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Introduction Total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAHBSO) is a surgical procedure involving the removal of the uterus, both ovaries,

and the fallopian tubes through an incision in the abdomen. The lymph nodes in the pelvis may also be removed. This is a treatment for endometrial cancer and uterine sarcoma. ( Accessed from http://www.ugr.es/~oncoterm/csdata/TOTAL-ABDOMINAL-HYSTERECTOMY-AND-BILATERAL-SALPINGOOOPHORECTOMY.html on January 2,2011) Fibroids (also referred to as myoma, leiomyoma, leiomyomata, and fibromyoma ) are benign tumors, which grow on the outside, inside or within the smooth muscle in the wall of the uterus. They are not cancers. In very rare cases, a rapidly growing fibroid may become cancerous. This happens to one in a thousand pre-menopausal women, although the risk rises to one in a hundred for women diagnosed with rapidly growing fibroids after menopause.

Fibroids are very common. Approximately 30% of women have fibroids large enough to cause symptoms. Some studies suggest that many more women have fibroids but most fibroids do not cause symptoms. Fibroids that remain small may never require treatment. Since the female hormone estrogen appears to encourage their growth, fibroids usually shrink at menopause and rarely cause problems after this time. We do not understand why fibroids occur. Women whose close female relatives have fibroids are more likely to develop symptoms, suggesting that the cause is partly genetic. Fibroids are also much more common among African-Canadian women as many as 50 percent of African American women over the age of 35 have fibroids.( http://www.womenshealthmatters.ca/centres/pelvic_health/fibroids/index.html. access on 01/31/11)
Recently there is an increasing trend for minimal access surgery (MAS) for treatment of uterine myomas. Laparoscopic myomectomy has provided minimal inva sive alternative to laparotomy for subserosa and intramural myomas. It is associated with faster postoperative recovery and potentially less postoperative adhesions. Main concerns are however subsequent fertility, reproductive outcome and long-term recurrence. Other alternatives are laparoscopic assisted myomectomy, laparoscopic ultraminilaparotomic embolised myomectomy, laparoscopically assisted transvaginal myomectomy, myolysis and cryosurgery. Hysteroscopic access is required for sub mucous myomas. The idea of this review is to analyse recent techniques which are used to treat uterine myomas. Recent evidence favours safety and reliability of laparoscopic myomectomy. Prospective randomised controlled trials comparing laparoscopic myomectomy with laparotomy myomectomy will clarify the status further (http://www.ayubmed.edu.pk/JAMC/PAST/16-1/NazliRev.htm access on 01/31/11)

Through this case study, the researchers were given an opportunity to know more about this condition so that they could apply the knowledge they learned in the nursing practice. This is why the researchers chose this case, to widen their understanding about the Operation and the reason for undergoing this surgery.

CBC Nursing Responsibilities: Prior: y Explain the procedure to the patient y Inform the patient that there are no fluid/food restrictions but shall avoid exercise y Inform the patient that the test requires blood sample y Inform the patient who will perform the test and when it will be performed y Inform the patient that there will be discomfort from needle puncture and pressure from the tourniquet y If patient is being treated from infection, advise that this test will be repeated several times to maintain progress During: y Ensure that the blood is taken from the arm or hand that has an intravenous line. Hemodilution with intravenous fluids causes a false decrease in the values of some tests

After: y Apply pressure on the puncture site y Send specimen immediately to the laboratory y Proper documentation Urinalysis NURSING RESPONSIBILITIES FOR URINALYSIS PRIOR: y Check doctors order y Explain to the SO the purpose and the procedure of urinalysis y Provide clean specimen cup y Explain to the SO obtain the midstream specimen when getting the urine of the patient DURING: y Collect the urine in a clean specimen cup y Label the specimen cup properly y Obtain results and secure it to the patient chart y Refer the result to the physician AFTER: y The specimen should be delivered to the laboratory within 1 hour y Obtain results and secure it to the chart y Refer the results to the physician X-ray NURSING RESPONSIBILITIES PRIOR y Explain to the patient that the test is used in evaluating the lungs and the heart. y Inform the patient whether they will be transported to the radiology department or have the x ray done at the bedside. y Inform the patient that the procedure takes 5-10 minutes. y Inform that no pain is associated with the test and here are no food or fluid restrictions. DURING y Instruct the patient to remove clothing and metallic objects from the waist up. y Give the patient a gown or robe to wear. Cover the ovaries with a lead shield or apron to prevent exposure. y Place patient in standing, sitting or recumbent position in front of the x-ray film holder. y Instruct pt. to inhale deeply, to hold her breath while the x-ray is taken and then exhale after the film is taken. AFTER y Provide extra blankets for patient chilled from exposure during chest x-ray. y Inform the pt. of the possible need for additional chest x-rays to evaluate progression of the disease process or to determine the need for a change in therapy. y Evaluate test results in relation with pt.s symptoms and other tests performed. UTZ Nursing Responsibilities and Considerations Endo vaginal Ultrasound Prior: y Explain the purpose of the procedure to the patient. y Assess if the pt had an X-ray with contrast material such as barium within the past 2 days. Barium that remains in the intestines can interfere with the ultrasound test. y Assess if the pt is to latex so that a latex -free cover can be put on the transducer before it is used y Ask the client to completely empty the bladder y Prepare an enema before the test. y Ask the patient to remove all her clothes below the waist and put on a gown before the test. y Provide privacy During: y Assist the patient in the correct position for accurate results. y Ask the patient to take a breath and hold it for several seconds during the test. y Instruct the patient to lie very still while the ultra sound is being done.

