Renal Replacement Therapies Overview
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Questions and Answers

What clinical manifestation is likely associated with an infection?

  • Dizziness
  • Loss of appetite
  • Shaking chills (correct)
  • Visual disturbances

What is the primary goal of the new approach to kidney transplantation described?

  • To enhance the recipient's immune response to infections
  • To prevent rejection without using immunosuppressive drugs (correct)
  • To eliminate the need for all medications post-surgery
  • To prevent the development of kidney disease

What does the process of injecting blood stem cells from the donor achieve?

  • It allows donor immune cells to attack the recipient's body
  • It directly restores kidney function without surgery
  • It completely eradicates the recipient's original immune cells
  • It helps establish a hybrid immune system recognizing the donor's organ (correct)

Which of the following actions is essential for hospital staff and visitors in infection control?

<p>Performing careful hand washing consistently (D)</p> Signup and view all the answers

What should be monitored to determine if the new hybrid immune system is effective?

<p>Mix of cells from both the recipient and the donor (B)</p> Signup and view all the answers

What is a key component of preoperative teaching for patients undergoing elective abdominal surgery?

<p>Postoperative pulmonary hygiene (A)</p> Signup and view all the answers

Which immunosuppressive agent is known as Prograf?

<p>FK-506 (A)</p> Signup and view all the answers

What is the purpose of early ambulation in the preoperative phase?

<p>To prevent postoperative complications (D)</p> Signup and view all the answers

What characteristic distinguishes hyperacute rejection from other types of rejection?

<p>Rapid onset within 24 hours (A)</p> Signup and view all the answers

What is a primary complication associated with hemodialysis?

<p>Disequilibrium Syndrome (C)</p> Signup and view all the answers

Which symptom is specifically associated with both acute rejection and infection?

<p>Fever (D)</p> Signup and view all the answers

What is the main goal of postoperative management for a transplanted kidney?

<p>Maintain homeostasis until functioning (D)</p> Signup and view all the answers

Which access method is NOT used for hemodialysis?

<p>Peritoneum (B)</p> Signup and view all the answers

What dietary consideration is important for patients post-kidney transplant?

<p>Increased protein to support kidney function (C)</p> Signup and view all the answers

What nursing intervention is essential to monitor during hemodialysis?

<p>Check BP and pulse rate every 30-60 minutes (D)</p> Signup and view all the answers

What is the most reliable test for evaluating kidney transplant rejection?

<p>Percutaneous renal biopsy (C)</p> Signup and view all the answers

Continuous Renal Replacement Therapy is most appropriate for which condition?

<p>Acute or urgent conditions (D)</p> Signup and view all the answers

Which of the following is a characteristic of peritoneal dialysis?

<p>Utilizes the peritoneum as a membrane (B)</p> Signup and view all the answers

What is one reason high-flux dialysis would be preferred?

<p>It increases clearance of low- and mid-molecular-weight molecules (D)</p> Signup and view all the answers

What should be monitored in the dialysate during peritoneal dialysis?

<p>Intake and output to minimize discomfort (B)</p> Signup and view all the answers

Which of the following symptoms indicates the necessity for hemodialysis in chronic conditions?

<p>Uremic signs and symptoms (B)</p> Signup and view all the answers

Which symptom may indicate an infection during clinical assessments?

<p>Shaking chills (D)</p> Signup and view all the answers

What is the primary novel technique being utilized in the prevention of rejection after kidney transplantation?

<p>Multiple small doses of radiation targeting the immune system (C)</p> Signup and view all the answers

What effect does the injection of blood stem cells from the donor have on the recipient?

<p>It helps create a hybrid immune system recognizing the donor's organ (B)</p> Signup and view all the answers

Which of the following practices is essential in infection control measures for hospital staff and visitors?

<p>Careful hand washing (D)</p> Signup and view all the answers

How did the Stanford team determine that the new hybrid immune system would not attack the transplanted organ?

<p>By testing the recipient’s immune cells against donor cells in the laboratory (B)</p> Signup and view all the answers

What is an appropriate indication for using Continuous Venovenous Hemofiltration (CVVH)?

<p>Fluid overload due to oliguric kidney disease (C)</p> Signup and view all the answers

Which statement about kidney transplantation is correct?

<p>Related living donors generally provide more successful transplant outcomes than cadaver donors. (D)</p> Signup and view all the answers

What preoperative evaluation is necessary for a patient undergoing kidney transplantation?

<p>Tissue typing and blood typing (B)</p> Signup and view all the answers

What should be monitored to ensure safety during the insertion of a catheter for dialysis?

