Davao Doctors College Gen. Malvar St.

Davao City

In Partial Fulfillment of the Requirements in NCM 104

“Total Abdominal Hysterectomy and Bilateral Salpingo Oopherectomy”

Submitted by: Melinda R. Sundo BSN4 14C/ Group 28

Submitted to: Llewelyn I. Cortez,RN, MN

June 2010

...................................................................16-17 Reference...........................10 Surgical Discussion................................................................................ ............................................14-15 Drug Study……………………………………………………………………………......................................... …......................4-9 Pathophysiology...........................................................................................13 Nursing management..................................................................................Table of Contents Definition of terms ..................................................................18 ..11-12 Instrumentation..........................................................................................................2-3 Review of Anatomy and Physiology of the Uterus and Cervix................................................1 Introduction.................................................

the procedure is called spaying and is a form of sterilization.two very fine tubes lined with ciliatedepithelia. debilitating gynecological medical ovaries. Salpingectomy . in females "womb") in is a which endometrial- like cells appear and flourish in areas outside the uterine cavity. most commonly on the most mammals including humans. does not have clear benefits over total hysterectomy in women with non-cancerous disease and should not be recommended as a superior technique Fibroids — Fibroids (also known as leiomyoma) are noncancerous growths of uterine muscle that occur in up to one-third of all women.s a surgical procedure whereby the uterus (womb) is removed. 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 Fallopian tubes.surgical technique that removes the uterus while leaving the cervix intact.refers to the surgical removal of a Fallopian tube. .Definition of Terms hysterectomy . Oophorectomy (or ovariectomy) is the surgical removal of an ovary or ovaries. via the utero-tubal junction. condition and metra. Cervix. Endometriosis (from endo. leading from the ovaries of female mammals into the uterus. Supracervical hysterectomy. the equivalent structures are the oviducts. Fibroids may become larger during pregnancy. In nonmammalian vertebrates. uterus s a major female hormone-responsive reproductive sex organ of "inside". Removal of the ovaries in women is the biological equivalent of castration in males. and the term is occasionally used in the medical literature instead of oophorectomy.is the lower. In vetinary science. and typically shrink after menopause.

carcinoma in situ. Indications OF TAH-BSO Hysterectomy is often performed on cancer patients or to relieve severe pelvic pain from things like. A hysterectomy is a surgical procedure whereby the uterus (womb) is removed. or microinvasive carcinoma of the cervix). Therefore. Hysterectomy may be total. also called supra-cervical. Salpingo refers specifically to the fallopian tubes which connect the ovaries to the uterus.000 women will undergo a hysterectomy A hysterectomy is also performed to treat uterine cancer or very severe pre-cancers (called dysplasia. It can sometimes lead to endometrial cancer.Endometrial hyperplasia — Endometrial hyperplasia is the term used to describe excessive growth of the endometrium (the tissue that lines the uterus). that of removal of the cancer from the body. or CIN III. such as tranexamic acidand more moderate surgical procedures. Hysterectomy is the most common non-obstetrical surgical procedure of women in the United States. This procedure is the foundation of treatment for cancer of the uterus. Hysterectomy is also refered to as sugical menopause. Oophorectomy is the surgical removal of an ovary or ovaries. Non-hormonal treatments are also available. such as ablations (removal of the lining of . Terectomy is the surgical removal of the uterus.this is the removal of the uterus including the cervix as well as the tubes and ovaries using an incision in the abdomen. as removing the body and cervix of the uterus or partial. endometriosis or adenomyosis.. Introduction Total Abdominal Hysterectomy and Bilateral Salpingo Oopherectomy. a premenopausal (still having regular menstrual periods) woman whose uterine fibroids are causing bleeding but no pain is generally first offered medical therapy with hormones. A hysterectomy for endometrial cancer (uterine lining cancer) has an obvious purpose. Approximately 300 out of every 100.

