PUROC, LIZA M.

AUGUST 29, 2020

BSN-III
NCM 103

Perioperative Care for Kidney Patients

Patients with enduring kidney ailment frequently want clinical interventions for vascular access
then used for therapeutic problems correlated towards comorbid situations. Perioperative
morbidity and mortality rates are increased in these patients. Preoperative consideration to
mutual medical difficulties that occur in patients through impaired renal function can minor
around surgical hazards. Hyperkalemia can remain provisionally enhanced through the
intravenous management of an insulin-dextrose grouping or bicarbonate, and polystyrene
binding mastics or dialysis can eliminate additional supplies of potassium. Improved
hemorrhage interrelated to uremic platelet dysfunction can be accomplished by the
management of desmopressin, cryoprecipitate, or estrogens, then in circumventing the usage of
medications through antiplatelet belongings near toward the period of operation. Transfusions
of red blood cells would remain reserved for usage in patients through clinically important
anemia, because the antibody construction may be decreasing the possibility of effective renal
replacement in the upcoming. Cardiovascular virus is the maximum mutual origin of death in
patients through renal virus. Patients through chronic kidney virus might be have high blood
pressure and hypoglycemia in the perioperative dated. Preoperative testing might be essential
in the patients through cardiac risk issues. If upcoming vascular access splicing is to considered,
intravenous line assignment and plasma draws would be circumvented in a patient's
nondominant armrest. The kidneys strainer unused and extra liquid from the blood. As kidneys
fail, unused builds up. Symptoms mature gradually and aren't definite to the virus. Some people
have no indicators at very and are identified by a lab test. Medication helps manage symptoms.
In later stages, filtering the blood with a machine (dialysis) or a transplant may be required.

Keywords
Renal blood flow; Chronic kidney disease; Cardiovascular virus

Introduction
Surgery on the heart muscle, valves, arteries, or the aorta and other large arteries connected
to the heart is called Heart surgery, also called as Cardiac surgery or cardiovascular surgery.
This surgery is performed by cardiologists and cardiac surgeons. All the heart related problems
do not require surgery. Sometimes, they can be overcome by changing the lifestyle,
medications or non surgical procedures. Nowadays, many of the heart surgeries are being done
on the heart through smaller cuts. Symptoms for heart or cardiovascular problems may differ
for women and men, also different for types of heart disease. Majority of people have
symptoms like chest pain shortness of breath and fainting.

Some common types of heart surgery are as follows: Coronary artery bypasses grafting (CABG),
Heart valve repair or replacement, Insertion of a pacemaker or an implantable cardioverter
defibrillator (ICD), Maze surgery, Aneurysm repair, Heart transplant, Insertion of a ventricular
assist device (VAD) or total artificial heart (TAH).

Daily several people undergo open heart surgery across the world and survival rate is also high.
It takes more weeks’ time to heal the patient’s body from heart surgery. Open heart surgery is
a major operation that requires close monitoring and immediate postoperative support.
Postoperative period begins with the patient’s admission to the postanesthesia care unit (PACU)
and ends once the anesthesia has worn off enough for the patient to be safely transferred to
the appropriate nursing unit. It is normal for a person to remain in the intensive care unit (ICU)
for a couple of days after the procedure to receive further care

Postopeartive care by professional nurse plays major role for heart surgery patients for their
speedy recover. It includes monitoring vital signs, airway patency, neurologic status; managing
pain; assessing the surgical site; assessing and maintaining fluid and electrolyte balance; and
providing a thorough report of the patient’s status to the receiving nurse on the unit, as well as
the patient’s family. Each patient care space is supplied with a blood pressure monitoring
device, cardiac monitor, pulse oximeter, oxygen, airway management equipment, and suction.
After heart surgery, patients experience tiredness and pain which is common, gradually regain
strength over the following month. If patient feels difficulty breathing, fever, and excessive
sweating consider as serious infection and advised to seek urgent care. The patient will be
discharged from hospital once the patient condition is stable and free from all complicated
symptoms. Recovery time may vary from patient to patient and type of the surgery.

