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The Nursing Care of the Patient after Kidney Transplant
Ondřichová, Adéla ; Bakusová, Tereza (advisor) ; Komínek, Tomáš (referee)
(v AJ) This bachelor thesis focuses on nursing care for a patient after kidney transplantation and presents a case study of a specific patient with chronic renal injury due to Alport syndrome, who underwent kidney transplantation from a cadaveric donor. The aim of this thesis is to describe and evaluate the nursing care provided to the patient after kidney transplantation. The theoretical part provides an overview of renal failure, elimination methods, aspects related to transplantation, and a crucial section, patient education after transplantation. In the practical part are described the basic steps of preparing the patient for kidney transplantation and following nursing care in the first few days after transplantation. The case study of the patient is presented by describing his health status before and after transplantation. At the end of this part are described nursing diagnoses, the results of nursing care, and its effectiveness in the context of the patient's overall health status. Key words: kidney transplant, nursing care, postoperative care, patient education, immunosuppressive therapy
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The Role of Nurse of Patient after Kidney Transplantation
ŠEVČÍKOVÁ, Tereza
The diploma thesis sets two goals: 1. To find out the role of the nurse in postoperative care of a patient after a kidney transplant. 2. To map the specifics of nursing care for patients after kidney transplantation. Therefore, in order to meet the goals, four research questions were set: 1. What is the role of the nurse in postoperative care of a patient after a kidney transplant? 2. How does the role of a nurse in the postoperative period in a patient after a kidney transplant differ from postoperative care of the patient to another abdominal operation? 3. How does the role of a nurse in the postoperative period differ in a kidney transplant patient after another abdominal surgery in the standard ward and in the ICU? 4. What are the differences in the postoperative nursing care of a patient after a kidney transplant and the postoperative care of a patient after another abdominal surgery in the first days after the operation? The theoretical part of the work is divided into individual chapters, which describe the history and development of kidney transplantation, indications and contraindications of kidney transplantation, organ donation and inclusion on the waiting list, surgical techniques of transplantation and postoperative complications, immunosuppression and specifics of postoperative care and the effect of transplantation on pregnancy. Furthermore, the theoretical part deals with the history and modern view of the roles of nurses, the relationship between nurse and patient and finally the role of nurses in surgical fields. The practical part of the diploma thesis is processed by a qualitative method in the form of a semi-structured interview. The interview was conducted on the basis of pre-prepared questions with ten general nurses working in the inpatient department and intensive care unit of Transplant Surgery at IKEM. The analysis of the interviews took place in the form of "paper-pencil" and the method of open coding. All interviewed nurses refused to record the interviews in the form of an audio recording, which was respected. The results were divided into categories. The work should provide a comprehensive view of patient care in the postoperative period after kidney transplantation, describe its complexity and the differences between patient care after normal abdominal surgery and after transplantation. It can be used as a teaching material.
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Quality of life in renal transplant recipients and the possibilities of its affecting through different forms of intervention
Králová, Helena ; Mahrová, Andrea (advisor) ; Vaňous, František (referee)
Title: Quality of life in renal transplant recipients and the possibilities of its affecting through different forms of intervention. Aims: 1) To evaluate quality of life in renal transplant recipients and compare it with that of the general population. 2) To analyze effects of a 6 months controlled intervention exercise program, special diet, combination of special diet and exercise program and control group on the health related quality of life and to compare results between groups. Methods: We studied a composite group of 21 patients (mean age 58,4 9,34 years) after renal transplantation. Patients were randomly divided into four groups, each group had different program, as described above. The assessment of the quality of life was performed twice, before and after six months of a regular intervention program. We used standardized questionnaires KDQOL-SFTM . We have also assessed the importance of individual dimensions of quality of life with questionnaire WHOQOL - 100. Results were analyzed using descriptive statistics, non-parametric Wilcoxon signed-rank test and non-parametric Kruskal Wallis test. Statistically significance was considered on p ≤ 0,05. Results: After the pre-test and evaluation of the quality of life we assessed, that from 8 dimensions there were 5 lower after the...
