2 DefinitionHysterectomy is the surgical removal of the uterus to treat cancer, dysfunctional uterine bleeding, endometriosis, nonmalignant growths, persistent pain, pelvic relaxation and prolapse, and previous injury to the uterus.women often seek second opinions, and the number of other therapeutic options (ie, laser therapy, endometrial ablation, and medications to shrink fibroid tumors) has increased
3 Hysterectomy can be performed using a variety of surgical approaches Hysterectomy can be performed using a variety of surgical approaches. A total hysterectomy involves removal of the uterus and the cervix.Hysterectomy can be supracervical or subtotal, in which the uterus is removed but the cervix is spared. Malignant conditions usually require a total abdominal hysterectomy and bilateral salpingo- oophorectomy (removal of fallopian tubes and ovaries).
4 In radical hysterectomy, the uterus and surrounding tissue are removed, including the upper third of the vagina and pelvic lymph nodes.Hysterectomy can be performed through the vagina, through an abdominal incision, or laparoscopically (in which the uterus is removed in sections through small incisions using a laparoscope).
5 A laparoscopically assisted approach can also be used for vaginal hysterectomy, with excellent results and rapid recovery. This procedure is performed as a short- stay procedure or ambulatory surgery in carefully selected patients. It also can be used effectively in patients who are obese
6 Preoperative Management The physical preparation of a patient undergoing a hysterectomy is similar to that of a patient undergoing a laparotomy.The lower half of the abdomen and the pubic and perineal regions may be shaved, and these areas are cleaned with soap and water (some surgeons do not require that patients be shaved).To prevent contamination and injury to the bladder or intestinal tract, the intestinal tract and the bladder need to be empty before the patient is taken to the operating room.An enema and antiseptic douche may be prescribed the evening before surgery, and the patient may be instructed to administer these treatments at home. Preoperative medications may be administered before surgery to help the patient relax.
7 Postoperative Management The principles of general postoperative care for abdominal surgery apply, with particular attention given to peripheral circulation to prevent thrombophlebitis and DVT (noting varicosities, promoting circulation with leg exercises, and using elastic compression stockings).Major risks are infection and hemorrhagevoiding problems may occur, particularly after a vaginal hysterectomy because the surgical site is close to the bladderEdema or nerve trauma may cause temporary loss of bladder tone (bladder atony), and an indwelling catheter may be inserted. During surgery, the handling of the bowel may cause paralytic ileus and interfere with bowel functioning
8 Nursing DiagnosesAnxiety related to the diagnosis of cancer, fear of pain, possible perception of loss of femininity or childbearing potentialDisturbed body image related to altered fertility and fears about sexuality and relationships with partner and familyAcute pain related to surgery and other adjuvant therapyDeficient knowledge of the perioperative aspects of hysterectomy and postoperative self-care
9 Radiation TherapyRadiation may be used in the treatment of cervical, uterine and ovarian cancers either alone or in combination with surgery and chemotherapy. Several approaches are used to deliver radiation to the female reproductive system
10 Side Effects of Radiation Therapy Radiation side effects are cumulative and tend to appear when the total dose exceeds the body's natural capacity to repair the damage caused by radiation.Radiation enteritis, resulting in diarrhea and abdominal cramping, and radiation cystitis, manifested by urinary frequency, urgency, and dysuria, may occur.Fatigue is one of the most bothersome side effects and is often not relieved by rest