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NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs
May be related to
- Lack of exposure/recall
- Information misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions/request for information; statement of misconception
- Inaccurate follow-through of instructions, development of preventable complications
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Knowledge: Disease Process (NOC)
- Verbalize understanding of condition and potential complications.
- Identify relationship of signs/symptoms related to surgical procedure and actions to deal with them.
Knowledge: Treatment Regimen (NOC)
- Verbalize understanding of therapeutic needs.
6 Hysterectomy Nursing Care Plan (NCP)
- Low Self-Esteem — Hysterectomy Nursing Care Plan (NCP)
- Impaired Urinary Elimination — Hysterectomy Nursing Care Plan (NCP)
- Constipation/Diarrhea — Hysterectomy Nursing Care Plan (NCP)
- Ineffective Tissue Perfusion — Hysterectomy Nursing Care Plan (NCP)
- Sexual Dysfunction — Hysterectomy Nursing Care Plan (NCP)
- Knowledge Deficit — Hysterectomy Nursing Care Plan (NCP)
Knowledge Deficit — Hysterectomy Nursing Care Plan (NCP): Nursing Interventions & Rationale
| Nursing Interventions | Rationale |
| Review effects of surgical procedure and future expectations; e.g., patient needs to know she will no longer menstruate or bear children, whether surgical menopause will occur, and the possible need for hormonal replacement. | Provides knowledge base from which patient can make informed choices. |
| Discuss complexity of problems anticipated during recovery, e.g., emotional lability and expectation of feelings of depression/sadness; excessive fatigue, sleep disturbances, urinary problems. | Physical, emotional, and social factors can have a cumulative effect, which may delay recovery, especially if hysterectomy was performed because of cancer. Providing an opportunity for problem solving may facilitate the process. Patient/SO may benefit from the knowledge that a period of emotional lability is normal and expected during recovery. |
| Discuss resumption of activity. Encourage light activities initially, with frequent rest periods and increasing activities/exercise as tolerated. Stress importance of individual response in recuperation. | Patient can expect to feel tired when she goes home and needs to plan a gradual resumption of activities, with return to work an individual matter. Prevents excessive fatigue; conserves energy for healing/tissue regeneration.Note: Some studies suggest that recovery from hysterectomy (especially when oophorectomy is done) may take up to four times as long as recovery from other major surgeries (12 mo versus 3 mo). |
| Identify individual restrictions, e.g., avoiding heavy lifting and strenuous activities (such as vacuuming, straining at stool), prolonged sitting/driving. Avoid tub baths/douching until physician allows. | Strenuous activity intensifies fatigue and may delay healing. Activities that increase intra-abdominal pressure can strain surgical repairs, and prolonged sitting potentiates risk of thrombus formation. Showers are permitted, but tub baths/douching may cause vaginal or incisional infections and are a safety hazard. |
| Review recommendations of resumption of sexual intercourse. | When sexual activity is cleared by the physician, it is best to resume activity easily and gently, expressing sexual feelings in other ways or using alternative coital positions. |
| Identify dietary needs, e.g., high protein, additional iron. | Facilitates healing/tissue regeneration and helps correct anemia when present. |
| Review hormone replacement therapy (HRT). | Total hysterectomy with bilateral salpingo-oophorectomy (surgically induced menopause) requires replacement hormones. The long-term benefits of HRT (particularly estrogen) include a decreased incidence of cardiovascular disease, protection against osteoporosis, improved mood and cognition. |
| Encourage taking prescribed drug(s) routinely (e.g., with meals). | Taking hormones with meals establishes routine for taking drug and reduces potential for initial nausea. |
| Discuss potential side effects, e.g., weight gain, increased skin pigmentation or acne, breast tenderness, headaches, photosensitivity. | Development of some side effects is expected but may require problem solving such as change in dosage or use of sunscreen. |
| Recommend cessation of smoking when receiving estrogen therapy. | Some studies suggest an increased risk of thrombophlebitis, myocardial infarction (MI), cerebrovascular accident (CVA), and pulmonary emboli associated with smoking and concurrent estrogen therapy. |
| Review incisional care when appropriate. | Facilitates competent self-care, promoting independence. |
| Stress importance of follow-up care. | Provides opportunity to ask questions, clear up misunderstandings, and detect developing complications. |
| Identify signs/symptoms requiring medical evaluation, e.g., fever/chills, change in character of vaginal/wound drainage; bright bleeding. | Early recognition and treatment of developing complications such as infection/hemorrhage may prevent life-threatening situations. Note:Hemorrhage may occur as late as 2 wk postoperatively. |
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