Pre Operative nursing care Assess patient.

The health history and the physical and pelvic examinations are completed and the laboratory tests are performed. Encourage patient to share details of her menstrual history, the date of her last menstrual period, the events leading up to admission and the current degree of vaginal blood loss or discharge. Assess client’s knowledge of her condition and the surgery. Perform skin operation: The lower half of the abdomen and the pubic and perineal area may be shaved and these areas may be cleaned with soap and water. To prevent contamination and injury to the bladder or intestinal tract, the bladder and intestinal tract need to be empty before the patient is taken into the OR. The patient who has previously been prescribed with oral contraceptive drug will have to stop taking the drug 6 weeks prior to operation. Preoperative medications may be administered before surgery to help the patient relax. The patient must be allowed time to talk and ask questions. The nurse must know what information the physician has given the patient about the surgery. Encourage patient to practice foot and leg exercises before operation to understand how to carry out the exercises while in bed after surgery. Let the patient will wear anti-embolism socks to prevent venous stasis during the operation. Provide education: Loss of fertility if ovaries are to be removed in conjunction with the operation. Discuss surgical menopause.  Discuss how sexual intercourse may change.  Client whose ovaries are removed may complain of a decrease in libido.  Tell the client that once healing has occurred, intercourse should be pain free. Let the patient relax on bed until she leaves the ward escorted by her nurse who completes a safe transfer to the operating theater staff.

Intra Operative Nursing Care Prepare and assist for anesthesia. Maintain homeostasis and asepsis. Assist the surgeon and the whole team Assist in transferring the patient to the Operating table in a supine position. Ask patient to remove any jewelry or other objects that may interfere with the procedure. Ask patient to remove clothing and be given a gown to wear. Check for patency of the IV system. Monitor client’s HR, BP and breathing and report abnormalities. The skin over the surgical cite will be cleansed with an antiseptic solution

Post Op Perform usual post operative assessments. Evaluate psychological manifestations Monitor proximity of the bladder to the reproductive organ. Monitor Foley catheter to prevent susceptibility to UTI and temporary urinary retention Assist GI functions by listening to bowel sounds. Note distention and palpate whether abdomen is soft or firm Assess abdominal incision for bleeding and intactness. Assess vaginal bleeding. There is no distinct diet. Simple, strong, distinct flavors rather than complicated and multi-flavored dishes seem to be preferred with anything with smaller-than-usual portions. It’s best to avoid gassy foods like beans, broccoli and cabbage and/or foods that typically cause gas for you. Many suggest avoiding extra-spicy foods. Remember that all pos top surgical patients need protein to aid in healing. Include fiber in your post op diet, drink lots of water, and consume caffeinated drinks sparingly. If pain is experienced during sexual intercourse let the patient manipulate the penetration. Avoid heavy lifting for about 6 weeks to prevent straining the abdominal muscles and surgical sites. Avoid activities that increase pelvic congestion such as aerobics activity, horseback riding and prolonged standing. Report any fresh bleeding and any abnormal vaginal discharge to surgeon. Return for follow-up care as requested by the surgeon. Post op pain and discomfort are common, therefore the nurse should assess it’s intensity and administer analgesics as prescribed. If the patient has abdominal distention or flatus, rectal tube and application of heat to the abdomen may be prescribed Encourage patient to contact nurse or surgeon when bleeding is excessive. Encourage early ambulation o facilitate the return of normal peristalsis Montior and manage potential complications such as:  Hemorrhage: Count perineal pads used, assess the extent of saturation with blood and monitor vital signs. Guidelines for activity restriction are given above to promote healing and prevent post operative bleeding.

Deep Vein Thrombosis: Encourage and assist patient to change position frequently and exercise leg and feet while in bed. Instruct patient to avoid prolonged sitting in the chair with pressure on the knees, sitting cross legs and inactivity.

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