1. Revision Eman Abu alfawaris

2. Gynecological surgical care  Preoperative care -1 admission to hospital : Usually two days prior to major elective surgery. 2-Ceasing of the “pill”: you must assure from the pills ceased at least 6 weeks prior to admission, and if the patient still take it within that time, you must notify the doctors to avoid thrombosis. you must assure from the pills ceased at least 6 weeks prior to admission, and if the patient still take it within that time, you must notify the doctors to avoid thrombosis. 3- date of the last menstrual period always checked, to exclude any possibility of pregnancy always checked, to exclude any possibility of pregnancy 4- Consent forms: May require the signature of both patient and her husband 5 -specific investigation: - urine - urine - blood test - blood test -Chest x-ray -Chest x-ray - Vaginal examination - Vaginal examination

3.  Specific Preparations: 1- skin preparation: For abdominal operation abdomen and pubic areas are shoved. For vaginal and perineal procedures pubic to anus, and vulva shave is done, extended to the mid – thighs. For vaginal and perineal procedures pubic to anus, and vulva shave is done, extended to the mid – thighs. 2- blood preparation 3- enema: 1200ml tap-water is usually given on evening before surgery 4- vaginal preparation: cleaning douches are done to remove excessive or infective,discharge I certain cases cleaning douches are done to remove excessive or infective,discharge I certain cases 5- vaginal or cervix ulceration: it is treated by admission to the hospital several days prior to operation. Bed rest and twice daily packing if the vagina with gauze soaked in a suitable antiseptic solution.

4. The postoperative period  1-unless there is a specific contraindication, and the women are fully recovered consciousness, the nurse supported by 3-5 pillowsز  2- deep breathing and coughing  3- early ambulation is encouraged  4- sips of fluid are offered hourly and increase as tolerated  5- close observation of the patient  6- voiding, specially in the patient who not need for catheterization, it is difficult to observe the distended bladder if the lower abdominal dressing are present  7- administer pain relief medication

5. Specific gynecological care 1-Vaginal packs The pack is removed after 24 hrs or as instructed. It must gently removed, giving as analgesic before removal help to reduce patient pain, the nurse document the procedure ( removal) in the patient chart. Usually after the removal some of the vaginal blood loss occur and must carefully observed. 2- Bladder management: urinary tract infection and retention of urine are the commonest problems encountered after pelvic surgery. urinary tract infection and retention of urine are the commonest problems encountered after pelvic surgery. *health education to prevent that : *health education to prevent that : 1- fluid intake is encourage, it must be kept up to at least 3 l\day 1- fluid intake is encourage, it must be kept up to at least 3 l\day 2- accurate recorded of the intake and output 2- accurate recorded of the intake and output 3- urine frequency associated with burning may indicate for cystitis, that must good treated to prevent uterine and kidneys infection 3- urine frequency associated with burning may indicate for cystitis, that must good treated to prevent uterine and kidneys infection 4- most gynecological surgery followed by indwelling catheter specially after anterior vaginal wall repair to prevent pain and dysuria, and distention 4- most gynecological surgery followed by indwelling catheter specially after anterior vaginal wall repair to prevent pain and dysuria, and distention

6.  The catheter usually removed after 3-5 days. 3- prevent constipation: it is important to avoid it, because it associated starting can place under stress or suture line.medication assist bowel movement aren’t usually given at the third night after surgery.

7. The effect of any disorder on the patient’s view of her own sexuality -it is important to assess the mobility of the patient’s hips and check for any spinal problems so she can safely placed into lithotomy position for surgery @Postoperative care: @Postoperative care: 1- assess the degree of blood loss 1- assess the degree of blood loss 2- assure that patient pass urine before discharge 2- assure that patient pass urine before discharge note” when slight to moderate blood loss observed, the pad should changed on at least ever other occasion, but when blood loss is heavy must change the pad frequently and must notify the doctors. note” when slight to moderate blood loss observed, the pad should changed on at least ever other occasion, but when blood loss is heavy must change the pad frequently and must notify the doctors. @ discharge advice : @ discharge advice : 1- bleeding usually continue for about 10-14 days post- operatively. If it persists or become heavy and bad odors the patient must inform the doctors. 1- bleeding usually continue for about 10-14 days post- operatively. If it persists or become heavy and bad odors the patient must inform the doctors. 2- patient may resume work 4-7 days after the surgery 2- patient may resume work 4-7 days after the surgery 3-patient may resume her sexual activity after 14 days or when bleedind ceased. 4- follow up in the outpatient clinic 6 weeks after discharge

12. Wound care 1- the dressing should provide a warm, moist, acidic environment at the wound surface 2- the best cleansing solution is warmed normal saline 3- purpose of wound cleaning is to remove the debris and microorganisms that might delay healing or cause infection 4- the wound should not left exposed either, as it best kept at a temperature of 37c 5- repeated cleaning could do more harm than good, unnecessary cleaning and dressing traumatize new delicate tissue, cool the wound and remove the bactericidal exudates

13. Drains  1- removal is determined by the decreasing in amount of drainage  2- aseptic technique is employed the suture cut or safety pin removed and the drain carefully slid out, while the patient takes a series of deep breaths.  3- the sit is likely to seep for a while,so an absorbent dressing needs to be applied.

16. Blood transfusion  The patient will be observed for the signs and symptoms of adverse reaction or any complication of blood transfusion: 1- Allergic reaction 1- Allergic reaction 2- circulatory overload 3- disease transmission 4- a pyrogenic reaction 5- bacterial contamination 6- hemolytic reaction and incompatibility 7- hyperkalaemia 8- hypocalcaemia, air embolism

17. Post- operative nutritional care  Protein several reason exists for this increased protein demand : several reason exists for this increased protein demand : 1- building tissue, the process of wound healing 2- controlling shock, sufficient supply of plasma protein id necessary to protect the blood volume, and the shock symptoms result from a shrinking blood volume and the body effort to restore it. 3- controlling edema : when the serum protein level is low, edema will develop and generalize edema may effect heart and lung 4- healing bone: it is essential for bone formation 5- resisting infection: protein provide defense against infection *food sources of protein *food sources of protein - animal source: as milk, meat, egg - animal source: as milk, meat, egg plant sources as cereal, bread, legumes, vegetables, and fruits plant sources as cereal, bread, legumes, vegetables, and fruits

18. Water sufficient fluid intake is necessary to prevent dehydration. During post operative period, large water losses may occur from vomiting, hemorrhage, fever.