Decision Making In Practice Name Institution 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…
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 ...
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