CHI Exam 3 ari's

What is the patho for BPH?

Prostate gland enlarges -> extends upward into the bladder and inward causing bladder outlet obstruction impairing urinary elimination

What causes BPH?

Aging and increased dihydrotestosterone (DHT) levels leads to the glandular units in the prostate undergo nodular tissue hyperplasia

What are expected findings in BPH?

HI FUN

- Hesitancy (difficulty starting/stopping stream, dribbling urine), hematuria

- Intermittence, Incontinence (overflow)

- Frequency, Fullness

- Urgency

- Nocturia

What are risk factors for BPH?

- Older age

- Family hx

- Smoking, chronic alcohol use

- Obesity, decreased physical activity

- DM, HD

- Western diet (high fat, high carbs, low fiber)

- Testosterone and other androgen supplements

What are labs/diagnostic procedures are indicative of BPH?

UA or urine culture

- increased WBC and bacteria

Serum prostate-specific antigen (PSA) and a serum acid phosphatase level to rule out prostate cancer

- screening for men >50

- elevation indicates problem (> 2.5)

Basic metabolic panel

- BUN/CR

Transabdominal ultrasound and/or transrectal ultrasound (TRUS)

MRI

Digital rectal exam

- may reveal enlarged, smooth prostate

- C&S of prostatic fluid: performed if fluid is expressed during the exam

What meds are used to treat BPH?

Alpha Blockers

5-Alpha Reductase Inhibitors (5-ARI)

How do Alpha Blockers work for BPH?

Relax tension in the prostate smooth muscle by targeting alpha receptors

- tamsulosin

SE: OH, tachycardia, syncope, ED

CI: ED drugs

NI: can give at bedtime

- teach pt to report dizziness, lightheadedness, palpitations

- monitor BP

How do 5ARIs work for BPH?

Blocks the growth of prostate cells by targeting the 5AR enzyme

- finasteride

SE: libido impairment, ED, OH

- CI: ED drugs

NI: wear gloves if pregnant

- 5 months before results

What therapeutic procedures are used for BPH?

"Watchful waiting" observation period with yearly examination

Prostatic fluid can be released

Minimally invasive

- Transurethral needle ablation (TUNA): low radio-frequency that shrinks the prostate

Surgical

- Surgical resection

- Transurethral resection of the prostate (TURP)

--- irrigation to prevent clots

What are complications of BPH?

UTI

- d/t urinary stasis and persistent urinary retention

Kidney damage

- d/t backflow of urine into the ureters

What is involved in the nursing care for BPH?

Teach

- ways to prevent bladder distention

--- avoid drinking large amounts of fluid in a short period

--- avoiding alcohol, diuretics, and caffeine

--- void as soon as the urge is felt

--- avoid drugs that can cause urinary retention (antihistamines, anticholinergics, decongestants)

- keep surrounding area clean and dry to prevent skin breakdown

- if needed small undergarment pad to prevent undergarment soiling

What is the patho for UTI?

Cystitis is an inflammation or infection of the urinary bladder -> with infection is a UTI

- Uncomplicated UTI (acute bacterial cystitis): infection in a healthy, non-pregnant, pre-menopausal female pt. w/ anatomically and functionally normal urinary tract

What causes UTI?

Bacteria

- E. coli

Viruses

Fungi

Parasites

What are expected findings in UTI?

PAINFUL

Pain, burning, or discomfort during urination, prostate gland changes

Abdominal/back pain

Increased frequency

New color, clarity, or odor and pus (WBCs) or blood (RBCs)

Feelings of incomplete bladder emptying

Urgency

Low output or inability to urinate

Older adults

- may be vague as increasing mental confusion or unexplained falls

- sudden onset of or worsening of incontinence may be an early sx

- fever, tachycardia, tachypnea, and hypotension

- loss of appetite, nocturia, and dysuria

What are risk factors for UTI?

Female

- short urethra

Older adult clients

- decreased estrogen promotes atrophy of the urethral opening

BPH

Sexual intercourse

Frequent use of feminine hygiene products

Poorly fitted diaphragm

Catheters

DM

What are labs/diagnostic procedures are indicative of UTI?

