B.

Surgical Management

Alternative names   
Vaginal hysterectomy; abdominal hysterectomy; Laparoscopic hysterectomy;
Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus

Definition 
  
A hysterectomy is a surgical removal of the uterus, resulting in the inability to become
pregnant (sterility). It may be done through the abdomen or the vagina.

Description   
Hysterectomy is an operation that is commonly performed. There are many reasons a
woman may need a hysterectomy. However, there are non-surgical approaches to treat
many of these conditions. Talk to your doctor about non-surgical treatments to try first,
especially if the recommendation for a hysterectomy is for a cause other than cancer.
During a hysterectomy, the uterus may be completely or partially removed. The fallopian
tubes and ovaries may also be removed. A partial (or supracervical) hysterectomy is
removal of just the upper portion of the uterus, leaving the cervix intact.
A total hysterectomy is removal of the entire uterus and the cervix. A radical
hysterectomy is the removal of the uterus, the tissue on both sides of the cervix
(parametrium), and the upper part of the vagina.
A hysterectomy may be done through an abdominal incision (abdominal hysterectomy), a
vaginal incision (vaginal hysterectomy), or through laparoscopic incisions (small
incisions on the abdomen -- laparoscopic hysterectomy).
Your physician will help you decide which type of hysterectomy is most appropriate for
you, depending on your medical history and the reason for your surgery.

Indications  
 
Hysterectomy was indicated to the patient to control bleeding and eventually preventing
other complications like hypovolemia and shock
 I. NURSING CARE PLAN (PATIENT-BASED)
2nd Priority: Risk for Infection
NURSING
NURSING SCIENTIFIC
CUES OBJECTIVE INTERVENTIO RATIONALES EVALUATION
DIAGNOSIS EXPLANATION
NS

Subjective Risk for infection Risk for infection is the After 4 hours of Determine To be able to The patient shows
cues: related to condition wherein the NPI and patient’s level know where understanding and
(-) presence of person looses his body interventions, of the nurse will appreciation to
incisional defenses that makes patient will be understanding start his health the health
woundsecondary him susceptible/ aware of the of the problem teachings. teachings given.
Objective
to limited making him at risk for possible and establish To have a
cues:
rapport. baseline data
Weakness knowledge different infections and interventions that
Assess the and know the
noted regarding proper diseases. In the case of could minimize
patient and get manifestations
Limited wound care. a one day post-op her risk of having
initial vital of the
range of patient, the primary infection brought
signs. problem.
motion defense of the body by her condition.
Aseptic
Irritable which is the skin was
Provide health techniques
and broken allowing
teachings help minimize
restless microorganisms to
regarding the
Pallor enter in the body and
aseptic contamination
With cause infections and techniques of the wound
intact diseases. applicable to by
dressing. Manifestations of wound care. microorganis
impending infection Demonstrate ms.
include elevation of proper way of Betadine is a
WBC primarily the cleaning known
lymphocytes and fever. surgical wound. antiseptic that
Use of betadine helps reduce
is advised. microorganis
Encourage the ms.
use of clean and The dressing
sterile dressing is a good place
and changing it for
regularly or as microorganis
prescribed. ms to live.
Encourage Changing it
proper way of regularly
hand washing. prevents it
from
Encourage contamination.
patient to Hand washing
maintain good is the best way
personal to prevent the
hygiene like spread of
doing bed bath infection.
regularly and Good personal
oral care. hygiene
Encourage removes
client to wear microorganis
clean and loose ms in the
clothes. body.
Promote Clean and
comfort loose clothes
measures such facilitate
as changing of aeration of the
linens. wound thus
promoting
Encourage to faster healing.
have fewer Clean linens
visitors/ reduce the
minimize microorganis
interaction with ms in the
other people. environment.
This reduces
Monitor vital the
signs microorganis
frequently. m that the
patient could

Encourage get from

client to eat and others and

drink prescribed promote good

diet that is rest.

nutritious and To know if

balance. These there are
include CHON- deviations
rich, CHO-rich from the
and Vit.-rich normal range.
foods like Nutritious and
chicken/fish balance meals
and fruits & provide
vegetables. sufficient
Advise client to energy to
drink client and
medications and good
supplements resistance to
prescribed by the body.
the physician
religiously.

