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.
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.
- Low Self-Esteem
- Impaired Urinary Elimination
- Risk for Ineffective Tissue Perfusion
- Sexual Dysfunction
- Deficient Knowledge
- Other Possible Nursing Care Plans
Impaired Urinary Elimination
May be related to
- Mechanical trauma, surgical manipulation, presence of local tissue edema, hematoma
- Sensory/motor impairment: nerve paralysis
Possibly evidenced by
- Sensation of bladder fullness, urgency
- Small, frequent voiding or absence of urinary output
- Overflow incontinence
- Bladder distension
- Client will empty the bladder regularly and completely.
|Note voiding pattern and monitor urinary output.||May indicate urinary retention if voiding frequently in small and insufficient amounts|
|Palpate bladder. Investigate reports of discomfort, fullness, inability to void.||Perception of bladder fullness, distension of bladder above symphysis pubis indicates urinary retention.|
|Provide routine voiding measures: privacy, normal position, running water in the sink, pouring warm water over the perineum.||Promotes relaxation of perineal muscles and may facilitate voiding efforts.|
|Provide and encourage good perianal cleansing and catheter care (when present).||Promotes cleanliness, reducing risk of ascending urinary tract infection (UTI).|
|Assess urine characteristics, noting color, clarity, odor.||Urinary retention, vaginal drainage, and the possible presence of intermittent or indwelling catheter increase risk of infection, especially if the patient has perineal sutures.|
|Catheterize when indicated or per protocol if the patient is unable to void or is uncomfortable.||Edema or interference with nerve supply may cause bladder atony and/or urinary retention requiring decompression of the bladder. Indwelling urethral or suprapubic catheter may be inserted intraoperatively if complications are anticipated.|
|Decompress bladder slowly.||When a large amount of urine has accumulated, rapid bladder decompression releases pressure on pelvic arteries, promoting venous pooling.|
|Maintain patency of indwelling catheter; keep drainage tubing free of kinks.||Promotes free drainage of urine, reducing the risk of urinary stasis and retention and infection.|
|Check residual urine volume after voiding as indicated.||May not be emptying the bladder completely; retention of urine increases the possibility for infection and is uncomfortable or painful.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans and nursing diagnoses related to reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 11 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 6 Care Plans
- Mastectomy | 14+ Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans