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?

Monitoring urine output and assessing for acute kidney injury is the priority because the remaining kidney must compensate for the lost renal function, and early detection is crucial for patient safety. Other interventions are important but secondary to preventing life-threatening renal failure.

Core Nursing Explanation Key Concept Analysis: This question assesses the priority nursing intervention for a patient 24 hours post-radical nephrectomy (surgical removal of a kidney, often for renal cell carcinoma (RCC)). The core theme is postoperative assessment and prevention of life-threatening complications. After removal of one kidney, the patient's entire renal function depends on the remaining kidney. The most immediate and serious threat in the early postoperative period is acute kidney injury (AKI) due to surgical stress, potential damage to the remaining kidney's blood supply, or obstruction.

Answer Rationale: Key Point! Monitoring urine output is the priority because it is the most direct, real-time indicator of the remaining kidney's function. A significant decrease in urine output (oliguria:

Nursing Clinical Practice Guide Clinical Scenario: Mr. Johnson, 58, is in the surgical unit post-radical left nephrectomy. His vital signs are stable, but you are conducting your 2-hour assessment.

Nursing Intervention Strategy:

1. Assessment: Connect the urinary catheter to a urometer for accurate hourly urine output measurement. Palpate the abdomen for distension and pain. Assess the surgical dressing for bleeding or drainage. Auscultate bowel sounds.
2. Nursing Diagnosis: Risk for deficient fluid volume and Risk for acute kidney injury related to surgical removal of kidney and possible hemorrhage.
3. Planning & Implementation: The goal is to maintain urine output >30 mL/hr. If output drops:
   • Check for kinks in the catheter tubing.
   • Ensure adequate IV fluid infusion as ordered.
   • Assess blood pressure for hypotension.
   • Notify the surgeon immediately with the specific data (e.g., "Urine output 10 mL last hour, BP 100/60").
4. Patient Education & Evaluation: Once stable, educate on long-term kidney protection: maintain hydration, avoid nephrotoxic OTC drugs, control blood pressure, and report any signs of UTI or flank pain.

Patient Safety and Precautions:

• Fluid Balance: Meticulous Intake and Output (I&O) recording is non-negotiable.
• Medication Safety: Verify all new medications for potential nephrotoxicity. Question any order for NSAIDs.
• Early Mobilization: Encourage ambulation after ensuring hemodynamic stability and adequate pain control to prevent DVT, but never at the expense of skipping urine output checks.

Nursing Procedure & Medication Flow Procedure: Monitoring Post-Nephrectomy Patient 1. Q1h for first 24h: Measure urine output via catheter. (Key Point! Normal: >0.5 mL/kg/hr). 2. Q4h & PRN: Assess pain using a numeric scale. Administer prescribed opioids (e.g., hydromorphone) cautiously, monitoring for respiratory depression. 3. Daily: Weigh patient (same scale, same time) to monitor for fluid retention. 4. Monitor lab work: Electrolytes (especially potassium (K+)), BUN, Creatinine.

A Word from Your Senior Nurse: "In the fast-paced surgical unit, it's easy to get caught up in tasks. But for this patient, that hourly urine output is your north star. It tells you if their one remaining kidney is working. A sudden drop isn't just a number—it's a potential crisis. Your vigilant monitoring and swift communication can make the difference between a simple intervention and a trip to the ICU. Always connect the dots: low urine output -> check perfusion -> protect the kidney. That's what being a guardian at the bedside truly means."