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  1. 1. <ul><li>Case Analysis </li></ul>TAH-BSO
  2. 2. What Is TAH-BSO? <ul><li>Total Abdominal Hysterectomy and Bilateral Salphingo-Oopherectomy. </li></ul><ul><li>This is the removal of the uterus including the cervix as well as the tubes and ovaries using an incision in the abdomen.  A hysterectomy is the surgical removal of the uterus. Hysterectomy may be total, as removing the body and cervix of the uterus or partial, also called supra-cervical. Salpingo refers specifically to the fallopian tubes which connect the ovaries to the uterus. Oophorectomy is the surgical removal of an ovary or ovaries. </li></ul>
  3. 3. INDICATIONS <ul><li>Endometriosis- is an abnormal condition in which endometrial tissue is found in internal sites other than the uterus. Overall incidence in women of reproductive age is 5% to 10%. Women in their mid-30s are most commonly affected, though it can appear anytime form first menses to menopause. There is a familial disposition. </li></ul><ul><li>Benign Uterine Tumors (Leiomyomas)- fibroids, fibromas, fibromyomas, fibroleiomyomas, and myomas. </li></ul>
  4. 4. <ul><li>Leiomyomas are benign uterine tumors that arise from the uterine muscle tissue. They are the most common tumors of the female genital tract and occur in 20% to 30% in women. They are seen more often in African-American women, and are more common in women approaching menopause. </li></ul>
  5. 5. <ul><li>Endometrial or Uterine Cancer- is the most common malignancy of the female genital reproductive system. </li></ul><ul><li>In 2007 the American Cancer Society estimated that 39,080 new cases of uterine cancer would be diagnosed in the United States with an estimated 7400 women dying of uterine cancer. The 5-year survival rate is 96% if the cancer is discovered at an early stage. </li></ul><ul><li>It is most strongly related to an imbalance between estrogen and progesterone levels, resulting in excessive circulating estrogen. </li></ul>
  6. 6. <ul><li>Ovarian Cancer- the second most common gynecologic cancer, accounts for 3% of cancer occurrence and 6% of cancer deaths in women and is the leading cause of death from reproductive malignancies in women. An estimated 22, 430 new cases of ovarian cancer are expected to be detected in the United States in 2007, with 15, 280 deaths. White women show higher rates of ovarian cancer than do African-American women. Early diagnosis of ovarian cancer is uncommon. </li></ul>
  7. 7. Risk and Side Effects <ul><li>Hysterectomy has been found to be associated with increased bladder function problems, such as incontinence. When the ovaries are also removed, estrogen levels will fall. This removes the protective effects of estrogen on the cardiovascular and skeletal system. A menopausal woman has a three times greater risk of developing cardiovascular disease such as atherosclerosis, peripheral artery disease or of having a heart attack when compared to premenopausal women. Studies have also found that the risk of developing osteoperosis may increase </li></ul>
  9. 9. <ul><li>INTERNAL ORGANS </li></ul><ul><li>a. Uterus . The uterus is a hollow organ about the size and shape of a pear. It serves two important functions: it is the organ of menstruation and during pregnancy it receives the fertilized ovum, retains and nourishes it until it expels the fetus during labor. </li></ul><ul><li>-The uterus is located between the urinary bladder and the rectum. The uterus consists of the body or corpus, fundus, cervix, and the isthmus. The major portion of the uterus is called the body or corpus. The fundus is the superior, rounded region above the entrance of the fallopian tubes. </li></ul>
  10. 10. <ul><li>The cervix is the narrow, inferior outlet that protrudes into the vagina. The isthmus is the slightly constricted portion that joins the corpus to the cervix. </li></ul><ul><li>-The walls are thick and are composed of three layers: the endometrium, the myometrium, and the perimetrium. </li></ul><ul><li>b. Vagina - is the thin in walled muscular tube about 6 inches long leading from the uterus to the external genitalia. It is located between the bladder and the rectum. It provides the passageway for childbirth and menstrual flow; it receives the penis and semen during sexual intercourse. </li></ul>