which is an advantage in women with cancer or investigating growths of unclear cause. The scar may be horizontal or vertical. This is the most common type of hysterectomy. including the cervix.the uterus). she may be considered for a hysterectomy. or the bleeding continues to cause anemia (low red blood cell count due to blood loss). Total abdominal hysterectomy allows the whole abdomen and pelvis to be examined. . the doctor removes the uterus. and she has no abnormality on endometrial sampling. and large uterine fibroids are treated with total abdominal hysterectomy. Clearly a woman cannot bear children herself after this procedure. endometriosis. and the size of the area being treated. During a total abdominal hysterectomy. so it is not performed on women of childbearing age unless there is a serious condition. Cancer of the ovary(s) and uterus. such as cancer. after a very thorough evaluation to identify the cause of the pain. Total abdominal hysterectomy may also be done in some unusual cases of very severe pelvic pain. If she still has significant bleeding that causes major impairment to her daily life. and only after several attempts at non-surgical treatments. depending on the reason the procedure is performed.

. belly). most mammalsIntestinal surface(towa including humansrd the cervixBody of uterus8. while the other is connected to one or both fallopian tubesCervical canal10. and in . Round ligament The uterus (from Latin2. . Two uteruses usually form initially in a female fetus. opens into the vaginaPalmate folds of cervical canal9. . .Anatomy and Physiology of the Uterus and Cervix Uterus Human female internal reproductive anatomy 1. Versical hormone-responsive bladder)6. depending on the species. and opossumsVaginal portion of cervix15. It is within the uterus that the fetusPosterior lip11. Fundus reproductive sex uterus7. of a major Uterus3. usually developing as completely humans in placental and partially mammalsgestationCervical in marsupialsIsthmus of os (external)12. "uterus" female (womb. Supravaginal portion of cervix1 such as kangaroos4. Uterus5. such uterus13. develops during . surface of of plural uteruses or uteri) organUterine One end. or womb is cavity4. .

have an oviduct instead of a uterus. It is attached to bundles of nerves. such title=Anterior_lip&action=edit&redlink=1" as chimpanzeesCervix.placental mammals they may partially or completely fuse into a single uterus depending on the species. The term uterus is used consistently within the medical and related professions. bowel. pelvic bones and organs. while the Germanic derived term womb is also common in everyday usage in theEnglish language.php? primatesAnterior lip16. mammals which lay eggs and include the platypus. broad ligaments. and networks of arteries and veins. including the ovaries. although in some individuals the uteruses may not have completely fused. In monotremes. Marsupials have two uteruses.[1] The uterus is essential in sexual response by directing blood flow to the pelvis and to the external genitalia. . such as birds and reptiles. In many species with two uteruses. labia. much in the way that the head is continuous with the neck. only one is functional. either the term uterus oroviduct is used to describe the same organ. along with horses. in which the egg's yolk sac supplies a large part of the embryo's nutrition but also attaches to the uterine wall and takes nutrients from the mother's bloodstream. but the egg does not develop a placenta within the mother and thus does not receive further nourishment after formation and fertilization. and broad bands of ligaments such as round ligaments.wikipedia. The uterus helps separate and keep the bladder in its natural position above the pubic bone and the bowel in its natural configuration behind the uterus. each of which connect to a lateral vagina and which both use a third. and uterosacral ligaments. Humans and other higherHYPERLINK "http://en. which is continuous with the vagina. and clitoris. middle "vagina" which functions as the birth canal. vagina. which is continuous with the shoulders. Most animals that lay eggs. The uterus is continuous with the cervix. The uterus is needed for uterine orgasm to occur. cardinal ligaments.org/w/index. usually have a single completely fused uterus. Function The uterus provides structural integrity and support to the bladder. Marsupial embryos form achoriovitelline "placenta" (which can be thought of as something between a monotreme egg and a "true" placenta).

