مسااااااعده عاااااجله00 - ملتقى طلاب وطالبات جامعة الملك فيصل,جامعة الدمام

بعثره مشاعر · #1 2009- 11- 20

السلام عليكم ورحمه الله وبركاته

ابي منكم خدمه تكفون

ابي معلومات عن

pre and post operation care for women with various gynecological operation and health education

ابي جزئيه health education

ومشكورين مقدما
تحياتي00

nurse_mohammad · 2009- 11- 22

عليكم السلام و رحمة الله و بركاته

حصلت حق hysterectomy
ما ادري ينفع ولا لا ؟
عطيني خبر علشان اضيفهم في الرد :)

بعثره مشاعر · 2009- 11- 22

مشكور اخوي ماتقصر

اوكي نزلهم
تحياتي00

nurse_mohammad · 2009- 11- 23

سوري على التاخر
المصدر كتاب لبنكوت

Preoperative Management
1. qProcedure and reason for hysterectomy, what the procedure involves, and what to expect postoperatively are explained.
2. Patient must remain NPO from midnight the night before surgery and must void before surgery.
3. An enema is administered before surgery to evacuate the bowel and prevent contamination and trauma during surgery.
4. Vaginal irrigation is performed before surgery and skin preparation is done if ordered.
5. Preoperative medication is given to help the patient relax.

Postoperative Management
1. Postoperatively, the following assessment is made:

Wound appearance and drainage.
Vital signs, level of consciousness.
Level of pain.
Vaginal drainage (serous, bloody).
Intake and output.
Urge to void, bladder distention, residual urine (if appropriate).
Clarity, color, and sediment of urine.
Homans' sign or impaired circulation.
Return of bowel sounds, passage of flatus, first bowel movement.

2. Exercise and ambulation are encouraged to prevent thromboembolus, facilitate voiding, and stimulate peristalsis.

Complications
1. Incisional/pelvic infection.
2. Hemorrhage.
3. Urinary tract injury.
4. Bowel obstruction.
5. Thrombophlebitis/deep vein thrombosis (DVT).

Nursing Diagnoses
1. Acute Pain related to surgical procedure
2. Impaired Urinary Elimination related to decreased sensation and stimulation
3. Risk for Infection related to surgical procedure
4. Disturbed Body Image related to alteration in female organs and hormones
5. Sexual Dysfunction related to alteration in reproductive organs and function

Nursing Interventions
Relieving Pain
1. Assess pain location, level, and characteristics.
2. Administer prescribed pain medications. Ensure that patient knows how to use patient-controlled analgesia pump and is using it properly.
3. Encourage patient to splint incision when moving.
4. Encourage patient to ambulate as soon as possible to decrease flatus and abdominal distention.
5. Institute sitz baths or ice packs as prescribed to alleviate perineal discomfort.
6. Monitor level of sedation related to opioid administrationâ€”may interfere with ambulation and elimination.

Promoting Urinary Elimination
1. Monitor intake and output, bladder distention, signs and symptoms of bladder infection.
2. Maintain patency of indwelling catheter if one is in place.
3. Catheterize patient intermittently if uncomfortable or if she has not voided in 8 hours.
4. Catheterize to check for residual urine after patient voids; should be less than 100 mL. Continue to check if more than 100 mL, or bladder infection may develop.
5. Encourage patient to empty bladder around the clock, not only when feeling the urge, because of loss of sensation of bladder fullness.
6. Encourage fluid intake to decrease risk of urinary infection.

Preventing Infection
1. Assess vaginal drainage amount, color, and odor, incision site, and temperature.
2. Administer antibiotics as prescribed.
3. Assist use of incentive spirometer, coughing and deep breathing, and ambulation to decrease risk of pulmonary infection.

Strengthening Body Image
1. Allow patient to discuss her feelings about herself as a woman.
2. Reassure patient she is still feminine.
3. Encourage patient to discuss her feelings with her spouse or significant other.
4. Reassure patient that she will not go through premature menopause if her ovaries were not removed.

Regaining Sexual Function
1. Discuss changes regarding sexual functioning, such as shortened vagina and possible dyspareunia because of dryness.
2. Offer suggestions to improve sexual functioning.
- Use of water-soluble lubricants.
- Change positionâ€”female-dominant position offers more control of depth of penetration.

