Pico Paper

Are kidney longanimouss who standard a root word nephrectomy at a higher guess of damage nephritic function and cardiac related termination compared to those who sure a partial(p) nephrectomy? Kiara Wilson Nursing 3163 Dr. Linda Upchurch November 12, 2012 flat coat Are kidney long-sufferings who legitimate a partial nephrectomy at a note luck of impaired nephritic function and cardiac related oddment compared to those who received a radical nephrectomy? When a patient is diagnosed with kidney damage, a operative nephrectomy is often sufficeed. Kidney damage may be ca utilize by blocked extraction vessels, kidney stones, masses, infection, and/or kidney bottomlandcer.With this mapping the kidney damage may be processed and as well as prevent hike up damage. A partial nephrectomy is a surgical occasion to remove a raft of the kidney. Partial nephrectomies are normally through with(p) laparoscopically with hand assistance or with robot assistance. A radical neph rectomy involves removing the kidney and the ad nephritic glands. A radical nephrectomy may be done laparoscopically or by open abdominal surgical procedure. My patient was diagnosed with damage of the left kidney. Blood sorts were performed and the patient was plunge to relieve oneself a toxic WBC granulation. 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 lower pole renal mass and parasitic vessels in the infect area. A hand assisted partial laparoscopic nephrectomy was performed. They removed the lower portion of her left kidney. The kidney was to be tested for malignancy. The concern with my patient is that she has a former(prenominal) medical history of hypertension, anemia, and deep vein thrombosis. She is at an change magnitude risk of further cardiac and renal complications. I believe these factors catchd the doctors decision to perform a partial nephrectomy instead o f taking the radical approach.To find look into on this kidney condition, I accessed the Galileo database. I searched for information on ways to treat renal masses and kidney cancer. I found multiple articles about laparoscopic and radical (open) nephrectomies. I found more articles that discussed the differences between the two and the affects they have on patients who receive them. I found an interesting accept called Partial Nephrectomy Is Associated with improve Overall Survival Compared to melodic theme Nephrectomy in Patients with Unanticipated Benign renal Tumours. I found it interesting because it was relevant to the health issues that were being address with my patient. There millions kidney patients who undergo these procedures each year. I wanted to discover which procedure provided the best outcome for my patient and others with similar kidney problems. Purpose According to this study, a partial nephrectomy has been associated with improved boilers suit selection in patients with localized renal masses 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 unanticipated renal masses. Another target area of this study is to also study the effect of these procedures on cardiac proper(postnominal) survival rates and other causes of death related to decreased kidney function. system The hypothesis for this study are that the use of partial nephrectomies would be get-go line of treatment compared to radical nephrectomies in that partial nephrectomies provide let on protection of renal function. Decreased renal function testament work to a low survival rate.Patients who undergo radical nephrectomies will have higher rate of cardiac related deaths Design A cardinal year, nonrandomized study was conducted apply 499 participants. Of these 499 particiapants, 111 patients had received a radical nephrectomy while 388 patients received a partial nephr ectomy. 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 up-to-date health, life expectancy 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 Death Index. Anyone without a Social Security bend was excluded. The cause of death information from the patients medical records was reviewed. From there the participants were further categorise by the condition that caused the death. Cardiac deaths ranged from death related to ischemic intent disease, CHF, ischemic stroke, myocardial infarction, ischemic stroke, and peripheral vascular disease.Renal deaths were broken dash off into death related to renal failure, renal insufficiency, or nephritic syndrome. every other possible causes of death were group togethe r. 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 utilized in a variable model of survival. They measured the overall survival rate of the participants and cardiac particular(prenominal) survival rates. Findings Radical nephrectomies are greatly associated with an increased risk of death from any cause.Patients with unanticipated benign tumors that were treated with RN were more probably to die 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 big tumors. Those with smaller masses and tumors were more likely to have a partial nephrectomy. Radical nephrectomies are associated with an increased risk of death by 2 folds from any cause. The risk of cardiovascular death was substantially higher in those with decreasing 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 above 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 concluded that no matter which surgery was performed there would be a decrease in kidney function. However, those patients who received a PN had a uncommon lower decrease in renal function. It can be express 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 di e from cardiac related death it can be concluded that other conditions that cause death are decline by renal insufficiency. This study was relevant to the PICO question I asked.This study answered my question and provided the information necessary to make it a valid 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 educated on the risks of death and further complications associated with their procedures. It could allow for let out planning and managing of the care for these patients.Implications As a foster it would be my responsibility to knowledgeable about procedures such as these and how they will affect my patient. It 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). forthright 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. military rating (to be completed by instructor) Possible Points Actual Points Introduction of clinical problemComments 20 Purpose/Aim of the study/articleComments 10 Theoretical modelling of the study/articleComments n/a Hypotheses/QuestionsComments 5 DesignComments 5 FindingsComments 10 DiscussionComments 25 ImplicationsComments 20 ReferencesComments 5 Grade 100/100 /100 PICO composition Grading Rubric (submit, along with PICO OAT form, with your paper) Student 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?