A patient who has received a bone marrow transplant develops a maculopapular rash on the palms of both hands and the soles of the feet. The patient complains of severe abdominal pain with bloody diarrhea
What should the nurse suspect this patient is experiencing?
1. graft-versus-host disease
2. chronic tissue rejection
3. acute tissue rejection
4. hyperacute tissue rejection
Correct Answer: 1
In a transplant patient, a maculopapular pruritic rash beginning on the palms of the hands and soles of the feet indicates graft-versus-host disease. The rash can spread to involve the entire body and lead to desquamation. Gastrointestinal manifestations include abdominal pain, nausea, and bloody diarrhea. Chronic tissue rejection occurs from 4 months to years after the transplant of new tissue. Acute tissue rejection is the most common type of rejection, and occurs between 4 days and 3 months after the transplant. Acute rejection is mediated primarily by the cellular immune response, resulting in transplant cell destruction. The patient experiencing rejection demonstrates manifestations of the inflammatory process, with fever, redness, swelling, elevated BUN, creatinine, lower enzymes, and elevated bilirubin and cardiac enzymes. Hyperacute tissue rejection leads to rapid deterioration of organ function.
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