the path to the uterus is as follows: • Cervix uteri . Due to anatomical barriers such as the pelvis. (7. It then becomes implanted into theendometrium. The human uterus is pear-shaped and about 3 in. and derives nourishment from blood vessels which develop exclusively for this purpose. attaches to a wall of the uterus. cervix and the internal os.6 cm) long. the uterus is pushed partially into the abdomen due to its expansion during pregnancy. Regions From outside to inside."Body of uterus" • • Cavity of the body of the uterus Fundus (uterus) ."neck of uterus" • • • External orifice of the uterus Canal of the cervix Internal orifice of the uterus • corpus uteri . A female's uterus can be divided anatomically into four segments: The fundus.The reproductive function of the uterus is to accept a fertilized ovum which passes through the utero-tubal junction from the fallopian tube. creates a placenta. and develops into a fetus (gestates) until childbirth.2 pounds). The fertilized ovum becomes an embryo. corpus. Even during pregnancy the mass of a human uterus amounts to only about a kilogram (2. Anatomy The uterus is located inside the pelvis immediately dorsal (and usually somewhat rostral) to the urinary bladder and ventral to the rectum.

However under the influence of the body hormones and the pressure from the fetal head. I. It also provides support to the uterus due to attachment of muscles from the pelvic bone.The cervix is the lower most part of the uterus and is made up of strong muscles. The opening of the cervical canal is normally very narrow. The cervix protrudes and opens through a canal into the vagina. it can lead to miscarriages during pregnancy. Columnar Epithelium Landmarks (Uterus) • Endocervical canal • Columnar epithelium villi Ectropion Eversion of columnar epithelium onto ectocervix Appears like an Erosion • • • II. to allow the birth of a baby. If the opening is loose. as observed in some women. this opening widens to about 4 inches (10 cm. The function of the cervix is to allow flow of menstrual blood from the uterus into the vagina.) during labor. Transitional Landmarks (Squamous Metaplasia) Transformation Zone • • • • • • True Squamocolumnar junction Upper or proximal limit of squamous metaplasia From True (proximal) to Original (distal) SCJ Where premalignant changes and neoplasia occur Encompasses Immature and mature squamous metaplasia . and direct the sperms into the uterus during intercourse.

• Usually not visualized • • • Within endocervical canal Approximately 3 cm from observed SCJ Immature Squamous metaplasia • Observed Squamocolumnar Junction • • I. Squamous Epithelium Landmarks (Vagina) • Mature squamous metaplasia • Nabothian cysts/follicles are in this area • • Original Squamocolumnar Junction • • Ectocervix Squamous epithelium PATHOPHYSIOLOGY ABNORMAL UTERINE BLEEDING abnormal uterine bleeding pregnant pregnant first trimester normal pregnancy • implantation bleed 2nd and 3rd abnormal pregnancy not .

blood pressure. where they will spend one to two nights. patients are transferred to the recovery room (also known as the post-anesthesia care unit) so that they can be monitored while waking up. Patients are given general or spinal anesthesia plus sedation so that they feel no pain. and respiration are closely observed throughout the procedure. and generally requires one to two hours in the operating room. . Most patients will then be transferred to a hospital room.• abortion extrauterine ectopic intrauterine • trophoblastic • Surgical Discussion Abdominal hysterectomy is performed in a hospital setting. Heart rate. After surgery. blood loss.

(See "Patient information: Menorrhagia (excessive menstrual bleeding)". Abnormal uterine bleeding — Excessive uterine bleeding. They may cause excessive bleeding and pelvic pain or pressure. and typically shrink after menopause. there may be an alternative to hysterectomy. called menorrhagia. had vaginal childbirth. lifestyle factors (repeated heavy lifting over the lifetime). laser or cryosurgery).) Pelvic organ prolapse — Pelvic organ prolapse occurs due to stretching and weakening of the pelvic muscles and ligaments. Prolapse is more common in women who have been pregnant. Fibroids may become larger during pregnancy. abnormal uterine bleeding that does not improve with conservative treatments may require hysterectomy. (See "Patient information: Fibroids". or chronic constipation. . Cervical abnormalities — Hysterectomy is rarely needed for carcinoma in situ (CIN 3) that does not resolve after other procedures (such as cone biopsy. fatigue. This allows the uterus to fall (or prolapse) into the vagina. For some of these conditions. a hysterectomy is sometimes needed or preferred to medical therapy.) Endometrial hyperplasia — Endometrial hyperplasia is the term used to describe excessive growth of the endometrium (the tissue that lines the uterus). can lead to anemia (low blood iron count). Fibroids — Fibroids (also known as leiomyoma) are noncancerous growths of uterine muscle that occur in up to one-third of all women. It can sometimes lead to endometrial cancer. Although endometrial hyperplasia can often be treated with medication. (See "Patient information: Management of atypical squamous cells (ASC-US and ASCH) and low grade cervical squamous intraepithelial lesions (LSIL)" and "Patient information: Management of high grade cervical squamous intraepithelial lesions (HSIL) and glandular abnormalities (AGC)". Menorrhagia is generally defined as bleeding that lasts longer than seven days or saturates more than one pad per hour for several hours. described below.) However. Heavy or irregular bleeding are generally treated first with medication or other surgical alternatives to hysterectomy. and in those with certain genetic factors.Reasons for Abdominal Hysterectomy A hysterectomy may be recommended for a number of conditions. and contribute to missed days at work or school.