Elevated plasma WBCs

Clean catch urine sample

- self-clean before voiding

- initiate voiding after cleaning, the pt then stops and resumes voiding into the container

- do not let lips or inner part touch container

- only 1 ounce (30mL) is needed

Urinalysis

- leukocyte esterase (normal: -)

- nitrates (normal: -)

Urine culture and sensitivity

- bacteria in urine

What meds are used to treat UTI?

Antibiotics

Analgesics

Antispasmodics

Antifungal agents

What does Antibiotics do for UTI?

In uncomplicated UTIs, a 3-day course of oral antibiotics tx

- TMP-SMX

- Nitrofurantoin

- Fosfomycin

What does Analgesics do for UTI?

Used to promote comfort

- urine may turn orange

- phenazopyridine

What does Antispasmodics do for UTI?

Used to decrease bladder spasms and promote complete bladder emptying

What does Antifungal agents do for UTI?

Used if the infecting microbe is fungal

ADR: nephrotoxic

- amphotericin B and ketoconazole (Nizoral)

What therapeutic procedures are used for UTI?

Diet Therapy

- ensure sufficient fluid intake to maintain clear or light-yellow urine (2-3 L/day)

- cranberry juice or tablets daily may reduce the frequency and recurrent UTIs

--- CI: cystitis (bladder pain)

Warm sitz baths to relieve perineal discomfort

What is involved in the nursing care for UTI?

Teach about antibiotic use

- take full course, may take probiotic, manage SEs

Expect changes in color/texture of urine with some txs or UTI progression

Use appropriate techniques to prevent discomfort with sexual activities and how to prevent postcoital infections

- empty bladder and wash before and after intercourse

Adequate fluids to maintain urine color as clear or light yellow

Clean the perineum after urination

Empty bladder as soon as urge is felt

Avoid irritants such as caffeine, carbonated beverages, tomato products, chemical in bath water, vaginal washes, or scented toilet tissue

Seek prompt medical care if sxs recur

Pregnant women with cystitis require prompt and aggressive antibiotic tx because this infection can lead to preterm labor

What is the patho for Polycystic Kidney Disease (PKD)?

Hereditary kidney disorder -> fluid-filled cysts develop in nephrons

- Autosomal recessive -> more severe cysts present a birth, with death typically in early children

- Autosomal dominant -> most common form, cysts begin to multiple at age 30

What causes PKD?

Growing cysts damage the nephron, reducing kidney function and causing HTN

- the cysts do not filter blood; kidney failure occurs overtime

- cysts are at risk for infection, rupture and bleeding; contribute to kidney stone formation

- may enlarge 2-3x causing discomfort and abdominal organ displacement

What are expected findings in PKD?

- Pain

- HA

- Distended abdomen

- Enlarged, tender kidney on palpation

- Changes in urine, including clarity, odor

- Changes in pattern of urination including nocturia

- Dysuria

- Vital signs, HTN and fever

- Edema

- Uremic Sxs: N/V, pruritus, fatigue

- Emotional responses such as anger, resentment, futility, sadness, or anxiety related to chronicity or inheritable

What are risk factors for PKD?

Caucasian

Family hx of PKD

What are labs/diagnostic procedures are indicative of PKD?

- Urinalysis with findings of proteinuria and hematuria

- Urine culture and sensitivity if infection is suspected

- Serum CR/BUN to assess kidney function, creatinine clearance

- Renal sonography, CT scan, or MRI to assess the presence and size of cysts

What meds are used to treat PKD?

Analgesics

Antibiotics

- TMP-SMX or ciprofloxacin (Cipro)

- nitrofurantoin

- fosfomycin

What therapeutic procedures are used for PKD?

Needle aspiration of cysts

What are contraindications of PKD?

NSAIDS

What is involved in the nursing care for PKD?

HTN control and fluid management (MAJOR PRIORITY)

- antihypertensive as ordered

- diuretics to eliminate fluid overload

- daily weight to detect fluid-related overload

- daily weight to detect fluid-related weight gain

Pain management

- apply dry heat to the abdomen or flank

- teach relaxation or distraction techniques to self-manage pain and discomfort

Infection prevention

Constipation prevention

Diet therapy

- consult with dietitian to slow progression of kidney injury with fluid, sodium, and protein restrictions

Provide

- counseling, support, and teaching about health maintenance to promote self-management

Encourage

- family genetic testing

What Meds are Nephrotoxic?

NSAIDS

- ibuprofen

- aspirin

- naproxen

Antibiotics

Chemo meds

What is the patho for Chronic Kidney Disease (CKD)?