Conclusion
After surgical operation patient has to undergo postoperative care and ends by discharging
from the hospital. Sometimes, patients require additional care it may continue at home depends
on type of surgery and health issues of the patient. Apart from regular checkups patient should
do exercise and taking proper food as suggested by doctors. It can conclude that each patient
should undergo good and qualified nurse postoperative care in order to their recovery. In
addition, the patient must follow the instructions given by surgeons for their healthy and long
life.

References
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al.
Global  Prevalence of  Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS
One 2016;11(7).
Amoako YA, Laryea DO, Bedu-Addo G, Andoh H, Awuku YA. Clinical and demographic
characteristics of chronic kidney disease patients in a tertiary facility in Ghana. Pan Afr Med J
2014;18:274.
Chen N, Wang W, Huang Y, Shen P, Pei D, Yu H, et al. Community-based study on CKD
subjects and the associated risk factors. Nephrol Dial Transplant 2009;24:2117-23.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical
Practice Guideline for the Evaluation and  Management of  Chronic Kidney Disease. Kidney
IntSuppl 2013;3:1-150.
A. Make a synthesis on the salient points of the journal
 Patients with enduring kidney ailment frequently want clinical interventions for
vascular access then used for therapeutic problems correlated towards comorbid
situations
 Preoperative consideration to mutual medical difficulties that occur in patients
through impaired renal function can minor around surgical hazards.
 The point of this journal is that cardiovascular problems is the maximum origin of
death in patients through renal problems
 Patients through chronic kidney virus might be have high blood pressure and
hypoglycemia in the perioperative dated.
 Postoperative care plays an important role for speedy recovery of patients with both
cardiovascular and renal problems, it includes monitoring vital signs, airway patency,
neurologic status; managing pain; assessing the surgical site; assessing and
maintaining fluid and electrolyte balance; and providing a thorough report of the
patient’s status to the receiving nurse on the unit, as well as the patient’s family. In
addition, the patient must follow the instructions given by surgeons for their healthy
and long life.

B. Reason for choosing the journal

 I honestly choose this journal because this is the only journal that I can relate with
since I have a brother who was diagnosed with kidney failure before. I also want to
know what are some correlated with renal failure.

C. Expound the implication of the journal to the following:

c.1 Nursing Education

 Renal transplantation is the surgical implantation of a human kidney from a
compatible donor into a recipient. Renal transplantation is a means of restoring
renal function to normal in most patients, thus allowing a return to a healthy
lifestyle. Patients and their families often ask nurses for health information.
Professional nurses must ensure that patients and families understand the
transplantation and therapeutic regimen and provide health education. It should
be remembered that certain physiological, psychosocial and pathological
conditions might inhibit the education process. Before renal transplantation the
patient's understanding of the procedure and follow-up regimen and also the
patient's ability to cope with a complex medication regimen are assessed. The
nurse and the patient and family should work together to set realistic, achievable
goals, the aims of which are mutually agreed. The agreed goals of health
education should be documented in a care plan, which will also provide
reinforcement for both the nurse and patient.

c.2 Nursing Practice

Perioperative Management
Preoperative Evaluation and Preparation.

 In evaluating the patient, note the etiology of CRF (i.e., ± systemic disease),
urine output, type of dialysis, and most recent treatment. Look for physical
signs of systemic complications (anemia, left ventricular hypertrophy,
congestive heart failure, neuropathy, sepsis, malnutrition) and examine
shunt sites and/or CAPD catheter site for infection.
 Relevant lab studies include Hct, complete blood count, electrolytes (total
CO2 if arterial blood gases impracticable), blood urea nitrogen, creatinine,
Ivy bleeding time, electrocardiogram, and chest radiograph.
 Human recombinant erythropoietin: normal Hct; —risk of hypertension,
thrombosis.

Preoperative Preparation.

