APPENDECTOMY
An appendectomy is a surgical procedure
performed to remove the appendix, a small
pouch attached to the large intestine. This
procedure is commonly indicated for
appendicitis, an inflammation of the appendix
usually caused by a blockage or infection.
Appendicitis can lead to serious complications if
not treated promptly, including rupture and
peritonitis.
STEPS IN PROCEDURE:
1. Preparation: The patient is prepared for
surgery by fasting and receiving pre-
operative medications.
2. Anesthesia: General anesthesia is
administered to ensure the patient
remains unconscious and pain-free
during the procedure.
3. Incision: The surgeon makes an
incision in the lower right abdomen,
through which the appendix will be
accessed.
4. Identification: The surgeon locates the
appendix and carefully separates it from
surrounding tissues.
5. Removal: The appendix is surgically
removed and may be sent for further
examination (histopathology).
6. Closure: The incision is closed with
sutures or surgical staples, and a sterile
dressing is applied.
PRE-OPERATIVE NURSING CARE:
 Consent: Ensure that consent is already
signed and that the client understand
the procedure by asking him/her about it
and what its risk and benefits.
 Assessment: Conduct a thorough
assessment of the patient's medical
history, vital signs, and symptoms of
appendicitis.
 Preparation: Ensure the patient is NPO
(nothing by mouth) before surgery and
assist with pre-operative procedures
such as blood tests and imaging studies.
 Emotional Support: Offer emotional
support to alleviate anxiety and address
concerns about the surgery.
INTRA-OPERATIVE NURSING CARE:
1. Positioning: Assist with positioning the
patient on the operating table and
ensure proper alignment and padding to
prevent pressure injuries.
2. Monitoring: Continuously monitor the
patient's vital signs, oxygen saturation,
and level of anesthesia throughout the
procedure.
3. Assisting the Surgical Team: Provide
assistance to the surgical team by
passing instruments, maintaining a
sterile field, and providing suction or
irrigation as needed.
4. Patient Advocacy: Advocate for the
patient's safety and well-being, ensuring
adherence to aseptic technique and
proper surgical protocol.
POST-OPERATIVE NURSING CARE:
1. Assessment: Monitor the patient closely
in the recovery room for signs of
complications such as bleeding,
infection, or respiratory distress.
2. Pain Management: Administer
analgesics as prescribed to manage
post-operative pain and discomfort.
3. Wound Care: Monitor the surgical
incision for signs of infection or
complications, and provide appropriate
wound care and dressing changes.
4. Fluids and Nutrition: Initiate oral fluids
and a light diet as tolerated, advancing
as per physician orders to prevent
dehydration and promote healing.
5. Mobility: Encourage early ambulation
and movement to prevent complications
such as deep vein thrombosis and
facilitate bowel function.
6. Education: Provide discharge
instructions to the patient and family,
including wound care, activity
restrictions, medication management,
and signs of complications.
PHARMACOLOGIC MANAGEMENT:
1. Analgesics:
 Drug Class: Opioids
 Generic Name: Morphine
 Brand Name: MS Contin
  Mode of Action: Binds to opioid
receptors in the central nervous
system, altering the perception of
pain.
2. Antibiotics:
 Generic Name: Ceftriaxone
 Brand Name: Rocephin
 Mode of Action: Inhibits bacterial cell
wall synthesis, leading to
bactericidal activity against a wide
range of bacteria.
NURSING DIAGNOSES:
1. Acute Pain related to surgical incision
and tissue trauma secondary to
appendectomy procedure.
2. Risk for Infection related to surgical
incision and altered immune response
secondary to appendectomy procedure.
CESAREAN SECTION
Also known as C-section, is a surgical procedure
performed to deliver a baby through an incision
in the mother's abdomen and uterus. It is
typically recommended when vaginal delivery is
not possible or safe for the mother or baby due
to various medical reasons, such as fetal
distress, breech presentation, or maternal health
concerns.
