When caring for a patient after a kidney and pancreas transplant, repeatedly assess the function of both organs. Assess your patient for hypovolemia and dehydration, which may damage the kidney tubules and increase the risk of thrombosis of the pancreatic vessels. Monitor the patient’s intake and out­put, vital signs, skin turgor, blood urea nitrogen (BUN) level, creatinine level, and hematocrit. Elevated BUN and creatinine levels may indicate kidney dysfunction and rejection. A steadily declining hematocrit may reflect bleeding.

For the first 24 hours after surgery, adjust I.V. fluids every hour in response to your patient’s urine and nasogastric (NG) output. If she has an indwelling urinary catheter, you can monitor urine output accurately. The catheter also decompresses the bladder, allowing the suture line within to heal. After the NG tube and urinary catheter are removed, continue to monitor your patient’s intake and output.

Monitor blood glucose levels every 30 minutes to 1 hour for the first 24 hours after surgery and administer insulin or fluids containing dextrose as necessary. A patient may require insulin for 1 to 2 days after surgery because the function of the transplanted pancreas may be delayed. She may also require insulin if she’s receiving steroid therapy.

Review your patient’s daily laboratory test results, including electrolytes, complete blood count, hemoglobin level, and serum and urine amylase measurements. Collect urine specimens for cumulative amylase determinations taken at 12-hour or 24-hour intervals. Assess insulin, glucagon, and human C peptide levels three or four times per week. Pancreas scans and ultrasound examinations may be performed on the first day after surgery, then once a week until discharge. Ultrasounds examine the function of the new organs and enable the physician to determine the size of the graft and the patency of the veins.

Check your diabetes patient’s abdominal dressing and incision for blood and urinary drainage and for signs of infection. To decrease postoperative complications, have your patient sit on the side of her bed within 24 hours of surgery. She can begin sitting in a chair and taking short walks the day after surgery. Encourage her to cough, breathe deeply, and change positions frequently.