Beruflich Dokumente
Kultur Dokumente
The patient is able to understand Ilocano, Filipino and English as media of instruction. The patient has some concerns about the procedure especially on what to do after the operation and after discharge. Learning Need: Interventions to be done after the surgery Learning Diagnosis: Knowledge deficit related to lack on information resources in things to be done following a ureterolithotomy Goal: The patient will be able to apply home care instructions and know when to notify physician for possible complications
Learning Objectives After 15 minutes of patient teaching, the patient: a. Will be able to define ureterolithotomy in his/her own words b. Will be able to tell in her own words the purpose of DJ stenting
Learning Contents
Teaching Strategies
Method of Evaluation
What is Ureterolithotomy?
Instant feedbacking The patient will be able to define nephrectomy in his/her own words Instant feedbacking The patient will be able to tell in her oown words the purpose of DJ stenting
c. Will be able to discuss in his own words the importance of measuring his urine output every hour
The patient must be able to discuss in his own words the importance of measuring urine output
The patient will appropriately execute how to do DBE and will enumerate 5 things to do after surgery The patient will enumerate 5 signs of complications of the surgery where the physician should be notified
e. Will be able to identify 5 signs of possible complications which needs physician notification
Learning Contents: A Nephrectomy is the surgical removal of your kidney when disease or severe injury has caused permanent damage. A single kidney can carry on the functions normally managed by both kidneys and you can return to good health after the operation. Your doctors will have performed tests before this surgery was scheduled to ensure that your remaining kidney is functioning normally. Indications for nephrectomy A simple nephrectomy is indicated in patients with irreversible kidney damage due to symptomatic chronic infection, obstruction, calculus disease, or severe traumatic injury. Simple nephrectomy is also indicated to treat renovascular hypertension due to noncorrectable renal artery disease or severe unilateral parenchymal damage caused by nephrosclerosis, pyelonephritis, reflux dysplasia, or congenital dysplasia of the kidney. Urine Output A urine output of 1 cc/kg/hr or greater is assumed to indicate adequate perfusion to the kidneys. Post-operative and Home Care Instructions Urinary catheter You will have a tube in the urethra that will drain the urine from your bladder. This can be secured to your leg for comfort. It is particularly important after a Nephrectomy that your urine output is monitored closely as it indicates the health of your remaining kidney after surgery. Drains During surgery a small drain may be placed. This drain is used for drainage of excess fluid from the surgical area if there is need for it. It will be removed before discharge. You will have a foley catheter in your bladder. This will be removed on post-operative day 1 or 2. Sutures (stitches or staples) For this surgery, most suture material used is dissolvable and does not require removal. However, if non-dissolving suture material has been used, this will need to be removed approximately seven to ten days after surgery. HOME-CARE INSTRUCTIONS Continue walking when you return home.
The walking will help you build strength. Gradually increase the amount of walking you do each day. Take planned rest periods during the day. The best gauge is your own body and how you feel. It is very important that you continue walking when you are discharged from the hospital. Not only will this build strength but will also aid in preventing blood clots from the legs.
Avoid bending
If you must pick something up, bend with your knees, not your waist: stoop to pick up the item.
(Greater than 5 pounds) Anything you need to brace yourself to pick up is too heavy. Also avoid strenuous activity.
Take them slowly at first. You may wish to group your activities, so that you do not have to make many trips up and down stairs during the first week you are home.
Driving should be avoided for at least 4 weeks after surgery or until you are not taking pain medications or are pain free. Take breaks every couple hours if you are on extended trips. Get out of your car and walk around a bit.
Pain Medications
Do not drive any motorized vehicle, or sign any legal documents while you are taking pain medications. The medications may alter visual perception and impair judgement.
Gently wash the incision with soap and water, rinse well, and pat dry. So do not take a tub bath until the incision is completely healed. If you had an open nephrectomy you will have white strips called steri-strips on the incision. They will fall off in about a week.
Diet:
A well balanced diet is encouraged to promote healing and good bowel function. Return to your normal fluid intake.
Avoid constipation
If you become constipated, there are alternatives to consider. Increase the roughage in your diet. Drink prune juice or orange juice. You can take an over the counter laxative of your choice. Colace will be prescribed when you are discharged. Drink 6-8 glasses of water per day.
Your incision becomes red or swollen The skin around your incision is warmer than elsewhere and is slightly red There is drainage from your incision There is an opening in your incision You are having difficulty passing urine or your urine output becomes less than it normally has been There are chills or fever of 101 or more Severe pain that is not relieved by pain medication
References: Schilling, J (2006). Handbook of Medical-Surgical Nursing 4th edition, Lippincott, Williams and Wilkins copyright 2006