Nephrectomy

WHAT YOU SHOULD KNOW:

• A nephrectomy (ne-FREK-to-me) is surgery to remove all or part of your kidney. The kidneys are two bean-shaped organs found under the ribs on each side of the upper abdomen. The kidneys remove wastes and other unwanted chemicals from the body. These wastes are flushed from the body in the form of urine. Above each kidney is an adrenal gland, which is an organ that makes hormones. Hormones are special substances that control some functions of your body. These adrenal glands may also be removed during nephrectomy.
  
  
• You may need a nephrectomy when your kidney is damaged. This may be caused by clogged blood vessels, kidney stones, infection, or kidney cancer. These conditions decrease your kidney's ability to control blood pressure and to completely remove harmful wastes from your body. With nephrectomy, your kidney problem may be treated and further damage to your remaining kidney prevented. Your signs and symptoms may decrease and you may resume your usual activities.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery, such as infection or bleeding too much. You may have trouble breathing or get blood clots. Nerves, blood vessels, muscles, and intestines may be damaged. Even after a successful surgery, the remaining kidney may not be able to function as well as before. If you have kidney cancer, some cancer cells may have already spread to other parts of your body.
  
  
• If left untreated, your kidney problem may get worse. If you have kidney cancer, the cancer cells may spread to other areas of your body. These may cause fever, weight loss, weakness, high blood pressure, and decreased amounts of red blood cells. This may affect its ability to completely remove harmful wastes from your body. Too much of these harmful wastes may cause dizziness, headache, seizures, confusion, or fainting. These conditions may cause death, if not diagnosed and treated as soon as possible. Call your caregiver if you are worried or have questions about your condition, treatment, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
    
    
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Tests:
  
  
  • Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
    
    
  • Computerized tomography scan: This is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your abdomen. It may be used to look for abnormal changes and other problems with your kidneys.
    
    
  • Magnetic resonance imaging: This is also called an MRI. During the MRI, pictures of your abdomen are taken. An MRI may be used to check around your kidneys for other problems.
    
    
  • Renal arteriography: A renal arteriography is done to check for problems with blood vessels in your kidneys. Your caregiver uses a special dye to help blood vessels show up better on x-ray pictures. Tell your caregiver if you are allergic to iodine or shellfish (lobster, crab), as you may also be allergic to the dye used for this test.
    
    
  • X-rays: Before surgery, caregivers may want to have an x-ray (picture) of your abdomen to see any other problems with your kidneys.

During your surgery: You will be placed on your back or turned to your side after you go to sleep. Your skin will be cleaned with soap and water and then covered with clean sheets. An incision (cut) is made along your side or across your abdomen to reach the affected kidney. Once it is seen, the blood vessels attached to it are cut and tied. The affected kidney is removed by carefully cutting tissues covering and sticking to it. Your caregiver may remove all or part of your kidney. Your adrenal gland may also be removed. The incisions are closed with stitches (threads) and covered with a bandage.

After your surgery: You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound.

• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Medicines: Your caregiver may give you the following kinds of medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
    
    
  • Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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