  11. 11. <ul><li>c. Fallopian Tubes (Two) -Each tube is about 4 inches long and extends medially from each ovary to empty into the superior region of the uterus. They transport ovum from the ovaries to the uterus. There is no contact of fallopian tubes with the ovaries. The distal end of each fallopian tube is expanded and has finger-like projections called fimbriae, which partially surround each ovary. When an oocyte is expelled from the ovary, fimbriae create fluid currents that act to carry the oocyte into the fallopian tube. Oocyte is carried toward the uterus by combination of tube peristalsis and cilia, which propel the oocyte forward. The most desirable place for fertilization is the fallopian tube. </li></ul>
  12. 12. <ul><li>d. Ovaries (two) - The ovaries are for oogenesis-the production of eggs (female sex cells) and for hormone production (estrogen and progesterone). They are about the size and shape of almonds. They lie against the lateral walls of the pelvis, one on each side. They are enclosed and held in place by the broad ligament. </li></ul><ul><li>e. cervix (or neck of the uterus ) </li></ul><ul><li>-is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. </li></ul>
  13. 13. <ul><li>f. urethra </li></ul><ul><li>-is a tube that connects the urinary bladder to the genitals for removal out of the body. In males, the urethra travels through the penis, and carries semen as well as urine. In females, the urethra is shorter and emerges above the vaginal opening. </li></ul>
  14. 14. DIAGNOSTIC PROCEDURES <ul><ul><li>Before any type of hysterectomy, women should have the following tests in order to select the optimal procedure: </li></ul></ul><ul><ul><li>Complete pelvic exam including manually examining the ovaries and uterus. </li></ul></ul><ul><ul><li>Up-to-date Pap smear . </li></ul></ul><ul><ul><li>Pelvic ultrasound may be appropriate, depending on what the physician </li></ul></ul><ul><ul><li>A decision regarding whether finds on the above. or not to remove the ovaries at the time of hysterectomy. </li></ul></ul><ul><ul><li>Complete blood count </li></ul></ul>
  15. 15. Assessment Nursing Diagnosis Planning Nursing Interventions Rationale Evaluation Subjective: The patient may verbalized: “ My incision is hurts.” Objective: The patient manifested : -irritability -impaired physical mobility -disturbed sleep pattern -diaphoresis -restlessness -facial grimaces -pain scale of 8/10 Acute pain secondary to surgical operation Short term: After 4 hours of nursing interventions, the patient’s pain scale will decrease 8/10 to 4/10 Long term: After 1 day of nursing interventions, patient’s pain will diminish and perform activities like side movement and leg bending <ul><li>Establish rapport </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>Provide comfort measure </li></ul><ul><li>Encourage deep breathing </li></ul><ul><li>Provide safety measure </li></ul><ul><li>Develop communication review procedures/expectations and tell client when treatment will hurt </li></ul><ul><li>Administer analgesics as indicated to maximal dosage as needed </li></ul><ul><li>To gain trust </li></ul><ul><li>To obtain baseline data </li></ul><ul><li>To satisfy the confinement of patient </li></ul><ul><li>To inhibit pain </li></ul><ul><li>To prevent from injury </li></ul><ul><li>To alter pain and diminish emotional stress </li></ul><ul><li>To reduce concern of unknown and associated muscle tension </li></ul><ul><li>To maintain acceptable level of pain. </li></ul>Short term: The patient’s pain scale decreased 8/10 to 4/10 Long term: The patient’s pain diminished and performed activities like side movements and leg bending
  16. 16. <ul><li>After 8 hours of nursing intervention, the goal was met as evidenced by reported of increased energy and less pain to the surgical site. </li></ul><ul><li>After a series of nursing interventions, the client was able to perform her usual activities. </li></ul>1. Promotes faster recovery to the patient. 2. Determines if nutrition is adequate to support healing. 3. Reduces fatigue and chances of another delayed recovery. 1. To monitor healing process and provide for timely intervention as needed. 2. Aid in pain relief and promotes healing. Independent: 1. Advise the patient to have an adequate rest and sleep. 2. Assess nutritional status and current intake. 