Nursing Care and Management for Kidney Transplant Patients

Overview

• Lecture Title: Nursing Care and Management for a Patient with Kidney Transplant
• Lecture Context: Part of 90-day free NCLEX review classes, third day
• Timing: Classes held daily at 12:00 PM EST
• Main Topic: Kidney Transplant
• Subtopics: Nursing care and management, Q&A on Acute Kidney Injury (AKI) and Chronic Kidney Disease

Kidney Transplant

• Definition: Surgical implantation of a healthy kidney from a living or diseased donor into a patient with end-stage renal disease
• Eligibility:
  • No Living Donor: Added to a waiting list
  • Compatibility: Length of time on dialysis, waiting list, predicted survival post-transplant
  • Donor Types: Living, non-heartbeating, diseased
  • Compatibility Tests: Blood type, HLA (Human Leucocyte Antigen), minor antigens
  • Success: Higher chance of success with living or related donors

Preliminary Steps

• Compatibility Testing: Tissue compatibility includes blood type, HLA, and minor antigens
• Kidney from Donated Sources:
  • Living Donor: Highest likelihood of transplant success
  • Heartbeating Donor: Must be adequately perfused for viability

Recipient Qualifications

• Advanced Renal Failure: Requiring dialysis (peritoneal or hemodialysis)
• Projected Lifespan: At least 5 years
• Comprehension of Post-Surgery Care: Active involvement in recovery
• Potential Complications:
  • Surgical stress
  • Lifelong immunosuppressive treatments
  • Organ rejection
  • Other risks: age extremity, untreated cardiac disease, substance dependency, chronic infections

Nursing Care Before Surgery

• Blood Transfusion: From living donor to improve transplant success
• Hemodialysis: Day post-transplant to manage waste and fluids until kidney functions
• Preoperative Lab Tests:
  • Blood Chem: Kidney function, electrolytes
  • CBC: Anemia, infection
  • Coagulation Studies: Bleeding risk
  • Urine Culture: Detect UTI
  • Blood Typing and Crossmatching: Confirm compatibility
• Preoperative Medications:
  • Antibiotics: To prevent infections
  • Immunosuppressants: Corticosteroids, cyclosporin, azathioprine, mTOR inhibitors, monoclonal antibodies
  • Side Effects: Weight gain, mood swings, hyperglycemia

Nursing Care After Surgery

• Vital Signs Monitoring: Every 15 minutes initially, every 4 hours later
• Intake and Output: Hourly measurement of urine and fluid drains
• Urinary Output: At least 30 mL/hr
• Assess Urine Appearance: Report significant color changes
• Monitor for Organ Rejection:
  • Types: Hyperacute (within 48 hrs), acute (within months), chronic (1-2 years)
  • Signs: Fever, hypertension, pain, elevated BUN/creatinine, elevated WBCs, edema
• Post-Transplant Lab Tests: Frequent monitoring for early detection of complications
• Administer Immunosuppressive Medications: Monitoring and adjusting treatment

Potential Complications Post-Transplant

• Infection: Signs include fever, abnormal discharge, elevated WBCs
• Hemorrhage: Monitoring surgical site, drainage, notify physician immediately if significant bleeding detected
• Urinary Complications: Ensure optimal kidney function via strict I&O measurement, continuous bladder irrigation if needed
• Fluid and Electrolyte Balance: Monitoring and managing intake/output, replacing electrolytes as needed
• Constipation: Monitor bowel sounds, movements, administer stool softeners/laxatives

Patient Education

• Preoperative and Postoperative Care: Educate patient on expectations and complications
• Realistic Expectations: Honest discussion about benefits, potential challenges, and recovery process
• Support Systems: Arrange counseling, connect with support groups, promote open communication