Pico Paper

ar kidney endurings who certain a perfect nephrectomy at a higher risk of afflicted nephritic kick the bucket and cardiac link up end comp bed to those who received a incomplete nephrectomy? Kiara Wilson Nursing 3163 Dr. Linda Upchurch November 12, 2012 Background Are kidney patients who received a partial(p) nephrectomy at a depress risk of damage nephritic government agency and cardiac related close comp atomic number 18d to those who received a source nephrectomy? When a patient is diagnosed with kidney stultification, a surgical nephrectomy is practically performed. Kidney damage whitethorn be make upd by obturate blood vessels, kidney stones, potentiometer, infection, and/or kidney stoolcer.With this routine the kidney damage may be toughened and as well prevent besides damage. A partial nephrectomy is a surgical number to remove a portion of the kidney. partial derivative nephrectomies atomic number 18 normally done laparoscopically with hand assi stance or with robot assistance. A root word nephrectomy involves removing the kidney and the adrenal glands. A radical nephrectomy may be done laparoscopically or by open abdominal surgery. My patient was diagnosed with damage of the left(a) kidney. Blood tests were performed and the patient was found to defecate a toxic WBC granulation tissue. This toxic granulation led infection, inflammation and sepsis.An abdominal and pelvic CT scan found a 7. 8 x 5. 6 x 6. 2 cm, solid, enhancing left turn complicate pole renal mass and parasitic vessels in the infected area. A hand assisted partial laparoscopic nephrectomy was performed. They removed the diminisheder portion of her left kidney. The kidney was to be tested for malignancy. The concern with my patient is that she has a ancient medical history of hypertension, anemia, and deep vein thrombosis. She is at an change magnitude risk of save cardiac and renal complications. I believe these factors influenced the doctors decis ion to perform a partial nephrectomy instead of taking the radical approach.To reclaim research on this kidney condition, I accessed the Galileo informationbase. I searched for info on ways to treat renal batch and kidney cancer. I found multiple articles about laparoscopic and radical (open) nephrectomies. I found many articles that discussed the differences between the 2 and the affects they provoke on patients who receive them. I found an interesting bring called Partial Nephrectomy Is Associated with meliorate boilersuit Survival Compared to bag Nephrectomy in Patients with Unanticipated auspicious Renal Tumours. I found it interesting because it was relevant to the health issues that were being addressed with my patient. There millions kidney patients who bear with these procedures each year. I wanted to discover which procedure issued the best outcome for my patient and others with similar kidney problems. drive According to this look at, a partial nephrectomy h as been associated with improved boilers suit survival in patients with localized renal rabble compared to those who received a radical nephrectomy (Weight, 2010).The purpose of this study is to test the overall survival rate of patients who had unexpected renal masses. Another objective of this study is to also study the effect of these procedures on cardiac item survival rates and other causes of expiry related to decreased kidney function. Hypothesis The hypothesis for this study are that the use of partial nephrectomies would be first canal of treatment compared to radical nephrectomies in that partial nephrectomies provide better protection of renal function. Decreased renal function will lead to a low survival rate.Patients who undergo radical nephrectomies will confine higher rate of cardiac related destructions objective A seven year, nonrandomized study was conducted using 499 participants. Of these 499 particiapants, 111 patients had received a radical nephrectomy while 388 patients received a partial nephrectomy. The choice of which surgery to do was left of the surgeon and the patients preferences. They took into consideration the mass size, the appearance, the patients current health, keep foreboding and the comfort of the surgeon in making their decisions.The patients comorbidities were pass judgmented using the Charlson-Romano Comorbidity Index. Each patients vital signs were acquired using the Social Security goal Index. Anyone without a Social Security Number was excluded. The cause of last information from the patients medical records was reviewed. From there the participants were further categorized by the condition that caused the death. Cardiac deaths ranged from death related to ischemic heart disease, CHF, ischemic stroke, myocardial infarction, ischemic stroke, and peripheral vascular disease.Renal deaths were broken down into death related to renal failure, renal insufficiency, or nephritic syndrome. All other possible c auses of death were group together. Perioperative, postoperative data and renal function tests were collected before and after the procedures. Preoperative data was used to create the propensity model that was utilise in a multivariate model of survival. They heedful the overall survival rate of the participants and cardiac specialized survival rates. Findings Radical nephrectomies are greatly associated with an change magnitude risk of death from any cause.Patients with unanticipated kind tumors that were treated with RN were more promising to happen from any related health problem than those treated with PN. Participants who received a radical nephrectomy were more likely to be older, with high comorbidity scores, and larger tumors. Those with smaller masses and tumors were more likely to have a partial nephrectomy. Radical nephrectomies are associated with an change magnitude risk of death by 2 folds from any cause. The risk of cardiovascular death was substantially highe r in those with lessen post-operative renal function.Decreased kidney function was related to an increase in cardiovascular death and death from any other cause in overall majority patients. sixteen participants died of cardiac related deaths. Renal preservation was increased in the group that had the partial nephrectomy with majority of the patients having an eGFR to a higher place 60 %. Radical nephrectomy participants only had an eGFR of 30 % or lower. The higher eGFR is associated with an increase chance of survival in PN patients. Discussion Previous studies indicate that postoperative impaired renal function plays a role in the overall survival of patients with renal masses.The data reason that no matter which surgery was performed there would be a decrease in kidney function. However, those patients who received a PN had a remarkable lower decrease in renal function. It can be stated that patients have decreased function are at an increased risk of cardiac related death and death by other causes. For many of those who dont die from cardiac related death it can be concluded that other conditions that cause death are worsened by renal insufficiency. This study was relevant to the PICO drumhead I asked.This study answered my question and provided the information necessary to make it a effectual question. I believe the limitations to this study are that the researchers did not randomize their study. They picked which participants they thought would influence their study. The strengths of this article are that is discusses the importance of preserving renal function when performing a nephrectomy. It also provides evidence that patients should be cultivated on the risks of death and further complications associated with their procedures. It could allow for better homework and managing of the care for these patients.Implications As a nurse it would be my responsibility to knowledgeable about procedures such as these and how they will affect my patient. I t would be my job to educate the patients on what to expect from this surgery and what it means for their health. I could also use this information to better assess patients before and after these procedures. This research provides material that could be used to better treat and prevent life threatening conditions that could arise after surgery. References Landman, D. (2006). Open Partial Nephrectomy.Retrieved November 9, 2012, from Kidney Cancer Institute www. kidneycancerinstitute. com/open-partial-nephrec. html Landman, D. (2006). Open Radical Nephrectomy. Retrieved November 9, 2012, from Kidney Cancer Institute www. kidneycancerinstitute. com/open-radical-nephrec. html Weight, C. J. , & Leiser, G. (2010, April 29). Partial Nephrectomy Is Associated with Improved Overall Survival. EUROPEAN UROLOGY, 58, 293-298. Evaluation (to be unblemished by instructor) Possible Points Actual Points Introduction of clinical problemComments 20 Purpose/Aim of the study/articleComments 10 Theore tical framework of the study/articleComments n/a Hypotheses/QuestionsComments 5 DesignComments 5 FindingsComments 10 DiscussionComments 25 ImplicationsComments 20 ReferencesComments 5 Grade century/100 /100 PICO Paper Grading Rubric (submit, along with PICO OAT form, with your paper) bookman Name _Kiara Wilson______________Date November 12, 2012_____________ Are kidney patients who received a radical nephrectomy at a higher risk of impaired renal function and cardiac related death compared to those who received a partial nephrectomy?