Abdominal Hysterectomy

Notes

Definition
  • Surgical removal of the entire uterus through an abdominal incision.
  • A hysterectomy is indicated for a variety of conditions, including endometriosis, adnexal disease, postmenopausal bleeding, dysfunctional uterine bleeding, and benign fibromas or malignant tumors.
  • For women in their childbearing years, this surgery, as with a vaginal hysterectomy, can be a devastating blow psychologically, since they may feel they have lost their primary sexual characteristic and therefore can no longer function as women.

Abdominal Hysterectomy

Positioning
  • Supine, with arms extended on armboards.
Incision Sites
  • Lower transverse (Pfannenstiel), vertical, midline, or paramedian.
Packs/ Drapes
  • Laparatomy pack and/ or transverse Lap sheet.
  • Four folded towels
Instrumentation
  • Major Laparotomy tray or abdominal hysterectomy tray
  • Self-retraining retractor
  • Internal stapling instruments
Supplies/ Equipment
  • Basin set
  • Blades
  • Needle counter
  • Suction
  • Foley catheter with drainage bag
  • Solutions
  • Suture
  • Internal stapling
Procedure Overview
  1. After incising the skin, the incision is deepened through the subcutaneous tissue with the deep knife or cautery pencil.
  2. The fascia is nicked with the deep knife and incised using a curved Mayo dissecting scissors.
  3. Grasping one edge of the fascial margin with two or more Kocher clamps, blunt dissection separates the fascia from the underlying muscle.
  4. The muscle is divided manually. The peritoneum is then knicked with the deep knife, and the incision is lengthened with Metzenbaum scissors.
  5. A self-retraining retractor is placed in the wound, with moist lap sponges to protect the wound edges; the surgeon will “pack the bowel” away from the uterus with additional moist warm Lap sponges, and the operating table is placed in slight Trendelenberg position.
  6. The uterus is isolated by severing it from the uterine ligaments ans adnexa.
  7. The round ligaments of the uterus are ligated, divided, sutured, and tagged with a hemostat.
  8. To divide the ligaments, a curved Mayo scissors or scalpel is used. An internal stapling device can be used to free the uterus from the adnexa.
  9. The surgeon mobilizes the uterus to the level of the bladder.
  10. Using a Metzenbaum scissors and long tissue forceps, the surgeon separates the two structures by dissecting the peritoneal covering away from the bladder. This is called the bladder flap, and will be reattached (reperitonealized) later.
  11. Once the bladder has been separated from the uterus, mobilization is continued.
  12. At the level of the cervix, long Allis or Kocher clamps are placed around the edge of the cervix, and it is divided from the vagina using a long scissors or a long knife.
  13. If the ovaries are to be preserved, the ovarian ligaments is ligated and divided adjacent to the uterus.
  14. The uterosacral ligaments are ligated and divided, along with the cardinal ligaments.
  15. To close the wound, the surgeon begins by suturing the vaginal vault using an absorbable suture.
  16. The wound is irrigated with warm saline, and hemostasis is achieved.
  17. To close the peritoneum, the surgeon grasps the edges with several Kelly hemostats and the peritoneum is closed with a running suture.
Perioperative Nursing Considerations
  1. Foley catheterization is usually performed after the internal vaginal prep is completed but before the abdominal prep is begun.
  2. A sterilization permit may be required in addition to the operative permit.
  3. Instruments that have come in contact with the cervix and or vagina must be treated as contaminated and discarded into a basin that can be passed off the yield.
  4. Once the abdomen is opened, 4 x 4 Raytec sponges should be replaced by Lap sponges.
  5. If a free sponge has been placed in the vagina prior to closing, it is included in the sponge count and must be removed from the vagina before the count is correct and the patient leaves the room.
  6. Internal staples are usually contraindicated in severe cases of pelvic inflammatory disease or endometriosis.

image courtesy of: health.allrefer.com

 

Exam

Welcome to your Hysterectomy Practice Exam! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Consider the long-term physiological changes that result from the removal of reproductive organs.

1 / 10

1. Nurse Carla is preparing a care plan for Mrs. Jenkins, who is in the postoperative recovery period following an abdominal hysterectomy and bilateral salpingo-oophorectomy. As part of her care, what important information should Nurse Carla include in her explanation?

💡 Hint

Think about how to maintain the warmth of the compress and protect the surrounding area.

2 / 10

2. Nurse Karen is caring for Mrs. Lewis, who developed a slightly elevated temperature and swelling in her right calf following a total abdominal hysterectomy. The physician has prescribed warm moist compresses for her leg. Which nursing action should Nurse Karen take when applying the compress?

💡 Hint

Consider which action might negatively affect circulation or increase the risk of complications after surgery.

3 / 10

3. Nurse Cecilia is caring for a client who has had a vaginal hysterectomy. What should Nurse Cecilia avoid in the care of this client?

💡 Hint

Focus on the subtle behavioral changes that can be early indicators of decreased perfusion.

4 / 10

4. Nurse David is monitoring Mr. Thompson, a male patient who has undergone a total abdominal hysterectomy. Ten hours post-operation, Nurse David is assessing for early signs of shock. Which finding should alert him?

💡 Hint

Consider which client might be showing symptoms of a potentially life-threatening complication.

5 / 10

5. Nurse Emily has just received the shift endorsement and is determining which client to see first. Which client should Nurse Emily prioritize?

💡 Hint

Focus on the method that involves direct removal of fibroids through a minimally invasive surgical procedure.

6 / 10

6. Nurse Samantha is educating Ms. Rivera about treatment options for excessive bleeding due to fibroids. Which of the following statements accurately describes laparoscopic myomectomy, an alternative to hysterectomy?

💡 Hint

Pay attention to the patient's expression of feelings related to her self-identity and sense of loss.

7 / 10

7. Nurse Gina is providing post-operative care to Mrs. Thompson, who has recently undergone a mastectomy. As she listens to her patient's concerns, which statement should make Nurse Gina aware that Mrs. Thompson may be struggling with feelings of incompleteness?

💡 Hint

Consider the complication that involves localized bleeding and could lead to a drop in hematocrit.

8 / 10

8. Nurse Emily is seeing Ms. Taylor, a 32-year-old patient, for a follow-up visit after a vaginal hysterectomy. During the assessment, Nurse Emily notes that Ms. Taylor has a decreased hematocrit level. Which complication might this finding indicate?

💡 Hint

Consider that without menstruation, a consistent monthly schedule is recommended for BSE.

9 / 10

9. A 30-year-old client who recently had a hysterectomy visits the health center and asks Nurse Anna when she should perform breast self-examination (BSE). What is the best time for her to perform BSE?

💡 Hint

Consider the specific therapeutic purpose of a sitz bath and the importance of focusing heat on a particular area.

10 / 10

10. Nurse Laura is guiding the nursing assistant on how to properly administer a sitz bath to Mrs. Daniels, who recently had an abdominal hysterectomy. When the assistant asks why a regular bathtub cannot be used, what is the most accurate explanation Nurse Laura should provide?