Five stages

- Stage 1: normal GFR, at risk

--- >90mL/min

- Stage 2: mild CKD

--- 60-89mL/min

- Stage 3: Moderate CKD- fluid, protein, electrolyte restrictions, albuminuria (kidney damage) present

--- 30-59mL/min

- Stage 4: Severe CKD- homeostasis is an issue once 3/4 of kidney function is lost, urine output is decreased, fixed osmolarity, risk for fluid overload with edema, pulmonary crackles, SOB, pleural or pericardial friction rub, decreased heart and breath sounds

--- 15-29mL/min

- Stage 5: End-stage kidney disease (ESKD)- same as stage 4

--- <15mL/min

What causes CKD?

Progressive, irreversible, no recovery

What are expected findings in CKD?

- Uremia: azotemia with s/s

- Azotemia: a buildup of nitrogen-based (BUN/CR) waste byproducts in the blood

- Anuria

- Uremic fetor: breath that smells like urine

- Stomatitis: inflammation in mouth

- Halitosis: foul breath

- Metallic taste in mouth/anorexia/nausea

- Polyuria

- Pruritis: itching caused by uremic frost with evaporated sweat

- Increased phosphate

- HTN

- Hyperlipidemia

- Anemia

- Increased risk of infection

What is CKD-MBD (Mineral and Bone Disorder)/Renal Osteodystrophy?

Decrease calcium

- Trousseau's sign: + = carpal spasm

- Chovostek's sign: + = twitching of cheek

- Fractures

Increased clotting time

Anxiety and irritability

Heart arrhythmias

Increased serum Ca and Ph

Vascular and soft tissue calcifications -> calcium is deposited in atherosclerotic plaques in the lining of blood vessels -> increased CVD

What are Risk Factors for CKD?

- DM

- HTN

- Hyperlipidemia (#1 cause of CVD)

- Age >60

- Cardiovascular disease

- Family hx

- Exposure to nephrotoxic drugs

- Ethnic minority

--- African American, Native Americans

What are risk factors for ESKD?

- CVD (leading COD)

- African Americans plus HTN

- 11% of adults

- >50% with stage 3 or 4 CKD

What are labs/diagnostic procedures are indicative of CKD?

Increased serum CR: from protein metabolism

Increased BUN: from protein metabolism

Decrease Na: compromised Na reabsorption

Increase K: tissue breakdown, transfusions, dietary consumption

Increased Ph, Ca, Mg

ABG: metabolic acidosis

H&H: decreased

UA: + protein, glucose, WBC, decreased urine osmolarity

Blood osmolarity/osmolality: decreased early and increased late

GFR: 3-24 hr urine test

Renal US: atrophy, fibrosis

Biopsy

X-ray: hand bones may show CKD- MBD

What meds are used to treat CKD?

Loop/Thiazide Diuretics

Vitamins & Minerals

Erythropoietin-stimulating agents

Parathyroid Hormone Modulator

Antihypertensives

Lipid-lowering drugs (Statins)

What do Loop Diuretics do for CKD?

Used for mild/severe CKD to decreased fluid/HTN

- not used in ESKD

- 1kg = 1L of fluid

- furosemide

- NI: monitor for output 500-1000mL/24hr (shows effectiveness)

--- monitor for hypokalemia

What do Phosphate Binders do for CKD?

Form insoluble calcium-phosphate complex to inhibit GI absorption

--- calcium acetate, calcium carbonate

--- noncalcium phosphate binders: lanthanum carbonate, sevelamer (Renagel, Renvela) (does not affect Ca levels)

- NI: must be given with meals to prevent Ph absorption

--- monitor Ph and Ca levels

--- monitor for constipation

--- teach to report s/s of hypercalcemia or hypophosphatemia

What does Folate do for CKD?

Supplement

- folic acid/folate, cyanocobalamin

- NI: teach to take after dialysis

--- teach to take with meals to reduce nausea

What do Erythropoietin-stimulating agents do for CKD?

Prevents or corrects anemia caused by kidney disease through the stimulation of the bone marrow | SubQ

- less fatigue but can cause iron deficiency

- epoetin alfa (Epogen, Procrit, generic)

- SE: HTN

- NI: hold when hemoglobin levels are > 13g/dL, give < 10g/dL

--- monitor BP

What do Parathyroid Hormone Modulators do for CKD?

