Section 6: Organ-Specific Care: Kidney, Liver, Heart, Lung

NUR 433: Adult Health II; MCUSON; Mrs. Cooper

kidney: Graft placed in the _____ _____ outside the peritoneum; native kidneys usually stay. The donor ureter is tunneled into the bladder

iliac fossa

kidney: _____ _____ is the first vital sign: often very high at first; replace per protocol. Avoid hypotension. Watch K+, Hgb/Hct, and catheter patency

urine output

kidney: Early _____ can cause low Na+, low K+, and dehydration. Delayed graft function may need temporary dialysis

diuresis

kidney: _____ (about 10%, days to 3 months): fever, graft tenderness, hematuria, falling output, rising creatinine, weight gain, hypertension

rejection

kidney: The living donor often has more pain than the recipient; monitor their _____ function and Hct

kidney

kidney: _____-year graft survival: about 90% (deceased donor) and 95% (living donor)

one

kidney: priority: a sudden _____ in urine output after a brisk diuresis: check the catheter first, then notify the surgeon. It can mean obstruction, a clot in the graft vessels, or rejection

drop

liver: signs the _____ is working: improving INR, clearing lactate, normal glucose, waking up, bile production

graft

liver: _____: rising AST, ALT, bilirubin, alkaline phosphatase; jaundice, dark urine, clay stools, ascites, fever

rejection

liver: _____: bleeding, hepatic artery or portal vein thrombosis, bile leak or stricture, renal failure

complications

liver: New _____, rising lactate, or worsening INR can mean primary graft failure: report immediately

hypoglycemia

heart: The new heart is _____ (no nerve supply). Resting HR 90–110 with no vagal brake

denervated

heart: Heart rate rises slowly with exercise, relying on circulating _____: teach a warm-up and cool-down

catecholamines

heart: _____ is ineffective, and the patient won't feel angina during ischemia

atropine

heart: _____ is often silent (fatigue, dyspnea, weight gain, bloating), most common at 3–6 months; endomyocardial biopsy confirms

rejection

heart: _____: RV failure, bleeding, sudden cardiac death; long term, cardiac allograft vasculopathy

complications

***Memory aid: No nerves, no brakes, no pain: fast resting rate, slow response, no angina

lung: Lung-protective ventilation and early extubation. The _____ reflex is lost below the anastomosis: aggressive pulmonary hygiene

cough

lung: Primary graft dysfunction looks like _____ in the first 72 hours

ARDS

Lung _____: dyspnea, fever, hypoxemia, new infiltrates. Home spirometry: report an FEV1 drop of 10% or more

rejection

lung: _____ infection risk of any solid organ, because the lungs are open to the environment. Chronic rejection = bronchiolitis obliterans syndrome

highest