Case Analysis

TAH-BSO
 What Is TAH-BSO?

 Total Abdominal Hysterectomy and Bilateral

Salphingo-Oopherectomy.

 This is the removal of the uterus including the cervix as

well as the tubes and ovaries using an incision in the
abdomen.  A hysterectomy is the surgical removal of the
uterus. Hysterectomy may be total, as removing the
body and cervix of the uterus or partial, also called
supra-cervical. Salpingo refers specifically to the
fallopian tubes which connect the ovaries to the uterus.
Oophorectomy is the surgical removal of an ovary or
ovaries.
 INDICATIONS

 Endometriosis- is an abnormal condition in which

endometrial tissue is found in internal sites other than
the uterus. Overall incidence in women of reproductive
age is 5% to 10%. Women in their mid-30s are most
commonly affected, though it can appear anytime form
first menses to menopause. There is a familial
disposition.

 Benign Uterine Tumors (Leiomyomas)- fibroids,

fibromas, fibromyomas, fibroleiomyomas, and myomas.
 Leiomyomas are benign uterine tumors that arise from
the uterine muscle tissue. They are the most common
tumors of the female genital tract and occur in 20% to
30% in women. They are seen more often in African-
American women, and are more common in women
approaching menopause.
 Endometrial or Uterine Cancer- is the most common
malignancy of the female genital reproductive system.

In 2007 the American Cancer Society estimated that 39,080

new cases of uterine cancer would be diagnosed in the United
States with an estimated 7400 women dying of uterine
cancer. The 5-year survival rate is 96% if the cancer is
discovered at an early stage.
It is most strongly related to an imbalance between estrogen
and progesterone levels, resulting in excessive circulating
estrogen.
 Ovarian Cancer- the second most common gynecologic
cancer, accounts for 3% of cancer occurrence and 6% of
cancer deaths in women and is the leading cause of death
from reproductive malignancies in women. An estimated 22,
430 new cases of ovarian cancer are expected to be
detected in the United States in 2007, with 15, 280 deaths.
White women show higher rates of ovarian cancer than do
African-American women. Early diagnosis of ovarian cancer
is uncommon.
 Risk and Side Effects

Hysterectomy has been found to be associated with

increased bladder function problems, such as
incontinence. When the ovaries are also removed,
estrogen levels will fall. This removes the protective
effects of estrogen on the cardiovascular and skeletal
system. A menopausal woman has a three times greater
risk of developing cardiovascular disease such as
atherosclerosis, peripheral artery disease or of having a
heart attack when compared to premenopausal women.
Studies have also found that the risk of developing
osteoperosis may increase
ANATOMY AND PHYSIOLOGY
INTERNAL ORGANS
a. Uterus. The uterus is a hollow organ about the size and
shape of a pear. It serves two important functions: it is
the organ of menstruation and during pregnancy it
receives the fertilized ovum, retains and nourishes it until
it expels the fetus during labor.
-The uterus is located between the urinary bladder and the
rectum. The uterus consists of the body or corpus, fundus,
cervix, and the isthmus. The major portion of the uterus is
called the body or corpus. The fundus is the superior,
rounded region above the entrance of the fallopian tubes.
The cervix is the narrow, inferior outlet that protrudes into the
vagina. The isthmus is the slightly constricted portion that
joins the corpus to the cervix.
-The walls are thick and are composed of three layers: the
endometrium, the myometrium, and the perimetrium.

b. Vagina - is the thin in walled muscular tube about 6 inches

long leading from the uterus to the external genitalia. It is
located between the bladder and the rectum. It provides
the passageway for childbirth and menstrual flow; it
receives the penis and semen during sexual intercourse.
c. Fallopian Tubes (Two) -Each tube is about 4 inches long
and extends medially from each ovary to empty into the
superior region of the uterus. They transport ovum from
the ovaries to the uterus. There is no contact of fallopian
tubes with the ovaries. The distal end of each fallopian
tube is expanded and has finger-like projections called
fimbriae, which partially surround each ovary. When an
oocyte is expelled from the ovary, fimbriae create fluid
currents that act to carry the oocyte into the fallopian tube.
Oocyte is carried toward the uterus by combination of tube
peristalsis and cilia, which propel the oocyte forward. The
most desirable place for fertilization is the fallopian tube.
d. Ovaries (two)- The ovaries are for oogenesis-the
production of eggs (female sex cells) and for hormone
production (estrogen and progesterone). They are about
the size and shape of almonds. They lie against the
lateral walls of the pelvis, one on each side. They are
enclosed and held in place by the broad ligament.

e. cervix (or neck of the uterus)

