A 57-year-old female is admitted for a radical abdominal hysterectomy due to uterine cancer. She has risk factors including her age, family history of cancer, and obesity. Uterine cancer occurs due to genetic mutations in endometrial cells. Clinical manifestations may include abnormal bleeding or pelvic pain. The patient will undergo a total abdominal hysterectomy to remove the uterus and cervix. Post-operatively, nurses will manage her pain and risk of infection while monitoring for complications. With treatment, most clients return to their baseline health within a year.
2. Objectives
• Review risk factors, etiology, and
clinical manifestations of the client
scheduled for a total abdominal
hysterectomy surgery
• Discuss nursing interventions and
outcomes of the post-operative total
abdominal hysterectomy client
3. Our Client
• 57 year old female admitted for surgery
o Radical abdominal hysterectomy
o ROS
• HEENT – wears bifocals for presbyopia and myopia; no neurological deficits
noted; hearing intact; client denies hoarseness; lymph nodes soft, mobile
• Resp – able to climb two flights of stairs w/o SoB; regularly walks for
exercise; RR 16
• Breasts – soft, non-tender, no lumps or lesions palpated
• CV – pre-hypertensive BP 130/80, HR 81, SpO2 99 RA
• MSk – no evidence of DJD
• GI – normal bowel habits reported; BMI 27.3
• GU – uterine cancer; urinary frequency, functional urinary stress
incontinence; reports post-menopausal bleeding, mild pelvic pain,
dyspareunia
• General: client reports mild fatigue and sleep disturbances, denies weight
loss, fever, chills, weakness
7. Etiology
• Unknown, thought to be genetic mutation
o Need for surgery:
o Often life threatening (not immediate, but serious enough)
• Invasive cancer of the uterus, cervix, vagina, fallopian tubes,
and or ovaries
• Unmanageable infection
• Unmanageable bleeding
• Serious complications during childbirth, such as a rupture of the
uterus –
• See more at:
https://www.nwhn.org/hysterectomy/?gclid=Cj0KEQiAxMG1BRD
Fmu3P3qjwmeMBEiQAEzSDLsiG4s6G1OYn4wDZJumHlh6LYt
LnFyhBtUAgK8i6Vr4aAhRM8P8HAQ#sthash.Ei6tbnTC.dpuf
8. Pathophysiology
• Endometrial cells mutate, become
undifferentiated, invade uterine
tissue, forms tumors
o Highly likely to metastasize
• Pelvic area, vagina
• Lungs (most common)
• Brain
• Liver
10. Clinical Manifestations
• May be none
• Dysfunction uterine bleeding (DUB)
o Fibroids
• Infection
• Cancer (similar to other solid organ or
tissue S&S)
• Pelvic pain
• Pain after intercourse (dyspareunia)
• Others?
11. Procedures
• Partial or Subtotal Hysterectomy– removes the body of the
uterus, cervix left in place.
• Total or Simple Hysterectomy – removes uterus and cervix.
(TAH)
• Hysterectomy with Bilateral Salpingo-Oophorectomy –
removes the uterus, cervix and fallopian tubes. (TAH-BSO)
• Radical Hysterectomy – removes the uterus, cervix, ovaries,
fallopian tubes and affected lymph glands; possibly upper
portions of the vagina.
• See more at:
https://www.nwhn.org/hysterectomy/?gclid=Cj0KEQiAxMG1BRD
Fmu3P3qjwmeMBEiQAEzSDLsiG4s6G1OYn4wDZJumHlh6LYtL
nFyhBtUAgK8i6Vr4aAhRM8P8HAQ#sthash.Ei6tbnTC.dpuf
12. Surgical Approaches
• Abdominal
o Pfannenstiel (bikini line scar)
o Mid-line laparotomy (radical TAH)
• Vaginal
o Technically more difficult, better results for most patients
• Laparoscopic Assisted Vaginal (LAVH)
o Majority of dissection performed through laparoscopic methods, uterus
removed through vagina, cuff sutured from inside or through vagina
• Robot Assisted Laparoscopic Vaginal
Hysterectomy
o Similar to LAVH, robotic manipulation of instruments results in less
tissue damage, faster recovery for patient
16. Nursing Diagnoses
• Risk for
o Falls (effects of medications)
o Infection (compromised skin and mucous
membrane integrity)
• Fluid volume deficit related to
blood loss
• Others?
18. Interventions
• Pain management
• Encourage ambulation
• Fluids
• Advance diet as tolerated
• Encourage rest
• Client education
• Monitor for manifestations of complications
• Discharge:
o Follow-up appointments, collaborations, chemotherapy and/or radiation
therapies
• Others?
19. Medications
• Pain medications (immediately post-op)
• HRT?
o May be contraindicated in client with reproductive tract cancer
• Chemotherapy
• Radiation therapy
• Others?
• Client education on expected therapeutic action, side
effects, adverse effects, when to call provider, when to
seek urgent/emergent care
20. Oncology Treatments
• Antiemetic prior to initiating chemotherapy
• Cool washcloth on back of neck
• Emesis basin on hand
• Distractions (for pain and discomfort)
• Allow client to express feelings
• Encourage client to discuss experiences with
others
• Assess social support, provide information about
resources
22. Outcomes
• ~ 1/3 of clients may experience urinary tract
complications/symptoms
o ~ 1/3 of these usually resolve in 12 months or less
• Most clients return to baseline within 1 year
or less
o Including
• Sexual activity and health
• Reduction of nocturia and stress incontinence
• Increased bladder capacity
• Improvement in quality of life (in many patients)
• Our client?