The Nursing care after the kidney surgery

In this PowerPoint you will find a general explanation of kidney surgeries its definition, causes, risk factors. And you will find a detailed description of the nurse role for the patient after the surgery.

1. Nursing care afte r kidney surgery

2. Supervisors PROF/ Eman Mahmoud PROF/ Entsar Gad Elmoula DR/ Thanaa Diab SUPR/ Asmaa   Abdelati

3. Done by 1. ابانوب عطيه فايز اقلاديوس 10. احمد حمدى عطيتو حسانين 19. اسراء حمدى احمد شحات 2. ابتسام عويس فتحى عبدالرضى 11. احمد خميس سعد حسين 20. اسراء ربيع علي محمد 3. ابتسام يوسف احمد عبدالرحمن 12. احمد شعبان احمد مجلى 21. اسراء زكريا اسماعيل هارب 4. ابراهيم اشرف محمد صادق 13. احمد صبحي احمد ابراهيم 22. اسراء زكريا انور خليل 5. ابوالحسن شاذلى حسن محمد 14. احمد صلاح الدين على محمد 23. اسراء سليم حسن سليم محمد 6. احمد ابوالحمد ابوالحسن احمد 15. احمد طلعت ابراهيم عبدالرحيم 24. اسراءعبد الحفيظ حسن ابازيد 7. احمد جبريل يوسف حسن 16. احمد عبدالرحمن يونس حسين 25. اسراء علاء احمد عبدالعزيز 8. احمد حسن عبدالجليل السيد 17. احمد عبده بدري ابوزيد 9. احمد حسن علي عثمان 18. احمد عمار احمد بكر

4. 26. احمد كمال مصطفى على 35. اريج سيد عطاالمنان امبارك 44. اسلام عبدالصبور ابوالعطا محمود 27. احمد محمد احمد على 36. ازهار جبريل سيد اسماعيل 45. اسلام عبدالله احمد محمود 28. احمد محمود علي محمد صالح 37. اسامه ابراهيم الدسوقي مصطفي 46. اسلام على احمد سطوحى 29. احمد نصر الدين عبد الوهاب حميد 38. اسامه احمد محمد محمود 47. اسلام ناصر حمدان محمد 30. احمد يسرى محمد الدندراوى 39. اسامه عبدالله محمد محمود 48. اسماء احمد حمدان على 31. احمد يوسف شعبان عمر 40. اسراء جمعه فهمي علام 49. اسماء احمد عبدالرحمن عبد الودود 32. ادم جادالرب حسن داوود 41. اسراء جمعه محمود احمد 50. عبدالرحمن عادل سيد عوض الله 33. اروى جابر محمد محمود 42. اسراء مصطفى عبدالكريم عبدالقادر 34. اروى خالد ابراهيم محمد 43. اسراء موسى جابر شحات

5. Outlines Introduction Definition What are the kidneys ? What is the function of the kidneys ? Indication of kidney surgery Contraindications for kidney surgery How to prepare for kidney surgery ? What will happene during kidney surgery ? ( in the operation room ) Risk after kidney surgery ( complications ) Nursing care plan

6. Introduction Kidney surgery is a major procedure that requires proper post-operative care and follow up to ensure recovery and prevent complications. The kidneys are vital organs in the body responsible for filtering waste and excess fluid from the blood. Kidney surgery is performed for several indications including removal of kidney stones, treatment of kidney tumors, or other disorders affecting the kidneys.

7. Definition Surgery to remove a kidney or part of a kidney. In a partial nephrectomy, part of one kidney or a tumor is removed, but not an entire kidney. In a simple nephrectomy, one kidney is removed. In a radical nephrectomy, an entire kidney, nearby adrenal gland and lymph nodes, and other surrounding tissue are removed

8. What are the kidneys ? The kidneys are two reddish-brown bean-shaped   organs  found in  vertebrates . They are located on the left and right in the  retroperitoneal space , and in adult humans are about  12 centimetres (4 + 1 ⁄ 2  inches) in length. They receive blood from the paired  renal arteries ; blood exits into the paired  renal veins . Each kidney is attached to a  ureter , a tube that carries excreted  urine  to the  bladder .

9. What is the function of the kidneys ? The main role of the kidneys : is  mai ntaning  homeostasis . They manage fluid levels, electrolyte balance, and other factors that keep the internal environment of the body consistent and comfortable.

10. The kidneys are powerful chemical factories that perform the following functions: remove waste products from the body remove drugs from the body balance the body's fluids release hormones that regulate blood pressure produce an active form of vitamin D that promotes strong, healthy bones control the production of red blood cells

11. Indication of kidney surgery The most common reasons for kidney surgery include: Kidney stones: Large stones may require surgical removal if they do not pass on their o wn. Kidney tumors: Both benign and cancerous tumors are often treated surgically through partial or complete kidney removal. Severe kidney damage or disease : Surgery may be needed in some cases of kidney disease, infection, or injury.

