A client who had a kidney transplant develops decreased urine output, increased serum creatinine level, and a slight elevation in temperature. The nurse anticipates providing which intervention?
a. Antibiotics
b. Extra IV fluids
c. High-dose steroids
d. Plasmapheresis
C
This client is most likely experiencing acute rejection, which usually occurs during the first 3 months post-transplant. Clinical manifestations of rejection include decreased kidney function (decreased urine output and increased creatinine level). The slight elevation in temperature is most likely caused by the immune system activity. Acute rejection is treated with high-dose ste-roids. Antibiotics would be indicated for an infection. It is possible for this client to have an in-fection, but the urine output and lab data are more indicative of rejection. This client is probably not dehydrated because the increase in creatinine level points to a more direct kidney problem (and is a specific manifestation of kidney graft rejection) and one goal of treatment in the renal transplant client is to avoid overhydration. Plasmapheresis is used in the setting of hyperacute rejection.
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