3. Advise the patient to limit strenuous activity like heavy lifting. Dependent: 1. Advise the patient to have a follow up check up. 2. Administer analgesics as prescribed. Short Term: • After 8 hours of nursing intervention, the client will be able to report increased energy and less pain. Long Term: • After a series of nursing interventions, the client will be able to perform her usual activities. Extension of the number of post operative days required to initiate and perform activities that maintain life, health, and well-being Delayed surgical recovery related to pain <ul><li>Subjective: </li></ul><ul><li>Objective: </li></ul><ul><li>- pain scale of 8 / 10 </li></ul><ul><li>weak looking </li></ul><ul><li>- restless </li></ul>Evaluation Rationale Intervention Goal Case Background Nursing Diagnosis Assessment
  17. 17. Assessment Nursing Diagnosis Planning Nursing Interventions Rationale Evaluation S > The patient may verbalized: -problem such as loss of sexual desire - inability to achieved desired satisfaction -conflicts involving values O> the patient manifested: -alteration in relationship with SO -Change of interest in self and others Sexual Dysfunction related to altered body structure and function Short term: After 4 hours of nursing interventions the patient will identify stressors in lifestyle that may contribute to the dysfunction Long term: After 3 day of nursing interventions the patients will verbalize understanding of individual reasons for sexual problems >Establish rapport >Monitor vital signs > Obtain sexual history including usual patterns of functioning and level of desires > Be alert to comments of client > identify current stressors in individual situations > Avoid making value judgments >Establish therapeutic nurse-client relationship >Provide ways to obtain privacy >To gain trust >To obtain maintenance data >To maximize communication and understanding >Sexual concerns are often disguised as humor, sarcasm, or offhand remarks > These factors may be producing enough anxiety to cause depression > They do not help the client >To promote treatment and facilitate sharing of sensitive information >To allow sexual expression for individual between partners without embarrassment Short term: The patient identified stressors in lifestyle that contributes to the dysfunction Long term: The patient verbalized understanding of individual reasons for sexual problems
  18. 18. Assessment Nursing Diagnosis Planning Nursing Interventions Rationale Evaluation S> O> the patient manifested: -Weakness -Pallor -with dry and intact dressing on the area. -Pain over the incision -Irritability -Presence of intact dressing Risk for infection secondary to surgical incision Short term: After 4 hours of nursing interventions, the patient shall identify and demonstrate intervention to prevent infection Long term: After 1 day of nursing interventions, the patient will not have infection >Establish rapport >Monitor V.S. >Note signs and symptoms of sepsis >Provide wound healing such as cleaning of wound >Provide care, change dressing as needed >Encourage increase intake of Vitamin C >Encourage deep breathing exercise >To gain trust >To obtain baseline data >To reduce complication and monitor for infection >To reduce risk for infection >To promote healing to the incision >To prevent infection to increase immune resistance >To increase healing of wound Short term: The patient identified and demonstrated interventions to prevent risk of infection Long term: The patient doesn’t experience infection
  19. 19. Assessment Nursing Diagnosis Planning Nursing Interventions Rationale Evaluation S > The patient may verbalized: “ I feel weak and thirsty.” O> the patient manifested: -decrease urine output -sudden weight loss -decrease skin turgor -dry mucous membranes -sunken eyeballs Risk for fluid volume deficit Short term: After 4 hours of nursing interventions the patient will identify risk factors and appropriate interventions Long term: After 3 day of nursing interventions the patients will demonstrate behaviors or lifestyle changes to prevent development of fluid volume deficit <ul><li>Establish rapport </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>Encourage increase oral fluid intake </li></ul><ul><li>Provide supplemental fluids as ordered </li></ul><ul><li>Monitor intake and output </li></ul><ul><li>Provide safety measures </li></ul><ul><li>Encourage the use of oresol </li></ul><ul><li>To gain trust </li></ul><ul><li>To obtain maintenance data </li></ul><ul><li>To replace loss fluids </li></ul><ul><li>Prevents peak in fluid level </li></ul><ul><li>To ensure accurate picture of fluid status </li></ul><ul><li>Confusion can lead to accidents </li></ul><ul><li>To replace loss electrolyte. </li></ul>Short term: The patient identified risk factors and appropriate interventions Long term: The patient demonstrated behaviors or lifestyle changes to prevent development of fluid volume deficit
