The investigative roles of ASIC
Topic: Perioperative Nursing Management of a Patient Undergoing a Cadaver Kidney Transplant in all Phases of the Patient Perioperative Experience.
Perioperative Nursing Management to a Cadaver Kidney Transplant Patient
Successful kidney transplant is critical and highly crucial
in the context of offering improved quality and prolonged life. Consequently, it
is more efficient unlike long–term dialysis thereby administered to patients
having chronic or end stage renal disorder (Zuber,
et al. 2011). Therefore, there is need
to ensure successful transplant of a kidney from a donor and the respondent to
accept the organ and function effectively. Cadaver kidney transplant involves
getting a donation from a brain-dead potential organ donor (Glazer et al.
2009). The process of transplant from a
dead person is a critical one and involves various perioperative measures to
manage and ensure effective transplant process. This is ensured to utilise
organs from healthy persons who have passed on and having proper match to the
receiving patient (Doxiadis, de Fijter, Mallat, et al. 2007). This essay outlines the various
perioperative nursing management to a cadaver kidney transplant in all the
stages during the whole process. This will be achieved by discussing the various
operations necessary in the perioperative process of cadaver kidney transplant.
The processes are similar to live donor transplant only that with cadaver
transplant, there is need to ensure the organ from the dead donor is fit for
Chronic renal failure or the end-stage renal disease prompts
surgical procedures upon the patients whether undergoing dialysis or not (Klatte,
Seitz, Waldert, et al. 2010). The
carrying out of perioperative procedures to cadaver kidney transplant is equally
important to ensure the patient recovers and the new kidney is accepted by their
body system; that is, it matches with recipient’s body system. The
responsibility for perioperative care and nursing management of chronic kidney
disease patients is shared among the family physician, nephrologist,
anaesthesiologist and surgeon (Heemann et al. 2011). This ensures every aspect of the
nursing case is taken care of and efficiently ensured to make the patient
achieve full recovery. The perioperative nursing management practices are
carried out immediately before the operation and during the main surgery. The
procedures are carried out to ensure that the patient undergoes successful
transplant and does not attract other infections (Moroni, et al. 2010). The management practices as directed by
the surgeons will see to it that the renal system gets back to normal and the
excretion process runs effectively even during the operation by conducting a
prior dialysis to free the body off any harmful wastes. This is crucial to
ensure that once the new kidney is in operation, it is not overworked rest it
fails to pick up the system effectively due to excessive work.
Perioperative procedures are carried out to ensure stable and
healthy state of the patient in the course of the operation and take
precautionary measures in case of any alarm. The nurses evaluates the health of
the patients in regards to their blood pressure to determine probability of risk
to cardiac arrest, determining blood sugars, evaluation of presence of enough
blood to avoid anaemia, evaluate levels of potassium to determine whether
anaesthesia is to be used, evaluating acid-base disorders for reduce
perioperative risks (Evenepoel, Sprangers, Lerut,
et al. 2012). The procedures are
critical and are managed to ensure the body electrolytes are maintained to
minimise any chance of graft rejection after transplant. Candidates for renal
transplantation are subjected to extensive evaluation regarding their health
among other factors that may have adverse effects on the outcome (Doxiadis,
de Fijter, Mallat, et al. 2007). These
are carried out to ensure that the organ is accepted by the recipient’s body and
normal physiological process realised. Prior to the main operation, there are
procedures and management process necessary for consideration and evaluation.
Perioperative procedures are carried out to ensure compatibility and avoid
infection. In respect to cadaver kidney transplant, the perioperative nursing
management is critical and crucial to ensure the kidney obtained from the dead
donor is effective and working prior to transplant (Glazer, et al. 2009). The organ for transplant must be
obtained via consent from a healthy potential donor and calls for procedural
measures to re-achieve healthy and sound renal system. Consequently, health
tests like blood group, status of body functioning and blood sugars are assessed
prior to conducting kidney removal from the dead donor to ensure the organ is in
order. The organ is later treated with immunosuppression to promote acceptance
by the recipient.
Further, the kidney recipient is administered with
immunosuppression prior to operation which is vital in helping to prevent
alloimmune rejection response (Rang et al. 2006). The process is conducted to achieve the following: avoid acute and chronic
rejection; reduce the toxicity of drugs, as well as rates of infection and
malignancy; and eventually realise very high possible rates of patient and graft
survival (Egbuna, et al. 2007).
Immunosuppressive agents are administered before surgery to prevent graft
rejection. There is also need to look into the levels of potassium values in the
body system in order to avoid anaesthesia in patients having chronic kidney
disease with potassium serum level beyond 5.5 mEq per litre (5.5. mmol per
litre) (Rang, et al. 2006).
Nevertheless, it is necessary to administer acceptable levels of potassium level
prior to the main surgery. Nurses are expected to ensure continued dialysis
prior to transplant to ensure that the body waste products and excess waters are
removed without stressing the transplanted organ. Continued renal replacement
therapy is crucial in order to ensure fluid and electrolyte management and
prevent uremia even before the surgery (Zuber, et al. 2011).
During the surgery, there is need to minimise excessive
bleeding and this is ensured by controlling the occurrence of uremia to the
patient. This condition can lead to platelet dysfunction and result to enhanced
perioperative bleeding (KDIGO 2009). To minimise uremic complications, patients having end stage renal disease are
put into dialysis process a day prior to surgery. In respect to the bleeding and
platelets functioning, it is advisable that the patient ought not to be
subjected to antiplatelet agents, aspirin and dipyridamole (Persantune) within
72 hours prior to surgery with patients having end stage renal disease or uremic
chronic kidney disorder (Zuber, et al. 2011). It is also crucial to note that given
agents having minor platelet effects on patients without uremia can have
exaggerated effects on patients having end-stage renal disease and may
theoretically raise the risk of intraoperative bleeding.
