RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY

COLLEGE OF NURSING
Iba, Zambales



TOTAL ABDOMINAL HYSTERECTOMY BILATERAL SALPHINGO-
OOPHORECTOMY ( TAHBSO )





EMILIANA B. ESPEJO

BSN IV

.




CONTESSA M. GABRIEL,RM,RN,MAN
( Clinical Instructor )
























RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales






I. Introduction:
A uterine myoma (myoma uteri) is a solid tumor made of fibrous tissue;
hence it is often called a 'fibroid' tumor. Myomas vary in size and number, are
most often slow-growing and usually cause no symptoms. Myomas that do not
produce symptoms do not need to be treated. Approximately 25% of myomas will
cause symptoms and need medical treatment. Myomas may grow as a single
nodule or in clusters and may range in size from 1 mm to more than 20 cm in
diameter. Myomas are the most frequently diagnosed tumor of the female pelvis
and the most common reason for a woman to have a hysterectomy. Although they
are often referred to as tumors, they are not cancerous.
The cause of myomas has not actually been determined, but most uterine
myomas develop in women during their reproductive years. Myomas do not
develop before the body begins producing estrogen. Myomas tend to grow very
quickly during pregnancy when the body is producing extra estrogen. Once
menopause has begun, myomas generally stop growing and can begin to shrink
due to the loss of estrogen.





















RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales


II. Biographic Data:

Name: MRS. X
Birthday: September 17, 1967
Age: 46 years old
Sex: Female
Address: Locloc, Palauig Zambales
Occupation: Housewife
Religion: Roman Catholic
Civil Status: Married
Number of Children:
Nationality: Filipino
Date of Admission:
Chief Complaint: Abdominal Pain
Diagnosis: Myoma Uterine
Operation Perform: TABHSO
Physician: DR. X

























RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales


III. History of Present Illness:
Mrs. X was admitted in PRMMH with a chief complaint of abdominal pain. Mrs.
X undergo of TABHSO procedure.

IV. Past History :
No past history

V. Family History:

VI. Social History:
No social history































RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales

VII. Physical Assessment: ( Head to Toe ):
PARTS TECHNIQ
UE
NORMAL
FINDING
S
ACTUAL
FINDINGS
INTERPRETAT
ION
SKIN
HEAD


































RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales

VIII. Laboratory and Diagnostic Exam
Ultrasound
Sonography Report:The uterus is enlarged in size measuring 11cm x 9 cm. There is an
isoechoicmass at the anterior myometrium 9.7cm x 7.5 cm. Both adnexa are unremarkable. Nofluid in the
posterior culdesac.Impression:Myoma uteri, intramural, anterior
Interpretation: to consider uterine myoma

Hematology
Complete Blood Count



































RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales

IX. Anatomy and Physiology
ANATOMY AND PHYSIOLOGYAnatomy of Female
reproductive system
The internal reproductive organs
Vagina a 3-4 inch long dilatable canal located
between the bladder and
ther e c t u m ; c o n t a i n s r u g e a ( w h i c h p e r m i t
c o n s i d e r a b l e s t r e t c h i n g w i t h o u t tearing);org
an of copulation; passageway of menstrual discharges and fetus.
2)
Uterus hol l ow pear - s haped f i br omus cul ar
or gan 3 i nches l ong, 2 i nches wide,1 inch thick and weighing 50-
60 grams in non pregnant woman.
hel d i n pl ace by br oad l i gament s ( f r om s i des of t he
ut er us t o pel vi cwalls;also hold fallopian tubes and ovaries
in place) and round ligaments )from sides of the uterus to mons pubis)
abundant blood supply from uterine and ovarian arteries.

Composed of 3 muscle layers :perimetrium,myometrium,endometrium.

Cons i s t of 3 par t s : corpus(body)
upper portion with triangular partcalled fundus ;
isthmus
-area between corpus and cervix which forms a part


RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales

X. Drug Study:
Drugs name Mechanism of
action
Indications Adverse
reaction
Nursing
consideration
Metoclopra
mide
Hydrochlori
de
- Stimulates
motility of
the upper
GI tract by
increasing
lower
esophageal
sphincter
tone. Also
blocks
dopamine
receptors at
the
chemorecep
tor trigger
zone.
- Preventin
g or
reducing
nausea
and
vomiting
induced
by
cisplatin
and other
chemothe
rapy.

DOSAGE: 10
mg (2 ml) I.V as
a single dose
over 1 to 2
minutes
CNS:
restlessn
ess,
headache
,
dizziness
, anxiety,
drowsine
ss
G.I:
nausea,
bowel
disturban
ce
SKIN:
rash
OTHER:
fever
- Monitor
blood
pressure
frequently in
patient
receiving I.V
dosage
- Contraindicat
ed whenever
stimulation
of G.I
motility
might be
dangerous in
pheochromoc
ytoma and
epilepsy.
Ranitidine - Competitive
ly inhibits
the action
of histamine
at receptor
sites of the
parietal
cells,
decreasing
gastric acid
secretion.
- Doudona
l and
gastric
ulcer;
pathologi
cal
hypersecr
etory
condition
s, such as
ZOLLIN
GER-
ELLISO
N
SYNDR
OME
DOSAGE: 50
mg I.V every 6
to 8 hours
CNS:
headache
, malaise,
dizziness
,
confusio
n
CV:
bradycar
dia
GI:
nausea,
constipat
ion
SKIN:
rash
- Use
cautiously in
patients with
hepatic
dysfunction,
dosage
should be
adjusted in
patients with
impaired
renal
function
- Remind
patient that if
he/she taking
ranitidine once
daily, he/she
should take it
at bedtime for
best results.

RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales

XI. Nursing Care Plan:
Assessment Diagnosis Planning Intervention Evaluation
Subjective
data:
masakit
po ung opera
ko as
verbalized by
the patient.

Objective:
- Pain
scale of
6 over
10.
Risk for
infection
related to
exposure of
surgical
wound in
the
environmen
t
After 8 hours of
nursing
intervention the
patients will:
- Patients
remain free
for
infection
as
evidenced
by normal
vital signs
and
absence of
purulent
drainage
from
wounds
and
incision
- Encourage
intake of
protein and
calorie rich
foods.
After 8 hours
of nursing
intervention,
client was able
to be free from
infections
brought by
harmful
microorganism
s as evidenced
by normal vital
signs and
absence of
purulent
drainage in her
surgical
wound.




















RAMON MAGSAYSAY TECHNOLOGICAL UNIVERSITY
COLLEGE OF NURSING
Iba, Zambales

XII. Course in the Ward
Mrs. X was received lying on bed comfortably, afebrile, for TABHSO procedure.
Vital sign taken, IVF patency checked and regulated, diet instructed by the doctor.
Medications given as doctors order