Medications
and
supplement
help prevent
complications
of the disease
and promote
cure and
recovery to
patient.
 1st Priority: Pain

NURSING SCIENTIFIC NURSING

CUES OBJECTIVE RATIONALES EVALUATION
DIAGNOSIS EXPLANATION INTERVENTIONS

Subjective Acute Pain Pain is an After 3 hours of Perform Pain is a The patient
cues: related to tissue unpleasant sensory nursing comprehensive subjective verbalizes a
“Masakit ya injury secondary and emotional intervention, the assessment of pain experience and decrease in pain
to surgical experience that is patient will to include location, must be scale of below
ing meopera
intervention. normally associated verbalize characteristic, described by the 5/10, grimaces are
ku.”
with injury to body decrease level onset, duration, client in order to diminished and
quality, intensity, plan effective achieved
Objective tissues. The basic of pain.
treatment.
cues: elements of pain are and its tolerance to
With the sensory precipitating activity.
limited impulses generated factor.
mobility Relaxations
by injury-sensitive
Facial techniques help
receptors in the Encourage use of
grimace reduce skeletal
noted nervous system. relaxation technique
muscle tension,
These sense organs, such as focused
With which will
called nociceptors, breathing.
guarding reduce the
behavior convert mechanical, intensity of pain.
Irritable thermal, or
and Monitor vital signs.
chemical Personal factors
restless assess
stimulations that can influence
Weakness injure or threaten pain and pain
noted Create a quiet,
tissues into tolerance.
nondisruptive
Pain scale impulses that are environment.
above
transmitted along
8/10
peripheral nerves to Administer Comfortable and
the spinal cord, and analgesic as quiet

from there to higher ordered. atmosphere

brain centers. promote a relax

feeling and
permit the client
to focus on the
relaxation
technique rather
Provide than external
socialization as distraction.
diversional activity.

Keeping the
client busy will
Administer pain reduce the pain
medication as sensation.
order. Socialization is
a means to
divert the
attention of the
client.

To alleviate or
if not, reduce
the pain
experience.
 NURSING SCIENTIFIC NURSING
CUES OBJECTIVE RATIONALES EVALUATION
DIAGNOSIS EXPLANATION INTERVENTIONS

Subjective Disturbed Disturbed Sleeping After 4 hours of Determine patient’s To be able to The patient will
cues: Sleeping Pattern Pattern is the NPI and level of know where have periods of
“ Eku related to pain condition wherein interventions, understanding of the nurse will rests because of
secondary to the person cannot patient can the problem and start his health the reduction of
making
parenting role. achieve adequate achieve rest establish rapport. teachings. pain and
Mipatudtud”
rest due to different periods due to Assess the patient To have a disruptions in the
Objective
and get initial vital baseline data environment.
cues: disruptions that reduction of
signs. and know the
Weaknes could be physical pain and
Promote conducive manifestations
s noted (pain), as in the disruptions in
environment for of the
Drowsine case of my patient. the
sleep such as: problem.
ss psychological environment.
Keeping a well-
observed (anxiety),
fixed bed. A well fixed
Droopy environmental
bed reduces
eyes (poor
Keeping a quiet the strain
Frequent environmental
environment by that the
yawning conditions), etc. lowering voice patient
noted Manifestations are during interaction feels.
Limited seen during the day Keeping a well- Less
range of and theses include ventilated interaction
motion drowsiness, lack of environment by reduces the
Irritable energy, frequent opening windows, strain that
and yawning, etc. the patient
restless Encourage patient feels.
Pallor to maintain good
With dry personal hygiene A well-

and intact like doing bed bath ventilated

dressing. regularly and oral environmen

care. t prevents
Encourage client to the patient
avoid wearing from
constricting clothes. perspiring
thus
Encourage activities reducing
that promote irritability.
expenditure of Maintaining
energy such as good personal
passive exercises hygiene
and chatting with promotes
S.O. feeling of
Advise the patient wellness to
to take a nap when client.
the baby is asleep
and advice the S.O Loose clothing
to take care of the promotes good
baby so that the circulation and
mother will be reduces the
rested irritability felt
by the patient.
Monitor vital signs These
frequently. activities
promote

Encourage client to feeling of

eat and drink tiredness thus

prescribed diet that making the

is nutritious and patient feeling

balance on time. sleepy.

These include The first week

CHON-rich, CHO- postpartum is

rich and Vit.-rich a period where

foods like in the mother

chicken/fish and should regain

fruits & vegetables. energy lost

Advised changing during

of sleeping position delivery. So

at least every 20 taking care of

mins. the baby by

Advise client to the S.O for the

drink medications meantime will

and supplements give chance to

prescribed by the the mother to

physician have enough

religiously. rest, and

regain her lost
energy.
To know if
there are
deviations
from the
normal range.
Nutritious and
balance meals
provide
sufficient
energy to
client and
good
resistance to
the body. This
also promotes
feeling of
satiety that
makes the
person sleepy.

Changing
sleeping
position
promotes good
circulation.
Medications
and
supplement
help prevent
complications
of the disease
and promote
cure and
recovery to
patient.
CONCLUSION

Understanding one’s disease is the best way for us to have the best knowledge
and health teachings that we could give to our patient. It is through this case study
that we realized that presence of an infirmity affects the totality of one person. One
might face/accept it very well but others might not. It is our duty as health care
providers to take the initiative to find and provide for possible explanations/ support
that our clients need.
As for this case- Post partum hemorrhage, the pathophysiology of the disease
is the main key to have better understanding of the disease process itself. With this,
risk factors are modified; possible preventions are given and proper treatments and
cure are provided.