INDICATIONS
1. Fetal Distress:
2. Breech Presentation
3. Cephalopelvic Disproportion (CPD
4. Placenta Previa
5. Placental Abruption
6. Previous Cesarean Section
7. Multiple Gestation
8. Maternal Health Conditions
9. Uterine Rupture
10. Failed Induction of Labor
STEPS IN PROCEDURE:
1. Preparation: The patient is prepared for
surgery by fasting and receiving pre-
operative medications.
2. Anesthesia: General anesthesia or
regional anesthesia (spinal or epidural)
is administered to numb the lower body
and provide pain relief during the
procedure.
3. Incision: A horizontal or vertical incision
is made in the abdomen, typically below
the bikini line, to access the uterus.
4. Uterine Incision: A vertical or transverse
incision is made in the uterus to access
the baby.
5. Delivery: The baby is gently delivered
through the uterine incision, followed by
the placenta.
6. Closure: The uterine incision and
abdominal incision are closed with
sutures or staples, and a sterile dressing
is applied.
PRE-OPERATIVE NURSING CARE:
1. Consent: Ensure that consent is already
signed and that the client understand
the procedure by asking him/her about it
and what its risk and benefits.
2. Assessment: Conduct a comprehensive
assessment of the patient's medical
history, vital signs, and obstetric
condition.
3. Preparation: Ensure the patient is NPO
(nothing by mouth) before surgery,
administer pre-operative medications,
and facilitate pre-operative procedures
such as blood tests and imaging studies.
4. Emotional Support: Offer emotional
support to alleviate anxiety and address
concerns about the surgery and baby's
health.
INTRA-OPERATIVE NURSING CARE:
1. Positioning: Assist with positioning the
patient on the operating table and
ensure proper alignment and padding to
prevent pressure injuries.
2. Monitoring: Continuously monitor the
patient's vital signs, oxygen saturation,
and level of anesthesia throughout the
procedure.
3. Assisting the Surgical Team: Provide
assistance to the surgical team by
passing instruments, maintaining a
sterile field, and providing suction or
irrigation as needed.
4. Baby Care: Assist with neonatal care
immediately after delivery, including
assessing the baby's condition, drying,
 stimulating, and facilitating bonding with
the mother.
POST-OPERATIVE NURSING CARE:
1. Assessment: Monitor the patient closely
in the recovery room for signs of
complications such as bleeding,
infection, or respiratory distress.
2. Pain Management: Administer
analgesics as prescribed to manage
post-operative pain and discomfort.
3. Wound Care: Monitor the surgical
incision for signs of infection or
complications, and provide appropriate
wound care and dressing changes.
4. Fluids and Nutrition: Initiate oral fluids
and a light diet as tolerated, advancing
as per physician orders to prevent
dehydration and promote healing.
5. Mobility: Encourage early ambulation
and movement to prevent complications
such as deep vein thrombosis and
facilitate recovery.
6. Education: Provide discharge
instructions to the patient and family,
including wound care, activity
restrictions, medication management,
and signs of complications.
Pharmacologic Management:
1. Analgesics:
 Generic Name: Morphine
 Brand Name: MS Contin
 Mode of Action: Binds to opioid
receptors in the central nervous
system, altering the perception
of pain.
2. Antibiotics:
a. Generic Name: Cefazolin
b. Brand Name: Ancef
c. Mode of Action: Inhibits
bacterial cell wall synthesis,
leading to bactericidal activity
against a wide range of
bacteria.
NURSING DIAGNOSES:
1. Acute Pain related to surgical incision
and tissue trauma secondary to
Cesarean section procedure.
2. Risk for Infection related to surgical
incision and altered immune response
secondary to Cesarean section
procedure.
CHOLECYSTECTOMY
Laparoscopic cholecystectomy is a minimally
invasive surgical procedure used for the removal
of a diseased gallbladder.
