TOTAL ABDOMINAL HYSTERECTOMY MIND MAPPING

Group 3B - Jardin, Lacxina, Langub, Lantin, Lariosa

PATIENT
KENNA SINGH

PREDISPOSING FACTORS PRECIPITATING FACTORS

➢ Age - 63 years old ➢ Occupation – Retired
➢ Gender - Female Elementary Teacher
➢ Race - Asian ➢ Lack of knowledge in terms of
➢ Family History - Breast her present illness
cancer (Mother’s side), ➢ Stressed in terms of her
Diabetes and asthma (Father’s condition
side)

SUBJECTIVE CUES:
➢ Chief complaints of enlargement of abdomen and vaginal bleeding
➢ Client verbalized that months prior to her admission she would feel an on
and off pelvic discomfort and back pain.
➢ Client claims she would easily feel fatigued and had loss of appetite. She
also experienced weight loss of 4kgs.
OBJECTIVE CUES:
➢ Noted enlargement of the abdomen
➢ Vaginal bleeding observed
➢ Laboratory Results
◆ Low Hematocrit level (0.35 L/L)

◆ Low Hemoglobin level (102 g/L)

◆ Low RBC count (3.3x10^12/L)

◆ Elevated WBC count (12.3x10^12/L)

◆ Low INR (1.9)

◆ Low potassium (2.7 mmol/L)

➢ Patient tested negative for Covid-19 through RT-PCR swab

➢ Diagnostic imaging through CT scan shows right ovarian neoplasm

PATHOPHYSIOLOGY OF DISEASE
Ovarian cancer usually spreads through local shedding into the peritoneal
cavity followed by implantation on the peritoneum, as well as by local invasion
of the bowel and bladder. The patterns of spread differ for the various histologic
classification of the tumors. Thus, epithelial tumors spread mainly by direct
exfoliation of cells throughout the peritoneal cavity, as well as by lymphatic and
hematogenous routes. Germ cell tumors tend to spread primarily by way of
retroperitoneal lymphatics. Intestinal obstruction can result from involvement of
small intestine in the direct spread of tumors. Hematogenous spread is rare but,
when present, usually signifies advanced disease. Prognosis is largely dependent
on the stage of tumor, surgical effectiveness, and response to chemotherapy. In
patients who ultimately succumb to this disease, the malignancy is usually
confined to the abdominal cavity, resulting in malnutrition, cachexia, and
ultimately death

TYPE OF SURGERY
Total abdominal hysterectomy
 BRIEF DESCRIPTION OF SURGERY

A total abdominal hysterectomy is a surgical procedure

that removes the uterus and the uterus through an
incision in the lower abdomen.

PREOPERATIVE CHECKLIST

SURGEON ASSIST ROLE ANESTHESIOLOG SCRUB NURSE CIRCULATING ORDERLY

ROLE IST ROLE ROLE NURSE ROLE ROLE
➢ Work closely
➢ Head of the with the ➢ Assesses the ➢ Selects ➢ Completes a ➢ Ensures
surgical team surgeon in the patient before instruments, preoperative wards are
operating surgery equipment, assessment neat and tidy
➢ Examine supplies
room during
patients and surgical ➢ Selects and
appropriate for ➢ Establish and ➢ Assist
the surgery. implement the
make procedure administers patients by
diagnoses to anesthesia intraoperative plan lifting,
➢ Prepares the
determine the ➢ Also of care, evaluate turning, and
sterile field and
need for anticipates ➢ Intubates the sets-up sterile the care, and transporting
surgery. the surgeon’s patient if tables. provide for the them in
needs during necessary continuity of care wheelchairs
➢ Review the operation ➢ Assist with postoperatively. or on
patient ➢ Manages any applying surgical movable
medical ➢ Assist the technical drapes. ➢ Assists the beds.
history and surgeon with problems related anesthesia care
plan the best ➢ Communicates provider with ➢ Provides
tasks such as to the
with surgeons endotracheal
procedure for selecting administration of direct care
throughout the intubation
treatment. equipment, anesthetic agent procedure to
and support
holding open ensure a
➢ Performs incisions, ➢ Supervises the successful ➢ Performing on
preventive stopping patient condition operation going patient
and elective bleeding, throughout the assessment.
surgeries on closing the surgical ➢ Maintain sterility
patients. incision, procedure of the sterile ➢ Monitors sterile
among other field. technique of all
➢ Follow technical ➢ Monitors BP, members of the
established ➢ Anticipates the team and a safe OR
tasks. pulse,
surgeons needs environment
surgical respirations,
techniques ECG, blood O2 ➢ Surgical counts
during saturation level ➢ Assist the surgeon
instruments,
surgery. sponges & and scrub nurse by
sharps. operating non
➢ Prescribe sterile equipment,
preoperative ➢ Clean & prepare providing
and instruments for additional
postoperative sterilization. instrument and
treatment and supplies.
procedures.
➢ Maintain accurate
and complete
documentation.