<p>Signs of peritonitis and bleeding (A)</p> Signup and view all the answers

Which statement is true regarding the management of a patient in advanced dialysis procedures?

<p>Signs of mental confusion and nausea should be monitored. (D)</p> Signup and view all the answers

Which symptom is associated with hyperacute rejection?

<p>Tenderness at transplant site (A)</p> Signup and view all the answers

What is the primary reason for early ambulation in the preoperative phase?

<p>To enhance postoperative recovery (A)</p> Signup and view all the answers

Which immunosuppressive agent is commonly used to prevent transplant rejection?

<p>Azathioprine (B)</p> Signup and view all the answers

What is a key sign of acute rejection in kidney transplant recipients?

<p>Oliguria (B)</p> Signup and view all the answers

What diagnostic tool is most reliable for evaluating rejection in kidney transplantation?

<p>Percutaneous renal biopsy (A)</p> Signup and view all the answers

Which condition is managed with a tapering dosage of immunosuppressive agents?

<p>Chronic rejection (C)</p> Signup and view all the answers

Which of the following indicates a need for monitoring blood pressure after kidney transplantation?

<p>Increasing blood pressure (D)</p> Signup and view all the answers

What is not a common preoperative teaching focus for patients undergoing elective abdominal surgery?

<p>Cosmetic surgery options (A)</p> Signup and view all the answers

Which condition is NOT a primary indication for initiating hemodialysis?

<p>High blood pressure (C)</p> Signup and view all the answers

What is the primary purpose of using a high-flux dialysis membrane?

<p>To enhance the removal of low- and mid-molecular-weight molecules (D)</p> Signup and view all the answers

Which of the following complications is associated with peritoneal dialysis?

<p>Exit site infection (B)</p> Signup and view all the answers

During hemodialysis, how frequently should blood pressure and pulse rate be checked?

<p>Every 30-60 minutes (A)</p> Signup and view all the answers

What is a key nursing intervention before initiating peritoneal dialysis?

<p>Check for patency of the catheter (C)</p> Signup and view all the answers

Which type of dialysis access is primarily used in hemodialysis?

<p>Arteriovenous fistula (B)</p> Signup and view all the answers

Which statement about fluid management in hemodialysis is accurate?

<p>Fluid overload must be monitored and managed due to its complications. (A)</p> Signup and view all the answers

What is the typical duration of a hemodialysis session?

<p>3 to 4 hours (D)</p> Signup and view all the answers

Flashcards

Infection Clinical Manifestations

Signs of an infection, including shaking chills, fever, rapid heartbeat (tachycardia), fast breathing (tachypnea), and changes in white blood cell count (leukocytosis or leukopenia).

Aseptic Technique

A set of procedures to prevent contamination and infection

Kidney Transplant - New Approach

A new kidney transplant method that avoids immunosuppressants by using radiation and stem cells to modify the patient's immune system, allowing the body to accept the new organ.

Immunosuppressants

Drugs that prevent the body's immune system from attacking transplanted organs.

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Transplantation Process

Kidney transplant procedure includes surgery initial use of immunosuppressive drugs, controlled reduction of immune cells, injection of stem cells, and monitoring to ensure the body accepts the donor organ.

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Hemodialysis

A type of kidney replacement therapy that filters blood through a dialysis machine to remove waste and excess fluids.

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Peritoneal Dialysis

A type of kidney replacement therapy that uses the lining of the abdomen to filter waste and excess fluids from the blood.

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Dialyzer

A device used in hemodialysis to filter blood, containing hollow fibers with a semipermeable membrane.

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Access for Hemodialysis

The way blood is accessed for filtering, including arteriovenous fistula, grafts, or catheters.

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Hemodialysis Duration

The time a hemodialysis session typically lasts, ranging from 3 to 4 hours.

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Peritoneal Dialysis Duration

This procedure lasts for 36 hours in total.

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Hemodialysis Complication

Potentially dangerous side effects of hemodialysis, including disequilibrium syndrome and hypotension.

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Peritoneal Dialysis Complication

Potential risks associated with peritoneal dialysis, such as exit site infection, peritonitis and hernia.

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Preoperative Nursing Interventions

Management of a patient undergoing elective abdominal surgery, including teaching on postoperative pulmonary hygiene, pain management, diet, IV/arterial lines, tubes, and early ambulation.

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Postoperative Kidney Transplant Management

Maintaining homeostasis after kidney transplant until the transplanted organ functions well, using immunosuppressive therapy like Azathioprine, Prednisone, Cyclosporine, etc.