INDICATIONS
 Cholecystitis (Acute/Chronic)
 Symptomatic cholelithiasis
 Biliary dyskinesia- hypofucntion or
hyperfunction
 Acalculous cholecystitis
 Gallstone pancreatitis
 Gallbladder masses/polyps
 Go to:
CONTRAINDICATIONS
 Inability to tolerate pneumoperitoneum
or general anesthesia
 Uncorrectable coagulopathy
 Metastatic disease
PROCEDURE:
After induction of anesthesia and intubation, the
laparoscopic cholecystectomy may begin.
1. First, insufflation of the abdomen is
achieved to 15 mmHg using carbon
dioxide.
2. Next, four small incisions are made in
the abdomen for trocar placement
(supraumbilical x1, subxiphoid x1, and
right subcostal x2).
3. Utilizing a camera (laparoscope) and
long instruments the gallbladder is
retracted over the liver.
4. this view is defined as (1) clearance of
fibrous and fatty tissue from the
hepatocystic triangle, (2) the presence
of only two tubular structures entering
into the base of the gallbladder, and (3)
the separation of the lower third of the
gallbladder from the liver to visualize the
cystic plate.
5. Once this view is adequately achieved,
the operating surgeon can proceed with
 confidence that he/she has isolated the antibiotics to prevent surgical site
cystic duct and cystic artery. infection and antiemetics to reduce
6. Both structures are carefully clipped and nausea and vomiting associated with
transected. anesthesia.
7. Electrocautery or harmonic scalpel is
then used to separate the gallbladder 5. Informed Consent: Ensure that the
from the liver bed completely. patient has provided informed consent
8. Hemostasis should be achieved after for the cholecystectomy procedure after
the abdomen is allowed to deflate to 8 understanding the risks, benefits, and
mmHg for 2 minutes. alternatives. Address any questions or
9. This technique is employed to avoid concerns the patient may have before
missing potential venous bleeding that obtaining consent.
can be tamponaded by elevated intra-
abdominal pressure (15 mmHg). Intra-operative Nursing Considerations and
10. The gallbladder is removed from the Interventions:
abdomen in a specimen pouch. 1. Patient Positioning: Assist with
11. All trocars should be removed under positioning the patient on the operating
direct visualization. table in the supine position with arms
12. Closure of port sites is surgeon specific; extended, ensuring proper alignment
this author recommends fascial closure and padding to prevent pressure
of trocar sites greater than 5 mm to injuries.
avoid incisional hernias in the 2. Monitoring: Continuously monitor the
postoperative period. patient's vital signs, oxygen saturation,
and electrocardiogram (ECG)
Pre-operative Nursing Considerations and throughout the procedure, alerting the
Interventions: surgical team to any abnormalities or
concerns.
1. Patient Assessment: Conduct a 3. Assisting the Surgical Team: Provide
thorough assessment of the patient's assistance to the surgical team by
medical history, including any previous passing instruments, maintaining a
surgeries, allergies, medications, and sterile field, and providing suction or
co-existing conditions such as diabetes irrigation as needed. Anticipate the
or hypertension. needs of the surgeon and team
2. Education: Provide pre-operative members to ensure smooth progress of
education to the patient and family the procedure.
regarding the cholecystectomy 4. Fluid Management: Monitor fluid
procedure, including the purpose, risks, balance and urine output during surgery,
benefits, and expected outcomes. adjusting intravenous fluid
Discuss pre-operative preparations such administration as needed to maintain
as fasting requirements, medication adequate hydration and perfusion.
instructions, and bowel preparation if
indicated. Post-operative Nursing Considerations and
3. Emotional Support: Offer emotional Interventions:
support and address any concerns or
anxieties the patient may have about the 1. Assessment: Monitor the patient closely
surgery. Provide reassurance and in the post-anesthesia care unit (PACU)
encouragement to alleviate fears and for signs of complications such as
promote a positive attitude towards the bleeding, respiratory distress, or
procedure. hypotension. Assess the surgical
4. Pre-operative Medications: Administer incision for signs of infection,
pre-operative medications as hematoma, or dehiscence.
prescribed, which may include
 2. Pain Management: Administer
analgesics as prescribed to manage
post-operative pain and discomfort,
using a multimodal approach to optimize
pain relief and minimize side effects.
