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.

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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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Impaired Urinary Elimination

Nursing Diagnosis

May be related to

  • Mechanical trauma, surgical manipulation, presence of local tissue edema, hematoma
  • Sensory/motor impairment: nerve paralysis

Possibly evidenced by

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  • Sensation of bladder fullness, urgency
  • Small, frequent voiding or absence of urinary output
  • Overflow incontinence
  • Bladder distension

Desired Outcomes

  • Client will empty the bladder regularly and completely.
Nursing InterventionsRationale
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.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans and nursing diagnoses related to 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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