left or ride side position after kidney surgery?

TazziRN, RN · May 25, 2007

I had a left nephrectomy. Trust me, even if the books say to put the pt on the left side, ain't no way on God's green earth will the pt listen. It hurts too much! And the only way I could lay supine was if the bed was cranked up about 30 degrees. I could not lay flat on my back for about 3 weeks, and it was over a month before I could lay on my left side.

Actually......come to think of it, I was left on my back for the first day, with the cycler hose on my legs.

GingerSue · May 25, 2007

thanks Tazzi

if the client's HOB is elevated 30 degrees, then is it still considered "supine"?

or would it be low-Fowler's?

sounds like lying on the affected side is too painful?

why is the patient to be positioned on the side?

is the patient to be positioned on the affected or unaffected side during that first 24 hrs?

TazziRN, RN · May 25, 2007

Low Fowler's. Can lay completely flat either because it stretched a fresh incision.

It's not that putting a pt on his side is important, as much as it is for skin integrity. You always turn pts who cannot turn themselves.

Yes, it's very painful. Removing a kidney is very traumatic to the body, because the organ literally has to be carved out of the surrounding structure. Many people also lost a small chunk of the last rib, if it's in the way. I did. If the nephrectomy is on the left, place the pt on the right if there is an order to turn.

TazziRN, RN · May 25, 2007

Oh...and anytime there is surgery on the torso or above you want the pt to be at least 30 degrees, never flat unless it's spinal surgery. Part of it is comfort so the incision is not stressed. Part is safety, to reduce the chance of aspiration if there is vomiting. For brain surgery it's to help reduce ICP.....all kinds of reasons.

GingerSue · May 25, 2007

I'm trying to understand the hypothetical orders for a hypothetical client

who has had a left nephrectomy.

The orders say to alternately position on left side and supine x 24 hours.

But later in the paperwork, it says to postion alternately on the right side and supine.

So I am trying to clarify which side, and why or why not?

Is supine also wrong? Should it be low-Fowler's?

So far my textbooks don't say.

thanks

TazziRN, RN · May 25, 2007

Right side because of pain and stress on the surgical site.

If by "supine" the hypothetical orders means literally supine, then it's wrong and should be low Fowler's. If it just means "on the back" but not necessarily flat, then it's okay.

GingerSue · May 25, 2007

thanks

TazziRN, RN · May 25, 2007

You're welcome!

GingerSue · May 25, 2007

I wondered if maybe positioning on the left side (with left nephrectomy) had something to do with the short drain in the incision - maybe it's to help re: drainage from the wound during that first 24 hrs?

so why position on the right side? other than to be off the back? and to move around?

TazziRN, RN · May 25, 2007

Shouldn't be a drain, but if there is you don't want to occlude it. Yes, the positioning would be to help with circulation.

GingerSue · May 25, 2007

any idea, in this hypothetical situation in which

the hypothetical client comes in with abdominal

pain and has a nephrectomy (with the possibility

of carcinoma that turns out to be a benign

tumor) - why a SBS would be ordered?

(what is an SBS?)