3. Wound Care: Monitor the surgical
incision for signs of infection or
complications, and provide appropriate
wound care and dressing changes as
needed. Instruct the patient on proper
wound care techniques and signs of
infection to report.
4. Fluids and Nutrition: Initiate oral fluids
and a light diet as tolerated, advancing
as per physician orders to prevent
dehydration and promote healing.
Monitor intake and output to ensure
adequate hydration and nutrition.
5. Ambulation and Activity: Encourage
early ambulation and movement to
prevent complications such as deep vein
thrombosis and facilitate bowel function.
Provide assistance and support as
needed to promote safe mobility and
independence.
PHARMACOLOGIC MANAGEMENT:
1. Analgesics:
 Drug Class: Nonsteroidal anti-
inflammatory drugs (NSAIDs)
 Generic Name: Ibuprofen
 Brand Name: Advil, Motrin
 Mode of Action: Inhibits
prostaglandin synthesis, reducing
inflammation and pain.
2. Antiemetics:
 Drug Class: Antiemetics
 Generic Name: Ondansetron
 Brand Name: Zofran
 Mode of Action: Blocks serotonin
receptors in the gastrointestinal tract
and central nervous system,
reducing nausea and vomiting.
NURSING DIAGNOSES:
1. Acute Pain related to surgical incision
and tissue trauma secondary to
cholecystectomy procedure.
2. Risk for Infection related to surgical
incision and altered immune response
secondary to cholecystectomy
procedure.
OPEN REDUCTION INTERNAL FIXATION
(ORIF)
 is a surgical procedure used to treat
fractures by realigning and stabilizing
broken bones with the use of internal
fixation devices such as screws, plates,
or rods. This procedure aims to restore
anatomical alignment, provide stability to
the fracture site, and promote proper
healing.
Step-by-Step Procedure:
1. Preparation: The patient is positioned
appropriately on the operating table, and
general or regional anesthesia is
administered.
2. Incision: The surgeon makes an incision
over the fracture site to expose the bone
fragments.
3. Reduction: The fractured bones are
carefully manipulated (reduced) to
restore alignment and anatomical
position.
4. Fixation: Internal fixation devices such
as screws, plates, or rods are placed to
stabilize the fracture and maintain
alignment.
5. Closure: The incision is closed with
sutures or staples, and a sterile dressing
is applied to the surgical site.
INDICATIONS:
 ORIF is indicated for fractures that are
displaced, unstable, intra-articular, or
involve critical weight-bearing bones.
 It is commonly used for fractures of long
bones (e.g., femur, tibia, humerus) and
fractures involving joints or multiple
bone fragments.
CONTRAINDICATIONS:
  Relative contraindications to ORIF may
include severe medical comorbidities
that increase the risk of surgery, such as
uncontrolled diabetes, cardiovascular
disease, or compromised immune
function.
 Active infection at the surgical site is a
contraindication due to the increased
risk of post-operative complications.
Pre-Operative Nursing Care:
1. Assessment: Conduct a comprehensive
assessment of the patient's medical history,
allergies, medications, and previous
surgeries. Assess the fracture site,
neurovascular status, and skin integrity.
2. Education: Provide pre-operative education
to the patient and family about the ORIF
procedure, expected outcomes, risks,
benefits, and post-operative care
instructions.
3. Preparation: Ensure the patient is NPO
(nothing by mouth) before surgery,
administer pre-operative medications as
prescribed, and facilitate pre-operative
procedures such as laboratory tests and
imaging studies.
4. Emotional Support: Offer emotional support
and address any concerns or anxiety the
patient may have about the surgery.
