CHAPTER I

This chapter provides a comprehensive summary of the case study, including

its objectives and a brief discussion of Total Abdominal Hysterectomy with Bilateral

Salpingo-Oophorectomy (TAH-BSO). It outlines the patient’s demographic profile,

medical history, and diagnosis, which are essential for tracking health status.

Additionally, it presents findings from the physical assessment conducted by the

healthcare provider.

General Objective

As nursing students, our primary goal is to develop a deeper understanding of

Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO),

including its indications, surgical procedure, and post-operative management. This

study aims to enhance our knowledge, clinical skills, and compassionate approach to

delivering high-quality care to patients undergoing this procedure.

Specific Objective

• Conduct a comprehensive assessment of the patient’s health status, considering

both past and present medical conditions. Identify key health concerns and

formulate appropriate nursing diagnoses.

• Review the anatomy, physiology, and pathophysiology related to TAH-BSO,

linking them to the patient’s current health condition.

• Implement effective nursing interventions that promote recovery, manage pain,

and alleviate discomfort.

• Develop a Nursing Care Plan (NCP) tailored to the patient’s specific needs.

• Analyze the medications prescribed for the patient and ensure accurate

administration following the 12 Rights of Medication Administration.

 • Evaluate the effectiveness of nursing interventions and make necessary

adjustments to optimize patient outcomes.

Introduction

A hysterectomy is a surgical procedure involving the removal of the uterus. It

is one of the most frequently performed non-obstetric surgeries for women in the

United States. Statistics indicate that approximately 300 out of every 100,000 women

undergo this procedure.

This surgery is commonly performed to treat uterine cancer or severe

precancerous conditions, such as dysplasia, carcinoma in situ (CIN III), or

microinvasive cervical carcinoma. In cases of endometrial cancer (cancer of the

uterine lining), a hysterectomy is a primary treatment option to remove cancerous

tissue. However, cancer accounts for only 10% of hysterectomies, with the majority

being done for other reasons. One of the most frequent non-cancerous causes is uterine

fibroids (leiomyomas), which are benign tumors of the uterus with an unknown cause.

Other common indications include abnormal uterine bleeding, cervical dysplasia,

endometriosis, and uterine prolapse.

A Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy

(TAH-BSO) is a surgical procedure that involves the removal of the uterus, ovaries,

fallopian tubes, and cervix. It is most commonly performed for conditions such as

uterine or cervical cancer. Since the ovaries are removed, estrogen production ceases,

leading to an immediate onset of menopause. This procedure is also indicated for

conditions like endometriosis, ovarian cysts, pelvic inflammatory disease (PID), and

cancers affecting the ovaries, uterus, or cervix. Endometriosis occurs when

endometrial cells from the uterus grow outside of their normal location. The fallopian

tubes play a role in preventing the spread of endometriosis due to their sphincter-like

function. When
this function is lost, endometrial tissue may begin to bleed in response to hormonal

changes during the menstrual cycle.

Following a hysterectomy, many patients report a significant improvement in

their primary health concerns. Surveys indicate that most individuals who undergo the

procedure experience relief from their symptoms. Additionally, hysterectomy has been

shown to enhance overall quality of life. Women considering this procedure should

consult their healthcare provider to discuss how it may benefit their specific condition.

Patient’s Data

Demographic Profile

Name: Carol Villanueva Zamora

Age: 66 years old

Gender: Female

Birth Date: 08/18/1958

Birth Place: Isabela

Occupation: N/A

Civil Status: Married

Nationality: Filipino

Address: Purok 7, Bunol Guimba, Nueva Ecija

Religion: Roman Catholic

History of Present Illness

3 yr PTA, patient had progress mass at vulva. Consulting done revealing uterine prolapse.

