Nursing care of TAH patient
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Transcript of Nursing care of TAH patient
Care of the Medical-Surgical Client
s/p TAH patient
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
Our Client• 57 year old female admitted for surgery
o Radical abdominal hysterectomyo 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
Risk Factors
Risk factorsNon-modifiable Modifiable
• Age• Gender• Family history• Menarche• Menopause• Breast, Colon
Ovarian cancer• Others?
• Pregnancies• Gynecological
procedures• STDs• Lifestyle choices• Obesity• Oral Contraceptives• Others?
Etiology
Etiology• Unknown, thought to be genetic
mutationo 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=Cj0KEQiAxMG1BRDFmu3P3qjwmeMBEiQAEzSDLsiG4s6G1OYn4wDZJumHlh6LYtLnFyhBtUAgK8i6Vr4aAhRM8P8HAQ#sthash.Ei6tbnTC.dpuf
Pathophysiology• Endometrial cells mutate,
become undifferentiated, invade uterine tissue, forms tumorso Highly likely to metastasize• Pelvic area, vagina• Lungs (most common)• Brain• Liver
Clinical Manifestations
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?
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=Cj0KEQiAxMG1BRDFmu3P3qjwmeMBEiQAEzSDLsiG4s6G1OYn4wDZJumHlh6LYtLnFyhBtUAgK8i6Vr4aAhRM8P8HAQ#sthash.Ei6tbnTC.dpuf
Surgical Approaches• Abdominal
o Pfannenstiel (bikini line scar)o Mid-line laparotomy (radical TAH)
• Vaginalo 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 Hysterectomyo Similar to LAVH, robotic manipulation of instruments results in
less tissue damage, faster recovery for patient
Complications
Post-op Clinical Complications
• Pain• Bleeding• Infection• Urinary tract injury• Bowel injury• Dehiscence (why?)• Others?
Nursing Diagnoses
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?
Interventions
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?
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
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
Outcomes
Outcomes• ~ 1/3 of clients may experience urinary
tract complications/symptomso ~ 1/3 of these usually resolve in 12 months or less
• Most clients return to baseline within 1 year or lesso Including
• Sexual activity and health• Reduction of nocturia and stress incontinence• Increased bladder capacity
• Improvement in quality of life (in many patients)• Our client?
Questions?