Reduces parathyroid hormone by decreasing sensitivity to calcium helping to maintain more normal blood Ca and Ph levels

- cinacalcet (Sensipar)

--- NI: teach to report diarrhea and muscle pain (myalgia)

- sevelamer (Renagel): lowers Ph and w/o changing Ca level

What do Antihypertensives do for CKD?

Increases blood flow

- ACEi/ARBs: pt's with HTN and CKD

- CCBs: increase GFR and blood flow in kidney

NI: Goal- BP: 135/85

--- hold before dialysis

What are Contraindications of CKD?

- antacids with Mg, aluminum

- OTC decongestants (phenylephrine or pseudoephedrine) d/t incr. BP

- antihistamines

- NSAIDs (ibuprofen, naproxen)

What are Complications of CKD?

- Anemia

- Hypertension

- Dysrhythmias

- HF

- Metabolic acidosis

--- Kussmaul's respirations

What are therapeutic procedure for CKD?

Prevention (focus)

Management

- correction of extracellular fluid volume overload or deficit

- renal replacement therapy

- nutritional therapy

What are therapies for elevated potassium levels in CKD?

Regular Insulin

- insulin allows K to move into cell (lower)

- IV glucose is given with to prevent hypoglycemia

Sodium Bicarbonate

- corrects acidosis, shifting K into cell

Calcium Gluconate

- raises threshold for excitation

Hemodialysis

Sodium Polystyrene Sulfonate

- excretes K through BM

Dietary Restriction

- K intake limited to 40mEq/day

Patiromer

- binds K in GI tract, has delayed onset

What is involved in Nutritional Therapy?

Provide the food and fluids needed to prevent malnutrition and avoid Cx of CKD

- Protein: 0.55 - 0.60g/kg/day

- Fluid: as high as 1500-3000mL/day

- Potassium: 60-70 mEq or mmol/day

- Sodium: 1-3g/day

- Phosphorous: 700mg/day

What Nursing interventions should be implemented for protein restrictions?

Protein restriction

- increased protein breakdown and waste

Decreased protein leads to muscle wasting

- monitor BUN and serum prealbumin levels

- decreased prealbumin indicates poor protein intake

- if this occurs increase protein again

Teach high-proteins foods

- Avoid: red meats, poultry, seafood/fish, eggs, milk and cheese, beans, legumes, nuts, and soy, sweet potatoes

- Recommended: fruits, vegetables, grains (not whole), cereals

What Nursing interventions should be implemented for sodium?

Limit sodium to prevent fluid buildup and HTN

- no processed food, fast food, chips, pretzels, pickles, ham, bacon, sausage

- No salt substitutes

Teach high sodium foods

- table salt

- seasonings

- most canned foods and frozen dinners (rinse)

- salted snack foods

- Recommended: fruits, veg, frozen vegetables, fresh seasonings, fresh/dried herbs and spices, unsalted snacks

What Nursing Interventions should be implemented for potassium in CKD?

Limit potassium

Teach high potassium foods

- fruits (banana, melons, oranges, dried fruits)

- vegetables (deep colored and leafy greens, potatoes)

- beans

- milk

- nuts

- salt subs

- Recommended: raspberries, pineapple, grapes, asparagus, green beans, rice, noodles

What nursing interventions can be implemented to manage fluid volume in CKD?

Weigh daily at same time, using same scale, wearing same clothing

- 1kg = 1L fluid

Monitor I/Os

Keep fluids intake within prescribed amounts

Monitor for s/s of fluid overload q4h:

- decreased urine output

- rapid, bounding pulse

- rapid, shallow respirations

- dependent edema

- crackles or wheezes

- distended JVD

- decreased oxygen sat

- elevated BP

- narrowed pulse pressure

- assess LOC

- assess for HA or blurred vision

What Nursing Interventions should be implemented for phosphorous?

Teach high phosphorous foods

- dairy products

- nuts/seeds

- dried beans/peas

- bran cereals/whole grains

- beverages: cocoa, ale, beer, chocolate drinks, dark colas

Recommended: fresh fruits, fresh vegetables, popcorn, crackers, rice cereal, sherbert/sorbet, coffee/tea without milk, light colored sodas, fruit juices

calcium has inverse relationship (monitor both)

What are the General Principles of Dialysis?

