UNIT NINE
718
Understanding the Urinary System
CLINICAL JUDGMENT Mrs. Jackson is a single, 66-year-old woman with a 20-year history of type 2 diabetes, hypertension, hyperlipidemia, chronic anemia, and a total knee replacement. She has been diagnosed with CKD. She is being admitted to a medical unit from the emergency department for treatment of shortness of breath and CKD. Treatment will include hemodialysis. Mrs. Jackson has increasing shortness of breath, pitting edema, and a urine output of 375 mL yesterday. She is having premature ventricular contractions on the cardiac monitor. Her admitting serum laboratory values are sodium (Na) 131, potassium (K) 6, chloride (Cl) 97, calcium (Ca) 10, iron (Fe) 64, WBC 4,000, RBC 3.12, hemoglobin (Hgb) 10.1, hematocrit (Hct) 32, creatinine 2.2, and BUN 38. Her blood glucose levels yesterday were as follows: 0700, 154 mg/dL; noon, 142 mg/dL; 1700, 188 mg/dL. She has sliding-scale insulin coverage. An echocardiogram and chest x-ray will be done. She is having a two-tailed subclavian catheter placed for vascular access. Mrs. Jackson is withdrawn and quiet. 1. What is the first thing you do after getting the admitting handoff report? 2. What data do you report to the HCP? 3. What do you say to Mrs. Jackson regarding her withdrawn behavior? 4. What do you identify related to Mrs. Jackson’s understanding of her self-care needs? 5. What teaching do you reinforce for the scheduled diagnostic tests? 6. What nursing care do you provide for the vascular access? 7. What type of prescribed insulin do you prepare for sliding-scale insulin coverage? Why? 8. With what members of the health-care team do you collaborate? Suggested answers are at the end of the chapter. Kidney Transplantation Kidney transplantation can successfully free the patient with CKD from dialysis and dietary restrictions. During trans- plantation, a donor kidney is placed in the abdomen of the recipient (Fig. 37.11). The patient’s native kidneys remain in place unless there is a reason to remove them. The trans- planted kidney functions as a normal kidney. The donated kidney can come from a living family member, a nonrelated donor, or a cadaver donor (see “Cultural Considerations: Organ Donation” and “Patient Perspective”). Tissue and blood types must be matched to help prevent the body’s immune system from rejecting the donated kidney. Patients receive immunosuppressant medications to help prevent rejection, usually for the rest of the life of the transplanted kidney. Sometimes even with medications, the body rejects the kidney and the patient requires dialysis.
Diseased kidneys
Transplanted kidney
Transplanted ureter
Bladder
FIGURE 37.11 The transplanted kidney is placed in the abdomen.
Cultural Considerations Organ Donation
• Some cultural groups believe that the body must be kept intact after death and may oppose the removal of body parts or organ donation. Many organizations have policies in place to discuss organ donation with all families, which can be both jarring to the family and viewed as disre- spectful. Nurses can help to prepare families for these conversations by alerting them to these standard policies and reassuring them that their choices will be respected.
Patient Perspective Garth
The cause of my CKD remains a mystery. I was healthy and active until my first symptom of ankle edema occurred. Over the next 3 years, my kidney function declined. When my GFR was 12 mL/min, I was started on dialysis 3 days a week for 4 hours. Some people tolerated it well and could even go to work or school afterward, but I did not tolerate it. An hour after the dialysis session, I would be extremely fatigued and ache all over. As soon as I was home from the dialysis center, I would go to sleep. The rest of my day following dialysis was spent recover- ing from it, and this happened 3 days a week! Family activi- ties always had to be planned around my dialysis schedule. My family was supportive, but it certainly affected them as well. Families need support just as much as the patient. I was on the kidney transplant waiting list for two and half
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