Total hysterectomy denotes a surgical procedure undertaken to remove the uterus and cervix of a patient. The surgery is conducted following a diagnosed malignancies as well as non-malignant conditions of the cervix and uterus. Besides, cervical, ovarian or ovarian cancer may necessitate a total hysterectomy (Lewis et al., 2010). The surgery leads to early onset of menopause and therefore the female of reproductive age who undergoes total hysterectomy lose their ability to conceive.
In the event of a total hysterectomy, a nursing care plan is indispensable. The latter has a dual purpose of both pathophysiological and psychosocial interventions. Precisely, the plan assesses the risk of infections for the pre and post-operative patients (Calderon, Pasic & Castorena, 2012). Besides, nursing care takes into account the grieving aspect of the patient mainly due to losing of vital body parts as well as the trauma arising from 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. Most importantly, the abdominal pain that the patient complains of would be dealt with first. The pain is a common phenomenon among the post-operative patients who undergoes a total hysterectomy (Carpenito, 2009). According to the diagnosis, the patient mentions abdominal pain related to the hysterectomy surgery as evidenced by a pain of 5 out of 10 when measured by the pain assessment scale.
In a bid to manage pain, the evaluation of the source and the duration of pain would be paramount. The source of pain could arise from the incision sites. Possibly, the muscles in the abdominal walls might cause bruises on the incision areas leading to pain (Lewis et al., 2010). Moreover, abdominal distention might attribute to the pain. In addition, the patient has been diagnosed with Diabetes Mellitus as well as hypothyroidism. These conditions compromise the immune system hence impairs the healing of wounds at the incision sites.
In an attempt to intervene to the abdominal pain, it is imperative to assess the causative agent. This is achieved through monitoring of the signs and symptoms within the ileal reservoir. According to the assessment of the patient, the ileal conduit draining is rated at 200 ml over 7 hours. This is low when compared to the recommended levels.
Pouchitis entails the inflammation within the ileal pouch. Occasionally, the cause of the inflammation is unknown. However, the bacterial growth in the pouch could be attributed to the causative agent. Thus, insufficient frequent pouch emptying increases the risk of ileal pouchitis and subsequently the abdominal pain (Lewis et al., 2010).
The patient complains of abdominal pain. However, various clinical manifestations could present due to total hysterectomy. These include;
ü The surgery can cause traumas of the bladder, rectal or ureter. Therefore she needs to be examined for signs of urinary retention, bloody urine, prolonged diminished bowel sounds and absence of flatus (Carpenito, 2009).
Rationale: These structures are close to the surgical site hence can be predisposed to atopy. Besides, edema, as well as nerve trauma, can cause the infections of these structures.
ü Auscultate bowel sounds. This is manifested through abdominal distension. Besides, the presence of nausea or vomiting alters bowel movement hence attributing to abdominal pain.
Rationale: The bowel sounds confirms the presence of ileus hence these influence the interventions made.
ü Assess the possibility of ascites. These are manifested by abdominal distention and occurrence of pain (Lewis et al., 2010).
Rationale: Ascites is the oedema of the stomach. It causes abdominal pain. The patient could have accumulated fluid inside the peritoneum thus causing pain in the abdomen.
Intervention 1: The abdominal pain is controlled by use of pharmaceutical as well as non-pharmaceutical methods. Use of analgesia such as PCA and Opiates would help in the management of pain. The PCA is intravenously infused with 1-2% concentration at 4-6 ml/hr.
Rationale: The patient underwent abdominal surgery and hence will need pain control strategies. Hence, use of pain medications will help promote the healing process. Besides, the patient needs rest and avoid exertion which can aggravate the adnominal pain (Calderon, Pasic & Castorena, 2012). Moreover, use of PCA is associated with hypotension hence will help relieve the hypertensive condition of the patient.
Intervention 2: Encourage ambulation with the patient
Rationale: Ambulation is vital especially for the post-operative patient with abdominal pain. It promotes healing as well as reduces the complications associated with thromboembolism. Besides, ambulating the patient helps improve bowel movement hence reduces the period of stay in the hospital.
Intervention 3: Provide sitz baths. Tub baths are not recommended. During bathing, it is recommended to PAT dry the regions of incisions.
Rationale: This promotes relaxation of the abdominal muscles hence minimizes the instances of pain.
Intervention 4: Advice on moderate activities. The patient should reduce strenuous activities such as the lifting of heavy objectives. Driving should also be restricted for at least 1-3 weeks
Rationale: Uncontrolled activities such as lifting and driving cause strain on the abdominal wall, and this aggravates the pain (Carpenito, 2009). The post-operative total hysterectomy patients need to limit their physical activities to allow for the healing the wounds.
Intervention 5: Following abdominal pain, the RICE method is recommended in addition to analgesics drugs administered to the patient. This is aimed at promoting abdominal rest and relieving 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 is used to relieve 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.