or ovaries may require hysterectomy. Chronic pelvic pain — Chronic pelvic pain can be due to the effects of endometriosis or scarring (adhesions) in the pelvis and between pelvic organs.) Severe bleeding after childbirth — Hysterectomy may rarely be required in women who have uncontrollable bleeding after childbirth. early stage cancer" and "Patient information: Endometrial cancer treatment" and "Patient information: Ovarian cancer treatment". pelvic pain can also be caused by other sources. including the gastrointestinal and urinary systems. (See "Patient information: Cervical cancer treatment.46118P Malleable 1” x 4” 2 . cervix.46118 Malleable 1” x 8” .Cancer — Cancer of the uterus (endometrium). Instrumentation • • 2 . However.) It is important for a woman with pelvic pain to ask about the probability that her pain will improve after hysterectomy. (See "Patient information: Chronic pelvic pain in women".

• Assess perceived impact of change on activities of daily living (ADLs).44118C 18” Straight Arm with Cam Joint 2 Nursing Management • Assess perception of change in structure or function of body part (also proposed change). social behavior. the alteration results in a body image disturbance.46122 Malleable 2” x 8” 1 .• • • • • • • 2 . and occupational activities.46160 Harrington 2” x 6” 2 .46135 Fence 4” x 5” 1 . The extent of the response is more related to the value or importance the patient places on the part or function than the actual value or importance.g.46143 Fenestrated 1” x 3” 1 . • Assess impact of body image disturbance in relation to patient’s developmental stage. personal relationships.. Even when an alteration improves the overall health of the individual (e.41933 Hysterectomy Tray • 1 .46180 Heany 1” x 4” 1 .46660 Double Angled 1” x 3” • • • • • 1 .46663 Double Angled 1/2” x 2” 2 .46118A Malleable 1” x 10” 2 .46150 Richardson 2” x 4” 2 .41929 Rail Extender Long 1 . Adolescents and young adults may be particularly affected by changes in the structure or function of their bodies at a time when developmental changes are normally .46174 Deaver 2” x 5” 1 . an ileostomy for an individual with precancerous colon polyps).

getting glasses. social life. • Help patient identify actual changes. use of adaptive equipment. the length of which varies from individual to individual. Stages of grief over loss of a body part or function is normal. being pregnant. ranging from totally ignoring the altered structure or function to preoccupation with it. to work. interpersonal relationships. • • • Teach patient about the normalcy of body image disturbance and the grief process. . • • Note frequency of self-critical remarks Acknowledge normalcy of emotional response to actual or perceived change in body structure or function.g. Patients may perceive changes that are not present or real. Professional caregivers represent a microcosm of society.g..rapid. cosmetics. • Encourage verbalization of positive or negative feelings about actual or perceived change. or they may be placing unrealistic value on a body structure or function. and occupational activities. • Help patient identify ways of coping that have been useful in the past.. This compensates for actual changed body structure and function. and typically involves a period of denial. • Refer patient and caregivers to support groups composed of individuals with similar alterations. and at a time when developing social and intimate relationships is particularly important. Asking patients to remember other body image issues (e. and their actions and behaviors are scrutinized as the patient plans to return to home. • Demonstrate positive caring in routine activities. There is a broad range of behaviors associated with body image disturbance. It is worthwhile to encourage the patient to separate feelings about changes in body structure and/or function from feelings about self-worth. and to other activities. • Assist patient in incorporating actual changes into ADLs. wearing orthodontics. wigs. Teach patient adaptive behavior (e. having a leg cast) and how they were managed may help patient adjust to the current issue. Opportunities for positive feedback and success in social situations may hasten adaptation. use of deodorants). clothing that conceals altered body part or enhances remaining part or function. • Note patient’s behavior regarding actual or perceived changed body part or function.

