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
May be related to
- Lack of exposure/recall
- Information misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions/request for information; statement of misconception
- Inaccurate follow-through of instructions, development of preventable complications
- Client will verbalize understanding of condition and potential complications.
- Client will identify relationship of signs/symptoms related to surgical procedure and actions to deal with them.
- Client will verbalize understanding of therapeutic needs.
|Review the effects of surgical procedure and future expectations. The patient needs to know that she will no longer menstruate or bear children, and the possible need for hormonal replacement.||Provides knowledge base from which patient can make informed choices.|
|Discuss the complexity of problems anticipated during recovery: emotional lability and expectation of feelings of depression and/or sadness; excessive fatigue, sleep disturbances, urinary problems.||Physical, emotional, and social factors can have a cumulative effect, which may delay recovery, especially if the hysterectomy was performed because of cancer. Providing an opportunity for problem-solving may facilitate the process. Patient and SO may benefit from the knowledge that a period of emotional lability is normal and expected during recovery.|
|Discuss the resumption of activity. Encourage patient to do light activities initially, with frequent rest periods and increasing activities or exercise as tolerated. Stress importance of individual response in recuperation.||Patient can expect to feel tired when she goes home and needs to plan a gradual resumption of activities, with the return to work an individual matter. Prevents excessive fatigue; conserves energy for healing and tissue regeneration.|
|Identify individual restrictions: avoiding heavy lifting and strenuous activities, prolonged sitting or driving. Avoid tub baths and douching until physician allows.||Strenuous activity intensifies fatigue and may delay healing. Activities that increase intra-abdominal pressure can strain surgical repairs, and prolonged sitting potentiates the risk of thrombus formation. Showers are permitted, but tub baths and douching may cause vaginal or incisional infections and are a safety hazard.|
|Review recommendations of resumption of sexual intercourse.||When sexual activity is cleared by the physician, it is best to resume activity easily and gently, expressing sexual feelings in other ways or using alternative coital positions.|
|Identify dietary needs. Give foods high in protein and iron.||Facilitates healing and tissue regeneration and helps correct anemia when present.|
|Review hormone replacement therapy (HRT).||Total hysterectomy with bilateral salpingo-oophorectomy (surgically induced menopause) requires replacement hormones. The long-term benefits of HRT (particularly estrogen) include a decreased incidence of cardiovascular disease, protection against osteoporosis, improved mood and cognition.|
|Encourage taking the prescribed drug(s) routinely.||Taking hormones with meals establishes a routine for taking the drug and reduces the potential for initial nausea.|
|Discuss potential side effects: weight gain, increased skin pigmentation or acne, breast tenderness, headaches, photosensitivity.||Development of some side effects is expected but may require problem-solving such as a change in dosage or use of sunscreen.|
|Recommend cessation of smoking when receiving estrogen therapy.||Some studies suggest an increased risk of thrombophlebitis, myocardial infarction (MI), cerebrovascular accident (CVA), and pulmonary emboli associated with smoking and concurrent estrogen therapy.|
|Review incisional care when appropriate.||Facilitates competent self-care, promoting independence.|
|Stress importance of follow-up care.||Provides an opportunity to ask questions, clear up misunderstandings, and detect developing complications.|
|Identify signs and symptoms requiring medical evaluation, fever/chills, change in character of vaginal or wound drainage; bright bleeding.||Early recognition and treatment of developing complications such as infection and hemorrhage may prevent life-threatening situations. Hemorrhage may occur as late as 2 wk postoperatively.|
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