Nursing 4 Lecture 4 Renal Cell Carcinoma

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ncappadonia
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Nursing 4 Lecture 4 Renal Cell Carcinoma
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2012-02-04 20:33:07
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Nursing 4 Lecture 4 Renal Cell Carcinoma
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  1. Renal Cell Carcinoma
    • -Adenocarcinoma of the kidney
    • -Systemic affects occuring with this cancer type are called paraneoplastic syndromes

    • -Benign tumors are rare
    • -Risk factors: link to smoking, HTN, and obesity
    • -Tumor can advance significantly before detection
    • -Triad of manifestations: hematuria, flank pain, and palpable mass
  2. Paraneoplastic Syndrome:
    • -Anemia
    • -Erythrocytosis
    • -Hypercalcemia
    • -Liver dysfunction
    • -Increased sedimentation rate
    • -Hypertension
  3. The Cancer Usually Spreads To:
    • -Adrenal gland
    • -Liver
    • -Lungs
    • -Long bones
    • -Other kidney
  4. Staging for Renal Cell Carcinoma:
    Stage 1: Tumor within capsule

    Stage 2: Tumor invades perirenal fat

    Stage 3: Tumor extends into renal vein or regional lymphatics

    Stage 4: Common areas of mestasis- lungs, liver, other kidney, adrenal gland, long bones
  5. Assessment: History
    • -Known risk factors (smoking, chemical exposure)
    • -Change in urine color
    • -Abdominal discomfort
    • -Fever
    • -Family hx
  6. Assessment: Physical/Clinical Manifestations
    -Patients describe the flank pain as dull or aching

    -Bloody urine is a late common sign
  7. Assessment: Diagnostic
    • -Urinalysis may show RBC
    • -Decreased Hgb and Hct
    • -Hypercalcemia
    • -Increased ESR
    • -Increased levels of adrenocorticotropic hormone, hCG, cortisol, renin, and parathyroid hormone

    -Diagnosis requires a biopsy of the tumor
  8. Surgical Management
    NEPHRECTOMY!

    -Blood loss during the surgery is a MAJOR concern because renal cell tumors are highly vascular

    • Pre-op:
    • -Teaching
    • -Site of incision
    • -Drains
    • -Pain relief
    • -may give blood and fluids preoperatively to prevent shock

    • Operative:
    • -Patient placed on his or her side w/ the kidney to be removed uppermost
    • -Usually the opposite trunk area is flexed to incrase exposure of the kidney area
    • -Removal of the 11th or 12th rib is needed

    • Post-op Care:
    • -Assess for hemorrhage and adrenal insufficiency,abdominal distension, low urine output, hypotension, and altered LOC
    • -Low BP is sign of hemorrhage and adrenal insufficiency
    • -The second kidney is expected to provide adequate renal function, but it may take days to weeks
    • -Monitor urine output, weigh the patient, temp, pulse, respirations, and pain management
  9. Adrenal Insufficiency:
    Commonly associated with the following symptoms which can vary from mild to extreme

    • -Fatigue
    • -Decreased tolerance to cold
    • -Poor circulation
    • -Hypoglycemia
    • -Low blood pressure
    • -Allergies
    • -Depression
    • -Joint aches and pains
    • -Tendancy to constipation
    • -Muscle weakness
    • -Need for excessive amounts of sleep
    • -Subnormal body temperature
  10. Renal Trauma:
    • -Minor injuries such as contusions, small lacerations
    • -Maor injuries such as lacerations to the cortex, medulla, or branches of the renal artery
    • -Collaborative management
    • -Non surgical management: drug and fluid therapy
    • -Surgical management: nephrectomy or partial nephrectomy

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