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Table 13B.3. Postoperative orders for pediatric kidney transplant recipients

Nursing

Vital signs every 30 min for 4 hr, then every hour for 24 hr

Central venous pressure and urine otput every hour for 24 hr

Urine for glucose; abdominal girth; peripheral pulses; and nasogastric pH every

4 hr

Guaiac stool daily; turn, cough, and suction (as needed) Laboratory

Serum electrolytes, hematology, coagulation, and arterial blood gas immediately postoperative and at 4 hr postoperative

Serum electrolytes, calcium, and phosphorus every 4 hr for 24 hr

Daily electrolytes and hematoloty; coagulation and liver function tests twice weekly; cyclosporine levels 3 days week

Fluids

1 ml IV for 1 ml urine each hour (5% dextrose in water/45% normal saline with 10 mEq sodium bicarbonate/L if urine output < 8 ml/kg/hr; the glucose is changed to 1% dextrose in water if > 8 ml/kg/hr) Medications

Trimethoprim sulfa (2-4 mg/kg/day)

Antacid (1 ml/dose for < 2 yr old, 2 ml for 2-5 yr, and 3 ml for 5-10 yr) Nystatin 4 times/day, docusate, pain medication, and immunosuppression Radiology

Chest radiograph immediately postoperative and on postoperative day 1 Stent study on postoperative day 6.

Reprinted with permission from: Matas AJ, Najarian J. Pediatric Surgery 1998; 563-580. © 1998 Mosby-Year Book Inc.

glycemia. Electrolytes (sodium, potassium, bicarbonate, calcium, phosphorus, and magnesium) are checked every 2 hours and replaced. Trimethoprim is given to prevent Pneumocystis carinii infection and Legionaries disease. Antacids and nystatin are used to prevent gastrointestinal bleeding and thrush, respectively.

The child is transferred to the ward when urine output and electrolytes have stabilized. Infants and malnourished children are started on parenteral nutrition. Children with a single J stent have a stentogram on postoperative day 5. If there is no leak, the stent and Foley are removed. Those with a double J stent have it removed endoscopically at 6 weeks.

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