Hysterectomy - HYSTERECTOMY Hysterectomy is the surgical...

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HYSTERECTOMY Hysterectomy is the surgical removal of the uterus, most commonly performed for malignancies and certain nonmalignant conditions (e.g., endometriosis/tumors), to control life-threatening bleeding/hemorrhage, and in the event of intractable pelvic infection or irreparable rupture of the uterus. A less radical procedure (myomectomy) is sometimes performed for removing fibroids while sparing the uterus. Abdominal hysterectomy types include the following: Subtotal (partial): Body of the uterus is removed; cervical stump remains. Total: Removal of the uterus and cervix. Total with bilateral salpingo-oophorectomy: Removal of uterus, cervix, fallopian tubes, and ovaries is the treatment of choice for invasive cancer (11% of hysterectomies), fibroid tumors that are rapidly growing or produce severe abnormal bleeding (about one-third of all hysterectomies), and endometriosis invading other pelvic organs. Vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH) may be done in certain conditions, such as uterine prolapse, cystocele/rectocele, carcinoma in situ, and high-risk obesity. These procedures offer the advantages of less pain, no visible (or much smaller) scars, and a shorter hospital stay and about half the recovery time, but are contraindicated if the diagnosis is obscure. A very complex and aggressive surgical procedure may be required to treat invasive cervical cancer. Total pelvis exenteration (TPE) involves radical hysterectomy with dissection of pelvic lymph nodes and bilateral salpingo- oophorectomy, total cystectomy, and abdominoperineal resection of the rectum. A colostomy and/or a urinary conduit are created, and vaginal reconstruction may or may not be performed. These patients require intensive care during the initial postoperative period. (Refer to additional plans of care regarding fecal or urinary diversion as appropriate.) CARE SETTING Inpatient acute surgical unit or short-stay unit, depending on type of procedure. RELATED CONCERNS Cancer Psychosocial aspects of care Surgical intervention (for general considerations and interventions) Thrombophlebitis: deep vein thrombosis Patient Assessment Database Data depend on the underlying disease process/need for surgical intervention (e.g., cancer, prolapse, dysfunctional uterine bleeding, severe endometriosis, or pelvic infections unresponsive to medical management) and associated complications (e.g., anemia). TEACHING/LEARNING Discharge plan DRG projected mean length of inpatient stay: 2.9–5.9 days considerations: May need temporary help with transportation; homemaker/maintenance tasks Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Pelvic examination: May reveal uterine/other pelvic organ irregularities, such as masses, tender nodules, visual changes of cervix, requiring further diagnostic evaluation.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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Hysterectomy - HYSTERECTOMY Hysterectomy is the surgical...

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