Hysterectomy
Definition
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Hysterectomy 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
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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 salpingooophorectomy (removal of fallopian tubes
and ovaries).
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).
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A laparoscopically assisted approach can
also be used for vaginal hysterectomy,
with excellent results and rapid recovery.
This procedure is performed as a shortstay procedure or ambulatory surgery in
carefully selected patients. It also can be
used effectively in patients who are obese
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.
Postoperative Management
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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 hemorrhage
voiding problems may occur, particularly after a vaginal
hysterectomy because the surgical site is close to the
bladder
Edema 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
Nursing Diagnoses
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Anxiety related to the diagnosis of cancer,
fear of pain, possible perception of loss of
femininity or childbearing potential
Disturbed body image related to altered
fertility and fears about sexuality and
relationships with partner and family
Acute pain related to surgery and other
adjuvant therapy
Deficient knowledge of the perioperative
aspects of hysterectomy and postoperative
self-care
Radiation Therapy
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Radiation 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
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
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