Nursing care plan for women hysterectomized for benign causes PDF

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Hysterectomy (HT) is defined as surgical removal of the uterus. It is one of the most frequent surgical interventions performed worldwide. It is the second most common surgical procedure in women of reproductive age, after cesarean section, and the third most frequent intra-abdominal operation toget...

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Nursing care plan for women hysterectomized for benign causes Hysterectomy (HT) is defined as surgical removal of the uterus. It is one of the most frequent surgical interventions performed worldwide. It is the second most common surgical procedure in women of reproductive age, after cesarean section, and the third most frequent intra-abdominal operation together with appendectomy and cholecystectomy.1 Hysterectomy is one of the most frequently used techniques for the treatment of benign uterine diseases, mainly abnormal uterine bleeding, prolapse or

uterine fibroids. In

North

America,

more than

600,000

hysterectomies are performed per year, this figure is lower, although it exceeds 150 cases per 100,000 women per year and it is one of the 15 most performed hospital procedures. 2 The largest number of hysterectomies are found in the ages 40-44, but they are also performed on younger women. Removal of the ovaries is not always necessary, unless there is ovarian cancer or they are polycystic. If both ovaries are removed, the woman will experience surgical menopause regardless of age. Patients who keep one or both ovaries intact have a 50% chance of experiencing menopause 5 years after their hysterectomy. 3 86% of the patients are multiparous and 14% nulliparous. 63% are hysterectomized due to benign pathology and 37% due to malignant causes, 80% undergo abdominal surgery and 20% vaginally. 11% are operated on urgently and 89% on a scheduled basis. 4 Hysterectomy can be done in three ways: 1. Subtotal hysterectomy: The uterus is removed, leaving the cervix, ovaries, and fallopian tubes. 2. Total hysterectomy: The uterus and cervix are removed, leaving the ovaries and fallopian tubes.

1

3. Radical hysterectomy: This is the most extensive procedure, the uterus, ovaries, fallopian tubes and lymph nodes in the pelvis are removed. 5 The approaches to hysterectomy in

benign diseases

are:

abdominal

hysterectomy (HA), vaginal hysterectomy (HV), laparoscopic hysterectomy (LH) and robotic hysterectomy (HR). If there are no contraindications, it is advisable to do it by vaginal approach; When the vaginal approach is not possible, the abdominal and laparoscopic approaches have pros and cons that must be considered in the decision-making process. 6-8 (ANNEX I) The morbidity of this surgical procedure is currently low regardless of the approach, but we must take into account that it carries risks and complications related to anesthesia, bleeding, injury to neighboring organs, and vaginal infection. Regardless of the technique used, total hysterectomy leads to blood loss, shortens the length of the vagina, alters sexual function, and can damage the genitourinary tract. Most hysterectomies are performed for benign causes, to increase the quality of life of patients, however, it can lead to long-term postoperative problems such as sexual dysfunction and urinary incontinence. 9-10 It must also be taken into account that this intervention is a risk factor for developing self-esteem conflicts and that the health professional must deal with the fears, beliefs and anxiety of the patients to prevent depressive symptoms after discharge. Many times this is due to a woman's ignorance and false beliefs about hysterectomy. This is why education and emotional support throughout the nursing process is very important. 4,10,12 In most cases, the patient decides to undergo the intervention, that is, it is a chosen procedure and not an emergency operation, whose

The objective is to cure or alleviate the symptoms related to their gynecological problems (myomatosis, condylomatosis, fibrosis, etc.), which negatively affect the quality of life of patients. 12 However, considering hysterectomy only as a relief of the symptoms or the treatment of a disease, would not be a global vision of what the woman lives, distancing us from the real situation that they and their partners go through. 13-14 The importance of nursing in the care of hysterectomized women resides in the fact that despite the common nature of surgery, there is a deficit in the education they receive. In most cases, patients decide to undergo the intervention without understanding the consequences of the removal of the uterus. We must focus on educating patients, highlighting what they really want and need to know about the care before, during and after this surgery and its consequences. Women who are well informed feel more secure and supported in this experience. Information prior to hospitalization has better results than that provided during it. 15-17 The nursing professional must provide comprehensive, multidisciplinary and quality care, based on the needs of the person, throughout the process, to improve the quality of life of patients. We must approach care from a holistic perspective, taking into account the physical, psychological and social aspects It is important to establish an empathic relationship with the woman who is going to be intervened, and to have fluent communication in order to identify the main needs and prioritize the care of watch out. 18

