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

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

It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall Fallopian tubes. Salpingectomy . and the term is occasionally used in the medical literature instead of oophorectomy. in females "womb") in is a which endometrial- like cells appear and flourish in areas outside the uterine cavity.surgical technique that removes the uterus while leaving the cervix intact. Supracervical hysterectomy. leading from the ovaries of female mammals into the uterus. Fibroids may become larger during pregnancy. Removal of the ovaries in women is the biological equivalent of castration in males. the equivalent structures are the oviducts. and typically shrink after menopause.Definition of Terms hysterectomy . uterus s a major female hormone-responsive reproductive sex organ of "inside". Oophorectomy (or ovariectomy) is the surgical removal of an ovary or ovaries.two very fine tubes lined with ciliatedepithelia. debilitating gynecological medical ovaries. Cervix.refers to the surgical removal of a Fallopian tube. Endometrial hyperplasia — Endometrial hyperplasia is the term used to describe excessive growth of the endometrium (the tissue that lines the uterus). condition and metra. narrow portion of the uterus where it joins with the top end of the vagina.s a surgical procedure whereby the uterus (womb) is removed. . In nonmammalian vertebrates. the procedure is called spaying and is a form of sterilization. Endometriosis (from endo. It can sometimes lead to endometrial cancer.is the lower. via the utero-tubal junction. most commonly on the most mammals including humans. In vetinary science. 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.

Therefore. 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. Non-hormonal treatments are also available. endometriosis or adenomyosis. Hysterectomy may be total. or CIN III. A hysterectomy for endometrial cancer (uterine lining cancer) has an obvious purpose. Salpingo refers specifically to the fallopian tubes which connect the ovaries to the uterus. Oophorectomy is the surgical removal of an ovary or ovaries. or the bleeding continues to cause anemia (low red blood cell count due to blood . or microinvasive carcinoma of the cervix). Hysterectomy is the most common non-obstetrical surgical procedure of women in the United States. as removing the body and cervix of the uterus or partial.000 women will undergo a hysterectomy A hysterectomy is also performed to treat uterine cancer or very severe pre-cancers (called dysplasia. This procedure is the foundation of treatment for cancer of the uterus. Hysterectomy is also refered to as sugical menopause. Approximately 300 out of every 100. A hysterectomy is a surgical procedure whereby the uterus (womb) is removed.. that of removal of the cancer from the body.Introduction Total Abdominal Hysterectomy and Bilateral Salpingo Oopherectomy. such as tranexamic acidand more moderate surgical procedures. also called supra-cervical. carcinoma in situ. 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. such as ablations (removal of the lining of the uterus). If she still has significant bleeding that causes major impairment to her daily life. Indications OF TAH-BSO Hysterectomy is often performed on cancer patients or to relieve severe pelvic pain from things like.

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

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

title=Anterior_lip&action=edit&redlink=1" primatesAnterior lip16. although in some individuals the uteruses may not have completely fused. such as birds and reptiles. The reproductive function of the uterus is to accept a fertilized ovum which passes through the utero-tubal junction from the fallopian tube. vagina. have an oviduct instead of a uterus. and broad bands of ligaments such as round [1] ligaments. In monotremes. including the ovaries. pelvic bones and organs. It is attached to bundles of nerves. broad ligaments. It then becomes implanted into theendometrium. while the Germanic derived term womb is also common in everyday usage in theEnglish language. and clitoris. The term uterus is used consistently within the medical and related professions. 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. cardinal ligaments. and uterosacral ligaments. and networks of arteries and veins. and derives nourishment from blood vessels which develop exclusively . such as chimpanzeesCervix. Most animals that lay eggs. but the egg does not develop a placenta within the mother and thus does not receive further nourishment after formation and fertilization. labia. each of which connect to a lateral vagina and which both use a third. mammals which lay eggs and include the platypus. which is continuous with the vagina. The uterus is essential in sexual response by directing blood flow to the pelvis and to the external genitalia. either the term uterus oroviduct is used to describe the same organ. Function The uterus provides structural integrity and support to the bladder. usually have a single completely fused uterus. The uterus is continuous with the cervix. The uterus is needed for uterine orgasm to occur. Marsupials have two uteruses. 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. Marsupial embryos form achoriovitelline "placenta" (which can be thought of as something between a monotreme egg and a "true" placenta). bowel. which is continuous with the shoulders. along with horses. much in the way that the head is continuous with the neck. middle "vagina" which functions as the birth canal.