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Alternative methods in managing postoperative pain in living donor renal transplantant recipients
Nová, Michaela ; Hocková, Jana (advisor) ; Dynáková, Šárka (referee)
The main criteria for managing good postoperative care include the effective and appropriate choice of pain therapy. Experiencing pain is a purely individual feeling for each of us, so it is very important to have adequate and sufficient analgesia during this period. Modern management of post-operative pain therapy uses preparations of various pharmacological groups that potentiate and thereby more effectively reduce pain. By this mechanism, we can reduce the total dose of analgesics given, and more particularly, reduce the dose of opioids that have a higher risk of side effects. In this project i want to show how the analgesic catheter could be useful as alternative possibility in algorithm therapy of postoperative pain. Analgesic catheter enable continual local anesthetics administration, exactly 0,5% bupivacaine, which is operating in surgical wound. Main goal of the study is to find out and verify if analgesic catheter is method which provides continual analgesia strong enough to results in lower use of opioids. The research data will be determined by quantitative research using a questionnaire survey. Non standardized self-production questionnaire. will be given in a paper form to non-medical healthcare staff, who perform nursing activities The spectrum of patients is very specific; they are...
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Humoral rejection after kidney transplantation and monitoring antibodies against HLA and non-HLA antigens.
Valhová, Šárka ; Slavčev, Antonij (advisor) ; Mrázek, František (referee)
Kidney transplantation is the treatment of choice for patients with end stage renal failure and is associated with prolonged survival of patients and better quality of life than long-term dialysis. Simultaneously, however, transplantation carries the risk of immunological complications leading to graft rejection. A serious problem in patients after organ transplantation is the development of humoral rejection, which is most often associated with the presence of antibodies specific to HLA antigens, particularly against mismatched HLA antigens of the organ donor. In certain cases antibodies may be specific to antigens expressed on endothelial cells, not on lymphocytes, like MICA, MICB, ICAM, and up till now unidentified tissue-specific antigens. Humoral rejection has significantly worse prognosis for the transplanted kidney than cellular rejection, and therefore its timely diagnosis is of great importance for the subsequent choice of appropriate therapy. The diagnosis of humoral rejection is based on the simultaneous detection of C4d deposits in the peritubular capillaries of the transplanted kidney and the finding of antibodies specific to the mismatched antigens of the donor (donor specific antibodies, DSA). The aim of our retrospective study was to contribute to improvement of the diagnosis of acute and...
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Effect of physical activity Nordic Walking on body composition and cardiorespiratory parameters in individuals after kidney transplantation and dialysis individual.
Rousová, Martina ; Mahrová, Andrea (advisor) ; Horčic, Josef (referee)
Title: Effect of physical activity Nordic Walking on body composition and cardiorespiratory parameters in individuals after kidney transplantation and dialysis individual. Objective: The aim of the study was to determine the effect of physical activity Nordic Walking on body composition and cardiorespiratory parameters in individuals after kidney transplantation and dialysis individual. Method: This thesis has been prepared in the form of a qualitative case study. The study involved 9 probands at the beginning, but only 5 probands completed the study. It was done the input examination before the intervention. The intervention was made from 20 lessons of Nordic Walking which should take 60 minutes each of them. Then were probands tested again like the output examination. During these both examination were measured specific values of body composition, anthropometric values (height, weight, age, circuit level), as well as the distribution of muscle and fat mass in the body, the value of physical fitness, respectively. cardiorespiratory parameters of the individual, for which was used the spiroergometric test within a modified Balke's walking test. For to detect the quality of life was used before and after intervention standardized questionnaire assessing quality of life WHOQOL-BREF. Last but not...
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Differences in the quality of life in patients undergoing hemodialysis, peritoneal dialysis and kidney transplantation
Horníková, Dita ; Di Cara, Veronika (advisor) ; Vaňková, Milena (referee)
The literature indicates that treatment by means of elimination methods is extremely challenging for patients, bringing a fundamental change to their lives. The aim of the thesis was to identify and describe the challenges of treatment in patients with renal failure and how a given method of treatment affects the patient's quality of life and needs, as well as to understand the subjective difficulties and problems. A data collection method in the form of non-standardized semi-structured interviews was selected for qualitative research. The surveyed sample consisted of six patients of a dialysis centre. The respondents taking part in the qualitative research were informed in advance of the course, circumstances and ethical aspects of the research. The obtained data was analyzed, colour-coded and then sorted into subcategories. The results were interpreted using the "showdown" technique. The interviewed sample of respondents was subjected to multiple elimination methods in the treatment of their disease. Kidney transplant patients subjectively evaluated the quality of their lives as very high, talking about "a life of a normal man". Peritoneal dialysis patients also evaluated their quality of life as relatively high, highlighting a certain feeling of independence. Haemodialysis patients describe...
