P.

Thiagarajan 20/04/2010

Finals: OSCE ----- Nephrectomy

Introduction etc (elicit patient’s N/A/O)

Establish purpose of consultation…

- ”I understand that you’ll be having an operation to remove one of the kidneys, is this
correct? I’d like to talk to you today about this procedure, and also to answer any
concerns you might have. Would this be OK?”

Establish reason for Nephrectomy and patient’s understanding of procedure. Elicit concerns.

- “Do you know why you will be having this operation?”

- “Can you tell me what you understand by the term “Nephrectomy”?
- “Is there anything you are particularly worried about/would like to discuss with me?”

Explain

- A Nephrectomy is an operation to remove the kidney.

- There are several types, depending on how much of the kidney is removed (simple,
where just the kidney is removed, or radical, where the whole kidney and the adrenal
gland are removed).
- Usually, people can function very well with just a single kidney, although dietary
modifications may have to be made.

Before the operation

- On the morning of the surgery, you will be asked to come into hospital
- Will be introduced to nurse and anaesthetist, and asked to change into hospital gown
- Cannot eat or drink anything for 6 hours prior to surgery – this is to ensure that we
can give you anaesthetic safely.
- In theatre, the anaesthist will pop a line into the back of your hand, so that he can
give you some medication to help you relax. You’ll also be given the anaesthetic
though this.

How is it performed?
- Operation may be performed traditionally (i.e open surgery) or by keyhole surgery
(laparoscopic Nephrectomy).
- In the open surgery, an anaesthetist will give you a general anaesthetic, so that you
will be asleep throughout the procedure, and the surgeon will perform the operation
though a skin incision over your kidney.
- As you will be asleep throughout, you will not feel any pain during the procedure.
- Whole operation takes 3-4 hours.
- May spend up to a week in hospital post-op. Back to work at 6 weeks.

- Laparoscopic: use of telescope-like instruments to perform the operation.

- Smaller skin incisions, faster rate of recovery (home in 5 days).
- 3-4 small incisions made over the skin of your abdomen, and cameras/instruments
are inserted through these.
- At the end of the operation, a 5cm incision is made below the belt line, to allow the
kidney to be removed. Incision sites are then stitched up.
- Return to work within 2-4 weeks.

Recovery
- You’ll taken to a recovery room, and monitored whilst you wake up.
- You may feel groggy for a while as the anaesthetic wears off.
- Don’t worry, we will give you some oxygen via a face-mask to help you breathe.
- You may also experience pain and nausea (this is very common), and we can give
you some effective medication to relieve this.
P.Thiagarajan 20/04/2010

- CATHETER! There is a tube (‘catheter’) coming out from the bladder through the
urethra (water pipe) and connected to a ‘catheter bag’. This is removed after a day.
- Can drive when you are able to brake safely (this may take several weeks e.g. 4).
- DRAIN! You may also have a small plastic drain tube, attached to a drainage bag.
- We would recommend taking 4-6 weeks off work.

Risks
- As with every surgical procedure, there are risks
- Bleeding and infection most common (blood transfusion, antibiotics respectively).
- If you notice any bruising and/or discharge from the wound, be sure to notify a Dr.
- Chest infection: may be taught breathing exercises by physiotherapist.
- Injury to local structures --- may require conversion to open surgery.
- General risks associated with surgery e.g. clots to the legs/lungs, stroke, MI.

Pain Relief
- We would try to minimise the amount of pain you will feel after the operation.
- Early mobilisation is encouraged.
- Given paracetamol/morphine during the operation.
- Surgeon may inject some local anaesthetic into incision sites, so that you don’t feel
wound site pain after the operation.
- Analgesic ladder (post-op): regular paracetamol  ibuprofen  opioid-based.
- May also give you epidural/PCA pump: this is a device which allows you to control
how much pain relief medication you are receiving (you can press a button to
administer more medication, within the limit set up by the Dr).

Thanks
- Thank the patient
- Enquire about any existing questions
- OFFER LEAFLET
- Goodbye. And out.