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

this opening widens to about 4 inches (10 cm.The cervix is the lower most part of the uterus and is made up of strong muscles. to allow the birth of a baby. If the opening is loose. it can lead to miscarriages during pregnancy. and direct the sperms into the uterus during intercourse. as observed in some women.) during labor. Columnar Epithelium Landmarks (Uterus) • Endocervical canal • Columnar epithelium villi Ectropion Eversion of columnar epithelium onto ectocervix Appears like an Erosion • • • II. The cervix protrudes and opens through a canal into the vagina. The opening of the cervical canal is normally very narrow. It also provides support to the uterus due to attachment of muscles from the pelvic bone. However under the influence of the body hormones and the pressure from the fetal head. Transitional Landmarks (Squamous Metaplasia) Transformation Zone • • • • • • • True Squamocolumnar junction Upper or proximal limit of squamous metaplasia Usually not visualized • • • Within endocervical canal Approximately 3 cm from observed SCJ Immature Squamous metaplasia From True (proximal) to Original (distal) SCJ Where premalignant changes and neoplasia occur Encompasses Immature and mature squamous metaplasia . I. The function of the cervix is to allow flow of menstrual blood from the uterus into the vagina.

• 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 • abortion extrauterine ectopic 2nd and 3rd abnormal pregnancy intrauterine • trophoblastic • not .

Most patients will then be transferred to a hospital room. Heart rate. described below. called menorrhagia. blood pressure. there may be an alternative to hysterectomy. blood loss. where they will spend one to two nights. After surgery. Abnormal uterine bleeding — Excessive uterine bleeding.Surgical Discussion Abdominal hysterectomy is performed in a hospital setting. patients are transferred to the recovery room (also known as the post-anesthesia care unit) so that they can be monitored while waking up. For some of these conditions. and generally requires one to two hours in the operating room. can lead to anemia (low blood iron count). and respiration are closely observed throughout the procedure. fatigue. Patients are given general or spinal anesthesia plus sedation so that they feel no pain. and contribute to missed days at work or . Reasons for Abdominal Hysterectomy A hysterectomy may be recommended for a number of conditions.

. It can sometimes lead to endometrial cancer. laser or cryosurgery).school. Heavy or irregular bleeding are generally treated first with medication or other surgical alternatives to hysterectomy. Menorrhagia is generally defined as bleeding that lasts longer than seven days or saturates more than one pad per hour for several hours. They may cause excessive bleeding and pelvic pain or pressure. Although endometrial hyperplasia can often be treated with medication.) Endometrial hyperplasia — Endometrial hyperplasia is the term used to describe excessive growth of the endometrium (the tissue that lines the uterus). Fibroids may become larger during pregnancy. (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)". abnormal uterine bleeding that does not improve with conservative treatments may require hysterectomy. cervix. (See "Patient information: Cervical cancer treatment.) Pelvic organ prolapse — Pelvic organ prolapse occurs due to stretching and weakening of the pelvic muscles and ligaments. Cervical abnormalities — Hysterectomy is rarely needed for carcinoma in situ (CIN 3) that does not resolve after other procedures (such as cone biopsy. This allows the uterus to fall (or prolapse) into the vagina. Prolapse is more common in women who have been pregnant. (See "Patient information: Menorrhagia (excessive menstrual bleeding)". early stage cancer" and "Patient information: Endometrial cancer treatment" and "Patient information: Ovarian cancer treatment". had vaginal childbirth. a hysterectomy is sometimes needed or preferred to medical therapy.) However. (See "Patient information: Fibroids". or chronic constipation. or ovaries may require hysterectomy. Cancer — Cancer of the uterus (endometrium). Fibroids — Fibroids (also known as leiomyoma) are noncancerous growths of uterine muscle that occur in up to one-third of all women.) Severe bleeding after childbirth — Hysterectomy may rarely be required in women who have uncontrollable bleeding after childbirth. and typically shrink after menopause. lifestyle factors (repeated heavy lifting over the lifetime). and in those with certain genetic factors.