Removes excess fluids and waste products and restores F&E balance and acid-base balance

- Diffusion: high -> low concentration

- bicarb and Ca generally move the dialysate into the plasma

- Ultrafiltration: fluid removal

What is Peritoneal Dialysis?

Using the peritoneum space (semipermeable membrane) to diffuse via diffusion AND osmosis

- Advantages

--- flexible schedule for exchanges

--- few hemodynamic changes during and after exchanges

--- fewer dietary and activity restrictions

--- no vascular access

---

- Disadvantages:

--- risk for infection

--- increases glucose (caution w/ DM)

What Access is used for Peritoneal Dialysis?

Catheter Placement: no need for vascular access

Tenckhoff Catheter: intraabdominal catheter placed in IR or at bedside

What is the training/procedure for Peritoneal Dialysis?

Inflow

- 3-7 day training program

- less complex, can be managed by 1 person

- simple and often done at home, STERILE technique

- Tx time: 24hr

Dwell

- 30 min to 8 hr

Drain

- 15-30 gently massage or change position

What equipment is used for Peritoneal Dialysis?

sterile

Dialysate solution (contains glucose to create the pull)

- bacteria and other organisms too large to pass through membrane

Peritoneal Dialysis Systems

- Continuous Ambulatory PD (CAPD)

--- 24/7, 2L exchanges, done by pt

- Continuous-cycling PD (CCPD)

--- 24hr, by machine at night, final exchange dwells all day and emptied before bedtime, sterile catheter opened less often

- Intermittent PD (IPD)

--- auto or manual

What is the Urea Clearance for Peritoneal Dialysis?

Based on exchange, fluid and electrolytes in the peritoneal cavity

What are Complications for Peritoneal Dialysis?

- Exit site infection

- Hyperglycemia

- Carb and lipid abnormalities

- Respiratory distress

- Bowel perforation

- Weight gain

- Peritonitis

--- hard rigid abdomen, tender, N/V, Increased VS (HR, BP, SG pain, fever) dehydration, decreased bowel sounds,

- Hernias

- lower back pain

- Bleeding

- Protein loss

- Sepsis (BP low, HR high) medical emergency

What are Contraindications of Peritoneal Dialysis?

- Extensive peritoneal adhesions, fibrosis, active inflammatory GI disease

- Ascites or central obesity

- Recent abdominal surgery

What is involved in the nursing care for Peritoneal Dialysis?

Cleaning

- Mask up and wash hands

- Sterile gloves

- Assess for infections

- Use aseptic technique

Self- Management

- problems with outflow, ensure clamps are open and not kinked, turn from side to side, stand or cough

Teach

- Protein: 1.2-1.5g/kg/day

- Fluid restriction based on fluid weight gain and BP

- Sodium: restriction based on fluid weight gain and BP

- Phosphorus: 800mg/day

Effluent

- if opaque/cloudy send sample to lab (first sign of peritonitis)

Drainage

- monitor drainage (should look like urine)

- if not draining look for kinks and change positions

What is Hemodialysis?

Blood is passed through a machine, filtered, and then returned to a patient

- Advantages:

--- more efficient clearance of wastes

--- shorter treatment time

What Access is used for Hemodialysis?

Arteriovenous (AV) Fistula: formed by connecting an artery to a vein

- Allen test done before procedure

--- occlude artery -> blood return in < 15 sec

- Monitor for steel syndrome (pallor, pulseless, pain)

- Fistula less likely to clot than a graft

- 2-4mo before use

AV graft: more thrombogenic and increased risk for infection

- 1-2wk before use (for more urgent needs)

Temporary Vascular Access

What training/procedure is used for Hemodialysis?

- Requires a professional with specialized training

- 3x a week

—- 4hr session (common) OR 2, 5-6hr sessions (ongoing urine production)

What Equipment is used for Hemodialysis?

Dialyzers

- 4 parts: blood compartment, a dialysate compartment, a semipermeable membrane, and an enclosed structure

- HD Dialysate is not sterile

- Machine has bult-in safety features: ability to record VS, blood and dialysate flow, etc.

- Aseptic technique

- Blood clotting can occur: heparin is delivered during HD and remains active for 4-6 hours after

--- risk for hemorrhage, protamine sulfate should be readily available

What is the Urea Clearance for Hemodialysis?

