KIDNEY SURGERY
Kidney surgery may include nephrectomy(removal of the kidney), kidney transplantationfor end-stage renal disease (ESRD), procedures to remove stones or tumors, and procedures to insert drainage tubes (nephrostomy).
Nephrectomy is most commonly performed for malignant tumors of the kidney but may also be indicated for trauma and kidneys that no longer function due to obstructive disorders and other renal disease. The absence of one kidney does not result in impaired renal function when the remaining kidney is normal.
Preoperative Management
The patient is prepared for surgery, and consent is witnessed. Preoperative antibiotics and bowel cleansing regimen are prescribed.
Risk factors for thromboembolism are identified (smoking, oral contraceptive use, varicosities of lower extremities), and antiembolism stockings may be applied. Leg exercises are taught, and the patient is prepared for pneumatic/sequential compression stockings that will be used postoperatively.
Pulmonary status is assessed (presence of dyspnea, productive cough, other related cardiac symptoms), and deep-breathing exercises, effective coughing, and use of incentive spirometer are taught.
If embolization of the renal artery is being done preoperatively for patients with renal cell carcinoma, the following symptoms of postinfarction syndrome are observed for (may last up to 3 days):
Flank pain
Fever
Leukocytosis
Hypertension
Postoperative Management
Vital signs are monitored, and incisional area is assessed for evidence of bleeding or hemorrhage.
Pulmonary complications of atelectasis, pneumonia, and pneumothorax are observed for. Pulmonary toilet through deep breathing, percussion, and vibration is maintained. Chest tube drainage may be used (the proximity of the thoracic cavity to the operative area may result in the need for chest tube drainage postoperatively).
Patency of urinary drainage tubes is maintained (nephrostomy, suprapubic, or urethral catheter). Ureteral stents may be used.
Respiratory status and lower extremities are assessed for thromboembolic complications.
Bowel sounds, abdominal distention, and pain are monitored, which may indicate paralytic ileus and need for nasogastric decompression.
For kidney transplantation patients, immunosuppressant drugs (corticosteroids in combination with azathioprine [Imuran] or another agent) are ordered. Early signs of rejection include temperature greater than 100.4 ° F (38 C), decreased urine output, weight gain of 3 lb (1.5 kg) or more overnight, pain or tenderness over the graft site, hypertension, increased serum creatinine.
NURSING ALERT
Use frequent and close observation of blood pressure, pulse, and respiration to recognize hemorrhage (and shock)chief danger after renal surgery. Watch for pain, sanguineous drainage from drain sites, or expanding pulsatile flank mass. Prepare for rapid blood and fluid replacement and reoperation.
Nursing Diagnoses
Acute Pain related to surgical incision
Impaired Urinary Elimination related to urinary drainage tubes or catheters
Risk for Infection related to incision, potential pulmonary complications, and possibly immunosuppression
Risk for Deficient or Excess Fluid Volume related to fluid replacement needs and transplanted/remaining kidney function
Manual of Nursing practice 8th edition
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