Kidney Transplant

Question 1

Kidney Transplant Candidate

Answer 1

• 2-70yrs olf
• > 70 individual basis
• Free of uncorrectable cardiac disease
• Free of metastic cx, chronic infection, ETOH, & substance abuse
• Eval of urinary system
  > have to be able to void

Question 2

Kidney Transplant Donor

Answer 2

• Living/brain death/cadaver
• Match on tissue similarity
• Requirements
  > absence of systemic disease or infection
  > no current active cx
  > no HTN or kidney disease
  > adequate kidney function as determined by diagnostic studies

Question 3

Kidney Transplant - Preoperative

Answer 3

• Match w/ donor; immunologic studies; rejection
• Must have same blood type
• Teach for pre, during, & post
  > anti rejection meds
  > might need to dialysis 24hrs before & after surg
  > blood tranfusion from donor helps w/ rejection
  > must be ready for surg w/in short time frame

Question 4

Kidney Transplant - Postoperative

Answer 4

• Focused assessment
• Accurate I&Os/hr for 48hrs
• Urinary output
• Continuous bladder irrigation (CBI)
• Immunosuppressive drug therapy
• Complications
  > rejection (looks like kidney failure)
  > thrombosis
  > renal artery stenosis

Question 5

Kidney Transplant - Nursing Diagnosis

Answer 5

• Ineffective protection
• Risk for ineffective renal perfusion
• Risk for infection
  > priority
• Readiness for enhanced decision-making
• Readiness for enhanced family process
• Readiness for enhanced health management
• Readiness for enhanced spiritual well-being

Question 6

Kidney Transplant - Nursing Interventions

Answer 6

• Monitor for manis of rejection
  > incrd BUN, Cr, GFR, elect
  > I&O
• Monitor for manis of infection
• Transplant medications

Question 7

Tranplant Medications

Answer 7

• Corticosteriods
• Inhibitors of T-cell proliferation & activity
  > azathioprine
  > mycophenolic acid
  > cyclosporine
  > tacrolimus
• mTOR inhibitors
  > to disrupt stimulatory T-cell signals
• Monoclonal antibodies