Nephrectomy

  1. General information
    1. Surgical removal of an entire kidney
    2. Indications include renal tumor, massive trauma, removal for a donor, polycystic kidneys
  2. Nursing interventions: preoperative care
    1. Provide routine pre-op care.
    2. Ensure adequate fluid intake.
    3. Assess electrolyte values and correct any imbalances before surgery.
    4. Avoid nephrotoxic agents in any diagnostic tests.
    5. Advise client to expect flank pain after surgery if retroperitoneal approach (flank incision) is used.
    6. Explain that client will have chest tube if a thoracic approach is used.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Assess urine output every hour; should be 30-50 ml/hour.
    3. Observe urinary drainage on dressing and estimate amount.
    4. Weigh daily.
    5. Maintain adequate functioning of chest drainage system; ensure adequate oxygenation and prevent pulmonary complications.
    6. Administer analgesics as ordered.
    7. Encourage early ambulation.
    8. Teach client to splint incision while turning, coughing, deep breathing.
    9. Provide client teaching and discharge planning concerning
      1. Prevention of urinary stasis
      2. Maintenance of acidic urine
      3. Avoidance of activities that might cause trauma to the remaining kidney (contact sports, horseback riding)
      4. No lifting heavy objects for at least 6 months
      5. Need to report unexplained weight gain, decreased urine output, flank pain on unoperative side, hematuria
      6. Need to notify physician if cold or other infection present for more than 3 days
      7. Medication regimen and avoidance of OTC drugs that may be nephrotoxic (except with physician approval)

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