46118 Malleable 1” x 8” 2 .46174 Deaver 2” x 5” 1 . pelvic pain can also be caused by other sources.46160 Harrington 2” x 6” .46118A Malleable 1” x 10” 2 .Chronic pelvic pain — Chronic pelvic pain can be due to the effects of endometriosis or scarring (adhesions) in the pelvis and between pelvic organs. (See "Patient information: Chronic pelvic pain in women".46118P Malleable 1” x 4” 2 . Instrumentation • • • • • • • 2 . including the gastrointestinal and urinary systems. However.46180 Heany 1” x 4” 1 .) It is important for a woman with pelvic pain to ask about the probability that her pain will improve after hysterectomy.46122 Malleable 2” x 8” 1 .

46660 Double Angled 1” x 3” 1 .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 rapid.46135 Fence 4” x 5” 1 . and . There is a broad range of behaviors associated with body image disturbance. the alteration results in a body image disturbance.g.. • • Note frequency of self-critical remarks Acknowledge normalcy of emotional response to actual or perceived change in body structure or function. Stages of grief over loss of a body part or function is normal. an ileostomy for an individual with precancerous colon polyps).46150 Richardson 2” x 4” 2 . • Assess impact of body image disturbance in relation to patient’s developmental stage. 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.41933 Hysterectomy Tray 1 .44118C 18” Straight Arm with Cam Joint 2 Nursing Management • Assess perception of change in structure or function of body part (also proposed change).46143 Fenestrated 1” x 3” 1 . • Note patient’s behavior regarding actual or perceived changed body part or function. • Assess perceived impact of change on activities of daily living (ADLs). personal relationships.• • • • • • • • 2 . Even when an alteration improves the overall health of the individual (e. and at a time when developing social and intimate relationships is particularly important. ranging from totally ignoring the altered structure or function to preoccupation with it.46663 Double Angled 1/2” x 2” 2 . and occupational activities. social behavior.

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

somnolence. nervousness MODE OF ACTION: thought to inhibit calcium ion influx across cardiac and smooth muscle cells. HYPOPROTHROMBONEMIA caused by effect of oral anticoagulants CONTRAINDICATION: contraindicated to patients hypertensive to drugs . 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. headache. crushing. weakness. Also may dilate coronary arteries and arterioles. syncope.headedness. decreasing contractility and oxygen demand. light. or chewing them -advise patient to avoid taking drug with grape fruit juice VITAMIN K CLASSIFICATION: vitamins and minerals INDICATION: RDA. classic chronic stable angina pectoris CONTRAINDICATION: contraindicated in patients hypertensive to drugs ADVERSE EFFECTS: dizziness.DRUG STUDY NIFEDIPINE CLASSIFICATION: Antianginals INDICATION: Vasopastic angina.

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. eggs. spinach. flushing. centrally acting analgesics. opiods or psychotropic drugs .inflammatory. dizziness. 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 TRAMADOL HCl CLASSIFICATION: opiod analghesic INDICATION: moderate to moderately severe pain CONTRAINDICATION: contraindicated in patients with acute intoxication from alcohol.ADVERSE EFFECTS: dizziness. headache MODE OF ACTION: may inhibit prostaglandin synthesis to produce anti. liver. transient hypotension after IV administration.tell patient that foods that provide vitamin K include cabbage. sedation. fish. PATIENT TEACHING: -explain purpose of drugs . cauliflower. rapid and weak pulse MODE OF ACTION: An antihemorraghic factor that promotes hepatic formation of active coagulation factors. ADVERSE EFFECTS: drowsiness. analgesic. hypnotics. NSAID or probenecid.tell the patient to avoid hazardous activities if dizziness occurs . meats.

scribd. sleep disorder. coordination disturbance.do www.answer.medscape. anxiety.com/health-care-social-assistance/nursing-residential/ http://www. Website: http://findarticles.ADVERSE EFFECTS: dizziness. Smeltzer et all.com/px/getlogin.com. confusion. 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.allbusiness. vertigo. Volume 1. euphoria.com .google. headache. somnolence.Surgical Nursing. asthma. CNS stimulation.com www. seizures MODE OF ACTION: A centrally acting synthetic analgesic compound not chemically related to opiods. nervousness.com/p/articles/mi http://www.ph/ https://profreg.

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