A nurse is caring for a patient who underwent a radical nephrectomy for renal cell carcinoma 24 hours ago. Which nursing intervention is the priority for this patient?

The immediate postoperative phase after radical nephrectomy demands vigilant monitoring of the remaining kidney's function. The physiological priority is the early detection of acute kidney injury (AKI), as the solitary kidney must rapidly compensate for the loss of its counterpart.

• Strict Intake and Output: Monitor urine output hourly. Report output less than 0.5 mL/kg/hr immediately, as this is a primary indicator of AKI. Maintain a fluid balance chart.
• Renal Function Labs: Monitor serial serum creatinine and BUN levels. A rapid rise in creatinine suggests impaired filtration by the remaining kidney.
• Fluid Status Assessment: Assess for signs of fluid overload (e.g., crackles on auscultation, edema, jugular vein distension) or dehydration, as the kidney's regulatory function may be compromised.

• Report Critical Findings: Immediately notify the surgeon of oliguria, anuria, or a significant rise in creatinine to facilitate timely intervention, which may include fluid challenges or nephrology consultation.
• Maintain Catheter Patency: Ensure the urinary catheter is draining freely. Obstruction can mimic or cause AKI.
• Integrate Other Care: While monitoring is the priority, manage pain to facilitate deep breathing and mobility, and begin DVT prophylaxis as ordered once the patient is hemodynamically stable.