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LPK Transplant Nursing Feeling Lost

Nurses   (1,225 Views 11 Comments)
by PaddyW PaddyW (New) New

PaddyW has 6 years experience and specializes in Cardiac, Transplant.

930 Profile Views; 9 Posts

Hello. I have recently accepted a position in a hospital in the Bay Area. I am coming from a Cardiac and Telemetry background (progressive care). This position is a Specialized Med-Surg position (Transplant). It is a LPK (Liver, Pancreas, and Kidney) unit that deals with post op Day 2, complications of awaiting-pre-post transplant.

I am feeling a little worried. I know that I have a strong team with a lot of experience. I feel that I am still a new RN (1.6 years experience on the previous floor). I have experience as CNA/Unit Clerk/Telemetry Tech as well. I am having to learn a new charting system that is making it difficult to find my pertinent information. My time management skills are also suffering from the new unit hospital stuff. I realize that within 4-6 months these issues will be no longer present. They are simply exacerbating my anxiety regarding my true underlying fear. I do not know what to worry about and not worry about.

All the medications are very different. The meds themselves are different or the dosing is not what I am used to. I know how to research meds and ask questions about the parts I do not understand. What I am more concerned about is understanding the systems, complications, and pathophysiology of said complications. I am hoping a few kind souls will be willing to post either experiences or resources to help me understand what I need to know for this floor.

Thank you in advance.

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44 Posts; 1,435 Profile Views

I hope someone finds your topic and adds to it. I was placed on a transplant floor for my preceptorship and I'm definitely a little nervous. If you've gained some pointers since you wrote this in August, would love to hear your wisdom. Thanks!

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7 Articles; 1,142 Posts; 37,792 Profile Views

You sound like a very good nurse! I'm sure you will be fine with time. I am cross-trained to ICU but it's not my comfort zone. When they do rounds, and also when you are getting report, ask the nurse or doctor or NP what are the patient's goals. What things do you really need to watch for? Explain that you are newer to the unit and ask if they have time to go over things with you. And of course study your patho on the patients a few times until it sticks.

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NurseKatie08 has 11 years experience as a MSN and specializes in Geriatrics, Transplant, Education.

743 Posts; 12,852 Profile Views

I just saw this post...wish I had seen it when you posted initially. I've been a nurse 7 years and I work on a floor very similar to yours, except we do just livers/kidneys, no pancreas. Also deal with ESLD and ESRD and well as complications, rejection etc. Been working on this floor just over 3 years...willing to offer any advice I can! What are you struggling with?

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PaddyW has 6 years experience and specializes in Cardiac, Transplant.

9 Posts; 930 Profile Views

I have had a little bit more experience now. I have found a couple of excellent resources at my facility too. There is a weekly Transplant Round for physicians that I was allowed to attend and I get CE's to boot. Additionally I will be attending a Colo-rectal Cancer course Thursday 29th.

I am still having trouble just matching everything together. It is a lot of work to keep track of the prograf and cellcept levels, while providing the education on medications. I am use to people coming back from a CABG/CEA and being ambulated almost immediately. Here people come to me post-op day 2 or maybe the very end of day 1. They have a PCA/Epidural and are on abdominal precautions. It just feels like mobilizing this (important as it may be) is often beyond their capabilities or motivation at the time. I have resorted to in bed active/passive ROM, plus they are anti coagulated, using IS, and with SCDs that I advertise as leg massagers. My concern is trying to find the balance of how hard to push.

The other issue I was having, but has improved after attending round on the subject, is Hepatic Encephalopathy. This can be as bad as CIWA at times. Learning the balance between pain management (paracentesis, ascites, etc), patient safety (fall risk), medical treatment (lactulose and Rifaximin) has been tricky. I was hoping to find what works for you in this area.

ESRD is difficult, but I understand the pathology and treatment modalities.

I will share a couple of things that I have found helpful in the next post. I would love to hear from your experiences though.

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PaddyW has 6 years experience and specializes in Cardiac, Transplant.

9 Posts; 930 Profile Views

Using UpToDate has been helpful. Just to get a general understanding of some co-morbidity issues like Diabetic Gastric Paresis. Additionally these videos have been particularly helpful.

Refeeding Syndrom (as most are NPO for some time with TPN and occasionally TF)

Pancreatic Issues (often resulting in a Whipple)

Liver Issues (Cancer and possible resections)

Anatomy Review (Helpful when reading MD notes)

https://www.youtube.com/watch?v=XP-MdbVug_4

Diabetic Gastroparesis (I am getting the basic, but want to know more)

https://www.youtube.com/watch?v=FEqBzX2Twdw

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PaddyW has 6 years experience and specializes in Cardiac, Transplant.

9 Posts; 930 Profile Views

Thank you for the compliment! I am trying to do just that. The 4 patients on an 8 hour shift (1500-2330) is making research hard to do when I am in the zone, but as you can see by my previous post I am trying.

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44 Posts; 1,435 Profile Views

Thanks for all of the info! Will definitely be watching those videos and reaching out if I have more questions. :)

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PaddyW has 6 years experience and specializes in Cardiac, Transplant.

9 Posts; 930 Profile Views

Thanks for all of the info! Will definitely be watching those videos and reaching out if I have more questions. :)

I hope it helps. I am still hoping to attract the advice of an experience transplant RN on what to look for when I am in the thick of things.

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Kennyboy117 has 4 years experience.

6 Posts; 711 Profile Views

Hey any more insights to know about the LPK TRANSPLANT unit. I’m a travel nurse and I’m about to do a 13weeks in this type of unit! I have no experience in transplant! I start in 3 weeks 

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Kb_RN17 is a BSN and specializes in Med-surg, sub acute rehab.

3 Posts; 379 Profile Views

Hello I’m nervous I will start a travel assignment in med surg transplant unit Liver, pancrease and kidneys. I’ve had 3 years of med surg observation and 4 years in sub acute rehab...  any info I should know. Any drips meds and  common labs to monitor. And drains I should know. The usual plan of care home liver kidney pancreases. Any time specific things I should know. Any recommendation YouTube videos? 

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