- Passive transfer of toxins by diffusion

- Sodium moves from blood to dialysate

- Extra fluid is pulled by osmosis

What are Complications of Hemodialysis?

- Muscle cramps and back pain

- Loss of blood

- Hepatitis

- Disequilibrium syndrome

- HA

- Itching/pruritus

- Hemodynamic and cardiac complications (hypotension, cell lysis, anemia, dysrhythmias)

- Infection

- Increased risk for subdural and intracranial bleeding from anticoagulation and BP changes

What are Contraindications for Hemodialysis?

- Hemodynamic instability

- Severe vascular disease preventing vascular access

- Bleeding disorders

- Uncontrolled diabetes

What findings would indicate hemodialysis was effective?

- Decrease in serum potassium levels

- Weight loss

- Improvement in BP control

- Reduction in serum CR and BUN levels

What is involved in the nursing care for Hemodialysis?

- Weigh pt before and after dialysis

- Give heparin d/t risk for clots; hold HTN meds before

- Assess BP, HR, RR, temp, and LOC

- Do not take BP or start IV on extremity with vascular access

- Palpate for thrills or bruits over site q4h (normal)

- Assess distal pulses and circulation

- Elevate affected extremity after surgery

- Encourage routine ROM exercises

- Assess for infection at sites

- Teach pt not to carry heavy objects or anything that will compress extremity with the vascular access

- Teach not to sleep on top on extremity with vascular access

What is the selection process for the Kidney Transplant Recipient?

- No medical issues that increase risk

- HIV & Hep B or C okay to have

- 2-70 yo, >70 considered on individual basis

- Histocompatibility studies

What are Contraindications for the Kidney Transplant Recipient?

- Advanced, uncorrectable cardiac disease

- Metastatic cancer (less than 2-5 yrs)

- Chronic infection

- Psych issues (substance abuse)

- Long standing pulmonary disease

- GI disorders require treatment because of long term steroid use

- DM and other endocrine disorders are high risk

once tx is received transplant can be considered

What are the labs/diagnostics for a Kidney Transplant match?

Step 1

- Human Leukocyte Antigens (HLA) Matching

--- matching of 6 HLA is best

Step 2

- Panel Reactive Antibody (PRA)

--- lower % is better (less likely to be rejected)

Step 3

- Crossmatch test

--- negative = no reaction, no rejection (good result)

What is the surgical procedure for the Kidney Transplant Recipient?

Failing kidney is not removed unless infection may be present that causes pain

What occurs during Preop for the Kidney Transplant Recipient?

- 4-5 day hospital stay

- Workup: crossmatch done again right before surgery b/c blood antibodies change over time

- Maintain vascular access (may need after surgery)

- Dialysis usually 24 hours before surgery and an infusion of donor blood

- Urinary system evaluation

--- Some have not used lower urinary tract for years so ureter and bladder problems may require surgical correction before transplant

What meds are used to treat the Kidney Transplant Recipient?

- Immunosuppressants

- Corticosteroids

How do immunosuppressants work for Kidney Transplant?

Inhibitors of T-cell proliferation and activity, mTOR inhibitors, and monoclonal antibodies

- taken for life

- azathioprine, mycophenolic acid, cyclosporine, tacrolimus

- ADR: malignancy (cancers), CAD, HTN, infection

How do Corticosteroids work for Kidney Transplant?

Broadly inhibit cytokine production in most leukocytes, results in generalized immunosuppression

- may be weaned off after a couple years

- methyl prednisone

- ADR: hyperglycemia, infection, HTN, hyperlipidemia, osteoporosis, joint pain

What is the selection process for the Kidney Transplant Donor?

Live Donors

- Paired or chain exchange donation

- Must have compatible blood type & ABO compatibility

- Insurance will cover, not work time off

- Highest rate of kidney graft survival (90%)

- No current active cancer

- No HTN or kidney disease

- Adequate kidney function as determined by diagnostic studies

- Must express a clear understanding of the surgery and still be willing

- Some states require a psych eval to assess motivation

Deceased

- non-heart-beating donors and cadaveric donors

What is the surgical procedure for the Kidney Transplant Donor?

Laparoscopic for live donors

What occurs during Preop for the Kidney Transplant Donor?

- 2-4 day hospital stay, return to work 4-6 weeks

- labs

- pain management

- wound care

- psych support

What are complications of Kidney Transplants?