With respect to haemodialysis, it is critical to avoid the
use of heparin. In normal circumstances, a small amount of heparin is utilised
in the process of haemodialysis with a residual anticoagulant effect that last
for even two and a half hours (Ciapetti
et al. 2009). With respect to the effect
of heparin to intraoperative bleeding is not very clear and therefore the need
to avoid use of heparin or wait at least 12 hour after the last haemodialysis to
commence surgery procedures. Renal functions decline orchestrated by decreased
renal production of erythropoietin, the patient is prone to anaemia (Zuber,
et al. 2011). This calls for
perioperative measures by nurses to ensure sufficient blood supply to the
patient in case of anaemic conditions.
With cadaver transplant, the organ is thoroughly examined for
any infections from the dead donor prior to the eventual death. Amid the fact
that the dead person may be termed healthy prior to death, thorough medical
check-up ensures no current of prevailing conditions can jeopardise the success
of the transplant. The organ is removed surgically by the surgeons and specially
placed under sterile conditions to safeguard the organ from any opportunistic
infections (Rang et al. 2006). Consequently, the organ must be transplanted
within the specified duration from the time of removal from the cadaver donor to
the kidney transplant recipient. The correction of severe anaemia is crucial to
the patient of cadaver kidney transplant to alleviate complications arising from
perioperative loss of blood and haemodilutional effects that may arise (KDIGO
2009). Consequently, this calls for
sufficient supply of required blood of the patient to ensure ready and steady
supply for transfusion. One possible downside regarding to product transfusion
is the formation of an anti-body. This may reduce the future chances of the
patient for successful transplant, therefore during the operation; operative
nurses ensure management practices looking into all ways of doing away with
emergence of antibodies.
Further, hyperkalemia is also checked regularly in the
operation process as it may occur with intraoperative infusion of blood supply
due to cellular lysis (KDIGO 2009). The precautionary nursing management measure looks into preventing cellular
lysis in the patient circulatory system during transfusion. Blood sugars are
also monitored and subsequent administration of low dosage of dextrose infusions
made with respect to detection of hypoglycaemia (Heemann et al. 2011). Normal levels of sugars are necessary
to ensure the body reacts normally in the excretion process after transplant. In
case of excessive work with low or high blood sugars, the new organ may be
With resistance of bacteria to prophylactic antibiotics there
is a need to establish the effective option for the patient as many patients
with chronic renal failure receive them for surgical procedures (KDIGO
2009). A preferable option is the first
generation cephalosporin within a dosage appropriate for renal functioning which
would act effectively as a choice for empiric therapy. With regard to blood
pressures as earlier illustrated, preoperative and intraoperative hypertension
is common with patients having chronic renal ailment and is enhanced by various
factors (Klatte, Seitz, Waldert, et al. 2010). The factors include anxiety, stress of
surgery prompting catecholamine response, as well as baseline hypertension
arising from kidney failure. Measures are thereby taken to reduce effects of
stress, lessen anxiety and steady the patient through the surgery. For patients
with hypertension, there are exceptions allowing for continuity with
antihypertensive drug therapy through the surgical period (Klatte,
et al. 2010). This is crucial for the
wellbeing of the patient, as well as ensuring reduced occurrence of
complications during and after the transplant. There are drugs that should be
discontinued with surgery, these incorporate antihistamines and decongestants as
they may lead to rebound hypertension. With diuretics, for patients with chronic
kidney ailment, there is need to discontinue 2-3 days prior to surgery (Glazer,
et al. 2009). This is crucial with
perioperative procedures as its discontinuation avoids possible volume depletion
and intraoperative hypotension that may worsen the functioning of the renal
The cadaver kidney transplant calls for critical measures to
ensure the donor’s kidney is in perfect condition prior to transplant, apart
from the critical matching physiological aspects, there also need for ensuring
hygiene and alleviating infections (Doxiadis,
de Fijter, Mallat, et al. 2007). In
essence, there is also need to maintain a urinary catheter patency and closed
system with the latter ensuring minimal risk to urinary tract while the former
being crucial in keeping the bladder decompressed and prevent pressure on suture
lines (Glazer, et al. 2009). There have been great concerns with respect to the cadaver kidney transplants
and there has been an upper limit of the number of cadaveric transplants that
can take place. In essence for this essay, is the perioperative procedures
within the nursing profession carried out as management measures to ensure a
successful transplant. It is therefore crucial to ensure effective perioperative
nursing management practices during cadaver kidney transplant to ensure a
success kidney transplant and enhance life of the patient.
In conclusion, cadaver organ transplant is essential in ensuring lifesaving as
getting live donors for kidney transplant is not sufficient for all patients in
need of kidney transplant. However, there is a greater need to look critically
at the perioperative nursing management practices to ensure successful
transplant and subsequent effective renal system after surgery. The carrying out
of such an intrusive procedure is advantageous in the sense that the patient’s
life is enhanced and can live a more natural life after the surgery and be aided
by immune-suppressants (KDIGO
2009). Although there are other remedies
and therapies for end stage renal diseases, renal failure proves very fatal and
kidney transplants present an opportunity to ensure life. Further, kidney
transplant is the preferred treatment mode that is cost effective and ensures
quality of life enjoyed by the patient after the surgery. In essence, with the
advantages of kidney transplant, the source of kidney for transplant has been a
great topic for study.
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