Provide reassurance and encouragement to
promote a positive attitude towards the
procedure.
Intra-operative Nursing Care:
1. Positioning: Assist with positioning the
patient on the operating table and ensure
proper alignment and padding to prevent
pressure injuries.
2. Monitoring: Continuously monitor the
patient's vital signs, oxygen saturation, and
electrocardiogram (ECG) throughout the
procedure.
3. Assisting the Surgical Team: Provide
assistance to the surgical team by passing
instruments, maintaining a sterile field, and
providing suction or irrigation as needed.
4. Patient Advocacy: Advocate for the
patient's safety and well-being, ensuring
adherence to aseptic technique, surgical
protocol, and patient positioning to prevent
complications and optimize outcomes.
Post-operative Nursing Care:
1. Assessment: Monitor the patient closely in
the post-anesthesia care unit (PACU) for
signs of complications such as bleeding,
infection, or neurovascular compromise.
Assess the surgical incision for signs of
infection, hematoma, or dehiscence.
2. Pain Management: Administer analgesics
as prescribed to manage post-operative
pain and discomfort. Evaluate pain levels
regularly and adjust medication as needed.
3. Wound Care: Monitor the surgical incision
for signs of infection or complications, and
provide appropriate wound care and
dressing changes as needed.
4. Fluids and Nutrition: Initiate oral fluids and a
light diet as tolerated, advancing as per
physician orders to prevent dehydration and
promote healing. Monitor intake and output
to ensure adequate hydration and nutrition.
5. Mobility: Encourage early ambulation and
movement to prevent complications such as
deep vein thrombosis and facilitate
recovery. Provide assistance and support
as needed to promote safe mobility and
independence.
PHARMACOLOGIC MANAGEMENT:
1. Analgesics: Provide pain relief
medications as prescribed to manage
post-operative pain and discomfort.
Options may include opioids, non-
steroidal anti-inflammatory drugs
(NSAIDs), or acetaminophen.
2. Antibiotics: Administer prophylactic
antibiotics before surgery to reduce the
risk of post-operative infection,
especially in cases where implants are
used.
Nursing Diagnoses:
1. Acute Pain related to surgical incision
and tissue trauma secondary to ORIF
procedure.
2. Risk for Infection related to surgical
incision and altered immune response
secondary to ORIF procedure.
Post OP Complications
Wound dehiscence is a surgical complication
characterized by the spontaneous opening or
separation of a surgical incision along its suture
line, resulting in exposure of underlying tissues
or organs. This complication can occur in any
type of surgical wound but is most commonly
associated with abdominal surgeries.
Wound dehiscence typically occurs within the
first few weeks after surgery, during the initial
phase of wound healing when the tensile
strength of the incision is still low. It may present
as a partial or complete separation of the wound
edges, with varying degrees of tissue disruption.
Factors contributing to wound dehiscence
include poor surgical technique, compromised
wound healing, excessive tension on the wound,
infection, obesity, malnutrition, and underlying
medical conditions such as diabetes or
immunosuppression.
Clinical manifestations of wound dehiscence
may include:
 Visible separation of the wound edges
 Wound drainage or leakage
 Increased pain at the incision site
 Redness, swelling, or inflammation
around the wound
 Foul odor emanating from the wound
 Presence of exposed underlying tissues
or organs
Signs of infection such as fever, purulent
discharge, or systemic symptoms
Wound dehiscence is considered a serious
complication as it can lead to delayed wound
healing, increased risk of infection, formation of
abscesses, and potential evisceration
(protrusion of abdominal contents through the
wound). Prompt recognition and management of
wound dehiscence are essential to prevent
further complications and promote optimal
healing outcomes.
Management of wound dehiscence may include:
Immediate medical evaluation to assess the
extent of the wound separation and identify
underlying causes.
Wound care measures such as gentle cleansing,
application of sterile dressings, and use of
wound protectors or abdominal binders to
support the wound and minimize tension.