Pertinent Past Medical History

Hypertension

Admitting Diagnosis
G7P5 (5025)
Prolapse uterus Grade IV
Chronic Hypertension

Date admitted: 03/17/2025

Discharge Diagnosis:
G7P5 (5025)
Prolapse uterus Grade III
S/P Vaginal Hysterectomy with anterior/posterior colporrhaphy
Chronic Hypertension

Date discharge: 03/21/2025

 CHAPTER II

Definition of Care

A total abdominal hysterectomy with bilateral salpingo-oophorectomy

(TAHBSO) is a surgical procedure that involves the complete removal of the uterus,

cervix, fallopian tubes, and ovaries. It is most commonly performed to treat conditions

such as uterine or cervical cancer. Since the ovaries produce estrogen, their removal

leads to an immediate onset of menopause. This operation is typically conducted in a

single procedure, ensuring the elimination of all these reproductive structures.

Following a hysterectomy, menstruation ceases permanently, and pregnancy is no

longer possible.

Anatomy and Physiology

Uterus - A pear-shaped, muscular organ in the female reproductive system

responsible for nurturing a fertilized egg and supporting fetal development during

pregnancy. It is located in the pelvis between the bladder and rectum and plays a

crucial role in menstruation and childbirth.

Fallopian Tube – A pair of thin, flexible tubes that extend from the upper part of the

uterus to the ovaries. These tubes serve as the pathway for eggs to travel from the

ovaries to the uterus. Fertilization of an egg by sperm typically occurs within the

fallopian tube.

Ovary – A small, oval-shaped gland in the female reproductive system that produces

eggs (ova) and releases hormones such as estrogen and progesterone. These hormones

regulate the menstrual cycle, support pregnancy, and influence secondary sexual

characteristics.

Cervix – The lower, cylindrical portion of the uterus that connects to the vagina. It

acts as a passageway for menstrual blood to exit the body, allows sperm to enter the

uterus during reproduction, and dilates during labor to facilitate childbirth.

Vagina – A muscular, elastic canal that extends from the cervix to the external

genitalia. It serves multiple functions, including receiving sperm during intercourse,

allowing for menstrual flow, and acting as the birth canal during delivery.

Broad Ligament – A wide, flat fold of peritoneum that supports and stabilizes the

uterus, fallopian tubes, and ovaries within the pelvic cavity. It also contains important

blood vessels, nerves, and lymphatics that supply the reproductive organs.
Pathophysiology
Modifiable Factors

Clinical Manifestations

• Mild swelling and redness in the lower abdomen with pain

• Heavy, prolonged menstrual bleeding with associated dysmenorrhea

• Possible cough and colds due to immune system involvement

• Primarily affects women in their 40’s and early 50’s

Medical Management

Once the diagnosis is confirmed, proper medication management is crucial to

ensure patient safety. Medications are prescribed to prevent complications and assist

in recovery following procedures such as bilateral salpingectomy, oophorectomy, and

total abdominal hysterectomy (TAHBSO). It is essential to follow the ten rights of

medication administration to avoid errors.

• Ketorolac- A pain reliever that reduces inflammation.

• Losartan - A drug that lowers blood pressure.

• Cefuroxime – An antibiotic to prevent infection

Nursing Management (PRE-OP, INTRA-OP, POST-OP)

•PRE OP

 Conduct a comprehensive assessment of the patient’s overall

health status.

 Educate the patient on the significance of the procedure and the

expected outcomes.
  Provide emotional support to alleviate anxiety for both the patient

and their family.

 Ensure informed consent is obtained before proceeding with the surgery.

 Regularly monitor and document the patient’s vital signs.

 Assess the patient’s anxiety level and provide reassurance as needed.

•INTRA OP

 Maintain strict sterile technique to prevent infection.

 Ensure all surgical instruments, equipment, and supplies are

properly prepared and accounted for.

 Continuously assess the patient’s stability, including monitoring

vital signs and oxygen levels.

 Assist the surgical team in maintaining patient safety and

comfort throughout the procedure.

 Prepare for immediate post-operative care and transfer to the

recovery area.

•POST OP

 Closely monitor the patient for potential complications such as

bleeding, shock, respiratory distress, and cardiac issues.

