Total Abdominal Hysterectomy, Bilateral Salpingo-Oophorectomy: Decision Making in Practice - Essay Example

? Decision Making In Practice This paper discusses and analyses my decision making during my management of a patient who had undergone Total Abdominal Hysterectomy/ Bilateral Salpingo- oophorectomy (TAH BSO). I will outline the nursing care and management on the patient and how this relates with legal, ethical and professional issues. I will also outline how these issues affected the decisions that I made. In discussing the patient care, I will discuss about catheter care, nutritional assessment, pain control, cannula care and discharge planning. The paper will first give a brief overview about TAH BSO before discussing the nursing care and management of the patient. Overview Total Abdominal Hysterectomy (TAH) This refers to the excision of the uterus and cervix. This procedure is indicated in a variety of conditions including ovarian cancer, cervical dysplasia, pelvic relaxation, uterine prolapse, endometriosis and uterine fibroids (leiomyomas). About 10% of TAH is done for cancer, but the remaining 90% is performed due to non emergency and non cancerous reasons. This procedure may also be performed in when a patient continually experiences unusual pelvic pain. TAH ensures that a woman is not able to bear children again. The procedure is of advantage as it allows a total examination of the abdomen and pelvis, hence, it allows for the investigation of cancer and other unclear growths. Statistics reveal that approximately 300 women out of 100,000 women in the US undergo TAH. Even in non emergency and non cancerous conditions, TAH poses remarkable challenges for omen and health care practitioners (Anspach 2009, p65). During TAH, the uterus and cervix are detached from the fallopian tubes, upper vagina, ovaries, and the adjoining connective tissue and blood vessels. As a result of this, complications arising from the procedure are likely to be marked. The procedure, lasting about 2 hours, is normally performed in general anesthesia so that the patient does not wake up during the procedure. In order to minimize infections, vaginal cleansing is done and antibiotics are administered to the patient before the procedure is done. A urinary catheter is first passed through the patient’s urethra so that the bladder is emptied. This urinary catheter will remain in the patient throughout the procedure and some time after the procedure. Vertical and/or horizontal incisions are then made on the abdomen so that the uterus is exposed (Mehta 2008, p56). Bilateral Salpingo-Oophorectomy (BSO) This refers to the surgical excision of both sets fallopian tubes and ovaries. It is commonly done with TAH and is referred to as TAH/BSO which is done in about one third of all hysterectomies. BSO is done to treat gynecological cancers and infections. It is also indicated in cases of ectopic pregnancies that occur in the fallopian tube. Just like in TAH, general anesthesia is given to the patient before the start of the procedure, before an incision is made to remove the organs (Ricks 2008, p78). Management of the patient BAH/BSO is a surgical procedure, hence, it has a lot of complications ranging from surgical site infections, extreme pain and bleeding. All these, if not controlled, will are fatal. After the surgery, the patient stayed in the recovery room for some hours. The patient was then monitored to check whether there were any signs of pain. The patient had some pain, hence, we administered some analgesics and we also administered broad spectrum antibiotics to the patient so that infections would be prevented. Since the procedure requires close monitoring and management, the patient was required to stay in the hospital for about 4 to 5 days. There was also par vaginal bleeding, which we controlled and managed through the use of sanitary towels. Since it is normal for a patient who has undergone the procedure to have bloody vaginal discharge, we provided a lot of sanitary pads to the patient for purposes of controlling the excessive bleeding (Berek 2008, p87). Catheter Care The catheter was placed to the patient before the procedure, and normally, it is expected to be removed some days after the procedure. Catheters are a source of catheter-induced nosocomial infections, if they are not sterilized regularly. Catheters that are nor sterile may introduce ascending urinary tract infections which may spread to the kidneys, hence damaging the urinary system (Maxwell 2011, p90). In order to prevent these infections in the patient that I managed, we replaced the urinary catheters on a daily basis, and we ensured that we used sterilized surgical gloves in the procedure. We also advised the patient to avoid contaminating the catheters since this would pose a serious health hazard. Pain control The team also ensured that pain in the patient was well managed by use of analgesics. Any surgical procedure is painful, and the healing process is equally painful. TAH/BSO entails rupturing of membranes and connective tissue structures. This activates pain neurons in the patient, which brings about the extreme abdominal pain (Robotin 