 Hemodialysis: schedule day before surgery to avoid acute fluid and electrolyte
shifts.
 Continuous ambulatory peritoneal dialysis: continue until time of surgery
(assess abdominal girth).
 Preoperative blood transfusion is indicated only to treat acute blood loss or for
patients with cardiopulmonary disease undergoing major surgery with Hct
<28.
 Transfuse during dialysis to avoid fluid overload and hyperkalemia.
 Platelet dysfunction (bleeding time >15 min despite platelet count >100
k/mm3), should be corrected before major surgery with deamino-8-d-
arginine vasopressin (0.3 μg/kg over 20 min), which stimulates endothelial
release of VWF-VIII, or with cryoprecipitate (10 U), which contains VWF-
VIII.
 Labile or symptomatic hypertension must be controlled before elective surgery.
Patients on long-term clonidine or guanabenz should receive a clonidine
transdermal patch to prevent rebound hypertension.

Operative Preparation.

 Minimize sedative or opioid premedication, provide aspiration prophylaxis

(anticholinergic, H2-blocker, metoclopramide, sodium bicitrate).
 Use universal and aseptic precautions throughout.
 Avoid BP cuffs or arterial catheters on arm with arteriovenous fistula or shunt,
and avoid urinary catheter in anuric or oliguric patients.
 Invasive hemodynamic monitoring is indicated if large fluid shifts are
anticipated, or with sepsis or cardiopulmonary insufficiency.
 Avoid pressure or stretch on fistula sites, bony prominences, joints. Patients
with sensory neuropathy may not complain of positional discomfort. Renal
osteodystrophy = fragile bones and joints.
 Use active warming devices (e.g., forced-air convection blanket) to prevent
hypothermia.
  Consider intraoperative hemodialysis (CPB).

Anesthesia.

 Regional anesthesia is not contraindicated if coagulopathy is corrected, but

there is increased risk of hypotension (autonomic neuropathy) and infection.
When sympathetic block wears off after surgery, sudden increase in
systemic vascular resistance could precipitate pulmonary edema.
 For general anesthesia, use aspiration precautions (e.g., head up, rapid
sequence, cricoid pressure).
 Preo-ygenate and give adequate fluid load (250-1000 mL) before induction.
 Succinylcholine is not contraindicated in CRF if serum potassium is <5.0 mEq/L
and the patient has been dialyzed within the last 24 h. Avoid pancuronium
and pipecuronium.
 After tracheal intubation, increase minute ventilation to compensate for
chronic metabolic acidosis.
 Keep maintenance fluids to a minimum but fully replace fluid losses.
 Nephroto-icity is a theoretic possibility with enflurane (fluoride) or sevoflurane
(Compound A).
 Anticipate labile BP: hypotension (deep anesthesia, fluid losses, positional
changes) or hypertension (inadequate anesthesia). Beta-blockers or calcium
blockers are helpful.
 Anticipate hyperkalemia (β-blockers), arrhythmias, and potential for digo-in to-
icity.

Postoperative Care.

 Anesthetic emergence may be delayed, and complicated by vomiting,

aspiration, hypertension, persistent neuromuscular blockade, respiratory
depression, or pulmonary edema.
 CO2 retention in chronic metabolic acidosis: acute acidosis, hyperkalemia.
 If in doubt, a short period of postoperative mechanical ventilation allows
controlled emergence, avoids reversal agents, and facilitates evaluation of
neurologic and ventilatory function before e-tubation.
 Restrict maintenance fluid, replace sequestration or overt losses. Anticipate
and treat hyperkalemia.
 For severe uremia, use hemodialysis. Hemodynamically unstable: consider
peritoneal dialysis.
 CVVH/D: Large volume removal with hemodynamic stability, requires
heparinization.

c.3 Nursing Research

 The aim of this journal is to discuss and assess all possible effects of different quality
improvement interventions and its respective implementation from pre to
postoperative care. Clinical research continues to explore our evolving understanding
of fluid balance and type of fluid used in the resuscitation of the perioperative
 patient, renal replacement therapy, and alternative therapeutic approaches, such as
remote ischemic preconditioning.
 Promising therapeutic advances to prevent or treat perioperative acute kidney injury
to be a challenge.