what are nursing perioperative cares of patient with renal transplant?

Answer 1

Renal transplantation is an operation that leads to several immediate perioperative issues.

First off, the patient needs to be pre-operatively optimized to minimize operative risk. Many patients have significant cardiovascular or respiratory conditions which need to be managed. Preoperative beta-blocking medicine is known to decrease heart attack in the time around surgery. Statins are now found to have similar benefits. These medicines, and the continuity of their administration through the operative time period is an important issue.

Renal transplant patients are commonly hypertensive and/or diabetic. Ongoing monitoring and treatment of these issues is complicated by the stress of surgery and by the immunosuppressive medicines which include steroids. Nurses are required to check glucose and take vitals frequently, and to administer insulin and blood pressure medication.

The optimization of the immunosuppressive medication is a delicate balance. The transplant surgeons and their associates monitor this carefully, and there are a number of medication regimens out there being utilized. Nursing staff need to coordinate the timing of medication administration and lab draws in order for this data to be meaninful. Errors can be devastating. Some of these medications have side effects that need to be monitored and documented appropriately. Every transplant center has protocols for these issues.

The single most important parameter following a renal transplant, whether from a cadaver source or a living donor, is URINE OUTPUT. This needs to be checked very frequently and documented. Changes should prompt immediate attention. The first thing to do if a foley catheter output drops is to check the foley to verify it is positioned appropriately and that it flushes and flows. Patients who undergo renal transplant have diminished bladder capacity because of the years they spent making no urine. The sewn junction where the transplanted ureter enters into the bladder is at risk of rupture if the bladder is filling while the urine catheter is blocked! Blood clots, if seen in the urine, should be documented and reported to the surgeon, as they represent a risk for catheter clotting.

Finally, all surgical patients have an incision that needs to be checked and cared for. Transplant patients are no different. All surgical patients need to be encouraged to mobilize, despite pain, out of bed into chairs, and up to walk. This decreases the risk of post operative pneumonia and post operative deep vein thrombosis.

Transplant patients ultimately are no different from any other surgical patients. They undergo surgery because they are ill, they have medications to help manage their diseases, and they have post-operative infirmity relative to the surgical procedure that they receive.

Answer 2

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