Patient Education and Health Maintenance
1. Advise patient that a total hysterectomy with bilateral salpingo-oophorectomy produces a surgical menopause. Patient may experience hot flashes, vaginal dryness, and mood swings unless short-term hormonal replacement therapy is instituted.
2. Advise patient against sitting too long at one time, as in driving long distances, because of the possibility of blood pooling in the lower extremities, which increases the risk of thromboembolism.
3. Suggest patient delay driving a car until the third postoperative week because even pressing the brake pedal puts stress on the lower abdomen.
4. Tell patient to expect a tired feeling for the first few days at home and not to plan too many activities for the first week. She can perform most of her usual daily activities within 4 to 6 weeks, and feel like herself again within 2 to 3 months.
5. Tell patient not to feel discouraged if at times during convalescence she experiences depression, feels like crying, and seems unusually nervous. This is common, but will not last.
6. Remind patient to ask her surgeon about strenuous or lifting activities, which are usually restricted for 4 to 6 weeks.
7. Reinforce instructions given by the surgeon on intercourse, douching, and use of tampons, which are usually discouraged for 4 to 6 weeks. Sexual intercourse should be resumed cautiously to prevent injury and discomfort. Showers are permitted, but tub baths are deferred until healing is sufficient.
8. Instruct patient to report fever higher than 100آ°F (37.8آ°C), heavy vaginal bleeding, drainage, increased pain or cramping, and foul odor of discharge.
9. Emphasize the importance of follow-up visits and routine physical and gynecologic examinations.

Evaluation: Expected Outcomes
1. Verbalizes decreased pain
2. Voids every 4 to 6 hours of sufficient quantity
3. No fever or signs of infection
4. Verbalizes positive statements about self and positive outlook on recovery
5. Verbalizes understanding of possible changes in sexual functioning and what to do about it

Lippincott manual of nursing practice 8th

زهرة الامل · 2009- 12- 3

هذه نفس موضوع لبرزنتيشن حقنا

تعبت وانا ادور عنه

بعثره مشاعر · 2009- 12- 6

ههههههه
زهره أمل ايوه هذا مووضعنا
يللا اعرفيني

كارلوس · 2010- 9- 4

بالتوفيق يااختي

2009- 11- 22	#2
nurse_mohammad :: مشرف سابق:: منتدى كلية العلوم الصحية بالأحساء الملف الشخصي: رقم العضوية : 16648 تاريخ التسجيل: Sun Dec 2008 العمر: 36 المشاركات: 619 الـجنــس : ذكــر عدد الـنقـاط : 3247 مؤشر المستوى: 74 بيانات الطالب: الكلية: خريج كلية العلوم الصحية بالأحساء التخصص: تمريض المستوى: خريج جامعي	رد: مسااااااعده عاااااجله00 عليكم السلام و رحمة الله و بركاته حصلت حق hysterectomy ما ادري ينفع ولا لا ؟ عطيني خبر علشان اضيفهم في الرد :)

2009- 11- 22	#3
بعثره مشاعر أكـاديـمـي الملف الشخصي: رقم العضوية : 41268 تاريخ التسجيل: Fri Nov 2009 المشاركات: 3 الـجنــس : أنـثـى عدد الـنقـاط : 100 مؤشر المستوى: 0 بيانات الطالب: الكلية: الكليه الصحيه باالقطيف	رد: مسااااااعده عاااااجله00 مشكور اخوي ماتقصر اوكي نزلهم تحياتي00

