This document provides an overview of nursing management for patients undergoing renal transplantation. It discusses indications for transplantation, donor selection, surgical procedure, postoperative management including immunosuppressive therapy, potential complications, and discharge teaching. Nursing diagnoses addressed include risks for infection, fluid imbalance, pain, and transplant rejection. The prognosis is generally good with 1-year graft survival rates of 85-90% from living donors. Lifelong follow-up is required due to risks of infection, rejection, and side effects of immunosuppression.
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum. A more convenient method of dialysis in home itself.
It is the removal of solutes and water from body across a semipermeable membrane (dialyzer)
care during and after the dialysis is very important to prevent the entry of pathogens in to the body.
End-stage renal disease is a condition in which the kidneys no longer function normally and required excellent medical and nursing care for the managing this condition.
Infection control protocols in intensive care unitsANILKUMAR BR
Hospital acquired infections (HAIs) are common in intensive care unit (ICU) patient and are associated with increased morbidity and mortality.
The main reason being severity of illness, interruption of normal defense mechanism (e.g. mechanical ventilation), malnutrition & inability to ambulate make it more susceptible to multi drug resistant organism (MDRO).
The most frequent mode of transmission is Contact transmission, this may be direct or indirect other modes include droplet transmission, airborne transmission, common vehicle such as ventilator etc.
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum. A more convenient method of dialysis in home itself.
It is the removal of solutes and water from body across a semipermeable membrane (dialyzer)
care during and after the dialysis is very important to prevent the entry of pathogens in to the body.
End-stage renal disease is a condition in which the kidneys no longer function normally and required excellent medical and nursing care for the managing this condition.
Infection control protocols in intensive care unitsANILKUMAR BR
Hospital acquired infections (HAIs) are common in intensive care unit (ICU) patient and are associated with increased morbidity and mortality.
The main reason being severity of illness, interruption of normal defense mechanism (e.g. mechanical ventilation), malnutrition & inability to ambulate make it more susceptible to multi drug resistant organism (MDRO).
The most frequent mode of transmission is Contact transmission, this may be direct or indirect other modes include droplet transmission, airborne transmission, common vehicle such as ventilator etc.
Cancer of liver usually results from metastasis from a primary cancer at a distant location.
The liver is likely area of involvement i.e. cancer originated in the esophagus, lungs ,breast, stomach, colon, pancreas, kidney, bladder etc.Hepatic tumor may be malignant or benign.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Anaesthesia for Living Donor Combined Liver Kidney TransplantationApollo Hospitals
Orthotopic liver transplantation is now the best therapeutic option for patients with chronic liver failure [1]. Liver transplant is now a routine surgery performed in numerous medical centers throughout the world. Till now about 600 liver transplants have been performed in the Indraprastha Apollo Hospital, New Delhi. Combined liver kidney transplantation (CKLT) is the treatment for end-stage liver and kidney diseases. Combined liver kidney transplantation from living donors is performed in very few centers. Not many cases of Living donor combined Liver Kidney transplantation has been described in the literature. Here we report the clinical experience of our first living donor combined liver kidney transplantation (kidney after liver) in patient with end-stage liver disease (ESLD) and end stage renal failure (ESRD). Liver and kidney graft has been harvested from two living related donors.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
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Nursing Management of patient undergoing renal transplantation.pdf
1. Nursing Management of Patient Undergoing Renal
Transplantation
Presented By
Karana Ram
Msc.(n) 1st year
2.
3. INTRODUCTION
➢Renal transplantation is the treatment of choice for
chronic irreversible renal failure.
➢The current donation rate is much higher in the four
states of Tamil Nadu, Andhra Pradesh, Gujarat and
Maharashtra with it being 0.3 per million
population
4. ➢Definition
➢ Renal transplantation is the surgical implantation of a
Human kidney from a compatible donor in a recipient”.
OR
➢A kidney transplant is a surgery to place a healthy
Kidney from a living or deceased donor into a person
Whose kidneys no longer function properly.
5. History
➢1902- The first successful experimental kidney transplants were
performed at the Vienna Medical School in Austria with animals.
➢1909 - The first kidney transplant experiments were performed
humans in France using animal kidneys.
➢1933 - The first human-to-human kidney transplant was performed.
➢1950 - Cortisone-like medications were used to suppress the
human body immune system resulting kidney transplant success.
10. PRE-OPERATIVE/CHECKLIST-
1. VBG- Post Haemodialysis after admission
2. CBC, KFT, PT /APTT,.
3. Blood Grouping and cross matching.
4. ECG.
S. Nil orally.
6. Part preparation .
7. P.C. enema
8. Betadine paint
10. Written Consent
,11. Injection Emeset
12. Injection Augmentin- Dose: 600 mg IV BD
13. Injection Magnex forte 1.5 gm IV
14.Cap. Tacrolimus
16. Tab. Mofetyl S 720 mg
17. Tab. Ativan- 1mg
18. Injection rabbit ATG 75 MG
19. Injection Augmentin, Injection Magnex forte to be sent with patient in OT.
20. Recipient's arterial line, central line ON LEFT IJV
14. DONOR
Client placed in lateral decubitus
position
Incision made at level of 11th rib.
