Nursing Care Plans | 10/31/2011, 2:17 pm

8 TAHBSO Nursing Care Plans


TAHBSOTotal abdominal hysterectomy bilateral salpingo oophorectomy (TAHBSO) is the removal of entire uterus, the ovaries, fallopian tubes and the cervix. TAHBSO is usually performed in the case of uterine and cervical cancer. This is the most common kind of hysterectomy. Removal of the ovaries eliminates the main source of the hormone estrogen, so menopause occurs immediately.

View the surgical procedure for TAHBSO

Post-operative nursing care for patients who underwent TAHBSO would include:

  1. Determines patient’s immediate response to surgical intervention.
  2. Monitor patient’s physiologic status.
  3. Assess patient’s pain level and administers appropriate pain relief measures.
  4. Maintains patient’s safety(airway, circulation, prevention of injury)
  5. Administer medication, fluid and blood component therapy, if prescribed.
  6. Assess patient’s readiness for transfer to in hospital unit or for discharge home based on institutional policy.

This post includes several nursing care plans for post-TAHBSO patients.

1 Acute Pain

NDx: Acute pain secondary to surgical operation

Due to surgical procedure done that needs a surgical incision there will be presence of trauma in the area that signals an actual tissue damage and inflammation, this damage will cause an inflammation of the nerves when the nerves are affected, there will be the presence of pain.

AssessmentPlanningNursing
Interventions		RationaleEvaluation
Subjective: The patient may verbalized:“My incision hurts”Objective: The patient manifested

  • irritability
  • impaired physical mobility
  • disturbed sleep pattern
  • facial mask
  • diaphoresis
  • restlessness
  • facial grimaces
Short term:After 4 hours of nursing interventions, the patient’s pain scale will decrease 10/10 to 5/10Long term:After 1 day of nursing interventions, patient’s pain will diminish and perform activities like side movement and leg bending
  1. Establish rapport
  2. Emphasize ordered diet
  3. Monitor vital signs
  4. Provide comfort measures
  5. Encourage deep breathing
  6. Provide safety measure
  7. Develop communicationreview procedures/expectations and tell client when treatment will hurt
  8. Administer analgesics as indicated to maximal dosage as needed
  1. To gain trust
  2. To encourage patient not to eat untolerated food
  3. To obtain baseline data
  4. To satisfy the confinement of patient
  5. To inhibit pain
  6. To prevent from injury
  7. To alter pain and diminish emotional stress
  8. To reduce concern of unknown and associated muscle tension & To maintain acceptable level of pain.
Short term:The patient’s pain scale decreased 10/10 to 5/10Long term:The patient’s pain diminished and performed activities like side movements and leg bending

Navigation
  1. Acute Pain
  2. Hypothermia
  3. Hyperthermia
  4. Anxiety
  5. Fatigue
  6. Sexual Dysfunction
  7. Risk for Infection
  8. Risk for Deficient Fluid Volume
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