Research Paper on Hysterectomy: Reasons, Considerations & Complications

Introduction

A hysterectomy is a medical procedural surgery to remove the uterus of a woman. There are various reasons for a hysterectomy operation, and they include uterine fibroids associated with bleeding and other complications, cancer-related to the uterus and other reproductive organs of the female, unusual vaginal bleeding, recurring pelvic pain and more (Fraser, 2011). Hysterectomy for responses not linked to cancer is usually taken into account after all considerations to the cause have being tried. Hysterectomy may include the whole uterus or part of the uterus, and sometimes there is a removal of the ovaries, a process called oophorectomy. In cases of tubes removal, the operation is called a salpingectomy, and removal of the entire uterus, all the tubes, and the two ovaries is called a bilateral salpingectomy-oophorectomy. Generally, there are three kinds of hysterectomy, which include subtotal hysterectomy, which includes an operation removing the upper part of the uterus solely, and maintaining the position of the cervix. A total hysterectomy includes detaching the uterus together with the cervix. Lastly, a radical hysterectomy includes the removal of the full uterus together with the tissues located sideways, the cervix, and the topmost part of the vagina, This type of hysterectomy occur in the presence of cancer. Medical providers employ various approaches to hysterectomy, which are reliant on the level of experience the surgeon has. Other factors include the grounds on which hysterectomy is undertaken and the general health of the woman. The hysterectomy technique will, to some extent, determine the duration of healing and the type of scar that will occur (Fraser, 2011).

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The patient to be discussed in this paper is Paula Wellington. Paula is 42 years of age who had lately been admitted to posting the anesthesia recovery unit after going through a total hysterectomy with salpingo-oophorectomy secondary to uterine sarcoma. Mrs. Paula is lethargic although, she claims that she experiences pains in the surgical site spreading out to the legs. Mrs. Paula was diagnosed with Uterine Sarcoma with metastasis to the fallopian tubes and ovaries. She has no medical and surgical history except an obstetrical history of para 1 Gravida 1. Mrs. Paula has been on medication for Lo Loestrin Fe. Her family has had a history of cancer: her mother aged 67 years have a hysterectomy at age 45 from uterine cancer, and her father, aged 68, had prostate cancer. Her maternal grandmother had ovarian cancer.

Mrs. Paula's abdomen is soft and tender to touch. Her bowel movement is reasonable and there are no visible masses and depressions noted. However, Mrs. Paula has throbbing pain of level 10/10 and spreads out to the bilateral mid-thighs and lower back. Surgical dressing to the abdomen is in place. She has a foley catheter to gravity drainage, and the doctors observed clear amber-colored urine. The doctors have been using sanitary napkins to take care of the blood noted in the genitourinary area and regular changing of sanitary napkins. She is under continual monitoring in this area. She has a limited ROM in the musculoskeletal area. Mrs. Paula has been identified to be in a post-op phase of a total hysterectomy with salpingo-oophorectomy. A plan is underway to execute some nursing actions and knowledge impartment on what to anticipate postoperatively and how to averse possible problems. The plan is also expected to educate her on follow up care and discharge planning. Teachings on discharge will begin on admission.

The necessary procedure being undertaken are necessary and essential to check on the patient. Inspections of the urine and blood are essential to determine the level of abnormality, which may include excessive uterine bleeding, which can propel anemia (Subramanian, 2017). Medical providers will, therefore, be able to handle such scenarios. The doctors will be able to reduce or notice fatigue when they notice excessive uterine bleeding. Mrs. Paula's social history was normal, and the check-up was necessary to determine any missing day at work or any other regular visitation places such as the gym. It is essential to undertake such checks on the social history of the patient. In cases of heavy bleeding, the doctors first focus on the bleeding using appropriate medication or relevant surgical procedures before hysterectomy. Before any surgery includes a pre-discussion with the patient, which covers the degree of the surgery (Subramanian, 2017). This includes discussion on the removal or no removal of the ovaries, tubes, availability of estrogen therapy following the medical operation, and such. Estrogen therapy (ET) is usually focused on women who have had their ovaries detached, and they had not reached menopause. ET prevents hot flashes, night sweats, and loss of bone density pone to happen in cases of removal of ovaries. The care being given to Mrs. Paula is similar to the evidence-based requirement of care for hysterectomy. The Post-anaesthesia care unit is the recovery room a patient is taken after surgery where monitoring is undertaken. She was measured for her blood pressure, her pulse, temperature as vital signs which are included in the requirements for hysterectomy patient's recovery. There is also an observation of blood loss and respiration. The plan to educate Mrs. Paula to prevent complications is recommended because there are various complications which have the possibility of occurring after a hysterectomy. These complications may include hemorrhage, various infections such a continual high fever, constipation, damage to adjacent parts of her body, and more. Follow up care for Mrs. Paula is similar to the recommended evidence-based research on hysterectomy care (Fraser, 2011). However, there is no detail on the recovery plan, which includes fluids and food provision after surgery. However, the education given to Mrs. Paula would cover for the medication plan since it involves pain medicine required either intravenously, by intramuscular (IM) injection. Mrs. Paula was also inspected on depression and any suicidal thoughts because younger women may get depressed from a hysterectomy. Discharge teachings provided for her are recommended and covers her return to the normal daily activities and to encourage her activities to be able to prevent blood clots, gas pains, and even pneumonia. The discharge planning is essential and recommended as it teaches on life after abdominal hysterectomy. The discharge education teaches on sexual function and enjoyment as well and aims to get results on improvement or the lack of it, especially on pain, vaginal bleeding as well as sex life.

Conclusion

In conclusion, hysterectomy is the solution for abnormal uterine bleeding, fibroids, cervical complications, cancer of any reproductive organ, and therefore it should be heavily researched to improve the procedure. Studies related to the feedback of women to hysterectomy have shown the women satisfied with the outcome. Depression is highly associated with hysterectomy, especially for younger women, and therefore it is essential to focus on antidepressant therapies and remedies.

Reference

Fraser, I. S. (2011). Hysterectomy, endometrial destruction and the levonorgestrel intrauterine system are all effective therapies for heavy menstrual bleeding; satisfaction rates are highest after hysterectomy. Evidence-Based Medicine, 16(2), 55-56. doi: 10.1136/ebm1168

Subramanian, D. S. (2017). Pilates and Physiotherapy in post Total Hysterectomy - An Evidence Based Study. Journal of Medical Science and Clinical Research, 5(9). doi: 10.18535/jmscr/v5i9.48