Page 167 - Critical Care Nursing Demystified

152 CRITICAL CARE NURSING DeMYSTIFIED

left intact along with the SA nodes and inferior and superior vena cava. The
donor’s anterior walls of the atrial SA node, internodal condition pathways, and
ventricles are attached. The left and right atria are connected as well as the
pulmonary arteries and aorta. Pacing wires are attached.
Transplantation is usually performed when a patient has a cardiac structural
defect or has lost so much myocardium due to myocarditis or MI that the heart
cannot pump effectively, compromising CO. If greater than 40% of the left
ventricle dies from an MI, the patient will swiftly succumb to heart failure
without a transplant. The patient may be forced to severely restrict his or her
activity or have lifesaving measures like the IABP instituted until a suitable
donor is found.
Since both the donor’s and the recipient’s SA nodes are intact, the patient
will have two “P” waves on an ECG. The recipient atrial depolarization cannot
cross the suture line; therefore, the donor “P” wave depolarizes the heart. The
donor “P” waves are denervated so they do not respond to vagal influences, thus
the patient’s heart rate will be slightly higher than normal around 90 to 110
beats/minute. Because of postoperative edema, the patient may need tempo-
rary cardiac pacing to maintain an adequate CO.

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See section on open-heart surgery (OHS). The patient who requires transplan-
tation usually has advanced heart disease. The likelihood of survival without a
transplant in end-stage cardiac disease is less than 25% within 1 year. Patients
with fixed pulmonary hypertension, unresolved pulmonary infarction, and
advanced or poorly controlled diabetes are not candidates.

Interpreting Test Results

See tests for open-heart surgery (OHS).
HLA type to help decrease the likelihood of cardiac tissue rejection.

Nursing Diagnoses for Heart Transplantation Expected Outcomes
See section on open-heart surgery (OHS)

Interventions
See section on open-heart surgery (OHS).
Assess HR because the denervated heart rate does not respond as quickly as
the normal heart.