A kidney-transplant recipient taking sirolimus is scheduled for elective abdominal surgery. Which nursing action is most appropriate?
1Double the sirolimus dose on the morning of surgery to prevent rejection during the perioperative period.
2Continue the usual plan without notifying the transplant team because sirolimus does not affect surgical wound healing.
3Stop sirolimus and all other immunosuppressants for a full month, then restart them after the incision closes.
4Notify the transplant and surgical teams so wound-healing risk and the perioperative regimen can be planned before surgery.✓ Correct answer
Explanation
Sirolimus can impair wound healing and cause fluid accumulation, so the transplant and surgical teams should coordinate an individualized perioperative plan before elective surgery. The nurse should not independently double, stop, or substitute immunosuppressive therapy because doing so can create toxicity or rejection risk. Ongoing care also includes therapeutic drug monitoring and assessment of lipids, renal function, infection, and wound status as clinically indicated.
Clinical reasoning mTOR inhibition can delay wound healing. Elective surgery therefore requires advance coordination among the transplant, surgical, and prescribing teams.
Decision rule Escalate for an individualized perioperative regimen; do not direct the client to change immunosuppression independently.
Scenario 55-year-old male 1 year post-kidney transplant on sirolimus; scheduled for elective hernia repair next month.
mTOR inhibitor — An immunosuppressive medication class that includes sirolimus and can impair wound healing and increase lipid levels.
Perioperative immunosuppression plan — A coordinated, individualized plan that balances wound-healing and infection risks against the danger of transplant rejection.