1. Care of the
Medical-
Surgical Client
s/p TAH patient

2. Objectives
• Review risk factors, etiology, and
clinical manifestations of the client
scheduled for a total abdominal
hysterectomy surgery
• Discuss nursing interventions and
outcomes of the post-operative total
abdominal hysterectomy client

3. Our Client
• 57 year old female admitted for surgery
o Radical abdominal hysterectomy
o ROS
• HEENT – wears bifocals for presbyopia and myopia; no neurological deficits
noted; hearing intact; client denies hoarseness; lymph nodes soft, mobile
• Resp – able to climb two flights of stairs w/o SoB; regularly walks for
exercise; RR 16
• Breasts – soft, non-tender, no lumps or lesions palpated
• CV – pre-hypertensive BP 130/80, HR 81, SpO2 99 RA
• MSk – no evidence of DJD
• GI – normal bowel habits reported; BMI 27.3
• GU – uterine cancer; urinary frequency, functional urinary stress
incontinence; reports post-menopausal bleeding, mild pelvic pain,
dyspareunia
• General: client reports mild fatigue and sleep disturbances, denies weight
loss, fever, chills, weakness

4. Risk Factors

5. Risk factors
Non-modifiable Modifiable
• Age
• Gender
• Family history
• Menarche
• Menopause
• Breast, Colon
Ovarian cancer
• Others?
• Pregnancies
• Gynecological
procedures
• STDs
• Lifestyle choices
• Obesity
• Oral Contraceptives
• Others?

6. Etiology

7. Etiology
• Unknown, thought to be genetic mutation
o Need for surgery:
o Often life threatening (not immediate, but serious enough)
• Invasive cancer of the uterus, cervix, vagina, fallopian tubes,
and or ovaries
• Unmanageable infection
• Unmanageable bleeding
• Serious complications during childbirth, such as a rupture of the
uterus –
• See more at:
https://www.nwhn.org/hysterectomy/?gclid=Cj0KEQiAxMG1BRD
Fmu3P3qjwmeMBEiQAEzSDLsiG4s6G1OYn4wDZJumHlh6LYt
LnFyhBtUAgK8i6Vr4aAhRM8P8HAQ#sthash.Ei6tbnTC.dpuf

8. Pathophysiology
• Endometrial cells mutate, become
undifferentiated, invade uterine
tissue, forms tumors
o Highly likely to metastasize
• Pelvic area, vagina
• Lungs (most common)
• Brain
• Liver

9. Clinical Manifestations

10. Clinical Manifestations
• May be none
• Dysfunction uterine bleeding (DUB)
o Fibroids
• Infection
• Cancer (similar to other solid organ or
tissue S&S)
• Pelvic pain
• Pain after intercourse (dyspareunia)
• Others?

11. Procedures
• Partial or Subtotal Hysterectomy– removes the body of the
uterus, cervix left in place.
• Total or Simple Hysterectomy – removes uterus and cervix.
(TAH)
• Hysterectomy with Bilateral Salpingo-Oophorectomy –
removes the uterus, cervix and fallopian tubes. (TAH-BSO)
• Radical Hysterectomy – removes the uterus, cervix, ovaries,
fallopian tubes and affected lymph glands; possibly upper
portions of the vagina.
• See more at:
https://www.nwhn.org/hysterectomy/?gclid=Cj0KEQiAxMG1BRD
Fmu3P3qjwmeMBEiQAEzSDLsiG4s6G1OYn4wDZJumHlh6LYtL
nFyhBtUAgK8i6Vr4aAhRM8P8HAQ#sthash.Ei6tbnTC.dpuf

12. Surgical Approaches
• Abdominal
o Pfannenstiel (bikini line scar)
o Mid-line laparotomy (radical TAH)
• Vaginal
o Technically more difficult, better results for most patients
• Laparoscopic Assisted Vaginal (LAVH)
o Majority of dissection performed through laparoscopic methods, uterus
removed through vagina, cuff sutured from inside or through vagina
• Robot Assisted Laparoscopic Vaginal
Hysterectomy
o Similar to LAVH, robotic manipulation of instruments results in less
tissue damage, faster recovery for patient

13. Complications

14. Post-op Clinical
Complications
• Pain
• Bleeding
• Infection
• Urinary tract injury
• Bowel injury
• Dehiscence (why?)
• Others?

15. Nursing Diagnoses

16. Nursing Diagnoses
• Risk for
o Falls (effects of medications)
o Infection (compromised skin and mucous
membrane integrity)
• Fluid volume deficit related to
blood loss
• Others?

17. Interventions

18. Interventions
• Pain management
• Encourage ambulation
• Fluids
• Advance diet as tolerated
• Encourage rest
• Client education
• Monitor for manifestations of complications
• Discharge:
o Follow-up appointments, collaborations, chemotherapy and/or radiation
therapies
• Others?

19. Medications
• Pain medications (immediately post-op)
• HRT?
o May be contraindicated in client with reproductive tract cancer
• Chemotherapy
• Radiation therapy
• Others?
• Client education on expected therapeutic action, side
effects, adverse effects, when to call provider, when to
seek urgent/emergent care

20. Oncology Treatments
• Antiemetic prior to initiating chemotherapy
• Cool washcloth on back of neck
• Emesis basin on hand
• Distractions (for pain and discomfort)
• Allow client to express feelings
• Encourage client to discuss experiences with
others
• Assess social support, provide information about
resources

21. Outcomes

22. Outcomes
• ~ 1/3 of clients may experience urinary tract
complications/symptoms
o ~ 1/3 of these usually resolve in 12 months or less
• Most clients return to baseline within 1 year
or less
o Including
• Sexual activity and health
• Reduction of nocturia and stress incontinence
• Increased bladder capacity
• Improvement in quality of life (in many patients)
• Our client?

23. Questions?