2009- 11- 23	#4
nurse_mohammad :: مشرف سابق:: منتدى كلية العلوم الصحية بالأحساء الملف الشخصي: رقم العضوية : 16648 تاريخ التسجيل: Sun Dec 2008 العمر: 36 المشاركات: 619 الـجنــس : ذكــر عدد الـنقـاط : 3247 مؤشر المستوى: 74 بيانات الطالب: الكلية: خريج كلية العلوم الصحية بالأحساء التخصص: تمريض المستوى: خريج جامعي	رد: مسااااااعده عاااااجله00 سوري على التاخر المصدر كتاب لبنكوت Preoperative Management 1. qProcedure and reason for hysterectomy, what the procedure involves, and what to expect postoperatively are explained. 2. Patient must remain NPO from midnight the night before surgery and must void before surgery. 3. An enema is administered before surgery to evacuate the bowel and prevent contamination and trauma during surgery. 4. Vaginal irrigation is performed before surgery and skin preparation is done if ordered. 5. Preoperative medication is given to help the patient relax. Postoperative Management 1. Postoperatively, the following assessment is made: Wound appearance and drainage. Vital signs, level of consciousness. Level of pain. Vaginal drainage (serous, bloody). Intake and output. Urge to void, bladder distention, residual urine (if appropriate). Clarity, color, and sediment of urine. Homans' sign or impaired circulation. Return of bowel sounds, passage of flatus, first bowel movement. 2. Exercise and ambulation are encouraged to prevent thromboembolus, facilitate voiding, and stimulate peristalsis. Complications 1. Incisional/pelvic infection. 2. Hemorrhage. 3. Urinary tract injury. 4. Bowel obstruction. 5. Thrombophlebitis/deep vein thrombosis (DVT). Nursing Diagnoses 1. Acute Pain related to surgical procedure 2. Impaired Urinary Elimination related to decreased sensation and stimulation 3. Risk for Infection related to surgical procedure 4. Disturbed Body Image related to alteration in female organs and hormones 5. Sexual Dysfunction related to alteration in reproductive organs and function Nursing Interventions Relieving Pain 1. Assess pain location, level, and characteristics. 2. Administer prescribed pain medications. Ensure that patient knows how to use patient-controlled analgesia pump and is using it properly. 3. Encourage patient to splint incision when moving. 4. Encourage patient to ambulate as soon as possible to decrease flatus and abdominal distention. 5. Institute sitz baths or ice packs as prescribed to alleviate perineal discomfort. 6. Monitor level of sedation related to opioid administrationâ€”may interfere with ambulation and elimination. Promoting Urinary Elimination 1. Monitor intake and output, bladder distention, signs and symptoms of bladder infection. 2. Maintain patency of indwelling catheter if one is in place. 3. Catheterize patient intermittently if uncomfortable or if she has not voided in 8 hours. 4. Catheterize to check for residual urine after patient voids; should be less than 100 mL. Continue to check if more than 100 mL, or bladder infection may develop. 5. Encourage patient to empty bladder around the clock, not only when feeling the urge, because of loss of sensation of bladder fullness. 6. Encourage fluid intake to decrease risk of urinary infection. Preventing Infection 1. Assess vaginal drainage amount, color, and odor, incision site, and temperature. 2. Administer antibiotics as prescribed. 3. Assist use of incentive spirometer, coughing and deep breathing, and ambulation to decrease risk of pulmonary infection. Strengthening Body Image 1. Allow patient to discuss her feelings about herself as a woman. 2. Reassure patient she is still feminine. 3. Encourage patient to discuss her feelings with her spouse or significant other. 4. Reassure patient that she will not go through premature menopause if her ovaries were not removed. Regaining Sexual Function 1. Discuss changes regarding sexual functioning, such as shortened vagina and possible dyspareunia because of dryness. 2. Offer suggestions to improve sexual functioning. - Use of water-soluble lubricants. - Change positionâ€”female-dominant position offers more control of depth of penetration. Patient Education and Health Maintenance 1. Advise patient that a total hysterectomy with bilateral salpingo-oophorectomy produces a surgical menopause. Patient may experience hot flashes, vaginal dryness, and mood swings unless short-term hormonal replacement therapy is instituted. 2. Advise patient against sitting too long at one time, as in driving long distances, because of the possibility of blood pooling in the lower extremities, which increases the risk of thromboembolism. 3. Suggest patient delay driving a car until the third postoperative week because even pressing the brake pedal puts stress on the lower abdomen. 4. Tell patient to expect a tired feeling for the first few days at home and not to plan too many activities for the first week. She can perform most of her usual daily activities within 4 to 6 weeks, and feel like herself again within 2 to 3 months. 5. Tell patient not to feel discouraged if at times during convalescence she experiences depression, feels like crying, and seems unusually nervous. This is common, but will not last. 6. Remind patient to ask her surgeon about strenuous or lifting activities, which are usually restricted for 4 to 6 weeks. 7. Reinforce instructions given by the surgeon on intercourse, douching, and use of tampons, which are usually discouraged for 4 to 6 weeks. Sexual intercourse should be resumed cautiously to prevent injury and discomfort. Showers are permitted, but tub baths are deferred until healing is sufficient. 8. Instruct patient to report fever higher than 100آ°F (37.8آ°C), heavy vaginal bleeding, drainage, increased pain or cramping, and foul odor of discharge. 9. Emphasize the importance of follow-up visits and routine physical and gynecologic examinations. Evaluation: Expected Outcomes 1. Verbalizes decreased pain 2. Voids every 4 to 6 hours of sufficient quantity 3. No fever or signs of infection 4. Verbalizes positive statements about self and positive outlook on recovery 5. Verbalizes understanding of possible changes in sexual functioning and what to do about it Lippincott manual of nursing practice 8th
	التعديل الأخير تم بواسطة nurse_mohammad ; 2009- 11- 23 الساعة 02:36 AM

2009- 12- 3	#5
زهرة الامل أكـاديـمـي الملف الشخصي: رقم العضوية : 5284 تاريخ التسجيل: Fri Apr 2008 المشاركات: 51 الـجنــس : أنـثـى عدد الـنقـاط : 100 مؤشر المستوى: 68 بيانات الطالب: الكلية: الكليه الصحيه بالقطيف	رد: مسااااااعده عاااااجله00 هذه نفس موضوع لبرزنتيشن حقنا تعبت وانا ادور عنه

2009- 12- 6	#6
بعثره مشاعر أكـاديـمـي الملف الشخصي: رقم العضوية : 41268 تاريخ التسجيل: Fri Nov 2009 المشاركات: 3 الـجنــس : أنـثـى عدد الـنقـاط : 100 مؤشر المستوى: 0 بيانات الطالب: الكلية: الكليه الصحيه باالقطيف	رد: مسااااااعده عاااااجله00 ههههههه زهره أمل ايوه هذا مووضعنا يللا اعرفيني

2010- 9- 4	#7
كارلوس أكـاديـمـي الملف الشخصي: رقم العضوية : 58210 تاريخ التسجيل: Wed Sep 2010 المشاركات: 18 الـجنــس : ذكــر عدد الـنقـاط : 50 مؤشر المستوى: 0 بيانات الطالب: الكلية: كلية الاداره	رد: مسااااااعده عاااااجله00 بالتوفيق يااختي

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