In this article, we will discuss the nursing care plan for a patient undergoing a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO). Discover everything you need to know about hysterectomy nursing care plans and nursing diagnosis. This comprehensive guide covers the essential aspects of patient care after a hysterectomy.
What is Hysterectomy?
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. Less radical procedures such as myomectomy are sometimes performed for removing fibroids while sparing the uterus.
Total abdominal hysterectomy bilateral salpingo-oophorectomy (TAHBSO) is the removal of the 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): The body of the uterus is removed; the cervical stump remains.
- Total: Removal of the uterus and cervix.
- Total with bilateral salpingo-oophorectomy (TAHBSO): Removal of the 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, 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
The 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 diagnoses for Hysterectomy and TAHBSO:
- Low Self-Esteem
- Impaired Urinary Elimination
- Risk for Ineffective Tissue Perfusion
- Sexual Dysfunction
- Constipation/Diarrhea
- Deficient Knowledge
- Other Possible Nursing Care Plans
Low Self-Esteem
Nursing Diagnosis
- Situational Low Self-Esteem
May be related to
- Concerns about the inability to have children, changes in femininity, and effect on the sexual relationship
- Religious conflicts
Possibly evidenced by
- Expressions of specific concerns/vague comments about the result of surgery; fear of rejection or reaction of significant other (SO)
- Withdrawal, depression
Desired Outcomes
- The client will verbalize concerns and indicate healthy ways of dealing with them.
- The client will verbalize acceptance of self in the situation and adaptation to change in body/self-image.
Nursing Assessment and Rationales
1. Assess the emotional stress the patient is experiencing. Identify the meaning of loss for the patient and SO. Encourage the patient to vent feelings appropriately.
Nurses need to be aware of what this operation means to the patient to avoid inadvertent casualness or over-solicitude. Depending on the reason for the surgery (cancer or long-term heavy bleeding), the woman can be frightened or relieved. She may fear the loss of ability to fulfill her reproductive role and may experience grief.
2. Note withdrawn behavior, negative self-talk, use of denial, or concern with actual and/or perceived changes.
Identifies the stage of grief and the need for interventions.
Nursing Interventions and Rationales
1. Provide accurate information, reinforcing information previously given.
Provides an opportunity for patients to question and assimilate information.
2. Ascertain individual strengths and identify previous positive coping behaviors.
Helpful to build on strengths already available for the patient to use in coping with the current situation.
3. Provide an open environment for the patient to discuss concerns about sexuality.
Promotes sharing of beliefs and values about a sensitive subject, and identifies misconceptions or myths that may interfere with adjustment to the situation.
4. Provide time to listen to the concerns and fears of patients and SO. Discuss the patient’s perceptions of self-related to anticipated changes and her specific lifestyle.
Listening conveys interest and concern. Give opportunities to correct common misconceptions like women may fear the loss of femininity and sexuality, weight gain, and menopausal body changes.
5. Refer to professional counseling as necessary.
May need additional help to resolve feelings about loss.
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
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 | 10 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 6 Care Plans
- Mastectomy | 15 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
Its impressive to work for nurses fir overcome their frustration….keep it up