6 Hysterectomy and TAHBSO Nursing Care Plans


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.


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

Risk for Ineffective Tissue Perfusion

Nursing Diagnosis

Risk factors may include

  • Hypovolemia
  • Reduction/interruption of blood flow: pelvic congestion, postoperative tissue inflammation, venous stasis
  • Intraoperative trauma or pressure on pelvic/calf vessels: lithotomy position during vaginal hysterectomy

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • Client will demonstrate adequate perfusion, as evidenced by stable vital signs, palpable pulses, good capillary refill, usual mentation, individually adequate ­urinary output.
  • Client will be free of edema, signs of thrombus formation.
Nursing InterventionsRationale
Monitor vital signs; palpate peripheral pulses, and note capillary refill; assess urinary output and characteristics. Evaluate changes in mentation.Indicators of the adequacy of systemic perfusion, fluid/blood needs, and developing complications.
Inspect dressings and perineal pads, noting color, amount, and odor of drainage. Weigh pads and compare with the dry weight if the patient is bleeding heavily.Proximity of large blood vessels to the operative site and/or potential for alteration of clotting mechanism increases the risk of postoperative hemorrhage.
Turn the patient and encourage frequent coughing and deep-breathing exercises.Prevents stasis of secretions and respiratory complications.
Avoid high-Fowler’s position and pressure under the knees or crossing of legs.Creates vascular stasis by increasing pelvic congestion and pooling of blood in the extremities, potentiating the risk of thrombus formation.
Assist and instruct in foot and leg exercises and ambulate as soon as able.Movement enhances circulation and prevents stasis complications.
Check for Homans’ sign. Note erythema, swelling of extremity, or reports of sudden chest pain with dyspnea.May be indicative of the development of thrombophlebitis or pulmonary embolism.
Administer IV fluids, blood products as indicated.Replacement of blood losses maintains circulating volume and tissue perfusion.
Apply anti-embolism stockings.Aids in venous return; reduces stasis and risk of thrombosis.
Assist with or encourage the use of incentive spirometer.Promotes lung expansion and minimizes atelectasis.

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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