-is the lower, narrow portion of the uterus where it joins
with the top end of the vagina. It is cylindrical or conical
in shape and protrudes through the upper anterior
vaginal wall.
f. urethra
-is a tube that connects the urinary bladder to the genitals
for removal out of the body. In males, the urethra travels
through the penis, and carries semen as well as urine. In
females, the urethra is shorter and emerges above the
vaginal opening.
 DIAGNOSTIC PROCEDURES

 Before any type of hysterectomy, women should have

the following tests in order to select the optimal
procedure:
 Complete pelvic exam including manually examining the
ovaries and uterus.
 Up-to-date Pap smear .
 Pelvic ultrasound may be appropriate, depending on
what the physician
 A decision regarding whether finds on the above. or not
to remove the ovaries at the time of hysterectomy.
 Complete blood count
 Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Interventions

Subjective: Acute pain Short term: Establish rapport To gain trust Short term:
The patient may secondary to After 4 hours The patient’s pain
verbalized: surgical of nursing Monitor vital signs scale decreased
“My incision is hurts.” operation interventions, the To obtain baseline 8/10 to 4/10
patient’s pain scale will data
Provide comfort
decrease 8/10 to 4/10
Objective: measure
The patient manifested : To satisfy the
-irritability Long term:
Encourage deep confinement of Long term:
-impaired physical After 1 day of patient
breathing The patient’s pain
nursing interventions, To inhibit pain diminished and
mobility Provide safety
patient’s pain will performed activities
-disturbed sleep pattern diminish and perform measure
-diaphoresis Develop To prevent from like side movements
activities like side and leg bending
-restlessness movement and leg communication injury
-facial grimaces bending review To alter pain and

-pain scale of 8/10 procedures/expectati diminish emotional

ons and tell client stress
when treatment will To reduce concern
hurt
of unknown and
Administer
associated muscle
analgesics as tension
indicated to maximal To maintain
dosage as needed acceptable level of
pain.
 Assessment Nursing Case Goal Intervention Rationale Evaluation
Diagnosis Background

Subjective: Delayed Extension of Short Term: Independent:

surgical the number of • After 8 hours of •After 8 hours of
Objective: recovery post operative nursing 1. Advise the 1. Promotes faster nursing
- pain scale of related to days required intervention, the patient to have recovery to the intervention, the
8 / 10 pain to initiate and client will be able an adequate patient. goal was met as
-weak looking perform to report rest and sleep. evidenced by
-- restless activities that increased energy 2. Assess 2. Determines if reported of
maintain life, and less pain. nutritional nutrition is adequate increased energy
health, and status and to support healing. and less pain to
well-being current intake. the surgical site.
Long Term: 3. Advise the 3. Reduces fatigue
• After a series of patient to limit and chances of •After a series of
nursing strenuous another delayed nursing
interventions, the activity like recovery. interventions,
client will be able heavy lifting. the client was
to perform her able to perform
usual activities. Dependent: her usual
activities.
1. Advise the 1. To monitor healing
patient to have process and provide
a follow up for timely intervention
check up. as needed.

2. Administer 2. Aid in pain relief

analgesics as and promotes healing.
prescribed.
 Assessment Nursing Diagnosis Planning Nursing Rationale Evaluation
Interventions

S > The patient may Sexual Dysfunction Short term: >Establish rapport >To gain trust Short term:
verbalized: related to altered After 4 hours of >Monitor vital signs >To obtain The patient
-problem such as body structure and nursing interventions maintenance data identified stressors
> Obtain sexual
loss of sexual desire function the patient will in lifestyle that
history including >To maximize
identify stressors in contributes to the
- inability to achieved usual patterns of communication and
lifestyle that may dysfunction
desired satisfaction functioning and level understanding
contribute to the
of desires
-conflicts involving dysfunction >Sexual concerns are
values > Be alert to often disguised as Long term:
Long term:
comments of client humor, sarcasm, or
O> the patient The patient
After 3 day of offhand remarks
manifested: verbalized
nursing interventions
> These factors may understanding of
-alteration in the patients will > identify current
be producing enough individual reasons
relationship with SO verbalize stressors in
anxiety to cause for sexual problems
understanding of individual situations
-Change of interest depression
individual reasons for
in self and others sexual problems > They do not help
> Avoid making the client
value judgments
>To promote
>Establish treatment and
therapeutic nurse- facilitate sharing of
client relationship sensitive information

>To allow sexual

expression for
>Provide ways to individual between
obtain privacy partners without
embarrassment
 Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Interventions

