Kidney Transplant III: Nursing Management

Early rejection signs include oliguria (decreased urine output), edema, fever, elevated blood pressure, weight gain, and tenderness near the transplant site. In patients on cyclosporine, acute rejection may present solely as increased serum creatinine without other symptoms, making regular serum creatinine checks crucial for early detection.

Nurses measure urine output hourly and assess central venous pressure hourly to monitor fluid balance. Based on urine volume and electrolyte levels, intravenous fluids are adjusted as prescribed. Hemodialysis may be needed temporarily to maintain electrolyte balance until kidney function stabilizes.

Strict infection control includes hand hygiene, limiting exposure to people with active infections, and keeping patients away from fresh flowers and potted plants. Nurses monitor for fever, chills, rapid heartbeat, and increased breathing rate. Routine urine cultures detect bacteriuria, a common post-transplant issue requiring prompt intervention.

Kidneys from deceased donors may experience delayed graft function or acute tubular necrosis, resulting in minimal initial urine output. In contrast, kidneys from living donors typically begin urine production immediately, often in large volumes. Nurses adjust care based on the donor source and monitor for gradual kidney function improvement.

Nurses administer H2-blockers like famotidine or proton pump inhibitors like omeprazole to prevent gastrointestinal ulcers and bleeding. Antifungal mouth rinses are prescribed to mitigate fungal infections in the mouth and bladder, which can result from immunosuppressive and antibiotic therapy.

Nurses regularly review blood chemistry reports, focusing on white blood cell and platelet counts to assess immunosuppressive effects. They also check routine urine culture reports to detect bacteriuria and monitor serum creatinine levels, which may indicate rejection. Consistent lab monitoring supports long-term transplant health.

Nurses encourage deep breathing and coughing exercises to promote lung health and prevent atelectasis. Early mobilization is promoted to prevent complications and improve circulation. The surgical site is inspected regularly for infection, and patients are monitored for signs of adrenal insufficiency if corticosteroids are part of their medication regimen.