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Aspect of Care Essay: The Post-Operative Care Following a Hysterectomy and Bilateral Salpingo-oophorectomy.

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Introduction

Aspect of Care Essay: The Post-Operative Care Following a Hysterectomy and Bilateral Salpingo-oophorectomy Approximately 60,000 hysterectomy operations are performed each year (NHS Direct, 2002). Despite being a common surgical procedure the rate of post-operative complications had been reported to be 40 -50% (Schofield et al, 1991). Hysterectomy affects many aspects of a woman's health and involves a complex interaction of biological, psychological and social factors. Holistic health and social care is therefore essential to the identification of a patient's care needs and is an important factor in their successful recovery. This essay will analyse the care needs of a patient recovering from a total abdominal hysterectomy and bilateral salpingo-oophorectomy seen during a clinical placement. It will examine the wards use of a nursing model and integrated care pathway in caring for a patient after surgery. The care given during the postoperative period will also be described and will focus on the monitoring for post-operative respiratory and circulatory complications, monitoring for signs of infection, pain and anxiety management, wound care, prevention and treatment of constipation, patient education and the involvement of the patient's family on discharge. The names of the patient and her daughter-on-law have been changed to preserve confidentiality (NMC, 2002). Chloe Bower, an 81-year-old female, with known uterine cancer, was admitted to a gynaecological ward for elective surgery. She was booked to have a total abdominal hysterectomy and bilateral salpingo-oophorectomy (BSO), a surgical procedure that removes the uterus, cervix, fallopian tubes and ovaries (Norris, 1994). Four months early Chloe had experienced moderate vaginal bleeding and lower abdominal pain. She was referred by her GP to the hospital's gynaecological out patient service. Upon further investigation she was diagnosed with uterine cancer. Chloe's past medical and surgical history included osteoarthritis, which affects her knees and an appendectomy 40 years ago. Chloe's husband died 5 years ago and she lives alone. Her two sons and daughter live close by and a family member visits her at least once a week. ...read more.

Middle

found that the effectiveness of anticoagulant drugs is increased if the patient wears TEDs. TEDs work by mimicking deep leg vein calf muscle pumps and encourage venous return back up the leg (Wallis & Autar, 2001). Chloe was also encouraged to mobilise as much as her pain would allow. Whilst she was resting in bed, she was asked to keep her legs uncrossed and she was encouraged to wiggle her feet and flex her legs every hour. The physiotherapist showed her less painful methods of getting out of bed and transferring from bed to chair. By day 3 post-operatively Chloe could walk from her bed to the bathroom using only her walking frame. By day 5 postoperatively the nurse decided that Chloe was mobilising enough to promote effective venous return and the heparin injections were discontinued. Another potential post-operative complication was infection. Hysterectomy operations are associated with a high infection risk (Marjoribanks et al, 2004). Chloe was at risk from developing an infection from her operation site, IV cannula and Foley catheter. Because of Chloe's increased risk of infection, her doctor prescribed prophylaxis intravenous antibiotics. This practice is recommended in national guidelines for all types of hysterectomy has been estimated to more than halve the rate of postoperative infections (Duff, 1980 & Mittendorf, 1993, cited in Marjoribanks et al, 2004). A protocol for the administration of prophylaxis antibiotics and regime of monitoring for signs of infection was included in the ICP. Chloe's antibiotics were administered every 12 hours for four days via her cannula. To monitor for signs of infection, her temperature was taken every 4 hours during her stay in hospital, her wound and cannula site were inspected at least once per shift for signs of erythema, oedema, pain and localised surface temperature increase. A full blood count was also taken on day 1 post-op to look for leukocytosis. An accurate assessment and management of Chloe's pain was vital to her recovery. ...read more.

Conclusion

A review by Johnson et al (2004) concluded that the use of both verbal and written instruction is recommended when educating patients and their carers as it standardises care and appears to improve patient knowledge and satisfaction. Just prior to discharge, the nurse explained to both Chloe and Kim what to expect during the recovery period, what to avoid and what to look out for (i.e. signs of wound infection). She gave Chloe details of her out patient appointment and gave instructions and information on Chloe's new medications. Chloe was also given a copy of the wards discharge leaflet. The leaflets contained advice in the dos and don'ts following abdominal hysterectomy and provided advice on how she and her family could get further information. In conclusion, it can be seen that the complications following a hysterectomy can adversely affect the health of a patient. The use of general anaesthesia and opioids could have compromised Chloe's respiratory system. The surgical procedure also put her at risk of shock and infection and resulted in Chloe experiencing pain, anxiety and constipation. The surgery also affected Chloe's capacity to live independently during the recovery period and limited her ability to carry out tasks such as cooking and cleaning. It was clear that Chloe's age was an important factor that increased her risk of post-operative complications. Following Chloe's progress has shown the importance of identifying and addressing all of the biological, psychological and social factors that affected her health and recovery. These factors are shown to be interrelated and have multiple health effects. For example, if Chloe's need for anxiety management was not met she could have experienced more pain, fatigue and delayed healing. Some of Chloe's needs were common to all patients undergoing the same procedure and these were already identified in the wards ICP. Her more individual needs were identified through assessment, observation and asking questions such as using the pain score. Careful planning was also an important part of Chloe's successful discharge from hospital care. Chloe's discharge highlighted the importance of family involvement in caring for patient's social care needs. ...read more.

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