Kidney transplantation

Kidney transplantation

1. Kidney T ransplantation Presented by---- Mrs. Usha Rani Kandula , MSc.Nursing , Assistant professor, Department of Adult Health Nursing, College of Health Sciences, Arsi University, Asella , Ethiopia.

2. introduction -Kidney transplantation has become the treatment of choice for most patients with ESRD.

3. Reasons of kidney transplant -the desire to avoid dialysis or - to improve their sense of well-being and - the wish to lead a more normal life.

4. -Additionally , - the cost of maintaining a successful transplantation is one-third the cost of treating a dialysis patient.

5. definition of kidney transplantation -Kidney transplantation - transplanting a kidney from a living donor or human cadaver - to a recipient who has ESRD (End stage renal disease/ CRF).

6. Compatible ABO and HLA antigens -Kidney transplants from well-matched living donors who are related to the patient are slightly more successful than those from cadaver donors. (those with compatible ABO and HLA antigens) ABO- Blood grouping HLA- Human leukocyte antigen

7. Procedure -The success rate increases if kidney transplantation from a living donor is performed before dialysis is initiated.

8. Nephrectomy of the patient’s -A nephrectomy of the patient’s own native kidneys may be performed before transplantation.

9. Placement of new kidney The transplanted kidney is placed in the patient’s iliac fossa anterior to the iliac crest.

10. - The ureter of the newly transplanted kidney is transplanted into the bladder or anastomosed to the ureter of the recipient.

11. PREOPERATIVE MANAGEMENT -Maintenance of patient’s normal metabolic state - patient is free of infection, - preparing the patient for surgery.

12. Medical Management - performance of complete physical examination. -prior Identifying possible complications after transplantation.

13. Conducting investigations Tissue typing, Blood typing, Antibody screening to determine compatibility of the tissues and cells of the donor and recipient.

14. - Completion of other diagnostic tests. -Assessment of lower urinary tract. psychosocial evaluation of the patient.

15. Nursing Management - Pre-operative teaching of the patient. -Explanation of outcomes of the surgery. -Maintenance of post-operative care.

16. Immunosuppressive Therapy -The survival of a transplanted kidney depends on the ability to block the body’s immune response to the transplanted kidney.

17. Immunosuppressant agents -immunosuppressant agents such as Azathioprine ( imuran ), Corticosteroids (prednisone), Cyclosporine, and OKT-3 ( a monoclonal antibody ). Note:Minimising the doses of immunosuppressant agents.

18. Postoperative Nursing Management - ASSESSING THE PATIENT FOR TRANSPLANT REJECTION - oliguria , - edema , - fever , - increasing blood pressure, - weight gain, - swelling or tenderness over the transplanted kidney or graft.

19. Monitoring of blood reports -blood chemistry tests (BUN and creatinine ) leukocyte and platelet counts Note: Immunosuppression depresses the formation of leukocytes and platelets .

20. Clinical manifestations of infection -Clinical manifestations of infection include shaking chills, fever, rapid heartbeat and respirations (tachycardia and tachypnea ), and either an increase or a decrease in WBCs ( leukocytosis or leukopenia ).

21. Nursing care -Monitoring for infection . -Following aseptic measures while caring patient. -Performance of Urine c/s frequently -Observing wound drainage. -providing catheter care. -Minimize hospital/ patient visitors - Monitoring urinary functioning

22. -Care of patient under haemodialysis . -Monitoring patient fluid and electrolyte status. -Assessment of urinary drainage. -Monitoring intake and output of the patient. -Checking vital signs. -Administration of intravenous medications. -Identifying psychological status of the patient. -Monitoring and managing potential complications.

23. -Educating regarding physical exercises. -Education regarding home and continuous care. -Understanding anxiety level of the patient.

24. Instruments used for kidney transplantation

25. Top: -Webster infusion cannula . Bottom, left to right: -2 iris scissors, straight, sharp, 4 inch; -1 facelift scissors, curved, 7 3/4 inch; -2 Metzenbaum scissors, curved,7 inch.

26. Webster infusion cannula

27. Left to right: -2 Metzenbaum scissors, curved, 9 inch; -1 Potts-Smith cardiovascular scissors; -and 2 Ryder needle holders, 9 inch.

28. Tip of Ryder needle holder.

29. Left to right: A, 2 jeweler’s forceps, and tip; B, 2 Adson tissue forceps with teeth (1 × 2), and tip; C, 2 Gerald- DeBakey tissue forceps, 7 inch, and tip; D, 2 microdiamond dust ring forceps, 7 inch, and tip.

30. Left to right: A, 2 Autraugrip tissue forceps, titanium, and tips; B, 1 Kay aortic clamp, and tip; C, 2 Cushing vein retractors, and tips; D, 1 nerve hook, dull, and tip; E, 1 bulldog clamp applier, and tip; F, 1 Lahey gall duct forceps, and tip.

31. Left center and clockwise: -A, 1 Backhaus towel clip; -B, 4 Hartmann mosquito forceps, curved, and tip; -C, 2 microdiamond dust needle holders, 6 1/4 inch, and tip; -D, 2 Fell carbon inlay needle holders, 6 inch, and tip.

32. Thanking you