Page 145 - Critical Care Notes

4223_Tab04_131-140 29/08/14 8:28 AM Page 139

139
Pathophysiology
Primary indication is for treatment of renal cell carcinoma (adenocarcinoma of
the kidney), in which the healthy tissue of the kidney is destroyed and replaced
by cancer cells.
Secondary indication is for treatment of renal trauma → penetrating wounds
or blunt injuries to back, flank, or abdomen injuring the kidney; injury or lacer-
ation to the renal artery → hemorrhage.
Clinical Presentation
■ Flank pain (dull, aching)
■ Gross hematuria
■ Palpable renal mass
■ Abdominal discomfort or pain (present in 5%–10% of cases)
■ Hematuria (late sign)
■ Muscle wasting, weakness, poor nutritional status, weight loss (late signs)
Diagnostic Tests
■ Urinalysis (may show RBCs)
■ CBC
■ Complete metabolic panel (CMP)
■ ESR (sed rate)
■ Human chorionic gonadotropin (hcG) level
■ Cortisol level
■ Adrenocorticotropic hormone level
■ Renin level
■ Parathyroid hormone level
■ Cystoscopy
■ IV urogram
■ Renal angiogram or nephrotomogram
■ Ultrasound, CT of abdomen/pelvis with contrast
■ MRI, MRA
Postoperative Management
■ Monitor vital signs frequently.
■ Provide pain management.
■ Encourage patient to cough and deep breathe and to use incentive spirom-
eter every hour.
■ Encourage early mobilization.
■ Monitor intake and output strictly.
■ Assess for bleeding.
■ Administer IV fluids.
■ May require blood transfusion.
■ Obtain CBC every 6 hr × 24 hr, then every 12 hr for 24 hr early postop.
■ Monitor daily weight.
■ Monitor for adrenal insufficiency.
■ If drain in place, monitor and record color and amount of drainage.
GU