The left kidney mostly preferred for
laparoscopic removal.
15. HTK- Custodial Solution
HTK (Histidine-
Tryptophan-Ketoglutarate)
Solution.
HTK is perfused as a cold
solution, so that its
hypothermic effect
contributes to a
decreased metabolic rate.
16. RECIPIENT
Incision made between iliac crest and pubis.
Transplanted kidney placed in iliac fossa.
17. Contd,,
Renal artery anastomosed with external iliac artery and renal
vein with external iliac vein.
Donor ureter anastomosed with bladder mucosa
18.
19. Preoperative Management
•A complete physical examination is performed to
detect and treat any conditions that could cause
complications after transplantation.
•The patient must be free of infection at the time of
renal transplantation because after surgery the patient
will receive medications to prevent transplant
rejection.
•Hemodialysis is often performed the day before the
scheduled transplantation
•Provide psychological support to the patient.
20. Contd,,
• Patient should be NPO for 6 hours before
surgery.
• Informed consent should be taken from
patient as well as relatives also.
• Antibiotic should be given before surgery
as prescribed by surgeon.
• Skin preparation of operating site should
be done.
23. CALCINEURIN INHIBITORS
Eg: cyclosporine , tacrolimus
Dose : 6-8 mg/ kg per day
SIDE EFFECTS :.
Nephrotoxicity
Glucose intolerance
Hypertention
Gingival hyperplasia
24. PURINE ANTAGONIST
Azathioprine (Azoran)
DOSE: 1.5 to 2 mg/kg per day
ACTION: Inhibits both DNA & RNA synthesis and
prevents growth of lymphocytes
Side effects
●Neutropenia (main)
●Alopecia
●Muscular pains
●Malignancy
●Altered liver function
25. POSTOPERATIVE NURSING
MANAGEMENT
Maintaining the normal blood pressure.
Assessing the surgical site.
Blood sugar monitoring 4 hourly.
Maintain strict aseptic precautions and
Preventing from infection
Monitoring and managing potential complication.
Strictly monitor urine output hourly.
Assessing the patient from transplant rejection.
Replace the urine output with IV fluid.
Vaccinated the patient.
26. POST OPERATIVE NURSING DIAGNOSIS
INEFFECTIVE AIRWAY CLEARANCE
RELATED TO DEPRESSED RESPIRATORY
FUNCTION, PAIN, AND BED REST
➢Close monitoring of respiratory status.
➢Assess respiratory pattern, auscultate for
any crackles or abnormal respiratory sounds
➢Early chest physiotherapy
➢Encourage to do deep breathing exercises
27. RISK FOR FLUID AND ELECTROLYTE IMBALANCE
RELATED TO POTENTIAL GRAFT DYSFUNCTION
➢Assess CVP and urine output hourly.
➢Fluids given are 5% dextrose, RL, NS.
administered through central venous line.
➢Oral fluids are given once the patient
tolerates.
➢ Amount of fluid to be given
➢Output less than 50ml/hr : inform
➢Output 50- 200ml/hr: output+150ml
➢Output 200-400ml/hr: output amount
➢Output 400-500ml/hr:400ml of fluid
28. ACUTE PAIN RELATED TO SURGICAL
SITE INCISION
Assess pain : patterns, any radiating pain.
Administer analgesics as prescribed
●Epidural analgesia or PCA Opiate derivative-
morphine is commonly used
●Non pharmacological measures like
distraction, imagery, relaxation etc can be
used.
29. RISK FOR TRANSPLANT REJECTION IN THE RECIPIENT
RELATED TO NON HISTOCOMPATIBILITY
Assess for oliguria, edema , fever, increase BP, weight gain,
and swelling or tenderness over graft.
30. POTENTIAL FOR DEVELOPING INFECTION RELATED TO
THE IMMUNO SUPPRESSED STATE
➢Assess for infection: chills and fever, tachycardia,
tachypnea & decrease or increase in WBC count
➢Strict hand hygiene & use of barrier nursing
➢Meticulous care of urinary catheter, wound, peritoneal
catheter site & CVP line using aseptic technique.
➢Visitors are minimized and monitored for infections
➢Maintain patient’s personal & oral hygiene
31. DISCHARGE TEACHING
▪ Educate them about the need for continuing
immunosuppressive therapy.
▪ Instruct family members to assess for signs and symptoms
of transplant rejection, infection, & potential adverse effect
of immunosuppressant medication.
▪ Explain the patient need for life long follow up care.
▪ Avoid long time sitting,
▪ Watch for malignancy as the patient is receiving long term
immunosuppressive therapy.
32. DIETARY MODIFICATIONS
➢ Limit sodium, saturated fat and cholesterol intake.
➢ Monitor weight on a daily basis.