12. Contraindications for kidney surgery Patients with bleeding disorders . Heart problems lung disease, or liver disease may not be good candidates for kidney surgery due to health risks. In some cases, alternative non-surgical treatments are recommended if possible. Lone functioning kidney: Surgery cannot be performed if there is only one functioning kidney.

13. How to prepare for kidney surgery ? Preparation includes various tests like blood test, urine test, imaging scans. The patient is advised to stop eating and drinking 6-8 hours before surgery. Anesthesia is commonly general anesthesia. An IV tube will be inserted to provide fluids. Patient is asked to stop smoke 1-2 month before surgery. PT (prothrombin Time and Partial prothrombin Time ) monitoring is done to assess bleeding risk.

14. What will happene during kidney surgery ? (in the operation room) Patient received anesthesia. A catheter is inserted into the bladder. Robotic arms or laparoscopic tools are inserted through several small incisions. The surgeon visualizes the kidney and vasculature. The parts of kidney performed then are resected and removed. Incisions are closed with staples or sutures. Patient is shifted to recovery room.

15. Risk after kidney surgery complications Like all surgeries, kidney surgery poses some risks, including: Infection : There is a small risk of surgical site infection or kidney infection following the procedure. Blood clots: Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism) can occur after any surgery. Blood thinners and compression stockings are used to prevent clots. Bleeding : While rare, excessive bleeding can occur during or after the surgery. Transfusions or repeat surgery may be needed in some cases.

16. Damage to surrounding organs: There is a small risk of injury to the pancreas, spleen, liver or bowel during kidney surgery. Kidney failure: In rare cases, the remaining part of the kidney may be inadequate or fail following partial nephrectomy. Dialysis may be required.

17. Nursing care plan

18. Assessment Assess the patient's vital signs, including blood pressure, heart rate, respiratory rate, and temperature. Monitor the patient's pain level and location, as well as any signs of bleeding or infection. Assess the patient's urinary output and monitor for any signs of urinary obstruction or infection. Observe the patient's fluid and electrolyte balance, including monitoring for signs of dehydration or fluid overload.

19. Assess the patient's mobility and activity level, including any restrictions on movement or exercise. Evaluate the patient's psychological and emotional state, including any anxiety, depression, or other mental health concerns.

20. Evaluation Interventions Goal Nursing diagnosis Patient is free form any source of infection Maintain a clean patient environment, wear a mask in patient's room if policy indicates. Follow strict hand washing technique. Limit the number and duration of invasive devices. Assess patient's mouth for white lesions characteristic of oral candidiasis. Monitor vital signs and assess wound and urinary catheter sites regularly for signs of infection. The client will experience no signs/symptoms of infection Risk for infection related to surgical incision and urinary catheterization.

21. Nursing diagnosis Goal Interventions Evaluation Risk of blood clot formation (Deep venous thrombosis) related to surgery Prevent blood clots formation Prevent complications of the blood clot Bed rest to prevent clot dislodgment (movement) Elevate affected or both legs Turn patient every 2 hours Range-of-motion exercises to the unaffected leg Warm compresses to help reduce swelling Monitor vital signs every 4-6 hours Assess patient for complications of Plmonary embolism , such as shortness of breath, chest pain, cough, hemoptysis, tachypnea, crackles, tachycardia , and fever The client will have no complications and the blood clot will dissolve

22. Nursing diagnosis Goals Interventions Evaluation Risk of bleeding related to the surgery The patient will take measures to prevent bleeding the patient will be able to recognizes signs of bleeding that need to be reported immediately to a healthcare professional. The patient will not experience bleeding Educate the at-risk patient about precautionary measures to prevent bleeding Administer blood products if indicated Educate the patient and  family members  about signs of bleeding that need to be reported to a health care provider. Instruct the patient to observe skin and mucous membranes for oozing of blood. I nstruct the patient to avoid products that contain aspirin or NSAIDs The patient won’t suffer from bleeding and won’t report any signs of bleeding

23. Nursing diagnosis Goals Interventions Evaluation Risk for Decreased Cardiac Output related to kidney failure The client will maintain cardiac output within the client’s normal limits of BP/heart rate /pulse Encourage the patient to rest in bed Encourage the client to perform relaxation techniques A dminister or restrict fluids as indicated. Provide supplemental oxygen if indicated. Administer medications as indicated (dopamine ) Prepare for/assist with dialysis as necessary The cardiac output is within normal limits