➢ Tracking sponge,
needle, and
instrument counts.

➢ Preparing and
disposing of
specimens.
 INSTRUMENTS TO BE PREPARED

➢ 4x4/4x8 sponges (19)

➢ Visceral Sponge/Square packs (1)
➢ Allis forceps (4)
➢ Kelly straight (2)
➢ Kelly curve (7)
➢ Tissue forceps with or without teeth (4)
➢ Metzembaum (1)
➢ Mayo Scissors (1)
➢ Scapel Blade (2)
➢ Scalpel Blade Holder (2)
➢ Needle Holder (2)
➢ Mixter (1)
➢ Ovum/Foerster Forceps (2)
➢ Cautery Tip (1)
➢ Kochers/Ochners (8)
➢ Atraumatic sutures (6)
➢ Army Navy Retractor (1)
➢ Richardsons Retractor (1)
➢ Center Blade (1)
➢ Kidney Basin (1)
➢ Disposable Suction with Tubing (1)
➢ Heaney forceps (4)
➢ Balfour Retractor (1)

EQUIPMENTS TO BE PREPARED
➢ Hospital Stretcher
➢ Defibrillators
9➢ Anesthesia machines
➢ Cautery Machine
➢ Patient Monitor
➢ Surgical Table
➢ Surgical Lights
➢ Mayo table
➢ Back Table
➢ Suction machine

SURGICAL SIGN IN

Before Induction of Anesthesia

/ Patient identity confirmed / IV access and antimicrobial prophylaxis

/ Procedure and consent / Operating room equipment

/ Laterality and markings x Allergies and airway risk

/ Anesthesia intervention / Blood availability

SURGICAL TIME OUT

Before Skin Incision

/ Patient identity confirmation

/ Procedure, laterality, imaging film displayed (when applicable)

/ Team members induction (surgeon, anesthesiologist, nurses, etc.)

x Any anticipated critical events (co-morbid precautions)

 STEPS OF SURGERY

1. Laparotomy, development of the visual field

↓
2. Ligate and cut the round ligament
↓
3. Clamp, cut, and ligate the ovarian ligament and
Fallopian tube (or the infundibulopelvic ligament)
↓
4. Mobilization of the bladder
↓
5. Clamp, cut, and ligate the uterine artery and vein
↓
6. Push down the cutting stump with gauze
↓
7. Clamp, cut, and ligate the sacrouterine ligament and
the posterior half of the cardinal ligament
↓
8. Clamp, cut, and ligate the vesicouterine ligament and
the anterior half of the cardinal ligament
↓
9. Clamp the boundary between the portio vaginalis and
the vagina
↓
10. Incise the vagina and remove the uterus
↓
11. Disinfect the vagina and close the vaginal cuff
↓
12. Hemostasis
↓
13. Close the retroperitoneum
↓
14. Close the abdominal wall

SURGICAL SIGN OUT

Towards Final Closure of Skin

/ Complete name of procedure x Intraoperative antibiotics given (when applicable)

/ Instruments, sponge, needle, etc., count is x Number of packing (when applicable)

correct and complete

/ How specimen should be labeled x Concerns to be addressed

END OF PROCEDURE