Open Partial Nephrectomy

Discharge Open Partial Nephrectomy

VNA/HOMECARE INSTRUCTIONS:

It was a pleasure participating in your care. -You may shower but do not bathe, swim or immerse your incision. -Do not lift anything heavier than a phone book. -Do not drive or drink alcohol while taking narcotics. -Resume all of your home medications. -Call your Urologist's office (617-732-6325) to schedule a follow-up appointment in 1 week AND if you have any questions. -If you have fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from your incision, call your MD or go to the nearest emergency room.

HOSPITAL COURSE: Patient was admitted to Urology after undergoing a right **** left *****right partial nephrectomy. No intraoperative complications occurred; please see dictated operation report for further details. Patient was discharged from the PACU in stable condition. The hospital course was relatively uncomplicated, and pain was well controlled with IV then transitioned to oral pain medications. Diet was well tolerated initially with sips of clears which then gradually transitioned to a regular diet. Patient remained afebrile throughout hospital stay. The Foley catheter was removed, and the patient voided without difficulty. Subsequent to foley removal, JP output did not increase significantly and JP was removed prior to discharge. The patient was discharged in stable condition, ambulating independently, and with adequate pain control. Patient's incisions were healing well, without erythema, edema or discharge. Patient was given wound care instructions and advised to make a follow-up appointment with urologic surgeon.

PATHWAY Pain is often a big issue with these patients due to location of incision in the upper quadrant. Encourage ambulation, chest PT if needed, deep breaths. Po pain meds once tolerating toast and crackers. Diet: POD1 clears, POD2 clears maybe toast/crackers later in day, POD3 ADAT sometimes Dulc supp is used for these patients. avoid ACE,ARBS, diuretics, toradol until creatinine normalizes HLIV when po intake >400cc unless elevated creatinine then ask Chief. Labs: Basic metabolic, mag until on house diet, CBC, POD 1 then at Chiefs discretion. Check labs replete as needed. Home POD 3-4

Discharge meds: Oxycodone #45 Colace #60