2010, p87). Common analgesics that were given to the patient were acetaminophen, diclofenac and mefenamic acid. In controlling the pain, the patient was also asked to have enough rest since extreme body exertion complicates the abdominal pain. Normally, the doctor recommends that patients who have undergone the procedure wait fro over 6 weeks to involve themselves in physical activities. Therefore, in following these recommendations, we ensured that the patient remained on the bed for longer periods so that the body would be given enough time to heal. Cannula Care In patients who have undergone the procedure, cannulas are placed for purposes of drug administration and transfusions in case there is fear that the acute blood loss in the surgical procedure can lead to hypovolemic shock. This patient had cannulas for purposes of drug administration. As part of the patient management, cannulas are supposed to be replaced regularly since they pose a great risk for the development of nosocomial infections. In managing the patient also, cannulas were placed on the patient well with caution since careless placement of cannulas on patients may injure them or cause other forms of physical abuse. Nutritional Assessment Before conducting the surgical procedure, the blood profile of the patient was taken so that biochemical tests would be conducted on the patient. Further tests were also conducted to rule out serious infections before the surgery, and in case the infections were present, the health care team would come up with the appropriate measures of controlling them. The major risk for the operation is excessive bleeding which may cause anemia in the patient coupled with the loss of massive electrolytes and nutrients (Ricks 2008, p123). The patients may also have a depressed appetite. All these factors may cause nutritional derangements in the patient. As a result of this, the team ensured that a thorough nutritional assessment was conducted on the patient so that any derangements would be corrected before progression to the extreme. We continued to recommend a balanced diet for the patient since a potent nutrition is required for purposes of faster recovery. We recommended an intake of massive proteins since they are used for body building processes. Without proteins, the surgical area may not recover well. Assessing for nutrition entailed checking the weight and BMI constantly. Signs of wasting in the body were also checked. After the surgery, electrolyte and mineral assays were conducted on the patient so that any necessary infusions would be done on the patient. Other forms of management Apart from pain control, catheter care, cannula care, and nutritional assessment, other forms of management were patient reassurance and psychological support. Successful TAH/BSO means that a woman would not be able to bear children again. This disturbs them psychologically, and as a result of this they need psychological support to enable them come up into terms with their condition. In the recovery of the patient, I offered psychological support to the patient. I also encouraged friends and close family members of the patient to offer their psychological support so that the patient would recover promptly. Legal, ethical and professional considerations In managing the patient, the decision making I applied was in tandem with ethical, legal and professional issues. The essence of caring for a patient after surgery is ensuring that there is minimal harm and favorable conditions are provided that can enable the patient recover well. Ethical considerations in healthcare require that the healthcare provider minimizes injury, infections and anything that can lengthen the hospital stay. Catheter care, cannula care, nutritional assessment and pain control are ethical and professional procedures that ensured that the patient’s health was not compromised during the recovery period. No legal rights of the patient were compromised during the recovery period, which further implies that legal issues affected the decision making process. Since all these were well followed during the patient’s management, discharge planning was done in time. The patient was advised on the appropriate ways to recover domestically, and the patient was also encouraged to seek medical attention if there was persistence of the symptoms. References Anspach, B. M. (2009). Gynecology. New Jersey: J.B. Lippincott Co. Ashok Mehta, S. B. (2008). Diagnosis and Management of Cancer. Delhi: Jaypee Brothers Publishers. Delthia Ricks, L. B. (2008). One hundred questions and answers about hysterectomy. Massachusetts: Jones & Bartlett Learning. E. Albert Reece, R. B. (2010). Obstetrics and Gynecology: The Essentials of Clinical Care. New York: Thieme. Jonathan S. Berek, N. F. (2008). Practical gynecologic oncology. New York: Lippincott Williams & Wilkins. Lise Cloutier-Steele, S. T. (2008). Misinformed consent: women's stories about unnecessary hysterectomy. 2008: Wiley and Sons. Maxwell, D. J. (2011). Surgical techniques in obstetrics and gynaecology. London: Elsevier Health Sciences. Monica Robotin, I. O. (2010). 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