If you are working in the Gynaecology, you will come across several women being admitted for a Hysterectomy: the surgical removal of the Uterus. Typically, a hysterectomy is done to treat cancer, endometriosis or uterine prolapse.
There are 3 main types of Hysterectomy:
Total Hysterectomy: removal of Uterus and cervix
Supracervical/ Sub Total Hysterectomy: removal of Uterus without the cervix
Radical Hysterectomy: removal of Uterus and surrounding tissue, the upper third of the vagina and pelvic lymph nodes
There are also 3 different ways for the surgery to be done:
Through the vagina
An open incision on the abdomen
Pre-Operative Nursing Care for Hysterectomy
Hysterectomy Pre-Operative Nursing Assessment
Start by having a chat with your patient to establish a safe and therapeutic relationship. While having the conversation, make sure to ask specific questions that will explain your patient’s situation. So, ask her:
How she feels about the diagnosis
Whether she knows how the surgery works, and why it’s being done
If she is coping with it
Whether she needs any psychological or emotional support
If she has a relative or friend who can support her
Is she experiencing any pain or discomfort
During the nursing assessment you should also obtain a full medical and family history of your patient, as well as baseline vital signs.
Pre- Operative Nursing Diagnosis for Hysterectomy
Having finished the conversation, you can now build your nursing diagnosis, and you’ll most likely find the following:
Lack of knowledge about the surgery
Stress caused by the diagnosis
Fear from having the surgery
Anxiety related to loss of femininity or childbearing potential
Concern about sexual function
Hysterectomy Pre-operative Nursing Interventions
1. Education about Hysterectomy
Naturally, when patients first find out that they need to have a hysterectomy, they feel anxious, confused, and lost. So the information given to them at the first appointment is rarely absorbed.
As a nurse, you play a significant role in effectively educating your patient and addressing any questions. Start by giving her an overview of the surgery, what she can expect before, during and after the Hysterectomy. Moreover, you should discuss how it will affect future sexual function and hormone levels.
In most cases, the team will advise the patient to stop taking any anticoagulant medication, NSAIDS or Vitamin E as they can increase bleeding during the surgery and after. You should also inform your patient to bring comfortable underwear and large menstrual pads with her to use after the surgery. Lastly, reassure your patient that the post-operative pain will be addressed through analgesia and supportive measures.
2. Managing Anxiety & Fear
Pre-operative anxiety and fear can arise from many factors. Particularly in a Hysterectomy, patients often feel scared of how the surgery will affect their body in terms of reproduction, sexual function, and image. They might also feel embarrassed from being exposed through the whole process.
Encourage your patient to verbalise her fears and answer any questions that she might have. Explain to her that she can contact you or the clinic at any time if she wants. Advise your patient that you have additional healthcare staff who can help her, including social workers, spiritual advisors, psychologists and support groups.
Lastly, reassure your patient that once she is fully recovered, she will be able to function normally and go on with her daily life. She will also be followed up and given psychological and social help if needed.
3. Preparation on the Day of Surgery
The final step is to make sure that your patient is ready for surgery from the medical perspective. Your patient should be starved for at least 6 hours before the surgery, and make sure that she is kept hydrated through adequate IVI infusions.
On the morning of the surgery, ask her to take a pregnancy test to rule out any unexpected pregnancies. Check that her incision site is marked and confirm whether she needs to shave.
Finally, make sure that your patient has the following:
Allergy Bracelet (if applicable)
Changed into a hospital gown and removed her underwear
Removed all jewellery/ foreign teeth/ hearing aid/ contact-lenses/ glasses/ make-up
Before going down to the Operating Theatre, your patient’s file should have:
All medical notes and treatment charts
A signed consent form
Pre-operative medical assessment
An ECG done in the last 2weeks
Blood results, and Blood type from the past 3 days (often found online)
Post-Operative Nursing Care for Hysterectomy
Post Hysterectomy Nursing Assessment
Start by having a quick chat with your patient to determine her consciousness level. While having the conversation, ask her if she is in pain or feeling nauseous as these are expected after surgery. And you will also be assessing her airway and breathing patterns.
The next thing to do is to check:
Circulation in her hands and feet
Incision site (look out for swelling, bleeding, redness)
The drain (volume and colour)
The urine catheter (volume and colour)
Before leaving her side, ensure that the environment is safe; Place the bed rails up and give the nurse call bell to the patient. Check that all IV lines are secure and that the drain and catheter are not kinked. Lastly, ask the patient if she wants a relative or a friend to be by her side.
Post Hysterectomy Nursing Diagnosis
The nursing assessment is likely to highlight the following nursing diagnoses:
Acute pain and discomfort
Disturbed Body Image
Struggles with Activities of Daily Living
Post Hysterectomy Nursing Interventions
1. Relieving Pain and Discomfort
Moderate to high pain is expected after a Hysterectomy, depending on which method was used. Particularly, if your patient had laparoscopic surgery, you should encourage her to mobilise and lay on her side. These will help her pass flatus and decrease abdominal distention.
Administer the prescribed analgesia regularly to keep your patient from experiencing spikes of pain. Moreover, many patients will have a PCA after a Hysterectomy, so you should teach her how to use it.
2. Coping with body image
After a hysterectomy, it is common for women to feel anxious or scared. Mainly these emotions are festered from lack of knowledge about how their body has changed now.
You should assure your patient that once fully healed, she will still be able to experience sexual activity again. And given that most orgasms arise from clitoral stimulation, her sexual satisfaction will not be affected.
Another issue to note is that a hysterectomy might cause a hormonal imbalance, which can lead to depressed moods and heightened emotional sensitivity. So encourage your patient to express her feelings, and explain to her that she can get professional psychological and social help.
Post Hysterectomy Complications
Having a Hysterectomy might put patients at risk of:
Deep Vein Thrombosis
Post Hysterectomy Discharge Planning
Before sending your patient home, make sure that she has:
Anxiety under control
Accepted her body image
Minimal pain and discomfort
Verbalised knowledge of self-care at home
No Complications present
Did you find this helpful? If so then you should have a look at the rest of the Study Guides Here.
If reading is not for you, Don’t Worry! Take a look at my YouTube Channel were I explain the Pre-Operative Phase in Detail