24. Nursing diagnosis Goals Interventions Evaluation Excess Fluid Volume related to kidney failure The client will have : Norma l urinary output Stable weight Vital signs within the client’s normal range Absence of edema restrict fluids as indicated. Promote sodium and fluid restriction as indicated. Insert indwelling catheter, as indicated. Administer medication as indicated : (diuretics/ Vasodilators ( Prepare for dialysis as indicated The patient will have normal fluid volume

25. Nursing diagnosis Goal Intervention Evaluation Impaired urinary elimination related to urinary catheterization and postoperative pain. The patient will use techniques to prevent retention/urinary  infection . The patient will identify the cause of incontinence. The patient will provide a rationale for treatment. The patient will understand the condition. Encourage adequate fluid intake (2–4 L per day), and limiting intake during late evening and at bedtime. Recommend good hand washing and proper perineal care. Promote continued mobility Educate the patient about the importance of limiting the intake of alcohol and caffeine. Catheterize as indicated Patient verbalizs techniques to prevent urinary infection and retention  . Patient is able to properly self-catheterize/clean indwelling catheter  . Patient achieve s a normal elimination pattern normal output .

26. Evaluation Interventions Goal Nursing dignosis Patient is relieved from pain Acknowledge and accept the client’s pain. Assess the patient’s comfort level with non-pharmacological methods of pain relief Determine and administer the appropriate prescribed analgesic. Consider PCA if the patient is a candidate Perform nursing care during the peak effect of analgesics Reassess pain level after 30 minutes of interventions. Report maximum pain relief/control Patient uses pharmacological and nonpharmacological pain-relief strategies. Patient report improvement in mood, coping. Acute pain related to surgical incision and tissue trauma.

27. Evaluation Interventions Goal Nursing diagnosis Fluid is controlled and balanced Supply balanced electrolyte IV solutions as directed. Administer electrolyte replacements as prescribed. Monitor vital signs, particularly the blood pressure levels. Regularly check for the patient’s level of consciousness Educate the patient about avoiding foods high in sodium. Monitor input and output Patient will maintain normal electrolyte levels (serum potassium, sodium, calcium, magnesium, and phosphorus) Patient will maintain normal fluid balance Patient will maintain adequate hydration Patient will maintain normal kidney function Risk for fluid and electrolyte imbalance related to surgical stress and altered kidney function.

28. Evaluation Interventions Goal Nursing diagnosis The patient ia able to participate in activities of daily living to the fullest extent possible for their condition. Assist patient with muscle exercises as able or when allowed out of bed Present a safe environment: bed rails up, bed in a down position, and important items close by. Establish measures to prevent skin breakdown and thrombophlebitis from prolonged immobilit Execute passive or active assistive ROM exercises to all extremities. The patient will be able to perform physical activity independently The patient’s mobility will increase The patient will have no complications of immobility Risk for impaired mobility related to surgical site pain and postoperative restrictions.

29. Evaluation Interventions Goal Nursind diagnosis Patient feels comfortable and anxiety is releved Provide education about anxiety disorders. Administer anti-anxiety drugs, as ordered. Encourage relaxation techniques such as deep breathing. Educate the client on the importance of sleep hygiene and reducing environmental stressors. Assist the client with identifying and challenging irrational thoughts. The client will appear relaxed and report anxiety is reduced to a manageable level. The client will be able to verbalize snd express his feelings Anxiety related to surgery and postoperative recovery.

30. Recovery Most people take 4 to 6 weeks to recover from kidney surgery. Moderate activity and light exercise can begin after 2-3 weeks. More strenuous activity should wait until 6 weeks after surgery. Drink plenty of water to flush the kidneys. Follow up with the surgeon for any suture removal and to check on the remaining kidney. Most patients return to their normal daily activities and work after 2 months.

31. Resources Ruiz-Ortega M, Rayego-Mateos S, Lamas S, Ortiz A, Rodrigues-Diez RR. Targeting the progression of chronic kidney disease. Nat. Rev. Nephrol. 2020;16(5):269-88. DOI: 10.1038/s41581-019-0248-y [  Links  ] 3. Sallenave MP, Françoso MM, Gusukuma LW, Pestana JOM. Transplantar ou não transplantar. Em: Pestana JOM, Freitas TVS, Silva Junior HT, editores. Transplante renal: manual prático. São Paulo: Livraria Balieiro; 2014. p. 3-15. [  Links  ] htt p ://scielo.isciii.es/scielo.php?script=sci_arttext& p id=S2254-28842017000100010&lng=es http://scielo.sld.cu/scielo.php?script=scLarttext&pid=S0864-03192016000300002&lng=es