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6 Hysterectomy and TAHBSO Nursing Care Plans

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By Matt Vera, BSN, R.N.
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

4. Sexual Dysfunction

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Sexual Dysfunction

Nursing Diagnosis

Risk factors may include

  • Altered body structure/function, e.g., shortening of vaginal canal; changes in hormone levels, decreased libido
  • Possible change in sexual response pattern, e.g., absence of rhythmic uterine contractions during orgasm; vaginal discomfort/pain (dyspareunia)

Possibly evidenced by

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  • 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 verbalize understanding of changes in sexual anatomy/function.
  • Client will discuss concerns about body image, sex role, desirability as a sexual partner with SO.
  • Client will identify satisfying/acceptable sexual practices and some alternative ways of dealing with sexual expression.
Nursing InterventionsRationale
Listen to comments of the patient and SO. Provide an open and honest environment during discussions.Sexual concerns are often disguised as humor and/or offhand remarks.
Assess patient’s or SO’s information regarding sexual anatomy and function and effects of surgical procedure.May have misinformation or misconceptions that can affect adjustment. Negative expectations are associated with a poor overall outcome. Changes in hormone levels can affect libido and/or decrease suppleness of the vagina. Although a shortened vagina can eventually stretch, intercourse initially may be uncomfortable or painful.
Identify cultural or value factors and conflicts present.May affect return to satisfying sexual relationship.
Assist the patient to be aware of or deal with the stage of grieving.Acknowledging the normal process of grieving for actual and perceived changes may enhance coping and facilitate resolution.
Encourage patient to share thoughts and concerns with partner.Open communication can identify areas of agreement and problems and promote discussion and resolution.
Problem-solve solutions to potential problems, postponing sexual intercourse when fatigued, substituting alternative means of expression, using positions that avoid pressure on the abdominal incision, using a vaginal lubricant.Helps patient return to desired or satisfying sexual activity.
Discuss expected physical sensations and discomforts, changes in response as appropriate to the individual.Vaginal pain may be significant following the vaginal procedure, or sensory loss may occur because of surgical trauma. Although sensory loss is usually temporary, it may take weeks or months to resolve. In addition, changes in vaginal size, altered hormone levels, and loss of sensation of rhythmic contractions of the uterus during orgasm can impair sexual satisfaction. Many women experience few negative effects because the fear of pregnancy is gone, and relief from symptoms often improves the enjoyment of intercourse.
Refer to counselor or sex therapist as needed.May need additional assistance to promote a satisfactory outcome.
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4. Sexual Dysfunction

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:

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Matt Vera, BSN, R.N.
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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