crushing. decreasing contractility and oxygen demand. headache.headedness. syncope. or chewing them . Also may dilate coronary arteries and arterioles. classic chronic stable angina pectoris CONTRAINDICATION: contraindicated in patients hypertensive to drugs ADVERSE EFFECTS: dizziness. PATIENT TEACHING: -tell patient that chest pain may occur or may worsen briefly when beginning drug or when dosage increased -instruct patient to swallow extended release tablets without breaking. nervousness MODE OF ACTION: thought to inhibit calcium ion influx across cardiac and smooth muscle cells. light. somnolence. weakness.DRUG STUDY NIFEDIPINE CLASSIFICATION: Antianginals INDICATION: Vasopastic angina.

and anti pyretic effects PATIENT TEACHING: -correct hypovolemia before giving -carefully observe patients with coagulopathies and those taking anticoagulants -NSAID may mask signs and anti inflammatory actions . PATIENT TEACHING: -explain purpose of drugs . flushing.tell the patient to avoid hazardous activities if dizziness occurs . fish. eggs.-advise patient to avoid taking drug with grape fruit juice VITAMIN K CLASSIFICATION: vitamins and minerals INDICATION: RDA. cauliflower. rapid and weak pulse MODE OF ACTION: An antihemorraghic factor that promotes hepatic formation of active coagulation factors. spinach. HYPOPROTHROMBONEMIA caused by effect of oral anticoagulants CONTRAINDICATION: contraindicated to patients hypertensive to drugs ADVERSE EFFECTS: dizziness. and dairy products KETOROLAC CLASSIFICATION: NSAID INDICATION: short term management of moderately severe acute pain for single dose treatment CONTRAINDICATION: contraindicated as prophylactic analgesic before surgery or intraoperatively when homeostasis is critical and in patients currently recieing aspirin. meats. dizziness.tell patient that foods that provide vitamin K include cabbage. NSAID or probenecid. analgesic.inflammatory. sedation. transient hypotension after IV administration. liver. ADVERSE EFFECTS: drowsiness. headache MODE OF ACTION: may inhibit prostaglandin synthesis to produce anti.

answer.com/p/articles/mi http://www. opiods or psychotropic drugs ADVERSE EFFECTS: dizziness.com www. sleep disorder. coordination disturbance. CNS stimulation. confusion. hypnotics.com/px/getlogin.medscape.com/health-care-social-assistance/nursing-residential/ http://www. headache. euphoria.com .TRAMADOL HCl CLASSIFICATION: opiod analghesic INDICATION: moderate to moderately severe pain CONTRAINDICATION: contraindicated in patients with acute intoxication from alcohol. asthma. Website: http://findarticles. seizures MODE OF ACTION: A centrally acting synthetic analgesic compound not chemically related to opiods. Thought to bind to opiate receptors and inhibit reuptake of norepinephrine AND SEROTONIN PATIENT TEACHING: -tell patient to take drug as prescribed and not to increase dose or dosage interval unless ordered by physician -advise patient to check with prescriber before taking OTC drugs because interactions can occur Reference: Medical. Smeltzer et all.google.allbusiness. centrally acting analgesics. somnolence.ph/ https://profreg.com.do www. vertigo. nervousness. Volume 1. scribd.Surgical Nursing. anxiety.

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