Nephrectomy is a surgical procedure in which all or part of a kidney is removed. During a radical nephrectomy, a complete kidney is removed and structural adjustments may be made. In a partial nephrectomy, only diseased kidney tissue is removed.
Indications
- renal tumor
- polycystic (bleeding or infected) kidneys
- massive trauma to the kidneys
- elective kidney removal for donation purpose
Laparoscopic Nephrectomy vs Open Nephrectomy
In an open nephrectomy, an 18cm incision is made, while in laparoscopic nephrectomy, 5 puncture sites are made. This means that laparoscopic nephrectomy:
- is less painful
- requires no suturing and no staples
- requires a shorter hospital stay
- promotes faster recovery time
Nephrectomy Perioperative Care
Nephrectomy Preoperative Nursing Care
Apart from following the usual preoperative nursing care requirements, in nephrectomy preoperative nursing care, the nurse should:
- discuss procedure including incision location (flank incision on affected side) and possible tubes, drains and stent use during/after procedure with the patient
- inform patient about possible muscle aches following surgery due to side-lying positioning during surgery
- help in reducing surgery-related anxiety in the patient and family members by answering to any arising questions
- ensure adequate fluid intake
- ensure a normal electrolyte balance
- report significant abnormal laboratory values such as bacteriuria (bacteria in the urine) and blood coagulation abnormalities
Nephrectomy Postoperative Nursing Care
Apart from following the usual postoperative nursing care requirements, in nephrectomy postoperative nursing care, the nurse should:
- monitor and document accurately the patient’s fluid intake and output; record urine output every 1-2 hours following surgery and measure drainage from drains and drainage on dressings (weigh dry vs used dressing) and record separately; Total urine output should be at least 0.5ml/kg/hr; observe and document urine colour and consistency (any mucus, blood, sediment present?); intake should exceed output since excretion includes sweat; if patient’s output exceeds intake, there could be an underlying renal issue
- monitor patient weight daily using same scale and with patient wearing similar clothing; increased weight may indicate fluid retention, which increases the patient’s risk for heart failure
- monitor patient’s respiratory status to identify any possible acute deterioration signs early on (a rapid weak pulse is expected following surgery due to post-op shock); ensure the patient has adequate ventilation; patient may be reluctant to turn, cough and breathe deeply due to incisional pain, thus ensure comfort and ability to perform coughing and deep-breathing exercises (a spirometer or other respiratory devices may be used every 2 hours while the patient is awake) – ensure patient receives necessary pain medication; (Renal surgery often involves the removal of the 12th rib)
- monitor abdominal distension – during surgery, the abdomen is usually inflated with gases so organs are separated for easier surgical access; oral intake should be restricted until bowel sounds become present (usually 24-48 hours post-op); during this time, patient should be put on IV fluids
NOTE: The kidneys are responsible for the regulation of extracellular fluid and composition, erythropoietin production, vitamin D activation, and acid-base balance regulation. Thus…
Fluid retention increases the remaining kidney’s workload since it has to perform all these functions independently
Patient Discharge Plan
- teach patient to avoid bending (or if really necessary, bending from the knees and not the waist), avoid heavy lifting (<5lbs) and avoid strenuous activity
- teach patient to avoid making multiple trips up and down the stairs, but that it’s okay to use the stairs sparingly during the first week following discharge
- emphasise that driving should be avoided for at least 4 weeks following surgery; patient may resume driving only after pain medication is stopped and if pain free
- teach patient that while showering, incision site should be gently washed with soap and water, rinsed well and pat-dry; bathing should be avoided until the incision is fully healed (inform patient that steri-strips applied during an open nephrectomy fall off in about a week)
- encourage a well-balanced diet since this promotes healing and good bowel function
- teach patient to avoid constipation, and that if constipated, prune or orange juice should be tried; increasing water intake to 6-8 glasses of water per day may help; over-the-counter laxatives may also help
The nurse should emphasise the importance of contacting the physician IMMEDIATELY if:
- chills or a fever of 101 degrees fahrenheit or more develops
- severe uncontrollable pain develops
- surgical incision becomes red or swollen
- the surrounding skin of the incision becomes warmer and redder than other areas
- incision site is oozing
- incision site has an opening
- passing urine becomes difficult
- urine output decreases
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