 Check and record vital signs every 30 minutes during the

immediate recovery period

 Provide post-operative health education, including signs of

complications and when to seek medical attention.

 Implement dietary progression from NPO (Nothing Per Orem) to

clear liquids, then soft diet as tolerated.

 Educate the patient on proper wound care, hygiene, and infection

prevention. Immediately notify the anesthesiologist or attending

physician if any unusual symptoms or complications arise.

 CHAPTER III

Diagnostic Procedure

A. Hematology

Name: ZAMORA, CAROL V.

Age/Sex: 66 y/o / F Ward:

OB-GYNE

Date: 05/17/25

Examination Result Normal Ranges Examination

WBC: 11.65 4-10x10g/L RBC: 3.96

Lymphocytes: 0.13 0.20-0.50 Hemoglobin: 127

Monocytes: 0.03 0.03-0.10 MCHC: 340

Segmenters: 0.84 0.40-0.70 MCH: 32.1 26.5-33.5

Platelet Count: 348 150-450x10g/10 MCV: 94.4 80-99fl
MTV: 7- RDW.CV: 10-15%

PDW: 0.1-0.5% RDW.SD: 35-56fl

PCT: 100-300x10g/L H0.37 0.35-0.50
 Based on the patient’s laboratory results, Carol Zamora’s hemoglobin,

hematocrit, and white blood cell (WBC) levels are within the normal range. This

suggests a minimal risk of excessive blood loss during and after surgery. Additionally,

the absence of abnormalities in her WBC count indicates no underlying infections,

further reducing the possibility of perioperative complications. Overall, these findings

suggest that the patient is in stable condition and is a suitable candidate for the

planned surgical procedure.

A. Radiologic Procedure

Name Image Actual

Findi
ngs
and
Interpretation
Transvaginal Uterus: Enlarged anteverted
Ultrasound uterus with a large pelvic-
abdominal mass
(3+1x3.9+x3.60 cm)
occupying the entire anterior
myometrial wall, irregular
contour, heterogeneous
echo pattern.
Endometrium: Ill-defined with
minimal anechoic
intracavitary fluid, thin (0,5
cm).
Cervix: Intact endocervical
canal, measures 2.0x1.8x2.5
cm. Right Ovary: Normal.
Left Ovary: Not visualized.
Other Findings: No free fluid.
Radiology Report Findings:
The lungs are clear
The hearts is not enlarged
The rest of the visualized chest
structures are intact.

Impression:
Unremarkable chest readiograph

Carol V. Zamora presents with a markedly enlarged uterus and a sizable,

heterogeneous pelvic-abdominal mass, as identified through transvaginal and whole

abdomen ultrasounds. While the right ovary appears normal, the left ovary was not

visualized in either scan. The endometrium appears indistinct, raising concerns for

possible pathology. Additionally, mild diffuse hepatic steatosis was noted. To further

evaluate the uterine mass, additional diagnostic tests such as MRI, CT scan, or

endometrial biopsy are recommended. Close clinical monitoring, follow-up imaging,

and a multidisciplinary approach are crucial for comprehensive assessment and

appropriate management.
 CHAPTER IV

This chapter details the personalized nursing care plan developed for

Carol Zamora following her Total Abdominal Hysterectomy with Bilateral Salpingo

Oophorectomy (TAH-BSO). The plan provides a structured approach to her

postoperative care, including assessment, nursing diagnosis, goal setting, planning,

interventions, and evaluation. Rooted in Maslow’s hierarchy of needs, the care plan

focuses on key priorities:

• Managing and alleviating acute pain

• Preventing the risk of infection

• Addressing any knowledge gaps regarding her post-operative recovery

and self-care.