  20. 20. MANAGEMENT <ul><li>PRE-OPERATION </li></ul><ul><li>Interprets and upholds policies and procedures as determined by administrative body. </li></ul><ul><li>Identify knowledge and skills of peri- operative nursing. </li></ul><ul><li>Identifies nursing care problems through pre-operative visit and assist in the solutions and </li></ul>
  21. 21. <ul><li>INTRA-OPERATION </li></ul><ul><li>Ensures quality of care through proper use of instruments, equipments and supplies. </li></ul><ul><li>Observes proper positioning of the patient and maintaining the dignity of the individual As well, thus, providing maximum safety and comfort. </li></ul><ul><li>Identifies, prepares and send specimen obtained during operation for examination. </li></ul>
  22. 22. <ul><li>4. Assess patient’s stability and should know to report to the attending physician/s. </li></ul><ul><li>5. Carries out doctor’s post-operative order diligently. </li></ul><ul><li>6. Observes, checks and record patient assessment and refer when necessary. </li></ul><ul><li>7. Administers post-operative care. </li></ul><ul><li>8. Submits sundry report and account for the supplies and equipment used. </li></ul><ul><li>9. Responsible for the upkeep, Maintenance and care of equipment and instrument. </li></ul><ul><li>10. Informs appropriate personnel when supplies are needed or equipment and instruments are out of order. </li></ul>
  23. 23. <ul><li>POST-OPERATION </li></ul><ul><li>Responsible for all the safekeeping of patient’s personal belongings endorse by OR nurse. </li></ul><ul><li>Responsible for endorsing such items to patient’s relatives or floor nurse. </li></ul><ul><li>Diligently carries out doctor’s orders as soon as possible. </li></ul><ul><li>Check and record vital signs-blood pressure, pulse rate, O2 saturation, respiratory rate, temperature, color and condition of skin, if can move extremeties every 15 minutes (or as often as possible or as indicated by the patient’s condition) on the Nurse’s Post Anesthesia Record. </li></ul>
  24. 24. <ul><li>Observes and records neuro vital signs for neurological cases on the Neurological Vital Signs Form provided by the unit. </li></ul><ul><li>Observes keenly the patient’s who might undergo post-operative complications like bleeding, shock, respiratory distress, thyroid storm and cardiac arrest. </li></ul><ul><li>Notifies the anesthesiologist/AMD immediately for any unusual symptoms manifested by the patient. </li></ul>
  25. 25. PROGNOSIS <ul><li>The prognosis following an uncomplicated hysterectomy is good, regardless of the type of procedure performed. Symptoms are usually relieved by the procedure, and a full return to normal activities can be expected. </li></ul><ul><li>When hysterectomy is performed for cancer of the cervix or uterus, the prognosis depends upon the extent and severity of the cancer. Early-stage or low-grade cancer has a generally good prognosis, whereas more advanced stages or high-grade cancer with extensive spreading (metastasis) has a poor prognosis. </li></ul>
  26. 26. <ul><li>The predicted outcome after salpingo-oophorectomy doesn’t depend on whether the procedure is unilateral or bilateral usually does not affect the outcome, because the effect of the procedure and the healing from the surgery occur at much the same rate for removal of one or both fallopian tubes and ovaries. However, hormonal complications for premenopausal women may arise if both ovaries are removed. After bilateral oophorectomy, the woman will be at increased risk for osteoporosis, coronary heart disease, lung cancer, and cognitive impairment (dementia) unless hormone replacement therapy is implemented, and will become infertile. </li></ul>
  27. 27. Members: <ul><li>ACOSTA, Avigail Venice </li></ul><ul><li>ALULOD, Katrina Mae </li></ul><ul><li>BINGCANG, Danica Criska </li></ul><ul><li>DOLIENTE, Cephradine Monique </li></ul><ul><li>PESIGAN, Viktoria Katrina </li></ul><ul><li>SANCHEZ, Morgan </li></ul><ul><li>SINNUNG, Christian </li></ul>