S>
Risk for infection Short term: >Establish rapport >To gain trust Short term:
O> the patient
manifested: secondary to
surgical incision After 4 hours of >Monitor V.S. >To obtain baseline The patient identified and
-Weakness nursing data demonstrated
interventions, the >Note signs and interventions to prevent
-Pallor patient shall symptoms of >To reduce risk of infection
identify and sepsis complication and
-with dry and demonstrate
intact dressing on monitor for infection
intervention to
the area. prevent infection >To reduce risk for
>Provide wound infection
-Pain over the healing such as
incision cleaning of wound
Long term: Long term:
-Irritability >To promote healing to
>Provide care, the incision The patient doesn’t
After 1 day of change dressing
-Presence of intact nursing experience infection
dressing as needed >To prevent infection to
interventions, the increase immune
patient will not >Encourage resistance
have infection increase intake of
Vitamin C >To increase healing of
wound

>Encourage deep
breathing exercise
 Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Interventions

S > The patient may Risk for fluid Short term: Establish rapport To gain trust Short term:
verbalized: volume deficit After 4 hours of The patient
“I feel weak and nursing interventions Monitor vital signs To obtain identified risk
thirsty.” the patient will identify maintenance data factors and
risk factors and appropriate
O> the patient appropriate Encourage increase To replace loss fluids interventions
manifested: interventions oral fluid intake
-decrease urine output Prevents peak in

-sudden weight loss Long term:  Provide fluid level Long term:
-decrease skin turgor After 3 day of nursing supplemental fluids The patient
-dry mucous interventions the as ordered demonstrated
membranes patients will To ensure accurate behaviors or lifestyle
-sunken eyeballs demonstrate behaviors Monitor intake and picture of fluid status changes to prevent
or lifestyle changes to output development of fluid
prevent development Confusion can lead volume deficit
of fluid volume deficit Provide safety to accidents
measures
To replace loss
Encourage the use electrolyte.
of oresol
 MANAGEMENT
 PRE-OPERATION

1. Interprets and upholds policies and

procedures as determined by
administrative
body.
2. Identify knowledge and skills of peri-
operative nursing.
3. Identifies nursing care problems through
pre-operative visit and assist in the
solutions and
 INTRA-OPERATION

1. Ensures quality of care through proper use

of instruments, equipments and
supplies.
2. Observes proper positioning of the patient
and maintaining the dignity of the
individual
As well, thus, providing maximum safety
and comfort.
3. Identifies, prepares and send specimen
obtained during operation for
examination.
4. Assess patient’s stability and should know to report
to the attending
physician/s.
5. Carries out doctor’s post-operative order diligently.
6. Observes, checks and record patient assessment and
refer when necessary.
7. Administers post-operative care.
8. Submits sundry report and account for the supplies
and equipment used.
9. Responsible for the upkeep, Maintenance and care of
equipment and instrument.
10. Informs appropriate personnel when supplies are
needed or equipment and
instruments are out of order.
 POST-OPERATION
1. Responsible for all the safekeeping of patient’s personal
belongings endorse by OR nurse.
2. Responsible for endorsing such items to patient’s
relatives or floor nurse.
3. Diligently carries out doctor’s orders as soon as
possible.
4. Check and record vital signs-blood pressure, pulse rate,
O2 saturation,
respiratory rate, temperature, color and condition of
skin, if can move extremeties every 15 minutes (or as
often as possible or as indicated by the patient’s
condition) on the Nurse’s Post Anesthesia Record.
5. Observes and records neuro vital signs for
neurological cases on the
Neurological Vital Signs Form provided by the unit.
6. Observes keenly the patient’s who might undergo
post-operative complications
like bleeding, shock, respiratory distress, thyroid
storm and cardiac arrest.
6. Notifies the anesthesiologist/AMD immediately for any
unusual symptoms
manifested by the patient.
 PROGNOSIS

 The prognosis following an uncomplicated hysterectomy is

good, regardless of the type of procedure performed.
Symptoms are usually relieved by the procedure, and a full
return to normal activities can be expected.
 When hysterectomy is performed for cancer of the cervix
or uterus, the prognosis depends upon the extent and
severity of the cancer. Early-stage or low-grade cancer has
a generally good prognosis, whereas more advanced
stages or high-grade cancer with extensive spreading
(metastasis) has a poor prognosis.
 The predicted outcome after salpingo-oophorectomy
doesn’t depend on whether the procedure is unilateral or
bilateral usually does not affect the outcome, because
the effect of the procedure and the healing from the
surgery occur at much the same rate for removal of one
or both fallopian tubes and ovaries. However, hormonal
complications for premenopausal women may arise if
both ovaries are removed. After bilateral oophorectomy,
the woman will be at increased risk for osteoporosis,
coronary heart disease, lung cancer, and cognitive
impairment (dementia) unless hormone replacement
therapy is implemented, and will become infertile.
 Members:

 ACOSTA, Avigail Venice

 ALULOD, Katrina Mae
 BINGCANG, Danica Criska
 DOLIENTE, Cephradine Monique
 PESIGAN, Viktoria Katrina
 SANCHEZ, Morgan
 SINNUNG, Christian