Nursing
Assessment Diagnosis Outcome Planning Intervention Rationale Evaluation
Diagnosis
Acute Pain Carol Acute pain After nursing Focus on  Provide These Post
experiences Related to intervention, providing pain comfort interventions intervention,
persistent abnormal Carol will relief through help alleviate
measures. Carol reported
vaginal bleeding report a comfort discomfort,
uterine a reduction in
with associated reduction in measures, promote
bleeding due pain. • Encourag relaxation, pain,
body relaxation
to intramural e rest and and assess indicating
weakness. techniques,
myoma the successful pain
administering relaxation
uterine. effectiveness management
prescribed
analgesics, and • Administer of pain
management .
monitoring prescribed
pain levels and strategies.
analgesics.
response.
• Monitor pain
level and
response
 Nursing
Assessment Diagnosis Outcome Planning Intervention Rationale Evaluation
Diagnosis
Risk for Carol has Risk for Carol will Implement  Monitor the incision These Upon
Infection surgical incision infection remain strict aseptic
site for signs of measures discharge,
from Total related to free from techniques for
infection. help prevent Carol
Abdominal surgical signs of wound care, infection, Remained free
Hysterectomy incision. infection. monitor for promote from signs of
and Bilateral  Ensure proper hand wound
infection signs, infection,
Salpingo and administer
hygiene. healing, and indicating
Oophorectomy prescribed allow effective control
(TAHBSO), antibiotics. early measures.
increasing  Administer detection
susceptibility to Prescribed antibiotics of infections
infection. as needed for prompt
treatment.
Knowledge Carol lacks Knowledge Carol will Provide  Educate Carol on These Post education,
Deficit understanding deficit related demonstrate education on post-operative care and Interventions Carol
regarding post- to inadequate understandin post-operative medications. aim to demonstrated
operative care information g of post- care, review inform Carol understanding of
and medication regarding operative discharge  Review discharge about post-operative
management. post-operative care and instructions, instructions. necessary care and
care. medication address care, medication
management. questions and  Address questions or reinforce management,
concerns, and concerns. information indicating
provide written provided, effective patient
materials for clarify education.
reference. misunderstan
dings, and
support
learning and
recall.
 CHAPTER V

This chapter presents the Drug Study, providing comprehensive details about

the medications prescribed for the client. It covers the drug names, classifications,

indications, contraindications, potential adverse effects, and essential nursing

responsibilities. The medications included in this study are:

DRUG STUDY:

• Non-Steroidal Anti-Inflammatory Drug “NSAID” (Ketorolac)

• Antibiotic (Cefuroxime)

• Angiotensin II Receptor Blocker “ARB” (Losartan)

NAME OF CONTRA ADVERSE NURSING

CLASSIFICATION INDICATION
DRUG INDICATIONS REACTION RESPONSIBILITIES

Generic Name: Non-Steroidal Short-term  Peptic ulcer  Gastro intestinal Monitor for signs
Anti- management of disease bleeding of gastro intestinal
Ketorolac bleeding (black
Inflammatory moderate to
 Severe renal  Renal impairment stools, vomiting
Brand Name: Drug (NSAID) severe pain
Toradol impairment blood)
 History of  Dizziness,
Dosage: Gastrointestinal drowsiness,  Assess renal
30mg q8 bleeding Hypertension function before
administration
 Hypersensitivity to
NSAIDs  Educate the
patient about
potential dizziness
and to avoid driving

 Administer with
food to reduce
gastric irritation
 NAME CONTRA ADVERSE NURSING
CLASSIFICATION INDICATION
OF DRUG INDICATIONS REACTION RESPONSIBILITIES

Generic Name: Angiotensin II  Hypertension  Pregnancy -  Dizziness,  Monitor blood

Receptor Blocker (ARB) pressure regularly
Losartan  Prevention of Severe hepatic hypotension
Brand Name: stroke - impairment  Hyperkalemia  Assess kidney
Cozaar Diabetic  Fatigue function and electrolyte
levels
nephropathy  Hypersensitivity  Renal
Dosage: 100 mg to losartan impairment
once daily  Educate patients to
avoid potassium rich
foods

