T6: Kidney Transplant

Question 1

Dialysis cannot stimulate erythropoiesis so what do patients get doses of

Answer 1

epogen

Question 2

*Advantages of kidney transplant over dialysis

Answer 2

-Reverses many of pathophysiologic changes associated with renal disease
-Eliminates dependence on dialysis
-Less expensive than dialysis after first year

Question 3

Kidneys for transplant may be obtained from

Answer 3

*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.

Question 4

Paired organ donation

Answer 4

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

Question 5

Contraindications to transplant

Answer 5

-Disseminated malignancies
-Refractory/untreated cardiac disease
-Chronic respiratory failure
-Extensive vascular disease
-Chronic infection
-Unresolved psychosocial disorders

Question 6

signs of kidney rejection

Answer 6

fever, no UO, pain

Question 7

medications given to avoid kidney rejection

Answer 7

steroids and cyclosporins

Question 8

what levels need to be watched on antirejection medications

Answer 8

BUN and CRE because these drugs can be nephrotoxic

Question 9

Kidney Transplant Donor Sources

Answer 9

live and deceased donor

Question 10

during kidney transplant, where will the kidney usually be placed

Answer 10

in the abdomen (extraperitoneally in the iliac fossaRight iliac fossa is preferred)

Question 11

pre op nursing care for kidney transplant

Answer 11

-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

Question 12

The vascular access extremity should be labeled…

Answer 12

“dialysis access, no procedures” to prevent use of the affected extremity for BP measurement, blood drawing, or IV infusions before the patient undergoes surgery.

Question 13

does the donor or the recipient usually experience more pain?

Answer 13

the donor

Question 14

what is the first priority for recipient post op

Answer 14

-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

Question 15

what is used to monitor post op fluids

Answer 15

Central venous pressure readings

Question 16

if the patient develops metabolic acidosis from a delay in the return of kidney function..

Answer 16

*IV sodium bicarbonate may be required

Question 17

Acute tubular necrosis (ATN) in the transplanted kidney can occur because of

Answer 17

prolonged cold times causing ischemic damage and the use of marginal cadaveric donors

Question 18

While the patient is in ATN what is required

Answer 18

dialysis is required to maintain fluid and electrolyte balance.

Question 19

A sudden decrease in urine output in the early postoperative period is a cause for concern because

Answer 19

. 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

Question 20

Kidney Transplant Immunosuppressive Therapy

Answer 20

-Adequately suppress immune response
-Lifelong therapy
-Calcineurins—Cyclosporine and tacrolimus
-Corticosteriods-prednisone, methylprednisolone
-Cytotoxic-azathioprine, mycophenolate, sirolimus
-Maintain sufficient immunity to prevent overwhelming infection

Question 21

dietary teaching for Calcineurins—Cyclosporine and tacrolimus

Answer 21

avoid grapefruit/citrus increases toxicity CYP450 competitive

Question 22

hyperacute rejection

Answer 22

antibody-mediated, humoral) rejection
-Occurs minutes to hours (24hrs)after transplant

Question 23

acute rejection

Answer 23

-Occurs days to first 6 months after transplant

Question 24

Chronic rejection

Answer 24

-fibrosis and scarring
-Process occurs over months or years and is irreversible

Question 25

HINT HINT S/S of kidney rejection

Answer 25

-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.

Question 26

what is the biggest complication for kidney transplant

Answer 26

infection (most commonly in the first month)

Question 27

Most common infections observed in first month

Answer 27

Pneumonia
-Wound infections
-IV line and drain infections
-Urinary tract infections

Question 28

Kidney Transplant Complications: CV disease

Answer 28

*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.

Question 29

teaching for CV disease

Answer 29

*control risk factors such as elevated cholesterol, triglyceride, and blood glucose levels and weight gain.

Question 30

Kidney Transplant Complications: malignancies

Answer 30

-Primary cause is immunosuppressive therapy
-Regular screening is important

Question 31

preventative care for malignancies

Answer 31

-Protective clothing
-Sunscreen

Question 32

*Corticosteroid-related complications

Answer 32

-Aseptic necrosis of hips, knees, and other joints
-Peptic ulcer disease
-Glucose intolerance and diabetes
-Dyslipidemia
-Cataracts
-Infection
-Malignancies