Homeostasis: Kidney Transplant
azotemia
(excessive) urea and nitrogenous substances in the blood
transplant rejection: hyper-acute phase s/s
- HTN - pain at transplant site
transplant rejection
3 stages - hyper-acute phase - acute phase - chronic phase
when does acute rejection occur
3-14 days of transplantation
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
when does hyper acute rejection occur
almost immediately after transplantation
The nurse is caring for a diabetic client who received a kidney transplant and is taking methylprednisolone for immunosuppression. What is the nurse's priority assessment specific to this client?
assessing blood glucose levels
prograf (calcineurin inhibitors) action
bind to and decrease T-cell activation
kidney transplant: postoperative deceased donor
can take 2-3 weeks to function - may need dialysis until kidney starts functioning
when does chronic rejection occur
develops insidiously over months and year and may not be preceded by episodes of acute rejection
prograf (calcineurin inhibitors) patient teaching
do not take with grapefruit juice
function of kidney
filter blood and excrete it via urine
Rejection of a transplanted kidney within 24 hours after transplant is termed
hyperacute rejection
where is the kidney located
illiac fossa
transplant rejection: hyper-acute phase cause
immediate antibody reaction
kidney transplant pharmacological treatment
immunosuppressants - prograf (calcineurin inhibitors) - cellcept (antiproliferative agent) - prednisone (glucocosteroids)
kidney transplant: postoperative live donor
kidney begins working right away
prednisone (glucocosteroids) patient teaching
never stop abruptly
transplant rejection: acute phase onset
occurs within 3-14 days
transplant rejection: chronic phase onset
occurs within months - years
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
HIV patient and kidney transplant
patient can get transplant as long as CD4 is above 200 consistently
graft-versus-host disease (GVHD)
reduces the risk of post-transplant complications
a close match between a donor's and a patient's HLA markers is essential for...
successful transplant outcome
UNOS
united network for organ sharing
ABO
universal donor
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 20mL/hour
transplant rejection: hyper-acute phase onset
usually occurs within 24-48 hours
HLA
human leukocyte antigen - distinguishing identifiers that are responsible for antigens that will either accept the organ or not
transplant rejection: hyper-acute phase treatment
removal of organ
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
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
when does acute rejection occur?
within the first few days to weeks after transplantation, or it may occur suddenly months or even years later
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."
kidney transplant: preoperative labs
- BMP - CBC - PT/aPTT - urine culture - antibiotics - immunosuppressant therapy (lifelong)
prednisone (glucocosteroids) adverse effects
- GI upset - anemia - hypercholesterolemia - leukopenia
kidney transplant: postoperative
- deceased donor - liver donor - strict I&Os - diet - monitoring for complications
cellcept (antiproliferative agent) patient teaching
- do not crush or chew - teratogenic - always wear gloves and wash hands when handling medication
HLA matching
- engraftment - graft-versus-host disease (GVHD)
kidney transplant: preoperative patient teaching
- expected pain - IV/a-line catheter - NG tube - early ambulation
transplant rejection: chronic phase s/s
- gradual return of azotemia - fluid retention - electrolyte imbalance - fatigue
cellcept (antiproliferative agent) adverse effects
- leukopenia - anemia - hypercholesterolemia
kidney transplant: postoperative diet
- low fat - adequate phosphorus - high fiber - adequate protein - low sodium - low carb/sugar
prograf (calcineurin inhibitors) adverse effects
- nephrotoxicity - neurotoxicity - HTN - hyperglycemia - GI upset
kidney transplant: preoperative
- patient teaching - emotional/psychological support and evaluation - labs
kidney transplant contraindications
- recent malignancy - active infection (HIV, hepatitis, B&C) - severe irreversible disease (COPD, heart disease, PVD)
transplant rejection: acute phase s/s
- tenderness - fever - malaise - decrease in urine output
picking a donor
ABO and HLA compatability
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
kidney transplant: postoperative monitoring for complications
R.I.B. - REJECTION - INFECTION BLEEDING
A client who had a kidney transplant 3 months ago is experiencing an organ rejection. The reaction would be classified as:
acute rejection
treatment of choice for end stage renal disease (ESRD)
kidney transplant
engraftment
promotes growth and development of new healthy blood cells
