Kidney Transplant
A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be:
"You will be given medication to decrease the likelihood of your immune system attacking your new kidney."
Allograft
(graft from another person)
Hyper acute phase; when does it occur?
24-48 hours after transplantation
Acute Phase; when does it occur?
3-14 days
Rejection
CD4 T-cells target allograft antigens
The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use?
Contact the health care provider at first signs of an infection.
Cellcept
DO NOT CRUSH, CUT OR CHEW Teratogenic Always wear gloves when handling med/wash hands after
Kidney transplant is the treatment of choice for..
ESRD
Hyper acute manifestations
HTN, FEVER & PAIN AT TRANSPLANT SITE
The nurse is working with a client awaiting a kidney transplant. The nurse teaches the client about what testing to determine an organ match (histocompatibility)?
Human leukocyte antigen typing
Hyper acute phase; treatment
IMMEDIATE REMOVAL OF KIDNEY - Not reversible
Post-op food
Low-fat, High-fiber,
Glucocorticosteroids:
Never stop abruptly May need to increase dose during periods of acute illness or physiological stress (can aggravate mental illness)
A patient is postoperative day 3 following the successful transplantation of a kidney. The nurse is aware of the importance of assessing the patient for signs and symptoms of rejection. Consequently, the nurse is constantly monitoring the patient for:
Oliguria and edema
Chronic treatment;
Pt is required to take some sort of immunosuppressant therapy for the entire time they have the kidney
Post-op monitor for
Rejection, bleeding, infection, urinary function
The nurse is caring for a client with a history of a renal transplant who has just been diagnosed with chronic rhinosinusitis. While being admitted to the clinic, the client asks, "Will this chronic infection hurt my new kidney?" What should the nurse know about chronic rhinosinusitis in this client?
Taking immunosuppressive drugs can contribute to chronic rhinosinusitis.
UNOS =
United Network for Organ Sharing
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour
Assess bleeding at:
VS, LABS, ecchymosis/swelling @ kidney site, urinary drainage
Transplant overall reactions
Weight gain Oliguria Edema Increase in BP Swelling or tenderness over transplant site Elevated bun/creatinine
The nurse is caring for a black client who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurse's priority assessment specific to this client?
blood glucose levels
Prior to donation
check urinary structures (CT or X-ray)
Intraoperative Care
diseased kidneys remain new kidney placed in illiac fossa monitor Is/Os
Cyclosporine
do not take with grapefruit juice
Infection manifestations
fever, chills, tachycardia/pnea, increase/decrease in WBCs
The kidneys function -
filter the blood, cleanse the blood and transform waste into urine
Hemodialysis may be needed post-op if there is
fluid overload/hyperkalemia
Allogeneic
genetically different tissue of same species
Chronic; manifestations
gradual return of azotemia, fluid retention, electrolyte imbalance, fatigue
Rejection of a transplanted kidney within 24 hours after transplant is termed
hyperacute rejection.
Assess Bruit/Thrill post op; because
it could clot after transplant
Post op--- urinary function
measured every hour
Chronic; occurs when?
months to years
post op--- flowers
no fresh flowers in room post op
Human Leukocyte Antigen (HLA)
promotes healthy blood cells/reduces risk of post-transplant complications
Contraindications for UNO
recent malignancy, active infection, severe irreversible disease
Host
recipient
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
removal of the transplanted kidney.
Goal of immunosuppressant meds
suppress immune system to prevent rejection
Acute Phase; manifestations
tenderness, fever (could be low-grade), malaise, lethargy, azotemia (nitrogen in blood) , fluid retention, oliguria or anuria (no urine)
Graft
the cells, tissues, or organ to be transplanted
Dialysis
used for treatment of kidney failure & is life sustaining for people who are not candidates for transplant or who are awaiting
