Tahbso. Final Ppt. Philmix

5/22/2018 Tahbso. Final Ppt. Philmix

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Prepared by:

Sheena Mae M. Atienza

BSN

LEVEL IV-B


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Total Abdominal Hysterectomy

Bilateral Salpingo Oophorectomy

(TAH BSO) is a surgical procedure in which the health care provider

removes the uterus including the cervix and the ovaries

including the fallopian tubes.

The scar may be horizontal or vertical, depending on the

reason the procedure is performed, and the size of the

area being treated. It is performed to treat cancer of the

ovary(s) and uterus, endometriosis, and large uterine

fibroids. TAHBSO may also be done in some unusual cases of

very severe pelvic pain, after a very thorough evaluation

to identify the cause of the pain, and only after several

attempts at non-surgical treatments.


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Clearly a woman cannot bear children herself after this

procedure, so it is not performed on women of

childbearing age unless there is a serious condition,

such as cancer.

TAHBSO allows the whole abdomen and pelvis to be

examined, which is an advantage in women with cancer

or investigating growths of unclear cause.



(TAH BSO)


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Hysterectomymay 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.



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Indications OF TAH-BSO

Hysterectomy is often performed on cancer paitients or

to relieve severe pelvic pain from things like,

endometriosis or adenomyosis..

Hysterectomy is also used as a last resort for postpartum

obstetrical haemorrhage or uterine fibroids that cause

heavy or unusual bleeding and discomfort in some

women.

Transsexuals undergoing sex reassignment surgery as

part of a female-to-male (FTM) transition commonly have

hysterectomies and oophorectomies to remove the

primary sources of female hormone production.



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Risks & Side Effects OF TAH-BSO

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 topremenopausal women

Studies have also found that the risk of developing osteoperosis

may increase.



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Surgical Procedure Preparation and Positioning

The patient is in supine; arms may be extended on arm boards.

Apply electrosurgical dispersive pad.

Skin Preparation

Vaginal and abdominal skin preparations are required.

Put the patients legs in a frog-like position and prepare as for

Dilatation and Curettage,

Insert a foley catheter and connect to continuous drainage. Return the patients leg to their original position, and replace the

safety belt.

For abdominal preparation using iodine solution, begin at the

incision extending from nipple to mid-thighs, and down to the tables

at the sides



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Draping

Folded towel and a transverse or laparotomy sheet

Procedure

1. A pfannenstiel or the bikini incision is employed.

2. The peritoneal cavity is entered and a self retaining retractor place.

3. The patient is placed in Trendelenburg position, and the intestines

are protected with warm moist (saline) laparotomy pads.

4. The round ligaments of the uterus of the uterus are ligated, divided.

5. Sutured and tagged with a hemostat.

6. After identifying the ureters, the broad ligaments are Incised, and the

bladder is reflected from the anterior aspect of the cervix.

7. The infundibulopelvic ligaments are ligated and divided.

8. The uterosacral ligaments are ligated and divided.

9. The ligaments are likewise divided. The vagina is incisedcircumferentiall and the uterine s ecimen removed.



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A free sponge may be placed in the vagina prior to closure.

After hemostasis is secured, the vaginal cuff is closed; a drain may

be used.

The stumps of the uterosacral and round ligaments are sutured to

the angles of the vaginal closure. The pelvic peritoneum is approximated, and the wound is closed.

The free sponge is removed



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NURSING RESPONSIBILITIES

Preoperatively

Before the patient is brought back to the room, the scrub nurse

makes sure that the proper instruments and supplies areavailable for the procedure. She opens the appropriate sterile

packs and trays before scrubbing in to organize and count them.

After the patient is brought back to the room and anesthetized,

she may perform the abdominal and vaginal prep with an iodine

or chlorhexidine solution. She then gowns and gloves thesurgeons and helps with draping.



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NURSING RESPONSIBILITIES

Intra-operatively

Once the incision is made, the surgeons enter the abdominal

cavity and visualize the uterus. The scrub nurse must have theappropriate self-retaining retractor and blades available. At

various times during the procedure, he may be required to hold

the self-retainer or additional retractors in certain positions.

Removing the uterus, fallopian tubes and ovaries involves

several steps that are repeated on both sides. The nurse musthand the surgeons the proper clamps, scissors and sutures

quickly to allow for an efficient and safe procedure. Once the

uterus is out, he will hand it to the circulating nurse to be sent for

specimen, and count the instruments and supplies as the

surgeons close the vaginal canal. He will count again when they

begin closing the abdomen.



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Postoperatively

Once the procedure is finished, the scrub nurse helps the

surgeons clean the patient of prep solution and blood. She then

assists in dressing the incision. The instruments must be returned

to their trays and brought to the decontamination room, while the

operating room is cleaned and prepared for the next operation.

1. Determines patients immediate response to surgical intervention.

2. Monitor patients physiologic status.

3. Assess patients pain level and administers appropriate pain relief

measures.4. Maintains patients safety(airway, circulation, prevention of injury)

5. Administer medication, fluid and blood component therapy, if

prescribed.

6. Assess patients readiness for transfer to in hospital unit or for

discharge home based on institutional policy.



(TAH BSO)


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THANK

YOU!

Tahbso. Final Ppt. Philmix

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