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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Deficient Knowledge

Nursing Diagnosis

May be related to

  • Lack of exposure/recall
  • Information misinterpretation
  • Unfamiliarity with information resources

Possibly evidenced by

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  • Questions/request for information; statement of misconception
  • Inaccurate follow-through of instructions, development of preventable complications

Desired Outcomes

  • 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.
Nursing InterventionsRationale
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.
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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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