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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 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
- 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 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
- 13. Complications
- 14. Post-op Clinical Complications • Pain • Bleeding • Infection • Urinary tract injury • Bowel injury • Dehiscence (why?) • Others?
- 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?
- 17. Interventions
- 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
- 21. Outcomes
- 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?
- 23. Questions?