6 Hysterectomy and TAHBSO Nursing Care Plans

6 Hysterectomy and TAHBSO Nursing Care Plans
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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.

Types

  • 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.

Nursing Care Plans

Nursing goal for patients who are to undergo Hysterectomy or TAHBSO includes prevention or minimization of complications, supporting adaptation to change, preventing complications, and providing information on the prognosis and treatment regimen is well understood, and management of pain.

Listed below are six (6) nursing care plans (NCP) and nursing diagnosis for Hysterectomy and TAHBSO: 

  1. Low Self-Esteem
  2. Impaired Urinary Elimination
  3. Risk for Ineffective Tissue Perfusion
  4. Sexual Dysfunction
  5. Constipation/Diarrhea
  6. Deficient Knowledge
  7. Other Possible Nursing Care Plans
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Low Self-Esteem

Nursing Diagnosis

  • Situational Low Self-Esteem

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 the result of surgery; fear of rejection or reaction of significant other (SO)
  • Withdrawal, depression

Desired Outcomes

  • Client will verbalize concerns and indicate healthy ways of dealing with them.
  • Client will verbalize acceptance of self in situation and adaptation to change in body/self-image.
Nursing Interventions Rationale
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 the loss of femininity and sexuality, weight gain, and menopausal body changes.
Assess the emotional stress the patient is experiencing. Identify the meaning of loss for patient and SO. Encourage patient to vent feelings appropriately. Nurses need to be aware of what this operation means to the 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 the 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 the patient to use in coping with the current situation.
Provide an open environment for the patient to discuss concerns about sexuality. Promotes sharing of beliefs and values about a sensitive subject, and identifies misconceptions or myths that may interfere with adjustment to the situation.
Note withdrawn behavior, negative self-talk, use of denial, or over concern with actual and/or perceived changes. Identifies the stage of grief and need for interventions
Refer to professional counseling as necessary. May need additional help to resolve feelings about loss.
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See Also

You may also like the following posts and care plans:

Genitourinary Care Plans

Care plans related to the reproductive and urinary system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

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