Nursing Implications For individuals that are in the pre listing stage of liver transplants one main aspect to address is educating the patient and the family. One of the main nursing interventions is teaching patients and their family the importance of abstinence from both alcohol and tobacco if it is used. The continued use of alcohol can cause worsening condition of the patient’s current liver in addition to being a reason as to why the patient is no longer eligible for liver transplant (NIDDK, 2012).
If the patient uses tobacco it is important that they know they should stop moking as soon as possible due to the fact smoking can cause vascular issues within the liver which could result in clots (Doane, 2013). Also, tobacco when used in conjunction with immunosuppressive drugs can increase their risk for cancer (Doane, 2013). Another education aspect that should be handled by the nurse is educating the patient about the process of liver transplant eligibility. The patient should know that they will calculate their MELD score and what laboratory data goes into that.
Then, based on that score they will place the patient on his or her respective spot on the list. However, there are some additional guideline that must be followed, which depend on the specific organization policy which includes a sobriety period of 3,6, or 12 months (Rodrigo et. al, 2013). The nurse should be informed of the insurance status of the patient so cost information can be shared with the patient and his or her family member. The average cost surrounding a liver transplant is about 577,100 which does not include the lifelong care that will be needed (Doane, 2013, p. 21). In addition, to education the nurse should recommend a referral for a substance abuse consults. This can assist the family and patient in identifying new productive ways to cope with life stresses as well as assist the patient on their journey to sobriety. Substance abuse counseling should be utilized as much as possible because as stated earlier relapse rates decrease significantly when patients receive counseling both before and after transplant (Rodrigo et. al, 2013).
Through this relationship the nurse should always remember to employ the ethical principle of respect for human dignity and respect (ANA, 2015). As the nurse it is his or her responsibility to treat the atient respectfully no matter the personal opinions or biases that may be present. The patient and the family should be educated on the upcoming tests that will be required in order to gain information on the patient’s condition which include: x-rays, blood tests, complete health history, urine tests (NIDDK, 2012). In addition, to tests that check the capability of the heart, lungs and kidneys (NIDDK, 2012).
Listing Implications Once an individual has been placed on the list the nurse should continue to be focused on sobriety status and continue to ask the patient how counseling is going to assess their ompliance and willingness for change. In addition to sobriety the nurse will need to address any nutritional concerns with the patient. Nutrition will be a key factor in keeping the patient healthy enough for transplant and consequent healing. The patient should be informed that regular testing of blood urine and or breath will be done to asses drinking status (Allen, Wurst, Thon & Litten, 2013).
Information about the procedure should also be discussed so should a donor liver be available the patient has been informed about the procedure. The nurse should tell the patient and his r her family that once a donor liver is available for transplant the surgery will happen as soon as possible (NIDDK, 2012). The patient should also be informed that he will be under general anesthesia and will be completely asleep. Also, the patient should expect to have an incision in the abdomen and that the surgery can take up to 12 hours and can expect a hospital recovery period of 1-2 weeks (NIDDK,2012).
Any concerns that the patient or patient’s family has should be addresses and done so in a non-judgmental manner. It is our job to advocate for our patient and make sure they receive the est care possible no matter our personal feelings regarding the manner. Post Liver Transplant For an individual that has received the transplant one main concern to relay to the patient is the importance on staying compliant with the immunosuppressant medication. Compliance with the strict lifelong regimen of antirejection medication is absolutely critical to maintain surviving allograft (Doane, 2013, p. 19).
Failure to comply can lead to failure of the transplanted liver. Continued sobriety counseling should be encouraged to assist in the journey of being sober. Patients may e overwhelmed due to the stress of having a rigid medication schedule the rest of their life paired with the struggle with substance abuse. To help the patient deal with this issues it is important that nurses form a therapeutic trusting relationship with their patient that provides nursing care with respect of the patient and their values without prejudice (ANA, 2015).
These patients have dealt with enough stress the last thing the patient needs is their nurse judging or being overly critical of them and their choices. Recommendations Possible recommendations for future research should include ore data concerning the abstinence length that should be required for research. There is a common policy of the 6-month abstinence rules yet it there is not much data that supports the use of the abstinence period or deem it reliable (Rodrigo et. al, 2013).
The nurse’s role in this aspect is educating the patient that they do not need to remain abstinent just for 6 months they need to continue this abstinence for the rest of their lives in order to protect the transplanted liver. Social Policy Recommendations for social policy changes need to be made in order to protect the patient as well as other transplant andidates. One recommendation for policy change is making patients that have continually tested positive for alcohol to become ineligible for retransplantation should the liver become damaged again.
This should be a universal policy that should be used nationwide when determining eligibility. It is true individuals with substance abuse issues deserve a second chance but they cannot be allowed to habitually waste scarce resources due to non-compliance. In addition to changes to social policy a standard abstinence period should be instated nationwide so all patients must have the same level of esponsibility and compliance in order to receive liver transplants. New assessment tools should be used that can test alcohol levels for longer periods of time.
For example, ethyl glucuronide hair samples can show alcohol use up to a month prior (Allen et. al, 2012). In addition to new assessment tools patients should have to be called in for random testing dates in order for the healthcare providers to get an honest picture of individual’s alcohol use. This could be used because when patients have a consistent pattern of doctors’ appointments and a healthcare provider suspects alcohol use because they begin o know when they need to stop drinking in the days prior to avoid detection during their next check in.
The nurse’s role in this aspect would be collecting data from the patient which would include asking if the patient has been drinking and if they have when did it occur and how much was consumed. Nurses will also be the ones doing the initial assessment of these individuals when they come in for testing so they may be responsible for noticing certain assessment characteristics that point to alcohol use as well. Education Future recomm ndations for education is to use community enters and the hospital to educate individuals about the dangers of substance abuse as well as give resources in order to deal with the issue.
The best way to deal with a disease like alcoholism is education and prevention. In addition to educating the public on the risks associated with alcohol and liver disease we need to have seminars or meetings where people who are already dealing with cirrhosis or may be in the process of getting a transplant can come to get information and educate themselves in their condition and what they can do to improve their condition. The nurse’s role in this aspect is that we are the ain individuals who educate patients on a daily basis.
This could be an opportunity for nurses and other health care professions to join together to help educate people who are willing to learn. Conclusion After discussing the ethical concerns as well as data concerning alcoholic liver transplants the data shows that the issue is progressing in positive direction. This is related to the current evidence that was stated earlier that shows the promise of substance abuse counseling and decreases in the rates of relapse.
If the relapse rates continue to go down hopefully ndividuals will no longer have such harsh judgements towards alcoholics who receive transplants since it shows that just like other candidates with other etiologies, they too can be compliant when it involves medication regimen as well as sobriety. However, bias is a hard thing to overcome and unfortunately even though there has been promising advances this may always be an ethical issue. There has to be a partnership of education, medical treatments, and psychosocial therapy if this positive change is to continue for patients, their families and the communities around them.