# A nurse is caring for a client who received a kidney transplant 6 months ago and is on immunosuppressive therapy. The client reports feeling fatigued and has developed a persistent cough with white patches in the mouth. What is the priority nursing intervention?

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## 문제

A nurse is caring for a client who received a kidney transplant 6 months ago and is on immunosuppressive therapy. The client reports feeling fatigued and has developed a persistent cough with white patches in the mouth. What is the priority nursing intervention?

## 보기

1. Obtain specimens for culture and sensitivity testing and notify the healthcare provider immediately. **✔ 정답**
2. Administer prescribed antacids and encourage increased fluid intake for comfort.
3. Document the findings and schedule a follow-up appointment in one week.
4. Increase the client's immunosuppressive medication dosage as ordered for rejection.

**정답: 1**

## 해설

Immunocompromised transplant recipients are at high risk for opportunistic infections. Symptoms of fatigue, persistent cough, and oral thrush suggest fungal infection, requiring immediate specimen collection and provider notification for appropriate treatment.

## 심화 해설

Clinical Reasoning and Priority Setting

The client’s presentation of fatigue, persistent cough, and oral white patches 6 months post-kidney transplant, while on immunosuppressive therapy, strongly suggests an opportunistic infection. The white patches in the mouth are clinically consistent with oral thrush (oropharyngeal candidiasis), most commonly caused by Candida albicans. The persistent cough raises a critical red flag for a more serious, disseminated process, such as invasive candidiasis (IC) involving the respiratory tract, or another opportunistic pulmonary infection. In an immunocompromised host, a localized fungal infection can readily become systemic, leading to candidemia, which carries a high mortality rate [1][2].

Analysis of the Correct Answer (Option 1)

Obtaining specimens for culture and sensitivity testing and notifying the healthcare provider immediately is the priority intervention. The clinical signs in this immunocompromised client are sentinel findings for a potentially life-threatening infection. In solid organ transplant recipients, infections, including those caused by multidrug-resistant organisms and opportunistic fungi like Candida species, are a major threat to graft and patient survival [3]. The nurse’s immediate role is to gather objective data (specimens) to identify the causative pathogen and to ensure prompt medical evaluation for likely systemic antifungal therapy. Delaying diagnosis and treatment of invasive candidiasis directly increases the risk of poor outcomes, as IC is a potentially fatal infection [1]. The global epidemiological trend also notes a rise in non-albicans species with increasing drug resistance, making culture and sensitivity testing essential to guide effective treatment [1].

Analysis of Incorrect Answers

- Option 2: Administering antacids and encouraging fluids is a comfort measure that ignores the underlying infectious process. This action does not address the potential for systemic fungal infection and would dangerously delay life-saving treatment.

- Option 3: Documenting findings and scheduling a follow-up in one week constitutes a grave failure in clinical judgment. In an immunosuppressed transplant recipient, a 1-week delay in diagnosing and treating a suspected invasive infection could allow candidemia to develop, leading to sepsis and death.

- Option 4: Increasing the immunosuppressive medication dosage is contraindicated. The client’s symptoms are indicative of an infection, a consequence of their suppressed immune system. Augmenting immunosuppression would further impair the body’s ability to fight the infection, potentially transforming a localized fungal infection into a rapidly progressive, disseminated, and fatal invasive candidiasis [1][2].References (research sources)

- [1]Epidemiology of Invasive Candidiasis.Research articleBays DJ, Jenkins EN, Lyman M, Chiller T, Strong N, Ostrosky-Zeichner L, Hoenigl M, Pappas PG, Thompson Iii GR. (2024) · DOI: 10.2147/clep.s459600

- [2]Invasive Candidiasis in Contexts of Armed Conflict, High Violence, and Forced Displacement in Latin America and the Caribbean (2005-2025).Research articleRivas-Pinedo P, Motta JC, Gutierrez JMO. (2025) · DOI: 10.3390/jof11080583

- [3]Global challenges of bacterial infections in organ transplantation: assessment of risk factors and predominant bacterial pathogen profiles threatening liver, kidney, heart, and lung transplant recipients.Research articleMoradi F, Bahrami M, Nasrollahian S, Shirazi PS, Ghoreyshi NS, Ghobadi M. (2025) · DOI: 10.1186/s12879-025-11579-x

## 임상 시나리오

Post-Transplant Infection SurveillanceImmediate action for suspected opportunistic infection
In a transplant recipient on immunosuppressive therapy, any new symptom like fatigue, persistent cough, or oral white patches is a sentinel finding for an opportunistic infection. The priority is to obtain specimens for culture and notify the provider immediately.

The oral lesions are consistent with oropharyngeal candidiasis, but the cough raises concern for invasive candidiasis or another systemic infection. In immunocompromised hosts, localized fungal infections can rapidly progress to candidemia, which has a mortality rate exceeding 40%.

CautionNever attribute these symptoms to minor causes or delay intervention. Do not increase immunosuppression, as this will exacerbate the infection. Early antifungal therapy is critical for graft and patient survival.

## 핵심 개념

- **Opportunistic Infection** — An infection caused by pathogens that take advantage of a weakened immune system, commonly seen in transplant recipients on immunosuppressive therapy.
- **Oropharyngeal Candidiasis** — A fungal infection in the mouth caused by Candida species, presenting as white patches, and a common early sign of more serious systemic infection in immunocompromised patients.
- **Invasive Candidiasis** — A severe systemic fungal infection where Candida enters the bloodstream, potentially affecting organs like the lungs, and carrying a high mortality risk in transplant patients.
- **Immunosuppressive Therapy** — Medications given to transplant recipients to prevent organ rejection by suppressing the immune system, which simultaneously increases the risk of infections.
- **Culture and Sensitivity Testing** — A diagnostic procedure where a specimen is collected to grow and identify microorganisms and determine which antimicrobials are effective against them.

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