Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Understanding
Hysterectomy
A Research-Based Study Overview assigned by
the Medical Surgical Nurisng lecturer

By M.A. Vihari Menara IUFN223MAV

11th of September, 2024

Introduction This is often necessary for women with

persistent medical conditions that
Hysterectomy, one of the most common
affect their reproductive health.
surgical procedures for women, involves
the removal of the uterus, and in some While the idea of losing the uterus may
cases, additional reproductive organs. seem overwhelming, it’s vital to
remember that the procedure aims to
While the procedure can seem
enhance quality of life by alleviating
daunting, it’s essential to approach it
pain, excessive bleeding, or potentially
with accurate knowledge, and a touch of
dangerous medical conditions .
optimism.

This article delves into the definitions,

types, indications, surgical processes,
and nursing interventions for
hysterectomy, all while keeping things
light and informative.

What is a
Hysterectomy?

A hysterectomy is a surgical operation

that removes the uterus (womb),
resulting in the cessation of
menstruation and the ability to become
pregnant.

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Types of Radical Hysterectomy

Hysterectomy This is the most extensive, often for
(NHS, 2022) cancer treatment, removing the uterus,
cervix, parts of the vagina, and nearby
Hysterectomies come in different forms, lymph nodes.
each designed to address specific
medical issues. Let’s look at the types

Total Hysterectomy Choosing the appropriate hysterectomy

type depends on the underlying
The entire uterus and cervix are condition.
removed. This is the most common
type.

Partial (Subtotal) Radical procedures are often reserved

for cancerous growths, while simpler
Hysterectomy
procedures, like subtotal hysterectomy,
Only the upper portion of the uterus is
might be chosen for non-cancerous
removed, leaving the cervix intact.
issues such as fibroids .

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Cancer

Hysterectomy is a treatment option for

uterine, cervical, and ovarian cancers.

Chronic Pelvic Pain

When other treatments fail,

hysterectomy may offer relief.

Heavy Menstrual Bleeding

Uncontrolled heavy bleeding can affect

quality of life, and surgery may be the
best solution .

Hysterectomies are generally

Indications for considered after other treatments (like
a Hysterectomy medication or minor surgeries) fail to
Several medical conditions might resolve the issue.
necessitate a hysterectomy, including

Uterine Fibroids
Hysterectomy
These non-cancerous growths can Procedures
cause severe pain and heavy menstrual
bleeding.
Several surgical techniques are
available, each tailored to the patient's
Endometriosis medical history and the surgeon’s
A condition where the lining of the recommendations
uterus grows outside of it, causing
inflammation and discomfort.

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Abdominal Hysterectomy Medical Assessment

A cut is made in the abdomen to access A thorough evaluation, including blood

and remove the uterus. This method is tests and imaging, ensures that the
most effective for larger fibroids or patient is fit for surgery.
endometriosis.

Medication Adjustments
Vaginal Hysterectomy
Some medications may need to be
The uterus is removed through the discontinued (e.g., blood thinners).
vagina, and it leaves no visible scars.
Fasting

Patients typically need to fast for 8-12

hours before surgery.
Laparoscopic Hysterectomy

Emotional Support

Small incisions are made in the Preparing mentally and emotionally for
abdomen, and a camera guides the the surgery is just as important as
surgeon to remove the uterus. This physical preparation. Consider talking
method offers quicker recovery times . to a support group or counselor

The choice of surgical method depends

on various factors, including the size
and position of the uterus, the patient's
health, and the underlying condition
requiring surgery .

Pre-Operative
Preparations

Before undergoing a hysterectomy, Post-Operative

patients need to prepare both mentally Care
and physically
Recovery after hysterectomy involves
both rest and gradual re-engagement
with daily activities.

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Pain Management Infection

Pain and discomfort are common, Signs include fever, redness, and
especially in the first few days. swelling at the incision site.
Painkillers prescribed by the doctor help
The most common infections identified
manage this effectively.
after a hysterectomy include vaginal cuff
cellulitis, pelvic abscess or infected
hematoma, wound infection, and
Movement Encouragement
urinary tract infection.
Light walking post-surgery is
The risk of infection increases with
encouraged to prevent blood clots, but
operative times that exceed 3 hours,
strenuous activities are a no-go for 6-8
lack of preoperative antibiotics, and
weeks.
patient factors such as comorbid
medical conditions, compromised
immune status, obesity, and poor
Incision Care
nutrition.
If you’ve had an abdominal
hysterectomy, keeping the incision site
clean and dry is key to preventing Blood Clots
infections.
Moving around post-surgery helps
reduce the risk of blood clots.
Emotional Well-Being

Hormonal changes post-hysterectomy Damage to Surrounding Organs

can affect mood and emotions. Support
Rarely, the bladder, bowel, or ureters
from friends, family, or a counselor can
might be affected during surgery .
make a world of difference during this
time It’s essential to follow post-operative
care instructions and report any
concerning symptoms to your
healthcare provider immediately.

