{
  "name": "Hysterectomy",
  "slug": "hysterectomy",
  "url": "https://nursingplex.com/care-plans/hysterectomy",
  "category": "Surgery & Perioperative",
  "summary": "Uterine surgery recovery covering bleeding, bladder function, sexuality and grief over fertility loss.",
  "nursing_diagnoses": [
    "Acute pain",
    "Impaired urinary elimination",
    "Grieving",
    "Risk for infection"
  ],
  "overview": [
    "Hysterectomy is surgical removal of the uterus, performed for fibroids, endometriosis, abnormal bleeding, prolapse or malignancy. It may be total (uterus and cervix), subtotal, or radical, and may include removal of tubes and ovaries. Approaches include abdominal, vaginal, laparoscopic and robotic.",
    "Removing the ovaries in a premenopausal woman produces immediate surgical menopause with hot flashes, vaginal dryness and accelerated bone loss. Even without oophorectomy, the loss of fertility and the symbolic meaning of the uterus can provoke significant grief.",
    "Nursing care addresses postoperative bleeding and infection, urinary and bowel function, VTE prevention, and the emotional dimension of losing reproductive capacity."
  ],
  "key_facts": [
    {
      "label": "Bleeding limit",
      "text": "Saturating more than one perineal pad an hour is abnormal and must be reported."
    },
    {
      "label": "Urinary risk",
      "text": "Bladder atony and ureteral injury are recognized complications; monitor output and voiding after catheter removal."
    },
    {
      "label": "VTE",
      "text": "Pelvic surgery carries a high thrombosis risk — early ambulation and prophylaxis are essential."
    },
    {
      "label": "Activity",
      "text": "Nothing in the vagina and no heavy lifting for about six weeks to protect the vaginal cuff."
    }
  ],
  "nursing_priorities": [
    "Monitor for hemorrhage and vaginal cuff complications.",
    "Manage postoperative pain and abdominal distention.",
    "Restore urinary and bowel function.",
    "Prevent venous thromboembolism and infection.",
    "Support grief, body image and sexuality concerns."
  ],
  "assessment": {
    "subjective": [
      "Reports of abdominal or pelvic pain and gas discomfort",
      "Concerns about fertility loss, femininity or sexual function",
      "Complaints of hot flashes or mood changes after oophorectomy",
      "Reports of difficulty voiding after catheter removal"
    ],
    "objective": [
      "Vital signs and hemoglobin trends for bleeding",
      "Amount and character of vaginal drainage; pad counts",
      "Incision appearance and drain output",
      "Abdominal distention, bowel sounds and passage of flatus",
      "Urine output, residual volumes and calf swelling or tenderness"
    ],
    "related_factors": [
      "Surgical incision and pelvic tissue trauma",
      "Manipulation of bladder and bowel during surgery",
      "Anesthesia-related ileus and immobility",
      "Sudden hormonal withdrawal after oophorectomy",
      "Loss of childbearing capacity"
    ]
  },
  "goals": [
    "The client will remain hemodynamically stable without excessive bleeding.",
    "The client will void adequately and pass flatus within the expected timeframe.",
    "The client will report controlled pain and ambulate independently before discharge.",
    "The client will express feelings about the surgery and describe available support."
  ],
  "interventions": [
    {
      "title": "Monitor for hemorrhage and infection",
      "points": [
        "Count and weigh perineal pads; report saturation of more than one pad per hour.",
        "Check vital signs frequently and watch for tachycardia with falling blood pressure.",
        "Assess incision and drains; report purulent or foul-smelling discharge.",
        "Monitor temperature and white cell count."
      ]
    },
    {
      "title": "Restore function",
      "points": [
        "Assess voiding after catheter removal and check post-void residual if output is small.",
        "Encourage early ambulation, leg exercises and sequential compression devices.",
        "Manage gas pain with ambulation, rocking and avoidance of straws and carbonated drinks.",
        "Advance the diet as bowel sounds and flatus return; give stool softeners."
      ]
    },
    {
      "title": "Psychosocial support",
      "points": [
        "Invite the patient to express feelings about fertility, body image and sexuality.",
        "Explain expected menopausal symptoms and available hormone or non-hormonal options.",
        "Include the partner in teaching when the patient wishes.",
        "Refer to counseling or support groups when grief is prominent."
      ]
    }
  ],
  "patient_teaching": [
    "No sexual intercourse, tampons or douching for about six weeks or until cleared.",
    "Avoid lifting more than 10 pounds and strenuous activity during recovery.",
    "Expect light vaginal discharge for several weeks; report heavy bleeding or foul odor.",
    "Report fever, calf pain, shortness of breath or inability to urinate immediately."
  ]
}