After: y

Explain the results of the ultrasound

Document properly.

NURSING RESPONSIBILITIES FOR THE IVFS PRIOR : y Check the doctors order for the type of solution to be infused y Prepare the equipments needed and check also the expiration date y Obtain the intravenous solution and check for the sediments and any crack or leak from the containers y Observe fluid or discoloration, foreign particles, cloudiness if present do not use y Check IV tubing for discoloration or defect, if noted, secure new equipments DURING: y Explain the importance and purpose of IVF y Prepare the patient and explain the procedure y Maintain aseptic technique throughout the procedure and follow the proper procedures in infusing IV solution y Watch out for fluid overload AFTER: y Check for the swelling around the site for IV infiltration y Regulate IVF as ordered y Observe for the reaction of the patient to the solution given Nursing Responsibilities (bisacodyl) PRIOR: y Assess for abdominal distension, presence of bowel sounds, and normal bowel function. y Assess color, consistency and amount of stool produced. y Monitor for hydration status, and serum electrolytes. y Assess mental status before and throughout course of therapy. y Check for drug interactions DURING: y Darkening of solution does not alter potency. y Mix with fruit juice, water, milk, or carbonated citrus beverage to improve flavour. y Administer with a full glass of water or juice. y May be administered on an empty stomach for more rapid results. AFTER: y Assess for abdominal cramping, belching and flatulence. y Encourage patient to use other forms of bowel regulation such as increasing bulk in the diet and increasing fluid intake. y Advise patient to notify health care provider if diarrhea, flatulence, or abdominal cramping occurs. Nursing Responsibilities ( Cefuroxime) Prior

y y

y
During

Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance. Inspect IM and IV injection sites frequently for signs of phlebitis.

y y

Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms, Appendix F) rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy. Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their appearance promptly. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

After

y
y y

Report loose stools or diarrhea promptly. Report any signs or symptoms of hypersensitivity Document properly

Nursing Responsibilities (phosphosoda) Prior y Check the doctors order. y Provide privacy. To prevent feeling of embarrassment. y Promote relaxation. To relax anal sphincter and facilitate insertion of rectal tube. y Position the client (lateral) During y Lubricate 5 cm (2 in) of the rectal tube. y Allow solution to flow through the connecting tubing and rectal tube to expel air before insertion of rectal tube. This preventsintroduction of air into the colon. y Inset 7-10 cm (3-4 in) of rectal tube gently in rotating motion. To prevent irritation of anal and rectal tissues. y Introduce solution slowly. To prevent sudden stimulation of peristalsis, and the client can better tolerate introduction of solution. y Change the position to distribute solution well in the colon (high enema); if low enema, remain in left lateral position. (If the order is cleansing enema) After y y y y

After introduction of the solution, press buttocks together to inhibit the urge to defecate. Ask the client who is using the toilet not to flush it. The nurse must observe the return flow. Do perianal care. Make relevant documentation.

diet Nursing Responsibilities: PRIOR: y Check the doctors order first. y Obtain necessary information about the diet to be given.
DURING: y Establish rapport with the patient. y Explain the purpose of the diet to be given. y Give some tips on what specific foods to be taken.

AFTER: y

Document to the chart that you have explained the diet to the patient

Exercise Nursing Responsibilities: PRIOR: y Check the doctors order first. y Obtain necessary information about the diet to be given.
DURING: y Establish rapport with the patient. y Explain the purpose of the type of exercise to be given. y Give some tips on how to properly manage the type of exercise y Advice the significant other to monitor the patient to see if they are any unusual behaviors that the patient may manifest. AFTER: y

Document to the chart that you have explained the diet to the patient.