Transcript Dr. Aida Abd El-Razek Definition Hysterectomy is the surgical

Dr. Aida Abd El-Razek
Definition
Hysterectomy is the
surgical removal of the
uterus. 65% of these
procedures occur during
reproductive years.
Indication
 Obstetric Indication
*Uncontrollable P.P.H
*Rupture of uterus
*Placenta accreta
*Couvelaire uterus
*Gross uterine infection .
Gynaecological Indication
*Uterine Conditions
*Vaginal conditions
*Tubal conditions
*Ovarian conditions
*Abdominal
*Laparoscopic
* Vaginal
*Types of Abdominal
 Subtotal: body of the
uterus is removed, but
cervical stump remains.
 Total: body and cervix are
removed.
◘Total hysterectomy with
bilateral
salpingooophorectomy: entire uterus,
tubes, and ovaries are
removed.
Advantages of Subtotal Hys
 Easy and takes a short time
 Less liability to injure the
bladder, ureter & rectum.
 Less risk of pelvic infection
because the vagina is not opened.
 It is not followed by dyspareunia
Disadvantages of Subtotal Hys
 Carcinoma
may develop in cervical
stump.
 Menstruation can occur with high
subtotal hysterectomy.
 Poor drainage of the pelvis after
operation because the vagina is not
opened & so haematoma formation is
more common.
Advantages of Total Hys
It Avoid the risk of stump
carcinoma.
 Good drainage of the
pelvis because the vagina is
opened & haematoma
formation is less common.

Disadvantages of Total Hys
 Operation is difficult.
 Takes a longer time.
 More liability to injure bladder,
ureter & rectum.
 ↑ risk of pelvic infection.
 Dyspareunia
*Vaginal hysterectomy:
Removal of uterus
through the cervix and
vagina; cervical stump
may remain
Indications of Vaginal
hysterectomy
 Uterine prolapse.
 Chronic inversion of uterus.
 Dysfunctional uterine bleeding.
 Fibroid uterus the size of the uterus
is not more than 10 weeks
pregnancy.
Preoperative Management
• Determine if patient knows reason for
hysterectomy, what the procedure
involves, and what to expect
postoperatively.
• Patient must remain NPO from midnight
the night before surgery and void before
surgery.
*Administer an enema
*Perform vaginal irrigation.
*Skin prep is done if ordered.
*Administer preoperative
medication to help the patient
relax.
Postoperative Management
Postoperatively, assess for:
Wound appearance and drainage
Vital signs, level of consciousness
Level of pain
Vaginal drainage (serous, bloody)
Intake and output
Urge to void, bladder distention, residual urine
(if appropriate)
Clarity, color, and sediment of urine
Promote
exercise
and
ambulation
to
prevent
thromboembolus,
facilitate
voiding,
and
stimulate
peristalsis.
During operation
*Primary haemorrhage.
*Injury to the bladder , ureter
, and intestines
*Anesthetic complications
Postoperative complications
 Cardiovascular: reactionary &
secondary haemorrhage,
venous thrombosis and
pulmonary embolism
 Pulmonary: bronchitis,
pneumonia.
• Gastrointestinal tract: distension,
vomiting, acute gastric dilatation
and paralytic ileus. Peritonitis
• Urinary tract: UTI, retention of
urine
• Abdominal wound. Infection,
burst abdomen
*Vaginal discharge due to
infection of the vault.
*Formation of granulation
tissue in the vaginal vault
*Premature menopause
NURSING
CARE PLAN
Nursing Diagnoses
1.Pain related to surgical procedure
2.Altered Pattern of Urinary Elimination related
to decreased bladder sensation
3.Risk for Infection related to surgical
procedure
4.Self-Esteem Disturbance related to alteration
in female organs
5.Sexual Dysfunction related to alteration in
reproductive organs and function
Nursing Interventions
A.Relieving Pain
1. Assess pain location, level, and characteristics.
2. Administer prescribed pain medications.
3. Encourage patient to splint incision when moving.
4. Encourage patient to ambulate as soon as possible to
decrease flatus and abdominal distention.
5. Institute sitz baths or ice packs as prescribed to
alleviate perineal discomfort.
B.Promoting Urinary Elimination
1. Monitor intake and output, bladder distention, signs
and symptoms of bladder infection.
2. Maintain patency of indwelling catheter if one is in
place.
3. Catheterize patient intermittently if uncomfortable or
has not voided in 8 hours.
4. Check for residual urine after patient voids; should
be less than 100 mL. Continue to check if more
than 100 mL or bladder infection may develop.
5. Encourage patient to empty bladder around the
clock, not only when feeling the urge, due to loss of
sensation of bladder fullness.
6. Encourage fluid intake to decrease risk of urinary
infection.
C.Preventing Infection
1. Assess vaginal drainage for amount, color,
and odor, assess incision site and
temperature.
2. Administer antibiotics as prescribed.
3. Assist use of incentive spirometer, coughing
and deep breathing, and ambulation to
decrease risk of pulmonary infection.
D.Strengthening Self-Esteem
1. Allow patient to discuss her feelings
about herself as a woman.
2. Reassure patient she is still feminine.
3. Encourage patient to discuss her
feelings with her spouse or significant
other.
4. Reassure patient that she will not go
through premature menopause if her
ovaries were not removed.
E.Regaining Sexual Function
1.Discuss changes regarding sexual
functioning such as shortened vagina
and possible dyspareunia due to
dryness.
2.Offer suggestions to improve sexual
functioning.
A.Use of water soluble lubricants
B.Change position female dominant
offers more control of depth of
penetration.
Patient
Education/Health
Maintenance
*Total hysterectomy
produces a surgical
menopause.
*Advise her against sitting
too long at one time, as in
driving long distances,
because of the possibility of
pooling of blood in the
pelvis and causing
*Tell the patient to expect a
tired feeling for the first few
days at home and, therefore,
not to plan too many activities
for the first week. She will be
able to perform most of her
usual daily activities within a
month, and feel herself again
within 2 months.
Emphasize the importance of
follow-up and routine
physical and gynecologic
examinations.
*Instructions about
intercourse, douching, and
use of tampons, which are
usually discouraged for 4 to
6 weeks. Sexual intercourse
should be resumed
cautiously to prevent injury
and discomfort.
Evaluation
*Verbalizes decreased
pain
*Voids every 8 hours of
sufficient quantity
*Absence of fever and
signs of infection
*Verbalizes positive
statements about self and
positive outlook on
recovery
*Verbalizes understanding
of possible changes in
sexual functioning and
what to do about it