Audio Coursesby JellypodLesson 02 of 5
Overview
Mark Ellison: Hey everyone, welcome back to Nursing 101. I’m Mark Ellison, and today we’re unpacking kidney surgery—what to expect, what to watch for, and how to help your clients through it. I will be referencing this week's learning guide and we will start on slide 59. So, let’s start at the beginning: prepping for renal surgery, specifically nephrectomies. Now, there are a couple of flavors here—partial nephrectomy, which is just removing part of the kidney, sometimes called nephron-sparing, and then there’s the radical nephrectomy, where the tumor, kidney, adrenal gland, perinephric fat, & lymph nodes are all removed- sounds radical right?! No pun intended to visualize the differences you can see a comparison of these two procedures on slide 59 in this week's learning guide. The difference matters for us as nurses, because the more tissue removed, the more we need to think about how the body’s gonna compensate, right?
Mark Ellison: Before surgery or preoperatively, our job is to get the client ready—physically and mentally. Hydration is a big one. We want them well-hydrated to help flush out waste and keep those kidneys happy before we go in. And infection prevention—can’t stress this enough. We use CHG soap, or Hibiclens, to scrub down and lower the risk of surgical site infections. I always tell my patients, “This soap smells weird, but it’s your best friend right now.”
Mark Ellison: But honestly, the biggest hurdle is usually anxiety. People hear “kidney surgery” or nephrectomy and think, “Am I gonna need dialysis forever?” I had a patient once, let’s call her Linda, who was convinced losing a kidney meant her life was over. She was so anxious, she could barely listen to the pre-op instructions. So, I sat down and tried to explain it in plain language. I said, “Linda, think of your kidneys like a pair of coffee filters. If you lose one, the other can still do the job—maybe it works a little harder, but you’ll still get a good cup of coffee.” Not my best analogy, but it made her laugh, and she finally relaxed enough to ask questions. That’s the key—meet them where they are, use whatever silly metaphor you need, and make sure they know one kidney is usually enough for a normal life. Of course, every client’s different, but most folks do just fine.
Mark Ellison: And don’t forget, part of the nurse's role in the preoperative phase is prepping the client by educating about what’s coming after surgery—incisions, possible tubes, maybe a Foley catheter. The more they know, the less scary it is. I always say, “If you’re worried, tell me. If you’re confused, ask. There are no dumb questions, only unasked ones.” If you need to review the nurses role in the preoperative phase you can find more information in chapter 17 of the textbook.
Mark Ellison: Alright, so let’s roll into the OR. The way the surgeon gets to the kidney can really affect what happens next. There’s the flank approach, lumbar, thoracoabdominal, and laparoscopic. Each different approach is listed on slide 60. Each one means different positioning—sometimes the client’s on their side, sometimes almost twisted like a pretzel. I remember my own grandma had a partial nephrectomy, and she woke up with this gnarly shoulder pain. Turns out, it was from the way she was positioned during surgery. So, if your client’s complaining about weird aches, it might just be the after-effects of the position, not the surgery itself.
Mark Ellison: Now, once surgery’s done, the real work for us nurses begins. First priority: watch for hemorrhage. The kidneys are super vascular—like, they get 20 to 30 percent of the cardiac output. That’s a ton of blood flow. So, if there’s any bleeding, it can get serious fast. I am always assessing for postoperative bleeding both internal and external for any client who has had surgery. I always tell new nurses “If you see a drop in urine output, don’t just shrug it off.” I had a shift once where I was watching a post-op patient, and the only clue something was wrong was that her Foley bag stayed empty. No drama, no alarms, just… nothing. Turns out, she was bleeding internally. That’s why you gotta be on your toes—sometimes the first sign is subtle. Intervention is key when bleeding is suspected to prevent the big S word and no it's not four letters but five S-H-O-C-K. Besides decreased urine output you should be astute to changes in mental status, hypotension, tachycardia, and decreased oxygenation which could all indicate bleeding.
Mark Ellison: Besides bleeding, fluid balance is a big deal. After surgery, clients might need fluids or even blood products to make up for what they lost. But you also have to watch for fluid overload, especially if that one remaining kidney isn’t keeping up. And don’t forget about ileus—paralytic ileus is pretty common after kidney surgery. The gut just kind of goes on strike for a bit aka becomes paralyzed which is why it is called "paralytic" ileus. So, you’re watching for abdominal distention, no bowel sounds, that sort of thing. Early ambulation helps, but sometimes you just have to wait it out.
Mark Ellison: And, just to circle back because Jackie wants me to reiterate this key point- the reason bleeding drops urine output is because the kidneys need a certain blood pressure to filter. If the body’s losing blood, the kidneys sense that and start conserving fluid, so output drops. It’s like the body’s own emergency water-saving mode. It's like activating an alarm but the kidneys are activating the amazing RAAs system. The RAAS is important for saving anyone's- well I probably should not say it lol but you get the idea the RAAS is vital to life!
Mark Ellison: So, let’s talk about what happens after the first few hours—when the client’s out of the woods, but not quite ready to go home. Your main jobs: check urine output (ideally more than 0.5 mL per kilogram per hour), keep an eye on respiratory function, manage pain, and watch those labs—creatinine, BUN, hemoglobin, hematocrit. If urine output drops below 300 mL per shift, I don’t wait—I call the provider. Some places say 400 mL in 24 hours, but honestly, I’d rather be safe than sorry. Common complications after kidney surgery are listed in more detail on slide 62.
Mark Ellison: Infection prevention is still huge, especially if they’ve got a Foley catheter. Teach them to watch for cloudy urine, fever, burning—classic UTI or CAUTI signs. And incision care—keep it clean, dry, and watch for redness or drainage. Don't forget early ambulation and incentive spirometry help prevent postoperative pneumonia. And as always though it may not be a priority- treat the client's pain. There are so many interventions us nurses are responsible for.
Mark Ellison: When it’s time for discharge, I always go over a checklist with the client. It’s simple, I cover discharge medications and care of any drainage tubes at home such as foley catheter care. I always provide them with a list of signs and symptoms that they should report to the provider after discharging home such as fever, cloudy urine, decreased urine output, weight gain of more than 2lbs in a day, redness or purulent drainage from incision sites. You get the idea pretty much any sign or symptom which indicates they are experiencing a potential complication should be reported as soon as possible. I tell them, “If anything feels off, call your provider. Don’t wait.”
Mark Ellison: Alright, that’s a wrap for today’s episode of Nursing 101. We’ve covered prepping for surgery, what to watch for in the OR and recovery, and how to set your clients up for a safe discharge. Next time, we’ll dig into more surgical care tips—maybe even tackle the cardiac cycle, if I can get through it without tripping over my words. Thanks for listening, and keep those questions coming! References for this episode can be found at the end of this week's learning guide provided in this week's Canvas module.