➢ Avoid sugary snacks between meals
➢ Eat 1000- 1500mg calcium daily
➢ Regular exercise 30 mins at least 3 times a week
➢ Drink plenty of fluids 3 to 4 litres per day
33. Clinic visits
➢ Upto 2 months : twice a week
➢ 3 to 6 month : once a week
➢ 6 to 1 yr : once a month
➢ More than 1 yr : Atleast once in 3 months
Lab tests
➢ Test for kidney function
➢ Test for blood count
➢ Test for liver function
➢ Blood glucose
34. PROGNOSIS
▪ 1 year graft survival rates are 85% to 90% with
transplants from living donors and 75% to 80% with
cadaver kidneys
▪ The overall mortality rate 2 year after transplantation
is about 10%
36. GRAFT REJECTION
Sign and symptoms-
•Temperature higher than 100 °F (37.8 °C)
•Pain or tenderness over the grafted kidney
• 2- to 3-lb weight gain in 24 hours
•Edema
•Hypertension
•Elevated blood urea nitrogen and serum
creatinine levels Decreased creatinine clearance
Elevated white blood cell count
37. TYPES
Hyperacute rejection-
Hyperacute rejection occurs immediately in the
operating room or within 48 hours after the transplant.
Intervention:-
Removal of rejected kidney
38. ACUTE REJECTION
Occurs within 1 week postoperatively, but can occur
any time post transplantation.
Intervention:
Potentially reversible with increased
immunosuppressive therapy and corticosteroids.
39. CHRONIC REJECTION
Occurs slowly months to years after transplant(Gradual
decline in renal function.)
Associated with renal ischemia, hypertention, tubular
atrophy, interstitial fibrosis. Can be due to HLA
incompatibility, age, and ischemic history of a donor kidney.
Interventions:
Immunosuppressive medications and dialysis if
necessary.
40. RESEARCH ARTICLE
A Study on the Correlations of Anxiety and
Depression With Self-Management Ability
and Endogenous Creatinine Clearance Rate
in Renal Transplant Recipients
41. ABSTRACT
Objective: To explore the e
ff
ects of anxiety and depression on the
self-management ability and endogenous creatinine clearance rate of
renal transplant patients.
Method: Eighty-eight renal transplant recipients who were followed
up in the outpatient clinic of the A
ffi
liated Hospital of Zunyi Medical
University were selected using convenient sampling. The self-made
general data sheet, Self-Rating Anxiety Scale, Self-Rating Depression
Scale, and Self-Management Scale for Kidney Transplant Recipients
were used. Correlation analysis was used to
fi
nd factors related to
endogenous creatinine clearance, while multiple linear regression was
used to identify factors in
fl
uencing endogenous creatinine clearance.
Patients with or without anxiety and depression were divided into
groups, and the indexes of the groups were compared using the
independent samples t test or chi-squared test.
42. Contd,,
Results: Anxiety was present in 12.5% of patients, depression in 25%, and
a moderate level of self-management of renal transplant recipients had
endogenous creatinine clearance within the normal range, and 34.1% had a
body mass index not in the normal range .The endogenous creatinine
clearance rate was negatively correlated with age and degree of
depression, and positively correlated with body mass index, treatment
management score, and psychosocial management score. The main
in
fl
uencing factors of endogenous creatinine clearance rate were age, sex,
depression, body mass index, and treatment management score. The
endogenous creatinine clearance rate and psychosocial management
ability were signi
fi
cantly higher in patients without anxiety and depression
than in patients with anxiety and depression.
Conclusions: Anxiety and depression showed signi
fi
cant negative e
ff
ects
on the psychosocial self-management ability and endogenous creatinine
clearance rate of renal transplant recipients and thus should be given more
attention.
43. SUMMARY
In today’s seminar we have discussed about
the nursing management of patient
undergoing renal transplantation including
definition, history, indication, pre operative
screening and checklist ,contraindication
and its management.
44. CONCLUSION
The kidneys are a vital organ critical to the human
body. From filtering waste from blood to produce
red blood cells, it serves a crucial role. Renal failure
is a serious condition that could complicate the
course of many of patients. Therefore, renal
transplant is an important aspect leading to the
saving the life of individual at end stage. Successful
renal transplantation significantly improves the
outcome of a patient with end stage renal disease.
45. REFERANCE
1)Brunner and Suddarth; Textbook of Medical Surgical
Nursing 13th Edition Volume II. New Delhi; Wolters
Kluwer Publication.
2)Lewis. Medical Surgical Nursing Assessment and
Management of clinical problems.2015. New Delhi.
Elsevier. 2nd Edition. Volume II.
3)Petrica A. Potter; Fundamentals of Nursing South Asian
Edition Volume I. New Delhi; Elsevier Publications
4)Joyce M. Black, Jane Hokanson Hawks. Medical Surgical
Nursing Clinical Management of Positive Outcomes.2015.
New Delhi. Reed Elsevier India Private Limited. Volume
II.