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Perfusion of a Kidney Graft from a Donor After Cardiac Death Based on Immediately Started Pulsatile Machine Perfusion
Opatrný, Václav ; Moláček, Jiří (advisor) ; Bachleda, Petr (referee) ; Havránek, Pavel (referee)
Immediately started pulsatile machine perfusion of a kidney graft from a DCD (donor after cardiac death) as a way to improve its properties Opatrný V. Department of Surgery, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague Introduction: The number of kidneys available for transplantation still does not match the number of patients on the waiting list, which gets longer every year. At the same time, kidney transplantation is the only chance for the long-term survival of patients with good quality of life. Therefore, organs from marginal donors, including donors after cardiac death (DCD), have recently been used. The most common cause of death of these donors is severe trauma, especially craniocerebral trauma, or sudden cardiac arrest, followed by unsuccessful resuscitation. Kidneys can be harvested once an individual is declared dead according to the exact criteria. This involves initial washing of the grafts in the donor's body using a perfusion solution, followed by their removal and storage using selected preservation method. Mechanical pulsatile perfusion using special instrumentation is the most frequently used technique in the area of DCD. Despite of good long-term outcomes of grafts from DCDs, this group is burdened by a greater number of delayed graft...
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The effect of physical activity and nutrition interventions on physical fitness and quality of life during the first year after kidney transplantation
Švagrová, Klára ; Bunc, Václav (advisor) ; Brandejský, Petr (referee) ; Adámková, Věra (referee)
UNIVERZITA KARLOVA V PRAZE FAKULTA TĚLESNÉ VÝCHOVY A SPORTU The effect of physical activity and nutrition interventions on physical fitness and quality of life during the first year after kidney transplantation Abstract of disertation Zpracovala: Mgr. Klára Švagrová Školitel: Prof. Ing. Václav Bunc, CSc. Školící pracoviště: Laboratoř sportovní motoriky Praha, 2012 ABSTRACT Kidney transplantation is the best known treatment of chronic kidney failure. However, it is often accompanied by a number of health complications. The transplantation itself positively affects both physical fitness and quality of life during the first year after the transplant surgery which are seriously diminished when compared to the healthy population. This improvement can be even enhanced by appropriate physical activity and nutrition interventions otherwise both the physical fitness and quality of life would start declining after the first post-transplant year again. The aim of this study was to confirm a positive effect of a long-term physical activity and nutrition interventions on health-related physical fitness and health-related quality of life in a representative sample of individuals in the first year after the kidney transplantation. At the same time it was fundamental to verify that the experimental trial can be...
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Prediction of graft function development and rejection of transplanted kidney
Wohlfahrtová, Mariana ; Viklický, Ondřej (advisor) ; Zadražil, Josef (referee) ; Reischig, Tomáš (referee)
Improving the short-term results of kidney transplantation did not result in improving the long-term function and survival of kidney allograft. Organ shortage and increasing number of marginal donors remains the key problem in transplant today. The quality of donor organ is critical for graft function development and survival. The aim is to improve understanding to ischemia/reperfusion injury and its consequences, predict delayed graft function and rejection, improve organ allocation strategy and identify patients suitable for safe drug minimization or complete withdrawal of immunosuppressive therapy. Analysis of donor kidneys identified poor tubular cell quality and low survival factor, Netrin-1 expression levels, to be associated with delayed graft function. We confirmed that reperfusion phase of ischemia/reperfusion injury leads to minimal morphological but significant molecular abnormalities. Dissociation observed in histology and molecular pathology finding calls for an integrated approach in donor quality organ evaluation and allocation for transplantation. Significant heterogeneity within donors with expanded criteria was shown and subgroup of organs at low risk of delayed graft function was identified. We suggested donor biopsies to be performed as a routine praxis in all kidneys...
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