Medical Surgical Kidney transplant vs Biopsy #4

Question

While caring for a postoperative kidney transplant client, the nurse observes gross hematuria and clots in the client’s urine. Which action by the nurse is best?

Answers

  1. Irrigate the clots.
    • Rationale:

      This answer is not correct because the provider should be notified of gross hematuria or clots at once. An order is always required by the provider to irrigate the bladder due to the risks of irrigation.

  2. Palpate the bladder.
    • Rationale:

      This answer is not correct because bladder palpation is not indicated after a kidney transplant since hemodialysis is usually performed until adequate kidney function is established. Urine output usually begins right away if the donor was living.

  3. Remove the Foley.
    • Rationale:

      This answer is not correct since the first action of the nurse should be to contact the provider. Then in order to remove the Foley catheter, an order would need to be obtained.

  4. Notify the physician.
    • Rationale:

      This answer is correct because notifying the physician of these findings is important since gross hematuria or clots in the urine can indicate a complication. An immunosuppressed client with gross hematuria post-kidney transplant could be at risk for an infection or rejection of the graft. Also, blood clots can block the ureter and cause urine to back up and damage the kidney.

Overview

Gross hematuria or blood clots in urine after kidney transplantation needs to be addressed by the physician immediately. This could be a sign of rejection or if a clot blocks the ureter, damage to the kidney can be a consequence.

Explanation

Learning Outcomes

An immunosuppressed client with gross hematuria post-kidney transplant could be at risk for an infection or rejection of the graft. Also, blood clots can block the ureter and cause urine to back up and damage the kidney. For these reasons, it is important for the nurse to notify the physician if gross hematuria or clots are observed. The bladder should not be irrigated unless there is an order from the provider to do so. This is also true for the removal of a Foley catheter. Palpating the bladder is unnecessary due to post-kidney transplant, hemodialysis is performed until adequate renal function is established. Typically urine output begins immediately if the donor was living and in several days with a cadaver kidney.

Test Taking Tip

Have knowledge of when it is most appropriate to alert the provider of changes in your client’s condition and whether these changes are critical or noncritical.

Video Rationale