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Immunosuppressive Therapy

Medication to prevent the body from rejecting the transplanted kidney, gradually tapered over weeks.

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Kidney Rejection (Hyperacute)

Immediate antibody-mediated reaction after transplant (within 24 hours) leading to organ failure.

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Kidney Rejection (Acute)

Rejection in 3 to 14 days post-transplant.

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Kidney Rejection (Chronic)

Rejection develops after several weeks or months, often characterized by fatigue, edema, and tenderness.

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Rejection Diagnostics

Methods include ultrasound, percutaneous renal biopsy (most reliable), and x-ray to detect kidney issues and rejection.

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Postoperative Rejection Assessment

Evaluating symptoms like oliguria, edema, fever, elevated BP or weight gain for transplant rejection.

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Complications of Hemodialysis

Potential problems with hemodialysis, including disequilibrium syndrome (rapid changes in brain chemistry), hypotension (low blood pressure), and bleeding.

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Complications of Peritoneal Dialysis

Potential problems with peritoneal dialysis, including exit site infections (infection at the access point), peritonitis (infection of the abdominal lining), and hernia (bulge in the abdominal wall).

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Nursing Interventions for Hemodialysis

Care given to monitor for complications, such as checking vital signs regularly, observing for disequilibrium syndrome, and managing bleeding.

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CVVH

Continuous Venovenous Hemofiltration, a type of therapy used for patients with acute or chronic kidney failure, fluid overload, or high metabolic needs.

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CVVHD

Continuous Venovenous Hemodialysis, another type of therapy used for patients with acute or chronic kidney failure.

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Kidney Transplant

A surgical procedure where a healthy kidney from a living or deceased donor is placed in the recipient's body.

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Preoperative Management

The steps taken to prepare a patient for a kidney transplant, including physical exams, blood tests, and addressing any health problems.

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Postoperative Management

The care given to a patient after a kidney transplant, focusing on preventing rejection and promoting the new kidney's function.

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Types of Kidney Rejection

There are three main types of rejection: hyperacute (within 24 hours), acute (3 to 14 days), and chronic (after weeks or months).

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Hyperacute Rejection

Immediate (within 24 hours) rejection of the transplanted kidney due to a quick antibody-mediated reaction.

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Acute Rejection

Kidney rejection that occurs within 3 to 14 days after transplant, often characterized by signs of infection and decreased kidney function.

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Chronic Rejection

Kidney rejection that develops gradually over weeks or months, often leading to fatigue, edema, and tenderness around the transplant site.

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Signs of Rejection

Symptoms that may indicate kidney rejection include oliguria, edema, fever, increased blood pressure, weight gain, and tenderness over the transplanted kidney.

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Post-transplant Nursing Interventions

Nurses closely monitor for signs of rejection, infection, and assess kidney function by checking serum creatinine and BUN levels.

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Distinguishing Infection from Rejection

It's important to differentiate between infection and rejection, as both can cause similar symptoms.

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New Approach to Kidney Transplant

A method that uses radiation and stem cells to modify the patient's immune system, allowing the body to accept a new kidney without needing immunosuppressant drugs for the long term.

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Immunosuppressant Drugs

Medicines used to suppress the immune system and prevent it from attacking transplanted organs. The goal is to prevent the body's natural defense system from rejecting the new organ.

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How does the new kidney transplant method work?

  1. The usual transplant process begins, including surgery and initial immunosuppressant drugs.
  2. The patient receives controlled doses of radiation targeting the immune system and a drug to reduce immune cells.
  3. Stem cells from the kidney donor are injected into the patient.
  4. The stem cells travel to the bone marrow and reproduce new immune cells that recognize the donor organ as 'friend'.
  5. The patient is slowly weaned off immunosuppressant drugs.
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Hybrid Immune System

A combination of the patient's original immune system and the new immune cells from the donor stem cells. These mixed cells recognize the donated organ as 'self' and avoid rejecting it.

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Why is this new approach significant?

It offers a potential solution to the long-term use of immunosuppressive drugs, which can have significant side effects. This new approach aims to create a more durable transplant solution by changing the way the body accepts the donor organ.