JUSTIFICATION For this reason, this Nursing Care Plan will be carried out for women who have been hysterectomized for benign causes; to publicize the possible physical and psychological complications triggered by this intervention, such as: urinary incontinence, alteration of sexual and reproductive function, and depression, facilitating its prevention. As well as educating patients, providing all the necessary information to prepare them physically and psychologically. Treatment must be individualized; we must ensure a correct physical evolution and facilitate the emotional and psychological expression of patients. So that with good care from the nursing team, coping with the intervention is improved and the development of long-term problems is prevented, improving the quality of life of hysterectomized patients. 17-18

OBJECTIVES General purpose: Prepare a Nursing Care Plan for women who have been hysterectomized for benign causes to make known possible long-term problems, as well as the actions to be carried out to prevent them; so as to improve the convalescence period and the quality of life of patients.

Main goal: Prevent possible long-term complications in hysterectomized women such as urinary incontinence, sexual dysfunction and improve their emotional state.

Specific objectives: Provide all the necessary information to the hysterectomized patient about the intervention and the female genital tract, its subsequent care and possible physical and emotional consequences, to reduce anxiety related to the intervention and improve coping with the situation. Improve the self-perception of the hysterectomy patient and promote a good relationship between her and her partner, to prevent problems in sexual relations. Improve the quality of life of the hysterectomized patient during their longterm hospital stay, controlling postoperative pain and ensuring a correct physical evolution.

METHODOLOGY To update the subject, and in the application of the competences of the University Nursing Degree Curriculum, a bibliographic review has been carried out, for which books, theses and databases such as SciELO, Pubmed and Cochrane.

For the standardization of nursing diagnoses, outcome criteria, and key interventions, the NANDA-NIC-NOC taxonomy was used. As keywords for the search, the following were considered: "hysterectomy", "complications",

"depression",

"incontinence",

"sexuality",

"education",

"laparoscopic", shortening to complete free access articles published between the years 2006-2016. DATAB ASE SciELO

PubMed

SEARCH PROFILE AND hysterecto my sexuality AND hysterecto my education AND hysterecto my complications AND hysterecto my laparoscopic

Hysterecto my AND depression

ITEMS FOUND

SELECTED ITEMS

ITEMS USED

7

5

3

8

4

3

2 8

1 2

2

f i f t e e n F o u r .

4

3

1 2

4

Cochran e

Hysterecto my AND postoperati ve incontinenc e Hysterectomy

F i v e 4 7

1 4

1 0

1

3

1

BOOK S TITLE

YEAR

Herdman

Nursing Diagnoses, Definitions and

2014

T,

Classification 2015-2017 (NANDA).

Kamitsuru

10th

S. Bulechek GM,

Edition. Nursing Interventions

Butcher HK,

Classification (NIC). 6th

Dochterman

Edition.

AUTHOR

2014

JM, Wagner CM. Moorhead S,

Nursing Outcomes Classification (NOC).

Johnson M,

5th Edition.

2014

Maas ML, Swanson E.

AUTHOR

THE SIS TITLE

Ajú Coy JA.

Depressive state in pre and posthysterectomized patients, abdominal and / or vaginal route.

Arias Arias PC, Tenezaca Alao DA.

Prevalence and causes of hysterectomy in women treated in the gynecology and obstetrics department of the José Carrasco Arteaga Hospital in the city of Cuenca in the year 2012. Nursing care in the perioperative period of hysterectomy. Luis Heysen Inchásticategui-Chiclayo Hospital, Peru 2013.

Montenegro Castañeda IK.

YEAR 2015

2014

2014

STAGES OF THE NURSING PROCESS ASSESSMENT For the elaboration of the nursing care plan, the first thing that is carried out is an assessment using the functional patterns of M. Gordon. 21 Reflected in the following table: Table 1: M. Gordon Functional Patterns. Own elaboration. PATTERN 1: PERCEPTION OF HEALTH.

