Questions and Answers
What is the primary reason for instilling antibiotic solution into the bladder during a kidney transplant surgery?
To reduce the risk of infection
What is the significance of rapid revascularization in a kidney transplant procedure?
It is critical to restore blood flow to the transplanted kidney
What is the purpose of tunneling the donor ureter through the bladder submucosa during a kidney transplant procedure?
To establish a connection between the donor ureter and the recipient's bladder
What is the sequence of events during a kidney transplant procedure involving two sisters?
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What is the purpose of placing a urinary catheter into the bladder during a kidney transplant procedure?
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What is the significance of releasing the clamps during a kidney transplant procedure?
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What is the primary purpose of assessing fluid status in a hemodialysis patient?
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What is the primary function of the dialysate delivery and monitoring system?
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What is the purpose of adding heparin to the hemodialysis system?
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What is the primary purpose of assessing the patient's temperature before hemodialysis treatment?
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What is the purpose of flushing the dialyzer and blood lines with saline solution after the hemodialysis treatment?
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What assessment data should be obtained before initiating hemodialysis treatment for a patient like K.W.?
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What is the primary consideration for determining the infusion of replacement fluid in CRRT?
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What is the primary mechanism of solute removal in CVVHDF?
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What is a key advantage of CRRT compared to HD in terms of hemodynamic stability?
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What is a key difference between CRRT and HD in terms of monitoring requirements?
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What is a key advantage of CRRT compared to HD in terms of equipment requirements?
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What is the primary difference between CVVHD and CVVHDF in terms of dialysis fluid?
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What is the primary goal of immunosuppressive therapy in kidney transplant recipients?
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Why is it essential to monitor urine output in kidney transplant recipients?
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What type of rejection occurs minutes to hours after transplant?
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What is the consequence of chronic rejection in kidney transplant recipients?
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What is a priority teaching need for C.L. before discharge?
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Why is it essential to assess for hyponatremia and hypokalemia in kidney transplant recipients?
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What is a possible complication of a kidney transplant due to recurrence of the original kidney disease?
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What is a corticosteroid-related complication that can affect the eyes?
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What is the most likely cause of a patient's symptoms six days after a kidney transplant from a deceased donor?
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Which of the following is NOT a complication of a kidney transplant?
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What is a possible complication of corticosteroids in kidney transplant patients?
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Which of the following is a complication of a kidney transplant that can be treated with IV antibiotics?
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Study Notes
Hemodialysis Procedure
- Before HD treatment, assess fluid status by checking weight, BP, peripheral edema, heart, and lung sounds
- Assess vascular access and temperature
- Monitor vital signs (VS) every 30-60 minutes
- Two large-bore needles are placed in the fistula or graft: one for pulling blood from circulation to the HD machine and one for returning dialyzed blood to the patient
Hemodialysis System Components
- Dialysate delivery and monitoring system is used
- Heparin is added to prevent clotting
Hemodialysis Procedure (Termination)
- The dialyzer/blood lines are primed with saline solution to eliminate air
- The procedure is terminated by flushing with saline to return all blood to the patient
- Needles are removed, and firm pressure is applied
Case Study: Hemodialysis Readiness
- Before starting HD treatment, assess:
- Fluid status (weight, BP, peripheral edema, heart and lung sounds)
- Vascular access
- Temperature
- VS every 30-60 minutes
Kidney Transplant Surgical Procedure
- The transplant recipient undergoes:
- Urinary catheter placement into the bladder
- Antibiotic solution instillation to decrease infection risk
- Crescent-shaped incision
- The donor kidney is anastomosed to the recipient's iliac artery and vein
- The transplant recipient's ureter is tunneled through the bladder submucosa (ureteroneocystotomy)
Continuous Renal Replacement Therapy (CRRT)
- Infusion of replacement fluid is determined by the degree of fluid and electrolyte imbalance
- Anticoagulants are needed to prevent blood clotting
- Customized to patient's needs
Continual Renal Replacement Therapy (CRRT) vs Hemodialysis (HD)
- CRRT is continuous rather than intermittent
- Fluid volume can be removed over days versus hours
- Solute removal is by convection (no dialysate required) in addition to osmosis and diffusion
- Less hemodynamic instability
Kidney Transplant Nursing Management
- Postoperative care:
- Dehydration must be avoided
- Assess for hyponatremia/hypokalemia
- Monitor urine output and maintain catheter patency
- Patient education: signs and symptoms of rejection, infection, and surgical complications; follow-up care
Kidney Transplant Immunosuppressive Therapy
- Goals:
- Adequately suppress immune response to prevent rejection
- Maintain sufficient immunity to prevent overwhelming infection
Kidney Transplant Complications
- Rejection types:
- Hyperacute (antibody-mediated, humoral) rejection
- Acute rejection
- Chronic rejection
- Recurrence of original kidney disease:
- Glomerulonephritis
- IgA nephropathy
- Diabetic nephropathy
- Focal segmental sclerosis
- Corticosteroid-related complications:
- Aseptic necrosis of joints
- Peptic ulcer disease
- Diabetes
- Cataracts
- Dyslipidemia
- Infections
- Cancers
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