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Study Notes

Renal Replacement Therapies

  • Renal replacement therapies include hemodialysis, peritoneal dialysis, and continuous renal replacement therapy (acute/urgent and chronic/maintenance)
  • Hemodialysis: high and increasing potassium levels, fluid overload, impending pulmonary edema, increasing acidosis, pericarditis (uremic), advanced uremia
  • Chronic/Maintenance Hemodialysis: advanced CKD & ESKD, uremic signs & symptoms, hyperkalemia, fluid overload, general lack of well-being
  • Dialyzers: hollow-fiber devices with tiny capillary tubes, porous tubes acting as semipermeable membranes, constant flow of solution maintains concentration gradient facilitating waste exchange across membrane, removing and discarding waste in the dialysate solution, High-flux dialysis uses highly permeable membranes to increase clearance of low- and mid-molecular-weight molecules
  • Peritoneal Dialysis: uses the peritoneum, a 36-hour procedure
  • Hemodialysis Access: arteriovenous fistula, internal jugular/subclavian/femoral vein catheterization, arteriovenous graft
  • Hemodialysis Duration: 3 to 4 hours
  • Peritoneal Dialysis Duration: 36 hours
  • Complications for Hemodialysis: disequilibrium syndrome, hypotension, bleeding, exit-site infection, peritonitis, hernia, pulmonary complications
  • Complications for Peritoneal Dialysis: exit-site infection, peritonitis, hernia, pulmonary complications
  • Nursing Interventions for Hemodialysis: checking blood pressure and pulse every 30-60 minutes; weighing patient before and after dialysis, monitor intake and output, monitor for signs of disequilibrium syndrome, headache, hypertension, restlessness, mental confusion, and nausea; watch for signs of bleeding, avoiding taking blood pressure on AV fistula site, avoid blood extraction on AV fistula site, provide diversion activities throughout the dialysis process
  • Nursing Interventions for Peritoneal Dialysis: monitor vital signs and observe for changes in behavior, ensuring catheter patency; adding procaine HCI to dialysate to minimize discomfort, observing for signs of peritonitis, maintain aseptic technique during catheter insertion and throughout the procedure.
  • Continuous Renal Replacement Therapies: hemofilter, indications (acute or chronic kidney failure, fluid overload with oliguric kidney disease, high metabolic/nutritional needs), Continuous Venovenous Hemofiltration (CVVH), Continuous Venovenous Hemodialysis (CVVHD)
  • Kidney Transplantation: from living donor or cadaver, transplanted kidney placed in iliac fossa anterior to iliac crest, ureters anastomosed to the ureter of the recipient
  • Preoperative Management: bringing patient's metabolic state to a normal level, complete physical examination, tissue typing, blood typing, antibody screening, assessing lower urinary tract for bladder neck function and ureteral reflux, ensuring patient is free from infection, psychological evaluation, corticosteroid evaluation, and hemodialysis before transplant
  • Preoperative Nursing Interventions: management like elective abdominal surgery, preoperative teaching (postoperative pulmonary hygiene, pain management options, dietary restrictions, intravenous and arterial lines, tubes, early ambulation)
  • Postoperative Management: maintaining homeostasis until transplanted kidney functioning well, immunosuppressive therapy (azathioprine, corticosteroids, cyclosporine, OKT3, Prograf, Mycophenolate), tapering immunosuppressive drugs over several weeks, patient must take anti-rejection medication
  • Rejection & Failure: Hyperacute rejection (within 24 hours, immediate antibody-mediated reaction, generalized glomerular capillary thrombosis, necrosis, immediate removal of organ), Acute rejection (within 3 to 14 days, tenderness at transplant site, decrease in serum creatinine, malaise, fever, oliguria, early recognition and immunosuppressant therapy), Chronic rejection (after, fatigue, generalized edema, anuria or decreased urine output, tenderness at transplant site, immunosuppressive therapy), diagnostic tools (ultrasound, percutaneous renal biopsy, X-ray)
  • Drugs: azathioprine, belatacept, cyclosporine, everolimus, mycophenolate mofetil, prednisone, sirolimus, tacrolimus
  • Postoperative Nursing Interventions: assessing for signs and symptoms of rejection, oliguria, edema, fever, increasing blood pressure, weight gain, swelling or tenderness over the transplanted kidney or graft, assessment of serum creatinine, BUN, leukocytes and platelets, distinction between infection and rejection
  • Monitoring for Infection: protecting client from hospital staff, visitors, and others with active infections, careful hand washing is imperative, face mask may be worn, clinical manifestations (shaking chills, fever, tachycardia, tachypnea, either an increase or a decrease in WBCs, or leukopenia), practice strict aseptic technique
  • Update: new research from Stanford University, new approach to prevent rejection without immunosuppressive drugs, transplantation with the usual process and addition steps, blood stem cells from the donor, immune cells recognize donor organ as friend, monitoring recipient's hybrid immune system, slowly weaning patient away from immunosuppressive drugs

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