I have had a little bit more experience now. I have found a couple of excellent resources at my facility too. There is a weekly Transplant Round for physicians that I was allowed to attend and I get CE's to boot. Additionally I will be attending a Colo-rectal Cancer course Thursday 29th.
I am still having trouble just matching everything together. It is a lot of work to keep track of the prograf and cellcept levels, while providing the education on medications. I am use to people coming back from a CABG/CEA and being ambulated almost immediately. Here people come to me post-op day 2 or maybe the very end of day 1. They have a PCA/Epidural and are on abdominal precautions. It just feels like mobilizing this (important as it may be) is often beyond their capabilities or motivation at the time. I have resorted to in bed active/passive ROM, plus they are anti coagulated, using IS, and with SCDs that I advertise as leg massagers. My concern is trying to find the balance of how hard to push.
The other issue I was having, but has improved after attending round on the subject, is Hepatic Encephalopathy. This can be as bad as CIWA at times. Learning the balance between pain management (paracentesis, ascites, etc), patient safety (fall risk), medical treatment (lactulose and Rifaximin) has been tricky. I was hoping to find what works for you in this area.
ESRD is difficult, but I understand the pathology and treatment modalities.
I will share a couple of things that I have found helpful in the next post. I would love to hear from your experiences though.
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