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[nephro + -ectomy]
Surgical removal of a kidney. It may be to remove a renal cell carcinoma or an injured organ, or to harvest an organ for transplantation. The surgery may be performed with an open incision or by laparoscopy. Complications include spontaneous pneumothorax, infection, azotemia, or secondary hemorrhage.
The patient is prepared for surgery according to protocol. Aspirin or other medications that may cause postoperative hemorrhage are withheld. The patient and family are assured that, in most instances, the body will adapt to functioning with only one kidney. Postoperatively, vital signs are checked frequently; analgesics are administered (often by intravenous or epidural patient-controlled analgesia); and excessive bleeding is reported. Dressings are changed according to the surgeon's directions or agency protocol. Fluid intake and output, body weight, and electrolytes are carefully monitored. Hemodynamics are monitored closely; the patient is assessed for evidence of postoperative complications such as stroke, myocardial infarction, pneumonia, or atelectasis. The patient is encouraged to breathe deeply (using incentive spirometry) and to cough to prevent atelectasis and other pulmonary complications. Oral hygiene is provided, and early fluid and food intake encouraged. Antithrombotic or sequential compression hose are applied, and the patient is assisted to turn and move in bed. Positioning on the surgical side helps other organs fill operative dead space. Early ambulation is encouraged, usually within 24 hr. Discharge instruction focuses on the components of a renal diet (if necessary), taking care of the incision, recommended activities and restrictions, medications, and the need for follow-up.