Total hysterectomy denotes the surgical excision of the entire uterus, followed by repair of the vaginal vault. It can be done abdominally or vaginally, hence termed total abdominal and vaginal hysterectomy, respectively. Indications include benign lesions such as leiomyomas greater than 12-week size and endometriosis, as well as malignancy such as endometrial carcinoma. Trauma and obstetric factors such as post-partum hemorrhage such as that caused by an atonic uterus that doesn’t respond to a B-Lynch suture could also indicate hysterectomy.
In the event of a total hysterectomy, a nursing care plan serves both pathophysiological and psychosocial interventions (Calderon, Pasic & Castorena, 2012). Besides, nursing care takes into account the patient’s grieving aspect due to losing of vital body parts as well as the inability to sire children following total hysterectomy. The subsequent discussion is a case study analysis of the nursing care plan for a patient admitted to a health facility having undergone a total hysterectomy. The patient complains of abdominal pain.
Chosen Pathophysiological/Psychosocial Priority
The nursing priorities for the patient will be to prevent complications arising due to the surgery. Pain is a cardinal sign of inflammation, alongside rubor, calor and functio laesa. Postoperative infection could occur as a result of breakdown of local and systemic host defenses caused by organisms such as Staphylococcus aureus and Clostridium perfringens. This patient, by virtue of being hypertensive, diabetic, and with a history of malignancy, is therefore at higher risk of infection owing to delayed wound healing and immunosuppression.
Infection arising from the urinary tract could be as a result of retention of urine due to pain and spasm. Anuria and cystitis could lead to availability of infection nidi (Konar, 2013).
Post-operative bowel dysfunction could also be present, due to the mild abdominal pain. Paralytic ileus is very common after abdominal procedures, but in this case, infection should be the main concern.
Insufficient frequent pouch emptying also increases the risk of ileal pouchitis and subsequently the abdominal pain (Lewis et al., 2010).
Various clinical manifestations could present due to total hysterectomy. These include;
ü Hematuria and urinary retention. She needs to be examined for signs of urinary retention and bloody urine (Carpenito, 2009). A catheter should be put into place to monitor hematuria as there could be trauma to the bladder or ureter, considering her bladder is already weak following the bladder cancer.
Rationale: Iatrogenic injury to associated structures such as the bladder and ureter should be factored in due to the close relation of the same to the uterus.
ü Absent or reduced bowel sounds upon auscultation (Konar, 2013). Post-operative bowel dysfunction is very common; hence the abdomen needs auscultation for bowel sounds, thrills and bruits.
Rationale: Absent or extremely reduced bowel sounds confirms the presence of ileus hence these influence the interventions made.
ü Ascites. This is manifested by abdominal distention and occurrence of pain (Lewis et al., 2010). Percuss for shifting dullness.
Rationale: Fluid from the serous exudate accumulates within the peritoneum, causing pain through distention. Shifting dullness upon percussion confirms presence of liquid within the abdomen.
Intervention 1: Administer antibiotics
Rationale: A guided approach on administration of broad and narrow spectrum antibiotics should be used so as to treat pre-existing infections and prevent new infections.
Intervention 2: Regular wound dressing.
Rationale: This should be done using antiseptics such as Chlorhexidine and Povidone-iodine to prevent infection at the incision wound.
Intervention 3: Catheterization
Rationale: A Foley’s Catheter may be used to empty the bladder so as to prevent accumulation of urine leading to infection or more pain due to distention of the bladder. Catheterization also aids in monitoring of renal output for shock, and also observation of hematuria
Intervention 4: Administer analgesics
Rationale: Administration of NSAIDs and mild opioids if the pain increases in intensity is done, so as to make the patient more comfortable.
Intervention 5: Following abdominal pain, the RICE method is recommended in addition to analgesics drugs administered to the patient so as to promote abdominal rest and relieve the pain. Ice is moderately applied in the incision sites to minimize swellings.
Rationale: RICE method denotes rest, ice, compression, and elevation. The approach promotes rest to the body muscle. Ice relieves pain by reducing swelling of the wounds. Nevertheless, compression is undertaken to reduce blisters (Calderon, Pasic & Castorena, 2012). Moreover, elevation of the injured body parts is conducted as one applies to ice as a way to reduce swelling.
As indicated in the preceding discussion, nursing care is an important aspect for the patients who have undergone a total hysterectomy (Lewis et al., 2010). The care process aims to minimize as well as prevent pain and complications arising after surgery. As highlighted in the case study, the patient encounter abdominal pain after surgery. The priority was, therefore, to manage the pain and reduce hospital stay (Carpenito, 2009). Moreover, the nursing care focused on identifying therapy options that the patient can adopt after discharge. Therefore, the RICE method was illustrated to the patient.