rejection in kidney, liver, and heart allogeneic transplants. Cyclosporine is subject to therapeutic monitoring based on pharmacokinetics measures. The medication has low-to-moderate within-subject variability.
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