There is a lack of knowledge on the part of the hysterectomized woman about the intervention and its consequences, as well as the necessary physical and emotional care.

PATTERN 2: NUTRITIONALMETABOLIC. PATTERN 3: ELIMINATION.

There is no alteration in this pattern. The risk of

developing stress urinary incontinence

increases, due to surgical trauma from the removal of the uterus. PATTERN 4: ACTIVITY-EXERCISE

Their activities are limited, depending on the degree of pain

that

the

patient

presents

and

her

urinary

incontinence problems. PATTERN 5: SLEEP-REST

There is no alteration in this pattern.

PATTERN 6: COGNITIVE-PERCEPTIVE.

There is no alteration in this pattern.

PATTERN 7: SELF-

The myths and beliefs in relation to the uterus and the

PERCEPTION - SELF-

fact of being a woman, as well as the lack or scarcity of

CONCEPT.

information,

alter

the

emotional

pattern

of

the

hysterectomized woman.

PATTERN 8: ROLE-RELATIONSHIPS

The relationship with the sentimental partner is affected since the woman feels that she has lost value as such and / or sexual attractiveness associated with the loss of fertility.

PATTERN 9: SEXUALITY

Due to the removal of the uterus there is an alteration in

- REPRODUCTION

the sexual function of the woman, due to fears, on the part of the patient and / or her partner. Reproductive function is also impaired.

PATTERN 10: STRESS TOLERANCE

The patient presents concerns about her new state, with anxiety and lack of coping with her new situation.

PATTERN 11: VALUES - BELIEFS

The spiritual and / or religious values and beliefs are altered after the removal of the uterus.

DIAGNOSTICS OF EPHERMERY The main nursing diagnoses, their interventions and results are presented below, using the NANDA, NIC and NOC taxonomy. 22-24

Table 2: Main Nursing Diagnoses, Interventions and Results. Own elaboration. NURSING DIAGNOSTICS (00126) Deficient knowledge r / c misinterpretation of information m / p exposure of misconception. NOC NIC  0906: Decision making.  5618: Teaching: procedure / treatment of the  1606: Participation in decisions about healthcare. hysterectomized patient.  5606: Teaching: individual.  5250: Support in decision making. (00120) Low situational self-esteem r / c alteration of body image m / p self-negative verbalizations. NOC NIC  2002: Personal well-being.  5270: Emotional support.  1205: Self-esteem.  5400: Enhancement of self-esteem.  1208: Depression level.  1409: Self-control of depression. ( 00059) Sexual dysfunction r / c alteration of body structure or function m / p real or perceived limitation imposed by hysterectomy. NOC NIC  7110: Encourage family involvement.  1200: Body image.  1207: Sexual identity.  5220: Improved body image.  2001: Spiritual health.  5248: Sex counseling.  2609: Family support during treatment.  5426: Facilitate spiritual growth. (00069) Ineffective coping r / c situational crisis due to surgical intervention m / p anxiety. NIC NOC  5230: Increase coping.  1302: Coping with problems.  5440: Increase support systems.  1402: Self-control of anxiety.  5820: Decreased anxiety.  5880: Relaxation technique. (00017) Stress urinary incontinence r / c weakness of the pelvic muscles and structural supports m / p reports of involuntary loss of small amounts of urine when sneezing, coughing or laughing. NOC NIC  0610: Urinary incontinence care.  0502: Urinary continence.  0503: Urinary elimination.  0560: Pelvic floor exercise. (000132) Acute pain r / c surgical wound m / p verbal manifestation of intense pain. NIC NOC  1400: Pain management.  1605: Pain control.  2210: Administration of analgesics.  1843: Knowledge: pain management.

