Nursing care of TAH patient

1. Care of the Medical-Surgical Client s/p TAH patient

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 Radical abdominal hysterectomy 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, SpO 2 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

4. Risk Factors

5. Risk factors Non- modifiable Modifiable Age Gender Family history Menarche Menopause Breast, Colon Ovarian cancer Others? Pregnancies Gynecological procedures STDs Lifestyle choices Obesity Oral Contraceptives Others?

6. Etiology

7. Etiology Unknown, thought to be genetic mutation Need for surgery: 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

8. Pathophysiology Endometrial cells mutate, become undifferentiated, invade uterine tissue, forms tumors Highly likely to metastasize Pelvic area, vagina Lungs (most common) Brain Liver

9. Clinical Manifestations

10. Clinical Manifestations May be none Dysfunction uterine bleeding (DUB) 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=Cj0KEQiAxMG1BRDFmu3P3qjwmeMBEiQAEzSDLsiG4s6G1OYn4wDZJumHlh6LYtLnFyhBtUAgK8i6Vr4aAhRM8P8HAQ# sthash.Ei6tbnTC.dpuf

12. Surgical Approaches Abdominal Pfannenstiel (bikini line scar) M id-line laparotomy (radical TAH) Vaginal T echnically more difficult, better results for most patients Laparoscopic Assisted Vaginal (LAVH) Majority of dissection performed through laparoscopic methods, uterus removed through vagina, cuff sutured from inside or through vagina Robot Assisted Laparoscopic Vaginal Hysterectomy Similar to LAVH, robotic manipulation of instruments results in less tissue damage, faster recovery for patient

13. Complications

14. Post-op Clinical Complications Pain Bleeding Infection Urinary tract injury Bowel injury Dehiscence (why?) Others?

15. Nursing Diagnoses

16. Nursing Diagnoses Risk for Falls (effects of medications) Infection (compromised skin and mucous membrane integrity) Fluid volume deficit related to blood loss Others?

17. Interventions

18. Interventions Pain management Encourage ambulation Fluids Advance diet as tolerated Encourage rest Client education Monitor for manifestations of complications Discharge: Follow-up appointments, collaborations, chemotherapy and/or radiation therapies Others?

19. Medications Pain medications (immediately post-op) HRT? 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

21. Outcomes

22. Outcomes ~ 1/3 of clients may experience urinary tract complications/symptoms ~ 1/3 of these usually resolve in 12 months or less Most clients return to baseline within 1 year or less Including Sexual activity and health Reduction of nocturia and stress incontinence Increased bladder capacity Improvement in quality of life (in many patients ) Our client?

23. Questions?