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October 2012, Volume 42 Number 10 , p 50 - 53


  • Shawna VanLeeuwen BSN, RN
  • Mary H. Leenerts PhD, RN, ARNP
  • Mona Moran BSN, RN, CCM


AFTER OUR PATIENT Mr. J, 55, received a liver transplant, he seemed detached and was difficult to engage in his own care. He had to be readmitted 3 days after discharge due to his lack of self-care.Mr. J needed effective patient teaching to avoid organ rejection. This article explains why the teaching outcomes weren't achieved and why our experience with Mr. J led us to add screening for depression to our discharge planning process.Mr. J was admitted to the ICU and evaluated by a hepatologist, who diagnosed him with fulminant liver disease (severe hepatic dysfunction in the absence of preexisting liver disease) secondary to using the herb kava. Because kava can cause liver damage, including hepatitis and liver failure, the FDA has issued a warning that using kava supplements has been linked to a risk of severe liver damage.1,2 Mr. J had been buying kava over the counter for about 6 months to help him relax, according to the patient and his family.Because Mr. J needed a liver transplant to survive, he was placed on the transplant waiting list as a status 1 patient. Patients with this status are the most critical due to acute liver failure and face a life expectancy of less than 7 days without a transplant.3After receiving a liver transplant, Mr. J was transferred to the step-down unit and was met by the transplant coordinator to begin transplant teaching. The transplant coordinator attempted to teach Mr. J and his mother, father, and sister about care for his newly transplanted organ and self-care strategies for a safe discharge home. Instead, Mr. J watched TV while the nurse was teaching and asked if the nurse could come back later. The nurse documented and accommodated Mr. J's request and came back later, only to encounter the same behavior.Even with much encouragement from his family and the nurse, Mr. J refused to engage in teaching and wouldn't verbalize understanding or participate in return demonstrations. Mr. J told the transplant coordinator that he wanted the

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