Antibiotic therapy if infection is present or
suspected.
Surgical intervention may be required in severe
cases to reapproximate the wound edges,
remove necrotic tissue, and facilitate wound
closure.
Patient education on wound care instructions,
activity restrictions, and signs of complications to
monitor at home.
Preventive measures to reduce the risk of
wound dehiscence include meticulous surgical
technique, proper wound closure with
appropriate suture materials and techniques,
careful patient selection and optimization of
modifiable risk factors such as obesity,
malnutrition, and smoking cessation. Close
monitoring of post-operative patients for signs of
wound complications is essential for early
detection and intervention.
Evisceration is a surgical complication
characterized by the protrusion or extrusion of
internal organs or tissues through a surgical
incision or wound opening. It typically occurs in
abdominal surgeries, where the abdominal
contents, such as the intestines or omentum,
herniate through the abdominal wall incision.
Evisceration is considered a serious and
potentially life-threatening complication that
requires immediate medical intervention.
Evisceration can occur due to various factors,
including:
Poor wound closure technique: Inadequate
closure of the surgical incision or failure of the
suture or staple line to hold the tissues together
can predispose to evisceration.
Increased intra-abdominal pressure: Factors
such as coughing, sneezing, vomiting, or
straining can exert pressure on the abdominal
cavity, leading to the protrusion of abdominal
contents through a weakened incision.
Infection: Post-operative wound infections can
impair wound healing and weaken tissue
integrity, increasing the risk of wound
dehiscence and subsequent evisceration.
Obesity: Excessive adipose tissue in the
abdominal wall can increase tension on the
surgical incision and predispose to wound
complications, including evisceration.
Poor nutritional status: Malnutrition or
deficiencies in nutrients essential for wound
healing, such as protein and vitamin C, can
impair tissue repair and increase the risk of
wound complications.
Clinical manifestations of evisceration may
include:
Visible protrusion of abdominal organs or tissues
through the surgical incision.
Pain or discomfort at the site of evisceration.
Redness, swelling, or inflammation around the
wound opening.
Presence of serosanguinous or purulent
discharge from the wound.
Signs of infection, such as fever, chills, or
malaise.
Tachycardia or hypotension in severe cases,
indicating hemodynamic instability.
Management of evisceration requires immediate
medical attention and may involve:
Gentle repositioning of the protruding organs or
tissues back into the abdominal cavity.
Application of moist, sterile dressings over the
wound to protect the exposed organs and
minimize the risk of contamination.
Administration of intravenous fluids and
antibiotics to stabilize the patient and prevent
infection.
Surgical intervention may be necessary to repair
the wound, resect damaged tissues, and
reinforce the abdominal wall with additional
sutures or mesh.
Close monitoring of the patient's vital signs,
wound status, and fluid balance to detect any
signs of deterioration or complications.
Tonsillectomy is the surgical removal of your
tonsils. It’s done to treat sleep-related breathing
issues or frequent infections
INDICATIONS:
 Recurrent episodes of tonsillitis (usually
defined as 7 or more episodes in one
year, 5 or more episodes in two
consecutive years, or 3 or more
episodes in three consecutive years).
 Chronic tonsillar hypertrophy causing
airway obstruction or obstructive sleep
apnea.
 Peritonsillar abscess (pus collection
around the tonsils).
CONTRAINDICATIONS:
 Active infection: Tonsillectomy should be
postponed if the patient has an active
infection such as tonsillitis or
peritonsillar abscess to reduce the risk
of complications.
 Bleeding disorders: Patients with
bleeding disorders or those taking
anticoagulant medications may be at
increased risk of bleeding during and
after surgery.
Steps in Procedure:
1. Preparation: The patient is positioned
supine with the neck extended. General
anesthesia is administered, and the
patient is intubated.
2. Incision: The surgeon uses a
tonsillectomy instrument (such as a
tonsillar snare or dissection technique)
to remove the tonsils from the
surrounding tissue.
