Hysterectomy is the surgical removal of the uterus. It is most commonly performed for malignancies and certain non-malignant conditions, like endometriosis or tumors, to control life-threatening bleeding or hemorrhage, and in the event of intractable pelvic infection or irreparable rupture of the uterus. A less radical procedures (myomectomy) is sometimes performed for removing fibroids while sparing the uterus.
Total 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.
- Subtotal (partial): Body of the uterus is removed; cervical stump remains.
- Total: Removal of the uterus and cervix.
- Total with bilateral salpingo-oophorectomy (TAHBSO): Removal of uterus, cervix, fallopian tubes, and ovaries is the treatment of choice for invasive cancer (11% of hysterectomies), fibroid tumors that are rapidly growing or produce severe abnormal bleeding (about one-third of all hysterectomies), and endometriosis invading other pelvic organs.
- Vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH) may be done in certain conditions, such as uterine prolapse, cystocele/rectocele, carcinoma in situ, and high-risk obesity. These procedures offer the advantages of less pain, no visible (or much smaller) scars, and a shorter hospital stay and about half the recovery time, but are contraindicated if the diagnosis is obscure.
- A very complex and aggressive surgical procedure may be required to treat invasive cervical cancer. Total pelvis exenteration (TPE) involves radical hysterectomy with dissection of pelvic lymph nodes and bilateral salpingo-oophorectomy, total cystectomy, and abdominoperineal resection of the rectum. A colostomy and/or a urinary conduit are created, and vaginal reconstruction may or may not be performed. These patients require intensive care during the initial postoperative period. (Refer to additional plans of care regarding fecal or urinary diversion as appropriate.)
- Support adaptation to change.
- Prevent complications.
- Provide information about procedure/prognosis and treatment needs.
- Dealing realistically with situation.
- Complications prevented/minimized.
- Procedure/prognosis and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
- Pelvic examination: May reveal uterine/other pelvic organ irregularities, such as masses, tender nodules, visual changes of cervix, requiring further diagnostic evaluation.
- Pap smear: Cellular dysplasia reflects possibility of/presence of cancer.
- Ultrasound or computed tomography (CT) scan: Aids in identifying size/location of pelvic mass.
- Laparoscopy: Done to visualize tumors, bleeding, known or suspected endometriosis. Biopsy may be performed or laser treatment for endometriosis. Rarely, exploratory laparotomy may be done for staging cancer or to assess effects of chemotherapy.
- Dilation and curettage (D&C) with biopsy (endometrial/cervical): Permits histopathological study of cells to determine presence/ location of cancer.
- Schiller’s test (staining of cervix with iodine): Useful in identifying abnormal cells.
- Complete blood count (CBC): Decreased hemoglobin (Hb) may reflect chronic anemia, whereas decreased hematocrit (Hct) suggests active blood loss. Elevated white blood cell (WBC) count may indicate inflammation/infectious process.
- Sexually transmitted disease (STD) screen: Human papillomavirus (HPV) is present in 80% of patients with cervical cancer.
Nursing Care Plans
Nursing goal for patients who are to undergo Hysterectomy or TAHBSO includes prevention or minimization of complications, the prognosis and treatment regimen is well understood, and management of pain.
Listed below are six (6) nursing care plans (NCP) for Hysterectomy and TAHBSO:
- Low Self-Esteem
- Impaired Urinary Elimination
- Risk for Ineffective Tissue Perfusion
- Sexual Dysfunction
- Deficient Knowledge
- Other Possible Nursing Care Plans
Situational Low Self-Esteem: Development of a negative perception of self-worth in response to current situation.
May be related to
- Concerns about inability to have children, changes in femininity, effect on sexual relationship
- Religious conflicts
Possibly evidenced by
- Expressions of specific concerns/vague comments about result of surgery; fear of rejection or reaction of significant other (SO)
- Withdrawal, depression
- Verbalize concerns and indicate healthy ways of dealing with them.
- Verbalize acceptance of self in situation and adaptation to change in body/self-image.
|Provide time to listen to concerns and fears of patient and SO. Discuss patient’s perceptions of self-related to anticipated changes and her specific lifestyle.||Listening conveys interest and concern. Give opportunities to correct common misconceptions like women may fear loss of femininity and sexuality, weight gain, and menopausal body changes.|
|Assess emotional stress patient is experiencing. Identify meaning of loss for patient and SO. Encourage patient to vent feelings appropriately.||Nurses need to be aware of what this operation means to patient to avoid inadvertent casualness or over solicitude. Depending on the reason for the surgery (cancer or long-term heavy bleeding), the woman can be frightened or relieved. She may fear loss of ability to fulfill her reproductive role and may experience grief.|
|Provide accurate information, reinforcing information previously given.||Provides opportunity for patient to question and assimilate information.|
|Ascertain individual strengths and identify previous positive coping behaviors.||Helpful to build on strengths already available for patient to use in coping with current situation.|
|Provide open environment for patient to discuss concerns about sexuality.||Promotes sharing of beliefs and values about sensitive subject, and identifies misconceptions or myths that may interfere with adjustment to situation.|
|Note withdrawn behavior, negative self-talk, use of denial, or over concern with actual and/or perceived changes.||Identifies stage of grief and need for interventions|
|Refer to professional counseling as necessary.||May need additional help to resolve feelings about loss.|