Renal obj 4.txt

divert urine directly to the skin surface through a ureteral skin opening (stoma); must wear a pouch

one ureter one stoma

one kidney joined to the other and one stoma

two ureters, two stomas

collect urine in a portion of the intestine which is then opened onto the skin as a stoma; must wear pouch

at the top of small/lg intestine; oldest and most common

more down towards large intestine

divert urine to the lg intestine so no stoma; excretes urine with poop and bowel incontinence may result

divert urine into a surgically created pouch that functions as a bladder; stoma is continent; client removes urine by regular self cath

select stoma site; make sure pt understands there will be stoma

wound infection, wound dehiscence, urinary leakage, ureteral obstruction, small bowel obstruction, ileus, stomal gangrene

promote urine output, stoma care, ostomy and skin care, encouraging fluids, relieving anxiety, teaching stoma and appliance care

monitor drains for patency, amount and type of drainage, skin integrity, body image, sexuality issues, monitoring for potential complications, post up similar to ileal conduit

flank, lumbar, thoracoabdominal

treatment of choice for ESRD; elective-not emergency; success rate increases survival with a living related donor before dialysis is initiated

active or chronic infection, severe irreversible extra-renal disease, recent malignancy, autoimmune disease, morbid obesity, current ETOH abuse, HX of nonadherence, severe psychosocial problems

matched on tissue type, blood type, antibody screening; absence of systemic disease or infection; no history of cancer; no HTN or kidney disease; adequate renal functioning

adrenal gland remains intact; renal artery and vein tied off; donor kidney cradled in ilium; renal artery sutured to iliac artery and renal vein sutured to iliac vein; ureter sutured

organ rejection (most common and most serious); infection; bleeding, DVT, thrombosis of major renal vessels

glucocorticoids, cyclosporine, Tacrolimus (Prograf-100 times more potent than cyclosporine), Sirolimus (Rapamune)

all body systems, pain, fluid and electrolyte, patency and adequacy of urinary drainage system

ineffective airway, ineffective breathing, acute pain, fear and anxiety, impaired urinary elimination, risk for fluid imbalance

pain relief, promote airway clearance and effective breathing pattern, monitor urine output and maintain patency of urinary drainage systems; strict asepsis with catheter, s/s of bleeding, leg exercises and early ambulation to prevent DVT

pt and family, drainage care system, strategies to prevent complications, s/s of complications, follow up care, fluid intake, health promotion and screening