3. Hemostasis: Any bleeding from the
tonsillar bed is controlled using
electrocautery or other hemostatic
techniques.
4. Closure: The surgical site is inspected
for hemostasis, and the procedure is
completed. The patient is extubated and
transferred to the recovery room.
Pre-Operative Nursing Care:
1. Patient Assessment: Perform a
comprehensive assessment of the
patient's medical history, including
allergies, bleeding disorders, and
previous surgeries.
2. Education: Provide pre-operative
education to the patient and family about
the tonsillectomy procedure, expected
outcomes, risks, benefits, and post-
operative care instructions.
3. Preparation: Ensure the patient is NPO
(nothing by mouth) before surgery,
administer pre-operative medications as
prescribed, and facilitate pre-operative
 procedures such as laboratory tests and
imaging studies.
4. Emotional Support: Offer emotional
support and address any concerns or
anxiety the patient may have about the
surgery. Provide reassurance and
encouragement to promote a positive
attitude towards the procedure.
Intra-operative Nursing Care:
 Positioning: Assist with positioning the
patient on the operating table and
ensure proper alignment and padding to
prevent pressure injuries.
 Monitoring: Continuously monitor the
patient's vital signs, oxygen saturation,
and electrocardiogram (ECG)
throughout the procedure.
 Assisting the Surgical Team: Provide
assistance to the surgical team by
passing instruments, maintaining a
sterile field, and providing suction or
irrigation as needed.
 Patient Advocacy: Advocate for the
patient's safety and well-being, ensuring
adherence to aseptic technique, surgical
protocol, and patient positioning to
prevent complications and optimize
outcomes.
Post-operative Nursing Care:
1. Assessment: Monitor the patient closely
in the post-anesthesia care unit (PACU)
for signs of complications such as
bleeding, respiratory distress, or
hypotension. Assess the surgical site for
bleeding or signs of infection.
2. Pain Management: Administer
analgesics as prescribed to manage
post-operative pain and discomfort.
Evaluate pain levels regularly and adjust
medication as needed.
3. Fluids and Nutrition: Initiate oral fluids
and a light diet as tolerated, advancing
as per physician orders to prevent
dehydration and promote healing.
Monitor intake and output to ensure
adequate hydration and nutrition.
4. Activity: Encourage early ambulation
and movement to prevent complications
such as deep vein thrombosis and
facilitate recovery. Provide assistance
and support as needed to promote safe
mobility and independence.
Pharmacologic Management:
1. Analgesics: Provide pain relief
medications as prescribed to manage
post-operative pain and discomfort.
Options may include opioids, non-
steroidal anti-inflammatory drugs
(NSAIDs), or acetaminophen.
2. Antibiotics: Administer prophylactic
antibiotics before surgery to reduce the
risk of post-operative infection,
especially in cases of chronic tonsillitis
or peritonsillar abscess.
Nursing Diagnoses:
1. Acute Pain related to surgical incision
and tissue trauma secondary to
tonsillectomy procedure.
2. Risk for Infection related to surgical
incision and altered immune response
secondary to tonsillectomy procedure.
Uterine myomas, also known as fibroids, are
benign tumors that develop in the muscular wall
of the uterus.
They vary in size, number, and location within
the uterus, and can cause a range of symptoms
depending on their size and position.
While most uterine myomas are asymptomatic,
they can lead to symptoms such as abnormal
uterine bleeding, pelvic pain, and pressure
symptoms.
Etiologic Factors:
Hormonal factors: Estrogen and progesterone
play a role in the growth and development of
uterine myomas.
Genetic predisposition: Family history of fibroids
may increase the risk of developing them.
Other factors: Obesity, age (more common in
women of reproductive age), and race (more
common in African-American women).
Detailed Pathophysiology:
Uterine myomas arise from the smooth muscle
cells of the uterus, often in response to hormonal
stimulation.
Estrogen and progesterone promote the growth
of myomas, leading to the development of
discrete nodules or diffuse enlargement of the
uterus.