Rejection

- recipient will always have at least 1 experience with acute rejection; increase immunosuppressants

Susceptibility to infection

- inspect skin

- aseptic technique and hand washing (sterile gloves)

Thrombosis

Renal artery stenosis -> HTN

Graft failure

- AA, Hispanic Americans, and NA have greater incidence of graft failure and systemic cx

What is Hyperacute Rejection?

Onset

- within 48 hours of surgery

S/S

- increased temp, BP, and pain at transplant site

Tx

- immediate removal of the transplant kidney

What is Acute Rejection?

one episode is normal

Onset

- 1 week to any time after surgery

- over days to weeks

S/S

- Oliguria or anuria

- Temp over 100F (37.8C)

- Increased BP

- Enlarged, tender kidney

- Lethargy

- Elevated serum BUN/CR, K+ levels

- Fluid retention

Tx

- increase doses of immunosuppressive drugs

What is Chronic Rejection?

Onset

- gradually, within months to years

- irreversible

S/S

- gradual increase in BUN/CR levels

- Fluid retention

- Changes in serum electrolyte levels

- Fatigue

Tx

- conservative management until dialysis require

What is involved in the nursing care for Kidney Transplants?

Urologic management

- foley is placed to monitor UO and decompress the bladder; removed 3-5 days

- CAUTI prevention

Assessment of hourly output x 48 hours

- abrupt reduction in UO is a sign of rejection, AKI, thrombosis, or obstruction

- color may be pink/bloody after surgery, returns to normal over days/weeks

- daily urine for UA, glucose, acetone presence, sepcific gravity, and culture (if needed)

- replace 1 ml loss for 1 ml because UO can be as high as 1L per hr

- Electrolyte imbalances (high risk); hyponatremia/kalemia

- Daily weights

Real artery stenosis

- assess for bruits and kidney function

What is the patho for Cancer?

Changes in cellular proliferation

- defect in cellular proliferation

--- cancer cells divide in an indiscriminate, unregulated manner and exhibit significant variations in structure and size

- defect in cellular differentiation

--- cancer can arise from any cell in the body that can evade the normal regulatory control of proliferation or growth and cellular differentiation

What are Benign Tumors?

Encapsulated neoplasm that remains localized in te tissue of origin and is typically not harmful

- exert pressure on surrounding organs

- will decrease blood supply to the normal tissue

What are Characteristics of Benign Tumors?

Cell division

- continuous or inappropriate

Appearance

- specific morphologic features

Cell characteristics

- fairly normal; similar to parent cells

Encapsulated

- usually

Differentiated function

- many

Metastasis or migration of cell

- absent

Recurrence

- rare

Vascularity

- slight

Mode of growth

- expansive

What are Malignant Tumors?

Nonencapsulated neoplasm that invades surrounding tissue; spreads by means of four primary mechanisms

- Vascular system: circulate; may penetrate vessel walls and invade adjacent organs

- Lymphatic system

- Implantation

- Seeding: primary tumor sloughs off tumor cells into a body cavity

What are the Characteristic of Malignant Tumors?

Cell division

- rapid and continuous

Appearance

- anaplastic

Cell characteristics

- cells abnormal; become more unlike parent cell

Encapsulated

- rarely

Differentiated functions

- some or none

Metastasis or migration of cell

- yes

Recurrence

- possible

Vascularity

- moderate or marked

Mode of growth

- infiltrative, invasive, and expansive

What are different Malignant Tumors?

Epithelial tissue

- Adenocarcinoma | -carcinoma

Connective tissue

- Osteosarcoma | -sarcoma

Nervous system tissue

- Neuroblastoma | -oma

Hematopoietic tissue

- Multiple Myeloma | -oma

What causes Cancer?

- Chemical agents

- Radiation: UV and ionizing

- Viral

- Genetic

What are expected findings in Cancer?

CAUTION

Changes in bowel or bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or lump in the breast or elsewhere

Indigestion or difficulty swallowing

Obvious change in a wart or mole

Nagging cough or hoarseness

What are risk factors for Cancer?

Diet

- high fat, preservatives, smoked foods, salt-cured foods contained increased nitrated

- low fiber diet

Stress

Carcinogens

- cigarette smoking, tanning beds, sun exposure

Weight

- obesity

Sleep

Alcohol