(TAHBSO) Nursing Care Plan & Management

Total abdominal hysterectomy bilateral salpingo oophorectomy (TAHBSO) is the

removal of entire uterus, the ovaries, fallopian tubes and the cervix. TAHBSO is usually
performed in the case of uterine and cervical cancer. This is the most common kind of
hysterectomy. Removal of the ovaries eliminates the main source of the hormone
estrogen, so menopause occurs immediately.
Indications
▪ Endometriosis– is an abnormal condition in which endometrial tissue is found in
internal sites other than the uterus. Overall incidence in women of reproductive age
is 5% to 10%. Women in their mid-30s are most commonly affected, though it can
appear anytime form first menses to menopause. There is a familial disposition.
▪ Benign Uterine Tumors (Leiomyomas)– fibroids, fibromas, fibromyomas,
fibroleiomyomas, and myomas.
▪ Leiomyomas are benign uterine tumors that arise from the uterine muscle tissue.
They are the most common tumors of the female genital tract and occur in 20% to
30% in women. They are seen more often in African-American women, and are
more common in women approaching menopause.
▪ Endometrial or Uterine Cancer- is the most common malignancy of the female
genital reproductive system.
In 2007 the American Cancer Society estimated that 39,080 new cases of uterine
cancer would be diagnosed in the United States with an estimated 7400 women dying
of uterine cancer. The 5-year survival rate is 96% if the cancer is discovered at an early
stage. It is most strongly related to an imbalance between estrogen and progesterone
levels, resulting in excessive circulating estrogen.

▪ Ovarian Cancer– the second most common gynecologic cancer, accounts for 3% of
cancer occurrence and 6% of cancer deaths in women and is the leading cause of
death from reproductive malignancies in women. An estimated 22, 430 new cases
of ovarian cancer are expected to be detected in the United States in 2007, with 15,
280 deaths. White women show higher rates of ovarian cancer than do African-
American women. Early diagnosis of ovarian cancer is uncommon.
Risk and Side Effects
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 to premenopausal women. Studies have also found that
the risk of developing osteoporosis may increase.
Anatomy & Physiology
Internal Organs
1. Uterus . The uterus is a hollow organ about the size and shape of a pear. It serves
two important functions: it is the organ of menstruation and during pregnancy it receives
the fertilized ovum, retains and nourishes it until it expels the fetus during labor.
▪ The uterus is located between the urinary bladder and the rectum. The uterus
consists of the body or corpus, fundus, cervix, and the isthmus. The major portion
of the uterus is called the body or corpus. The fundus is the superior, rounded
region above the entrance of the fallopian tubes.
The cervix is the narrow, inferior outlet that protrudes into the vagina. The isthmus is the
slightly constricted portion that joins the corpus to the cervix.

▪ The walls are thick and are composed of three layers: the endometrium, the
myometrium, and the perimetrium.

2. Vagina – is the thin in walled muscular tube about 6 inches long leading from the
uterus to the external genitalia. It is located between the bladder and the rectum. It
provides the passageway for childbirth and menstrual flow; it receives the penis and
semen during sexual intercourse.

3. Fallopian Tubes (Two) –Each tube is about 4 inches long and extends medially from
each ovary to empty into the superior region of the uterus. They transport ovum from
the ovaries to the uterus. There is no contact of fallopian tubes with the ovaries. The
distal end of each fallopian tube is expanded and has finger-like projections called
fimbriae, which partially surround each ovary. When an oocyte is expelled from the
ovary, fimbriae create fluid currents that act to carry the oocyte into the fallopian tube.
Oocyte is carried toward the uterus by combination of tube peristalsis and cilia, which
propel the oocyte forward. The most desirable place for fertilization is the fallopian tube.

4. Ovaries (two) – The ovaries are for oogenesis-the production of eggs (female sex
cells) and for hormone production (estrogen and progesterone). They are about the size
and shape of almonds. They lie against the lateral walls of the pelvis, one on each side.
They are enclosed and held in place by the broad ligament.

5. Cervix (or neck of the uterus ) -is the lower, narrow portion of the uterus where it joins
with the top end of the vagina. It is cylindrical or conical in shape and protrudes through
the upper anterior vaginal wall.
6. Urethra -is a tube that connects the urinary bladder to the genitals for removal out of
the body. In males, the urethra travels through the penis, and carries semen as well as
urine. In females, the urethra is shorter and emerges above the vaginal opening.

Diagnostic Procedures
▪ Before any type of hysterectomy, women should have the following tests in order to
select the optimal procedure:
▪ Complete pelvic exam including manually examining the ovaries and uterus.
▪ Up-to-date Pap smear .
▪ Pelvic ultrasound may be appropriate, depending on what the physician
▪ A decision regarding whether finds on the above. or not to remove the ovaries at
the time of hysterectomy.
▪ Complete blood count

Management
Pre-operation
1. Interprets and upholds policies and procedures as determined by administrative
body.
2. Identify knowledge and skills of peri- operative nursing.
3. Identifies nursing care problems through pre-operative visit and assist in the
solutions.
Intra-operation
1. Ensures quality of care through proper use of instruments, equipments and
supplies.
2. Observes proper positioning of the patient and maintaining the dignity of the
individual As well, thus, providing maximum safety and comfort.
3. Identifies, prepares and send specimen obtained during operation for examination.
4. Assess patient’s stability and should know to report to the attending physician/s.
5. Carries out doctor’s post-operative order diligently.
6. Observes, checks and record patient assessment and refer when necessary.
7. Administers post-operative care.
8. Submits sundry report and account for the supplies and equipment used.
9. Responsible for the upkeep, Maintenance and care of equipment and instrument.
10. Informs appropriate personnel when supplies are needed or equipment and
instruments are out of order.
Post-operation
1. Responsible for all the safekeeping of patient’s personal belongings endorse by OR
nurse.
2. Responsible for endorsing such items to patient’s relatives or floor nurse.
3. Diligently carries out doctor’s orders as soon as possible.
4. Check and record vital signs-blood pressure, pulse rate, O2 saturation, respiratory
rate, temperature, color and condition of skin, if can move extremities every 15
minutes (or as often as possible or as indicated by the patient’s condition) on the
Nurse’s Post Anesthesia Record.
5. Observes and records neuro vital signs for neurological cases on the Neurological
Vital Signs Form provided by the unit.
6. Observes keenly the patient’s who might undergo post-operative complications like
bleeding, shock, respiratory distress, thyroid storm and cardiac arrest.
7. Notifies the anesthesiologist/ AMD immediately for any unusual symptoms
manifested by the patient.
Prognosis
▪ The prognosis following an uncomplicated hysterectomy is good, regardless of the
type of procedure performed. Symptoms are usually relieved by the procedure, and
a full return to normal activities can be expected.
▪ When hysterectomy is performed for cancer of the cervix or uterus, the prognosis
depends upon the extent and severity of the cancer. Early-stage or low-grade
cancer has a generally good prognosis, whereas more advanced stages or high-
grade cancer with extensive spreading (metastasis) has a poor prognosis.
▪ The predicted outcome after salpingo-oophorectomy doesn’t depend on whether
the procedure is unilateral or bilateral usually does not affect the outcome, because
the effect of the procedure and the healing from the surgery occur at much the
same rate for removal of one or both fallopian tubes and ovaries. However,
hormonal complications for premenopausal women may arise if both ovaries are
removed. After bilateral oophorectomy, the woman will be at increased risk for
osteoporosis, coronary heart disease, lung cancer, and cognitive impairment
(dementia) unless hormone replacement therapy is implemented, and will become
infertile.

Source: https://www.rnpedia.com/