The exact pathophysiology of uterine myomas is
not fully understood, but alterations in hormonal
signaling pathways and genetic factors are
thought to play a role.
Signs and Symptoms:
Abnormal uterine bleeding: Heavy menstrual
bleeding (menorrhagia), prolonged periods, or
intermenstrual bleeding.
Pelvic pain or pressure: Pelvic discomfort, lower
abdominal cramping, or pain during intercourse.
Enlarged uterus: Palpable mass in the lower
abdomen, often associated with urinary
frequency or constipation.
Reproductive symptoms: Infertility or recurrent
miscarriages, particularly with submucosal or
large intramural fibroids.
Diagnostic Tests:
Pelvic ultrasound: Imaging study to visualize the
uterus and identify the presence, size, and
location of uterine myomas.
Magnetic resonance imaging (MRI): Provides
detailed images of the uterus and surrounding
structures, useful for assessing the extent and
characteristics of fibroids.
Hysteroscopy: Direct visualization of the uterine
cavity using a thin, flexible scope inserted
through the cervix, useful for detecting
submucosal fibroids.
Endometrial biopsy: Sampling of the uterine
lining to rule out other causes of abnormal
uterine bleeding, such as endometrial
hyperplasia or cancer.
Pharmacologic Management:
Drug Class: Gonadotropin-releasing hormone
(GnRH) agonists.
Generic Name: Leuprolide acetate.
Brand Name: Lupron.
Mode of Action: Suppresses ovarian function
and decreases estrogen production, leading to
shrinkage of uterine myomas and symptom
relief.
Surgical Management:
Surgical intervention may be indicated for
symptomatic or large uterine myomas that do
not respond to conservative measures.
Procedures include:
Myomectomy: Surgical removal of uterine
myomas while preserving the uterus, often
performed via laparotomy, laparoscopy, or
hysteroscopy.
Hysterectomy: Surgical removal of the uterus,
which may be considered in women who have
completed childbearing or have severe
symptoms refractory to other treatments.
Nursing Diagnosis:
Acute Pain related to pelvic pressure and
discomfort secondary to uterine myomas.
Risk for Impaired Tissue Integrity related to
heavy menstrual bleeding and potential anemia.
Essential Nursing Interventions:
Manage Pain:
Assess and document the severity and location
of pelvic pain using a standardized pain scale.
Administer prescribed analgesics as directed to
alleviate discomfort and improve the patient's
comfort level.
Offer non-pharmacologic pain relief measures,
such as heat therapy or relaxation techniques, to
complement pharmacologic interventions.
Monitor Bleeding:
Assess menstrual flow and patterns, including
duration, frequency, and amount of bleeding.
Monitor vital signs, hemoglobin levels, and signs
of anemia, such as fatigue or pallor.
Educate the patient about signs of excessive
bleeding or anemia and when to seek medical
attention.
Provide Emotional Support:
Offer emotional support and reassurance to
patients experiencing distress or anxiety related
to their diagnosis and treatment options.
Encourage open communication and provide
opportunities for patients to express their
concerns and feelings.
Refer patients to support groups or counseling
services for additional support and coping
strategies.
Promote Optimal Nutrition:

Collaborate with dietitians to develop a balanced

diet plan rich in iron and other nutrients to
support hemoglobin levels and prevent anemia.
Educate patients about dietary sources of iron
and strategies to enhance iron absorption, such
as consuming vitamin C-rich foods with iron-rich
foods.
Monitor nutritional intake and provide education
on the importance of maintaining a healthy diet
to support overall well-being.
Educate About Medications and Procedures:

Provide information about prescribed

medications, including dosage, administration
instructions, potential side effects, and expected
outcomes.
Educate patients about the benefits and risks of
surgical interventions, including myomectomy
and hysterectomy.
Discuss alternative treatment options and
address any questions or concerns the patient
may have about their care plan.