 Advise against abrupt

discontinuation to
prevent rebound
hypertension

NAME CONTRA ADVERSE NURSING

CLASSIFICATION INDICATION
OF DRUG INDICATIONS REACTION RESPONSIBILITIES

Generic Name: Second-generation  Bacterial  Nausea,  Assess for allergy

 Hypersensitiv
Cefuroxime cephalosporin antibiotic infections
ity to vomiting, to cephalosporins or
respiratory,
Brand Name: urinary tract, cephalosporins diarrhea penicillins
Zinacef skin, and soft or penicillin -  Rash,
tissue infections)
hypersensitivity  Monitor renal and
Ceftin Dosage:
500mg q12  Lyme disease -  Severe renal reactions liver function during
Surgical impairment without
therapy
prophylaxis dosage adjustment  Clostridioides
difficile associated
diarrhea -Liver
enzyme elevation  Educate the patient
to complete the full
course of antibiotics

 Observe for signs

of superinfection
(e.g., oral thrush,
vaginal yeast
infections)
 CHAPTER VI
Evaluation and Findings

Upon conducting this study, we gained a deeper understanding of the

importance of employing the nursing process in the care and management of patients

like Carol Villanueva Zamora. Through thorough assessment and data collection, we

identified several key issues. These included the potential risk for infection due to the

invasive nature of the hysterectomy, as well as the acute pain and discomfort

experienced postoperatively. Additionally, the abrupt onset of menopause following

the Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-

BSO) presents challenges such as hormonal imbalances and possible emotional

distress.

It became evident that providing diligent postoperative care, including pain

management, monitoring for complications, and offering emotional support, is crucial

in ensuring a smooth recovery. Addressing these concerns promptly can prevent

longterm complications such as osteoporosis, cardiovascular disease, or psychological

distress due to hormonal changes. This case has been invaluable for us as students,

offering profound insights into the complexities of surgical patient care and the

necessity of holistic nursing interventions.

Furthermore, through information dissemination and health education, we

were able to enhance awareness regarding the implications of a hysterectomy,

including lifestyle adjustments and hormone replacement therapy considerations.

Ultimately, this study underscores the importance of delivering client-centered care

efficiently and competently to achieve optimal nursing outcomes while ensuring the

patient’s overall well-being.

Recommendations

To promote Carol Zamora’s recovery and prevent complications, a

comprehensive care plan should be implemented. This includes strict medication

adherence, a well-balanced diet, and appropriate physical activity to support her

overall health. Infection prevention measures, such as proper hygiene and

immunizations, should be reinforced alongside chronic disease management through

regular monitoring and lifestyle modifications. Emotional well-being must also be

prioritized by providing psychological support and fostering a strong social network.

Additionally, a well- structured discharge plan should be in place, outlining

medication schedules, follow-up care, and emergency preparedness to ensure

continuity of care and long-term wellness.

Conclusion

In conclusion, this case study highlights the critical role of comprehensive

nursing care in managing patients who undergo a Total Abdominal Hysterectomy with

Bilateral Salpingo-Oophorectomy (TAH-BSO). Through thorough assessment and

intervention, we identified key concerns such as infection risk, postoperative pain,

hormonal imbalances, and emotional well-being. Addressing these issues through

proper wound care, pain management, hormonal therapy considerations, and

psychological support is essential in ensuring a smooth recovery and overall patient

well-being.

Furthermore, this case underscores the importance of patient education and

lifestyle modifications, particularly in maintaining bone health, preventing

complications, and adjusting to post-hysterectomy changes. Regular follow-up care

plays a crucial role in monitoring the patient’s progress and addressing any emerging

concerns.

Overall, this study reinforces the significance of a holistic, patient-centered

approach in nursing care. By prioritizing both physical and emotional aspects of

recovery, we can enhance the patient’s quality of life and promote a positive health

outcome. This experience has deepened our understanding of surgical nursing,

emphasizing the need for diligence, empathy, and competence in delivering optimal care

to patients undergoing major surgical procedures.