Mr. Scott is a 31-year-old male with past medical history of a congenital anomaly that has led to kidney disease. The nephrologist has mentioned it is time to pursue either dialysis or a donor kidney. Mr. Scott and his family elect to proceed with a kidney transplant. He receives a kidney transplant from a living donor relative.
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# . Nursing priorities and interventions to be provided to the renal transplant patient in immediate post - op period are :-
1 Nursing diagnosis - Prevention of infection because the patient is immunocompromised now , chances of acquiring infection is more and should be taken care of by the following methods :-
- isolation of the patient
- minimum number of visitors
- avoiding boque ,and other articles from outside .
- use of personal protective equipments by the staff
- strict hand washing
- assessment of the patient for infection .
2- Nursing diagnosis - Graft versus host rejection .
Assess for graft versus host rejection . It includes assessing :-
- patient for any abdominal pain
- decreased urine output
- edema
- increase in weight
- increased GFR
3- Nursing diagnosis - Pain related to renal transplant surgery
- Assess the pain of the patient using pain scale
- Administration of analgesics as per the instructions
- Use of non- pharmacological methods for relieving pain
- Reevaluate pain based on the pain scale .
4. Nursing diagnosis - Nutritional management
- Advice the patient that for two or more days until the bowel gets functional the food will be provided through NG tube or parenteral route .
- Administration of liquid diet once gag reflux is back
- Then slowly shifting to semi -solid diet
- Advice the patient to have more fluids and fiber to avoid constipation .
- Charting of input and output
- Assessing the weight of the patient .
#. The goal of immunosuppression after an organ transplant is to avoid graft rejection by considering the donor as foreign agent .
Immunosuppressive drugs act to reduce the activation or efficacy of the immune system. Clinically, these drugs are used to:
-Prevent the rejection of transplanted organs and tissues (e.g., heart, kidney, liver, bone marrow).
-Treat a variety of diseases that have an autoimmune component to their pathogenesis (e.g., rheumatoid arthritis, systemic lupus erythematosus, psoriasis).
-Treat some non-autoimmune inflammatory diseases (e.g., long-term allergic asthma control).
Immunosuppressive mechanisms include:
Inhibitors that affect T cell recognition of alloantigen and signal transduction via the calcium-dependent calcineurin pathway (Signal 1).
Agents that inhibit costimulatory pathways for full activation of T cells. (Signal 2)
Inhibitors of cytokine-driven proliferation (Signal 3).
Inhibitors of purine and DNA synthesis.
The goal of immunosuppression is to give the patient the level of drug therapy thatleads to graft acceptance.
You want to minimize graft rejection as much as possible, but you have to balance that with the fact that you are giving the person
immunosuppressive drugs.
Therefore, they are going to be at a higher risk for susceptibility to infections and malignancies
#. The four types of rejection are :-
- Hyperacute rejection
a complement-mediated response in recipients with pre-existing antibodies (anti donor antibodies) to the donor. Occurs within minutes after transplantation.
- Acute rejection
Cell mediated due to cytotoxic T cell reacting against proteins from the donor organ (foreign MHCs). Occurs days or weeks after transplantation. Reversible with immunosuppressants such as cyclosporine (blocks IL 2 & y-INF formation) and OKT3.
- Chronic rejection
Antibody-mediated vascular damage (fibrinoid necrosis); occurs months to years after transplantation. Irreversible (need for a new organ).
- Graft versus host disease - occurs mainly in bone marrow transplantation , in which T cells of the graft attack the tissues of the recipient considering it as antigens .
#. Signs and symptoms of acute kidney rejection are :-
- oliguria or anuria
- fever
- raised BP
- enlarges tender kidneys
- fatigue
- fluid retention
- increased BUN , creatinine
- hyperkalemia
Mr. Scott is a 31-year-old male with past medical history of a congenital anomaly that has...
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