Potential Injury to the genitourinary tract during

Complications pelvic surgery, while rare, can lead to a
high risk of patient morbidity.
(Carugno & Fatehi, 2023)

While hysterectomy is a common

procedure, complications can arise Studies have indicated radical
hysterectomy as the most common type

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II
indirectly through interruption of
vascular supply.
of pelvic surgery associated with
urologic complications. Nerve Injury

Damage of the femoral nerve is the most

common cause of neuropathy
The bladder is injured more frequently
described after pelvic surgery.
than the ureters.

Other nerve injuries include the

A review of urinary tract injuries during
iliohypogastric and ilioinguinal nerves at
benign gynecologic surgery found lower
the level of the anterior abdominal wall
rates of bladder injury after abdominal
during laparotomy or excessive
hysterectomy than after laparoscopic
stretching of the fascia, the obturator
and vaginal approaches, consistent with
nerve from an inadvertent crush injury
other studies within the literature.
by clamps or excessive stretching, and
rarely, the peroneal nerve due to
positioning of the legs in the stirrups.
Injury to the bladder occurs most
commonly during dissection within the
vesicovaginal plane, whereas injury to
Nursing
the ureter is most common to occur
during dissection along the pelvic Interventions
sidewall, particularly when Nurses are the unsung heroes in the
encountering the infundibulopelvic hysterectomy recovery process. Here’s
ligaments where the ovarian vessels are how they help
ligated, but also during ligation of the
uterine vessels and at the bladder base.

While injuries to the bladder and ureter

may be noted during surgery, injury to
the serosal layer of the bladder may go
unnoticed during surgery if the defect in
the bladder wall is not full-thickness,
and delayed presentation of
vesicovaginal fistula can occur.

GI tract injuries during an abdominal

hysterectomy can occur via thermal
injury, direct mechanical damage, and

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Monitoring Vital Signs

Nurses check for signs of

complications, like infections or
abnormal bleeding.

Emotional Support

Nurses provide comfort and emotional

reassurance, answering any questions
the patient might have post-surgery.

Pain Management
Encouraging Mobility
Nurses administer medications and
Nurses encourage light movement to
ensure comfort by monitoring and
prevent complications like blood clots.
adjusting pain relief methods as
necessary.
Assistive Devices

Early Ambulation Educate the patient on the use of

assistive devices such as pillows for
Initiate early ambulation within the support during coughing or sneezing
postoperative period to prevent and abdominal binders for added
complications such as deep vein comfort and support.
thrombosis (DVT).

Respiratory Exercises
Incision Care
Instruct the patient in deep breathing
Monitor the surgical incision for signs of
exercises to prevent respiratory
infection, hematoma, or dehiscence.
complications and enhance lung
Teach the patient proper wound care expansion. Encourage coughing and
techniques, and ensure the incision site splinting to promote effective airway
remains clean and dry. clearance.

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Fluid and Nutrition Monitoring for Complications

Management

Monitor fluid intake and output,

Monitor for potential complications
encouraging adequate hydration.
such as infection, bleeding, or
Provide a balanced diet rich in fiber to thromboembolism.
prevent constipation, a common
postoperative concern.
Report any abnormal findings promptly
to the healthcare provider.
Urinary Catheter Management

If a urinary catheter is in place, monitor

Follow-up Care
urine output, assess for signs of urinary
tract infection, and ensure proper Schedule and discuss follow-up
catheter care. appointments with the healthcare
provider to assess the healing process,
Remove the catheter as soon as
address any concerns, and ensure
possible based on medical guidelines.
continuity of care.

Education on Menopausal
Medication Education
Symptoms
Educate the patient on prescribed
Provide education on potential
medications, including the purpose,
menopausal symptoms if the ovaries
dosage, and potential side effects.
were removed during the hysterectomy.
Discuss the importance of adherence to
Discuss hormone replacement therapy the medication regimen.
options if applicable and address any
concerns.

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

Conclusion

A hysterectomy, while significant, is a procedure aimed at

enhancing quality of life. Whether it's alleviating pain, stopping
heavy bleeding, or treating more serious conditions like cancer,
this surgery allows women to regain control of their health. With
proper medical guidance, post-operative care, and nursing
support, recovery can be smooth, and patients can look forward
to a healthier, happier life ahead.

References
Carugno, J., & Fatehi, M. (2023, July 18). Abdominal
Hysterectomy. From National Library of Medicine:
https://www.ncbi.nlm.nih.gov/books/NBK564366/
NHS. (2022, October 11 ). Hysterectomy. From NHS:
https://www.nhs.uk/conditions/hysterectomy/

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Lecturer Dr Chathurika Wirasagodaarachchi NUS2207 Medical Surgical Nursing II

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