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PLANNING AND EXECUTION After listing the nursing diagnoses, we proceed to the planning and execution of the nursing care plan, which is designed to be carried out throughout the process. The application of care would be carried out from the first consultation with the woman, either in Primary Care or in the hospital, through the surveillance and control of existing problems and the prevention of complications. (00126) Deficient knowledge Hysterectomy is usually an elective procedure, so women have time to be adequately educated before the intervention. Despite this, there is a lack of knowledge on the part of the hysterectomized woman about the intervention and its consequences, as well as the physical and emotional care they will need. Family, friends and the media are the sources of information most used by patients, however they are not reliable in terms of the legitimacy of the information. Before surgery, we would give the woman a brochure with information on: what is a hysterectomy, what happens after, and advice on how to take care of herself. (ANNEX II) It is important to create a close and trusting atmosphere with the patient from the first consultation, to help her organize her ideas and emotions, and keep her well informed. We must incorporate the couple in the information process, to explore the negative connotations about hysterectomy, since this influences the delay in decision-making. Incorporating the partner is a necessary and frequently forgotten aspect, since an informed partner is a support resource for the woman, both in decision-making and during followup.

Table 3: Interventions and results related to the nursing diagnosis of deficient knowledge. Own elaboration. Interventions (NIC) 5618: Teaching: procedure / treatment of the hysterectomized patient. Activities:      

Explain the purpose of the hysterectomy. Describe post-hysterectomy assessments / activities and the rationale for them. Reinforce information provided by other members of the care team, as appropriate. Determine the expectations of the hysterectomy by the patient. Correct unrealistic expectations of hysterectomy, as appropriate. Allow time for the patient to ask questions and raise concerns.

5606: Teaching: individual. Activities:  

Establish a relationship of trust. Determine the teaching needs of the patient.

    

Assess the current level of knowledge and understanding of the patient's content. Select the appropriate educational materials. Provide educational brochures, videos, and online resources, where appropriate. Correct misinterpretations of information, as appropriate. Give the patient time to ask questions and discuss her concerns



Include family, if appropriate.

5250: Support in decision making. Activities: 

Establish communication with the patient at the beginning of her admission.

 

Help the patient to identify the advantages and disadvantages of each alternative. Provide the information requested by the patient.

Results (NOC) 0906 Decision making. Indicators:   

0906.03: Identify the possible consequences of each alternative. 0906.08: Compare alternatives. 0906.09: Choose between several alternatives.

1606 Participation in decisions about healthcare. Indicators:  

1606.03: Search for information. 1606.02: Shows self-control in decision-making.

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(00120) Low situational self-esteem Among the negative aspects perceived by hysterectomized women is the inability to have children. After a hysterectomy the woman experiences fear, a feeling of emptiness, problems in the relationship with her partner, etc. All this contributes negatively to their self-esteem, so we must give emotional support and be attentive to the appearance of depressive symptoms. On the other hand, we must take into account the spiritual and religious values and beliefs of women, since having a uterus can be something perceived as important, and having to remove it can negatively affect expectations related to health and the perception of quality of life. We must help the patient to increase the personal judgment of her own worth

Table 4: Interventions and results related to the nursing diagnosis of Low situational selfesteem. Own elaboration. Interventions (NIC) 5270: Emotional support. Activities:   

Comment on the emotional experience with the patient. Encourage the patient to express feelings of anxiety, anger, or sadness. Listen to expressions of feelings and beliefs. Provide help in decision making.

5400: Enhancement of self-esteem. Activities:     

Observe the patient's statements about her self-worth. Help the patient find self-acceptance. Help the patient reexamine negative self-perceptions. Help the patient identify important effects of her culture, religion, race, gender, and age on self-esteem. Check the frequency of negative manifestations about yourself.

Results (NOC) 2002: Personal well-being. Indicators:  

2002.12: Execution of habitual roles. 2002.10: satisfaction with the ability to express emotions.

1205: Self-esteem. Indicators:   

1205.05: Description of the self. 1205.07: Open communication. 1205.01: Verbalization of self-acceptance.

1208: Depression level. Indicators:   

1208.19: Low self-esteem. 1208.07: Expression of feelings. 1208.01: Depressed mood.

1409: Self-control of depression. Indicators:  

1409.08: Refers absence of physical manifestations of depression. 1409.09: Refers improvement in mood.

(00059) Sexual dysfunction Hysterectomy has side effects on sexuality. Women may suffer from dyspareunia or coitalgia, due t...