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Care Plan Nephrectomy

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by GingerSue GingerSue (Member)

GingerSue has 20 years experience .

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this is for a nephrectomy because of a tumor

often the twelfth rib is removed {does the removal of this rib create any problems?} adequate ventilation, turn, deep breath and cough, adequate pain medication, respiratory devices every two hours while awake, ambulation early and frequently

Re: concern about paralytic ileus - what would be a suitable nursing diagnosis? {Risk for impaired bowel elimination related to surgery}

Edited by Joe V

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Daytonite has 40 years experience as a BSN, RN and specializes in med/surg, telemetry, IV therapy, mgmt.

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i'm not home at the moment, so i don't have access to all my care plan references and other books. however, i've compiled a list of websites that have most of the information you are looking for.

http://www.surgeryencyclopedia.com/la-pa/nephrectomy.html - nephrectomy

http://www.nlm.nih.gov/medlineplus/ency/article/003001.htm - kidney removal

http://kidneycancer.org/index.cfm?pageid=214 - although this is about removal of the kidney for cancer, it is referring to the surgery of the removal of the kidney and care, not the cancer

http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney/ - solitary kidney. how the body functions with only one kidney

http://kidney.niddk.nih.gov/kudiseases/a-z.asp - a to z list of topics on the national kidney and urologic diseases information clearinghouse website

with regard to your nursing diagnosis and paralytic ileus. . .choosing a "risk for" diagnosis is no different than choosing a diagnosis for a real problem except in this way: list all the symptoms of a paralytic ileus. these potential symptoms are the deciding factor as to what nursing diagnosis you will use. once you've chosen the correct nursing diagnosis, stick the words "risk for" in front of it. your nursing interventions are then directed at preventing the development of those symptoms.

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GingerSue has 20 years experience.

1,842 Posts; 28,341 Profile Views

thankyou

I'll be searching the sites

As I searched other internet sources related to kidney surgery, the ones that I looked at focus on cancer, and that is not the problem in this

particular client.

I have a bit more from another textbook, but is very brief.

And I read about erythropoietin produced by the kidney (a deficiency of erythropoietin leads to anemia - "in renal failure" -

And activation of vitamin D - the second step in activation occurs on the kidneys (clients with renal failure have deficienty of an active metabolite of vitamin D - what if it isn't renal failure but just removal of one kidney?)

And renin. And renal PG synthesis.

thanks for the link and I will continue reading.

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Daytonite has 40 years experience as a BSN, RN and specializes in med/surg, telemetry, IV therapy, mgmt.

2 Followers; 4 Articles; 14,602 Posts; 101,322 Profile Views

paralytic ileus occurs 24 to 72 hours postop. it is due to intraoperative manipulation of the intestinal organs, hypokalemia, wound infection and the use of opioids. symptoms of a postoperative paralytic ileus are:

  • nausea and vomiting
  • abdominal distension
  • no bowel sounds, flatus or bowel movements

as i said above, you look for nursing diagnoses that include those symptoms and refer to the etiology of the symptoms.

  • risk for nausea r/t administration of opioids, manipulation of gi tract
  • risk for constipation r/t decreased motility of gi tract
  • risk for acute pain r/t abdominal distention

in approaching your care plan for this patient, as with any case study, you begin by listing the assessment data. with a non-existing patient you have to close your eyes and imagine this patient going through the procedure and what you "would" see as abnormal assessment. when i say abnormal i am meaning that these are things that you are not going to find in a normal assessment--they are the symptoms the patient will have. much of it will include most of the things that occur to a patient undergoing general anesthesia and a open surgical procedure (where the body has been cut into). the remainder will be those things specific to the part of the body operated on and the anatomical and physiological symptoms that occur because of the removal of this kidney. so, you are right to start out by looking at the normal anatomy and physiology of the kidneys and they how this surgery alters that.

there is a previous post done on a care plan for an appendectomy patient that has all the side effects of general surgery listed. so, i don't have to repeat it all, and to give you a guideline, here is the link to it:

here is another surgical resource you may find helpful:

don't drive yourself nuts on this. do this project in an organized way. a good part of this assignment is to learn about what happens to the body when a kidney is removed. you accomplish that by reading about normal kidney function and then how the body functions with only one or no kidney. then, it becomes a surgical care plan. remember to follow the steps of the nursing process. the nursing process always begins with assessment of the patient. always. always. always. start by listing all the abnormal symptoms the patient can possibly exhibit. from those, you develop your nursing diagnoses. your nursing interventions and goals are all related to that list of abnormal symptoms. use the critical thinking flow sheet for nursing students link in my signature line to help you with your organization of this.

on another post you were asking about a sbs test. i've checked several resources i have (i'm at home now) on medical abbreviations. the only thing i'm finding that relates to a lab test is that sbs = serum blood sugar. either this is a typo on your instructions or it must be some kind of abbreviation that canadian labs use that we don't here in the u.s. when i was looking at your other post, i wasn't sure if you were meaning that this sbs also included all those other tests (hb, cbc, serum electrolytes, urinalysis, fbs) which would make it some sort of laboratory panel of tests. for example, we have an sma-7 which is a battery of 7 chemistry tests, but the sma is the name of the machine on which the tests are actually done.

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GingerSue has 20 years experience.

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In the interest of protecting the one remaining kidney, should the person eat a normal diet, or change their diet?

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