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Principles II-Exam III-Renal 25-35
pitcher or receiver & organ donation
33
Nursing
Graduate
11/21/2009

Additional Nursing Flashcards

 


 

Cards

Term

 

 

When does ischemic time begin & end w/ organ harvest?

Definition

 

 

It begins w/ the clamping of the donor's renal vessels and ends w/ the vascular anastomosis in the recipient.

Term

 

 

When does diuresis begin if ischemic time is less than 30 minutes (donor in 1 rm, recipient in next rm)?

Definition

 

 

QUICKLY!

Term

 

 

What happens if ischemic time is greater or equal to 2 hours?

Definition

 

 

There is a period of oliguria or anuria

Term

 

 

How is the kidney preserved? For how long?

Definition

 

 

Its kept in cold preservation solution at 4 degrees C

 

Cadaver kidneys can be preserved for 36-48 hours w/ cold perfusion

Term

 

 

Why is it important to use an adequate amount of balanced salt solution for donor preparation?

Definition

 

 

To ensure brisk diuresis from the donor kidney and offset the reduced venous return resulting from the use of the flank position.

Term

 

 

What is the greatest risk for the donor?

Definition

 

 

HEMORRHAGE

Term

 

 

Describe the flank position.

Definition

 

 

A lateral decub position

The bed elevates at the waist to form a gentle V shape

The head then is down slightly as is the lower extremities

Term

 

 

Does the choice of anesthesia for a living related donor matter?

 

Definition

 

 

No, the choice of anesthesia is not critical

 

But make sure you have adequate IV access and available blood

Term

 

 

What is the highest priority if the donor kidney is obtained from a brain dead patient?

Definition

 

 

Preservation of the graft!

Term

 

 

With brain death, there is a loss of sympathetic tone that may produce what?

Definition

 

 

Hypotension despite adequate volume replacement

Term

 

 

Brain death pts may come w/ many drips to maintain function, why do you often see high dose vasopressors?

Definition

 

 

-To reduce immediate allograft function and increase the risk for kidney damage.

Term

 

 

What function is paramont to maintain in brain dead donors & how do you do that?

 

Definition

 

URINE OUTPUT!

 

-You can use diuretics or low dose dopamine.

Term

 

 

Name some of the prepration associated w/ the recipient for organ donation.

Definition

 

-Free of acute illness and infection

(immunosuppressive therapy is used & can potentiate disaster if illness or infection is present)

-Correct fluid and electrolyte imbalances 24 hours before surgery

(pts should be dialyzed 24 hrs before procedure)

-Type & cross 2 units of WASHED PRBCs

Term

 

 

Can a diabetic receive a kidney?

Definition

 

 

Yes-if insulin dependent Type I

 

NO-if insulin dependent Type II

(because of related comorbidity)

Term

 

 

If the kidney fails, what will happen?

Definition

 

 

There will be an acute need to dialyze so make sure to maintain fistula patency!!

Term

 

 

Fluid management is tricky-how is it typically handled?

Definition

 

 

w/ the history of renal failure, a dry regimen is typically employed initially followed by fluid bolusing'

-As the kidney is anastamosed, it is imperative that it is perfused.

-to do this the pt must be volume loaded

Term

 

 

Can you use medications that are eliminated through the kidney?

Definition

 

 

Yes, but they may be used in reduced doses or if alternative exists, use it

Term

 

 

What type of anesthetic should be used in the recipient? How are drugs chosen?

Definition

 

A regional or general can be used. Most prefer general.

 

Drugs are chosen by their impact on the procedure and kidney.

(Nitrous-bowel enlargement

Sevo-renal involvement Compound A)

Term

 

 

Are NDMR that metabolize/eliminate via mechanism of kidney attractive choices?

Definition

 

 

YES-as a matter of fact they are =0)

-A newly transplanted but functioning kidney can clear NDMR drugs and anticholinesterase drugs at the SAME rate as a normal kidney-amazing...

Term

 

 

When are vascular clamps removed and what does this produce?

Definition

 

 

Once the kidney is in place. This produces a vascular influx of metabolites and potassium into the system.

(The preservation fluid in the kidney contains high potassium content.)

Term

 

 

 

Definition
Term

 

 

How much blood volume is removed from the overall circulation when the reperfusion of the kidney occurs?

Definition

 

 

300 mls

Term

 

 

When does acute immunlogic rejection of the kidney occur? What do you see?

Definition

 

 

As soon as the vascular clamp is released.

 

you'll see IMMEDIATE vascular reaction or collapse

Term

 

 

What is the treatment for a rejected kidney?

Definition

 

 

Immediately cross-clamp the organ & take it out!

Term

 

 

What symptoms will you see with a delayed rejection of an kidney?

Definition

 

 

Fever, local tenderness, loss of urine output

Term

 

 

What is cyclosporin toxicity associated with?

Definition

 

 

ARF

Term

 

 

Post transplant patients fall victim to opportunistic infections and are ________ times more likely to get _________.

Definition

 

 

They are 30-100 times more likely to get CANCER (large cell lymphoma is very common)

Term

 

 

Name three procedures that use cystoscopy.

Definition

1) Diagnostic

2) Biopsy

3) Renal calculi removal

4) Stent placement in ureter

5) Retrograde pylograms

6) Direct lithotripsy

7) Resection of bladder tumors

Term

 

 

How long is a cystoscopy? 

What type of anesthesia is utilized?

Definition

 

 

15-20 minutes

General which provides muscle relaxation

MAC sedation

Regional (epidural or spinal)

Term

 

 

If your going to use a regional technique, what level do you need? What does it NOT abolish?

Definition

 

 

T-10 level

 

Regional does not abolish the obturator reflex (external rotation and adduction of the thigh) due to stimulation of the obturator nerve by electrocautery through the lateral bladder wall

Term

 

 

What are your preoperative considerations for a transurethral resection of the prostate?

Definition

 

-BASELINE ELECTROLYTES!!

-Type and screen or cross (if coexisting anemia)

-Glands >40 ml may also require blood

-controlling bleeding w/ cystoscopy is difficult

Term

 

 

 

Definition
Term

 

 

 

Benign prostatic hypertrophy leads to what in men older than 60?

Definition

 

 

Asymptomatic bladder outlet obstruction

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