107486_hysterectomy and nursing management .ppt

Hysterectomy

1. HysterectomyHysterectomy

2. Hysterectomy is an operation in
which the uterus is removed. The
cervix, ovaries and/or Fallopian
tubes might also be removed.
It may be done abdominally or
vaginally.
Vaginal hysterectomy usually done
for some cases of uterine prolapse.

3. Indications of hysterectomyIndications of hysterectomy
Obstetrical:
Rupture of the uterus.
Uncontrollable post-partum hemorrhage.

Placenta accreta.
Gynecological:
Inflammatory as some cases of genital tuberculosis.
Tumors: benign (ovarian tumors, fibroids)
 Malignant (cervix, body and ovaries)
Displacement: some cases of uterine prolapse or chronic
inversion.
Some cases of dysfunctional uterine bleeding.

4. Types of hysterectomiesTypes of hysterectomies
1.Subtotal hysterectomy (partial)
involves removing the body of the uterus, but leaving the cervix in
place.
done for post partum hemorrhage and rupture uterus.
2. Total hysterectomy
involves removing the body of the uterus as well as the cervix,
much better than subtotal.
3. Pan hysterectomy
Total hysterectomy and bilateral of both ovaries
4. Radical hysterectomy
is done specifically in the case of invasive gynecological cancer.
Removal of the uterus, both tubes, and ovaries, the upper third of
the vagina, the iliac and obtruator lymph gland.
5. Ultra radical hysterectomy
Anterior excenteration Removal of the bladder
→
posterior excenteration Removal of the bladder and rectum
→

5. Advantages of subtotal Advantages of subtotal
hysterectomyhysterectomy

1.-It is easier and quicker than total
hysterectomy
2.There is less danger of injuring the
bladder.
3.Less danger of pelvic infection.
4.The cervix left to act as a support for
vagina.
5.The cervix discharge lubricates the
vagina

6. Advantages of total Advantages of total
hysterectomyhysterectomy
1.Provides better drainage of the
operation area.
2.If the cervix is lacerated or
infected, the source of irritant
discharge is removed.

7. vaginal hysterectomyvaginal hysterectomy
Indications of vaginal hysterectomy:
1.Some cases of uterine prolapse.
2.Some cases of dysfunctional uterine
bleeding.
3.Some cases of cancer body

8. Advantages of vaginal hysterectomy:
1.Absence of an abdominal scar.
2.Lower incidence of intestinal complication.
3.An associated genital prolapse can be treated at
the same time.

Disadvantages of vaginal hysterectomy:
1.It is unsafe and difficult in the presence of pelvic
adhesions.
2.The ovaries can not be removed in some cases.
3.It can not be done if the size of the uterus is
larger than a 14 weeks pregnant uterus.

9. Postoperative Complications of Postoperative Complications of
abdominal hysterectomyabdominal hysterectomy
Shock.
Hemorrhage.
Infection,
Intestinal complications as acute gastric
dilatation.
Pulmonary complications e.g. bronchitis,
pneumonia, pulmonary collapse.
Venous thrombosis (DVT, SVT.)
Post operative anesthetic complications e.g.
Cyanosis, vomiting.
Remote Complications e.g. vaginal discharge
(infection), vaginal vault prolapse, low back ach,
Menopausal symptoms e.g. sadness, irritability.
(in younger female)

10. Methods of treatmentMethods of treatment
Deep breathing exercises:
to improve alveolar ventilation. (to minimize changes in lung volume and
gas exchange) from semi-fowler position, the abdominal muscle in slack to
allow greater diaphragmatic excursion
Rolling
to minimize trunk movement.
Coughing
Two stage cough preceded by deep breathing (the 1
st
raises the secretion,
the 2
nd
facilitate expectoration. Patient applies pressure on the incision by
pillows or hands.
Huffing:
accomplished by forceful expiration, If the patient unable to do
coughing
Ankle circles:
To minimize the occurrence of phlebitis and facilitate venous
return.
Abdominal muscles exercises .

11. Aims of treatmentAims of treatment
Pre-operative
Psychological preparation for the operation.
Aims of pre-operative treatment:
1.To prepare the patient physically and mentally
for the operation.
2.Teach her the exercises that will be done post
operatively.
3.To improve circulation.
4.To improve respiration.
5.To strength the abdominal muscles

12. •Post-operative
Aims:
•To improve circulation.
•To improve respiration and prevent chest
complications.
•To avoid muscle wasting.
•To prevent postural problems
Methods
•The same like cesarean section except arm exercises.
•Electrical stimulation to decrease pain (TENS).
•Laser to decrease pain and enhance healing