T6: Kidney Transplant Flashcards
Dialysis cannot stimulate erythropoiesis so what do patients get doses of
epogen
*Advantages of kidney transplant over dialysis
-Reverses many of pathophysiologic changes associated with renal disease
-Eliminates dependence on dialysis
-Less expensive than dialysis after first year
Kidneys for transplant may be obtained from
*compatible blood-type deceased donors, blood relatives, emotionally related (close and distant) living donors (e.g., spouses, distant cousins, etc.), and altruistic living donors who are known (friends) or unknown to the recipient.
Paired organ donation
occurs when one donor/recipient pair who are incompatible or poorly matched with each other find another donor/recipient pairs with whom they can exchange kidneys
Contraindications to transplant
-Disseminated malignancies
-Refractory/untreated cardiac disease
-Chronic respiratory failure
-Extensive vascular disease
-Chronic infection
-Unresolved psychosocial disorders
signs of kidney rejection
fever, no UO, pain
medications given to avoid kidney rejection
steroids and cyclosporins
what levels need to be watched on antirejection medications
BUN and CRE because these drugs can be nephrotoxic
Kidney Transplant Donor Sources
live and deceased donor
during kidney transplant, where will the kidney usually be placed
in the abdomen (extraperitoneally in the iliac fossaRight iliac fossa is preferred)
pre op nursing care for kidney transplant
-Emotional and physical preparation
-Stress that dialysis may be required
-Review need for immunosuppressive drugs and prevention of infection
-ECG
-Chest x-ray
-Laboratory studies
-Foley catheter with antibiotic solution
The vascular access extremity should be labeled…
“dialysis access, no procedures” to prevent use of the affected extremity for BP measurement, blood drawing, or IV infusions before the patient undergoes surgery.
does the donor or the recipient usually experience more pain?
the donor
what is the first priority for recipient post op
-Maintenance of fluid and electrolyte balance is first priority
-Large volumes of urine may be produced soon after transplanted kidney placed due to; New kidney’s ability to filter BUN, Abundance of fluids during operation, Initial renal tubular dysfunction
what is used to monitor post op fluids
Central venous pressure readings
if the patient develops metabolic acidosis from a delay in the return of kidney function..
*IV sodium bicarbonate may be required
Acute tubular necrosis (ATN) in the transplanted kidney can occur because of
prolonged cold times causing ischemic damage and the use of marginal cadaveric donors
While the patient is in ATN what is required
dialysis is required to maintain fluid and electrolyte balance.
A sudden decrease in urine output in the early postoperative period is a cause for concern because
. It may be due to dehydration, rejection, a urine leak, or obstruction. A common cause of early obstruction is a blood clot in the urinary catheter
Kidney Transplant Immunosuppressive Therapy
-Adequately suppress immune response
-Lifelong therapy
-Calcineurins—Cyclosporine and tacrolimus
-Corticosteriods-prednisone, methylprednisolone
-Cytotoxic-azathioprine, mycophenolate, sirolimus
-Maintain sufficient immunity to prevent overwhelming infection
dietary teaching for Calcineurins—Cyclosporine and tacrolimus
avoid grapefruit/citrus increases toxicity CYP450 competitive
hyperacute rejection
antibody-mediated, humoral) rejection
-Occurs minutes to hours (24hrs)after transplant
acute rejection
-Occurs days to first 6 months after transplant
Chronic rejection
-fibrosis and scarring
-Process occurs over months or years and is irreversible
HINT HINT S/S of kidney rejection
-Fever (greater than 100°F or 38°C), chills.
-Tenderness/pain over the transplanted area.
-Significant swelling of hands, eyelids or legs.
-Significantly decreased or no urine output.
-Weight gain (1-2kgs or 2-4lbs) in 24 hours.
what is the biggest complication for kidney transplant
infection (most commonly in the first month)
Most common infections observed in first month
Pneumonia
-Wound infections
-IV line and drain infections
-Urinary tract infections
Kidney Transplant Complications: CV disease
*CV disease is the leading cause of death after renal transplantation.
*Hypertension, dyslipidemia, diabetes mellitus, smoking, rejection, infections, and increased homocysteine levels (many of which existed prior to the transplant) can all contribute to CV disease.
*Immunosuppressants can worsen hypertension and dyslipidemia.
teaching for CV disease
*control risk factors such as elevated cholesterol, triglyceride, and blood glucose levels and weight gain.
Kidney Transplant Complications: malignancies
-Primary cause is immunosuppressive therapy
-Regular screening is important
preventative care for malignancies
-Protective clothing
-Sunscreen
*Corticosteroid-related complications
-Aseptic necrosis of hips, knees, and other joints
-Peptic ulcer disease
-Glucose intolerance and diabetes
-Dyslipidemia
-Cataracts
-Infection
-Malignancies
