Which client is at highest risk for compromised psychological adjustment after a hysterectomy?

Hysterectomy is the surgical removal of the uterus. It is most commonly performed for malignancies and certain non-malignant conditions, like endometriosis or tumors, to control life-threatening bleeding or hemorrhage, and in the event of intractable pelvic infection or irreparable rupture of the uterus. A less radical procedures (myomectomy) is sometimes performed for removing fibroids while sparing the uterus.

Total abdominal hysterectomy bilateral salpingo oophorectomy (TAHBSO) is the removal of entire uterus, the ovaries, fallopian tubes and the cervix. TAHBSO is usually performed in the case of uterine and cervical cancer. This is the most common kind of hysterectomy. Removal of the ovaries eliminates the main source of the hormone estrogen, so menopause occurs immediately.

Types

• Subtotal (partial): Body of the uterus is removed; cervical stump remains.
• Total: Removal of the uterus and cervix.
• Total with bilateral salpingo-oophorectomy (TAHBSO): Removal of uterus, cervix, fallopian tubes, and ovaries is the treatment of choice for invasive cancer (11% of hysterectomies), fibroid tumors that are rapidly growing or produce severe abnormal bleeding (about one-third of all hysterectomies), and endometriosis invading other pelvic organs.
• Vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH) may be done in certain conditions, such as uterine prolapse, cystocele/rectocele, carcinoma in situ, and high-risk obesity. These procedures offer the advantages of less pain, no visible (or much smaller) scars, and a shorter hospital stay and about half the recovery time, but are contraindicated if the diagnosis is obscure.
• A very complex and aggressive surgical procedure may be required to treat invasive cervical cancer. Total pelvis exenteration (TPE) involves radical hysterectomy with dissection of pelvic lymph nodes and bilateral salpingo-oophorectomy, total cystectomy, and abdominoperineal resection of the rectum. A colostomy and/or a urinary conduit are created, and vaginal reconstruction may or may not be performed. These patients require intensive care during the initial postoperative period.

Nursing goal for patients who are to undergo Hysterectomy or TAHBSO includes prevention or minimization of complications, supporting adaptation to change, preventing complications, and providing information on the prognosis and treatment regimen is well understood, and management of pain.

Listed below are six (6) nursing care plans (NCP) and nursing diagnosis for Hysterectomy and TAHBSO: 

1. Low Self-Esteem
2. Impaired Urinary Elimination
3. Risk for Ineffective Tissue Perfusion
4. Sexual Dysfunction
5. Constipation/Diarrhea
6. Deficient Knowledge
7. Other Possible Nursing Care Plans

1. Low Self-Esteem

Low Self-Esteem

Nursing Diagnosis

• Situational Low Self-Esteem

May be related to

• Concerns about inability to have children, changes in femininity, effect on sexual relationship
• Religious conflicts

Possibly evidenced by

• Expressions of specific concerns/vague comments about the result of surgery; fear of rejection or reaction of significant other (SO)
• Withdrawal, depression

Desired Outcomes

• Client will verbalize concerns and indicate healthy ways of dealing with them.
• Client will verbalize acceptance of self in situation and adaptation to change in body/self-image.

1. Low Self-Esteem

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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• Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
  An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
• Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
  A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
• NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
  The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
• Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
  Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
• Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
  Useful for creating nursing care plans related to mental health and psychiatric nursing.
• Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
  Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
• Maternal Newborn Nursing Care Plans (3rd Edition)
  If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
• Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
  An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
• All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
  Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.

See also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
  Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
  Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

Other care plans and nursing diagnoses related to reproductive and urinary system disorders:

• Acute Glomerulonephritis | 4 Care Plans
• Acute Renal Failure | 6 Care Plans
• Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
• Chronic Renal Failure | 11 Care Plans
• Hemodialysis | 3 Care Plans
• Hysterectomy (TAHBSO) | 6 Care Plans
• Mastectomy | 14+ Care Plans
• Menopause | 6 Care Plans
• Nephrotic Syndrome | 5 Care Plans
• Peritoneal Dialysis | 6 Care Plans
• Prostatectomy | 6 Care Plans
• Urolithiasis (Renal Calculi) | 4 Care Plans
• Urinary Tract Infection | 4 Care Plans
• Vesicoureteral Reflux (VUR) | 5 Care Plans

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.