INTRODUCTION

What is Total Abdominal Hysterectomy Bilateral-Salpingo-oophorectomy?

There are 2 parts of this surgery

1. Total abdominal hysterectomy, or TAH, is the removal of the uterus or womb.
The cervix is also removed.
2. Bilateral salpingo-oophorectomy, or BSO is the removal of the tubes and ovaries.

Indications OF TAH-BSO
Hysterectomy is often performed on cancer patients or to relieve severe pelvic pain
from things like, endometriosis or adenomyosis.
Hysterectomy is also used as a last resort for postpartum obstetrical haemorrhage or
uterine fibroids that cause heavy or unusual bleeding and discomfort in some women.
Transsexuals undergoing sex reassignment surgery as part of a female-to-male (FTM)
transition commonly have hysterectomies and oophorectomies to remove the primary
sources of female hormone production.
Risks & Side Effects OF TAH-BSO
Hysterectomy has been found to be associated with increased bladder
function problems, such as incontinence
When the ovaries are also removed, estrogen levels will fall.
This removes the protective effects of estrogen on the cardiovascular and skeletal
system.
A menopausal woman has a three times greater risk of developing
cardiovascular disease such as atherosclerosis, peripheral artery disease or of having
a heart attack when compared to premenopausal women
Studies have also found that the risk of developing osteoperosis may increase

Anatomy and Physiology

Female Reproductive System

Main Organs Involved

Vagina
Uterus
Oviduct
Ovaries

Vagina
Act as an organ of intercourse and to convey sperm to the cervixso that sperm can meet
with the ovum in the fallopian tube.
Complications: Vaginal Diseases: lumps, sores, discharge
Uterus
Its major function is to accept a fertilized ovum which becomes
implanted into the endometrium, and derives nourishment from blood vessels
which develop exclusively for this purpose.
If egg does not implanted the menstruation occurs.
Complication: Uterine Atony
Hysterectomy
Oviducts
Fallopian tubes or oviducts provide the fertilization site where the egg meets the sperm.
Complication: Pelvic Inflammatory, disease Salpingectomy
Ovaries
The main function is to produce, mature and discharge ova. Therefore, it is necessary for
maturation and maintenance of secondary characteristics in females.
Complication: Ovarian Cancer

POST OPERATIVE CARE:

Perform usual post-operative assessments.

Evaluate psychological manifestations
Monitor proximity of the bladder to the reproductive organ.
Monitor Foley catheter to prevent susceptibility to UTI and temporary urinary retention.
Assist GI functions by listening to bowel sounds.
Note distention and palpate whether abdomen is soft or firm.
Assess abdominal incision for bleeding and intactness.
Assess vaginal bleeding.
There is no distinct diet. Simple, strong, distinct flavors rather than complicated and multi-flavored dishes seem to be
preferred with anything with smaller-than-usual portions. Its best to avoid gassy foods like beans, broccoli and
cabbage and/or foods that typically cause gas for you. Many suggest avoiding extra-spicy foods. Remember that all
post op surgical patients need protein to aid in healing. Include fiber in your post op diet, drink lots of water,
and consume caffeinated drinks sparingly.
If pain is experienced during sexual intercourse let the patient manipulate the penetration.
Avoid heavy lifting for about 6 weeks to prevent straining the abdominal muscles and surgical sites.
Avoid activities that increase pelvic congestion such as aerobics activity, horseback riding and prolonged standing.
Report any fresh bleeding and any abnormal vaginal discharge to surgeon.
Return for follow-up care as requested by the surgeon
Post op pain and discomfort are common; therefore the nurse should assess its intensity and administer analgesics as
prescribed.
If the patient has abdominal distention or flatus, rectal tube and application of heat tithe abdomen may be
prescribed.
Encourage patient to contact nurse or surgeon when bleeding is excessive.
Encourage early ambulation to facilitate the return of normal peristalsis
Monitor and manage potential complications such as:
o Hemorrhage: Count perineal pads used, assess the extent of saturation with blood and monitor vital signs.
Guidelines for activity restriction are given above to promote healing and prevent post-operative bleeding

Deep Vein Thrombosis: Encourage and assist patient to change position frequently and exercise leg and feet while in
bed. Instruct patient to avoid prolonged sitting in the chair with pressure on the knees, sitting cross legs and inactivity

Postoperative Care
Main Article: TAHBSO Surgical Procedure and Perioperative Management
1.

Determines patients immediate response to surgical intervention.

2.

Monitor patients physiologic status.

3.

Assess patients pain level and administers appropriate pain relief measures.

4.

Maintains patients safety(airway, circulation, prevention of injury)

5.

Administer medication, fluid and blood component therapy, if prescribed.

6.

Assess patients readiness for transfer to in hospital unit or for discharge home based on institutional policy.

"Shake It Off"
I stay out too late
Got nothing in my brain
That's what people say, mmm-mmm
That's what people say, mmm-mmm
I go on too many dates [chuckle]
But I can't make them stay
At least that's what people say, mmm-mmm
That's what people say, mmm-mmm
But I keep cruising
Can't stop, won't stop moving
It's like I got this music
In my mind
Saying, "It's gonna be alright."
'Cause the players gonna play, play, play, play, play
And the haters gonna hate, hate, hate, hate, hate
Baby, I'm just gonna shake, shake, shake, shake, shake
I shake it off, I shake it off
Heart-breakers gonna break, break, break, break, break
And the fakers gonna fake, fake, fake, fake, fake
Baby, I'm just gonna shake, shake, shake, shake, shake
I shake it off, I shake it off
I never miss a beat
I'm lightning on my feet
And that's what they don't see, mmm-mmm
That's what they don't see, mmm-mmm
I'm dancing on my own (dancing on my own)
I make the moves up as I go (moves up as I go)
And that's what they don't know, mmm-mmm
That's what they don't know, mmm-mmm

Heart-breakers gonna break, break, break, break, break

And the fakers gonna fake, fake, fake, fake, fake
Baby, I'm just gonna shake, shake, shake, shake, shake
I shake it off, I shake it off
Shake it off, I shake it off,
I, I, I shake it off, I shake it off,
I, I, I shake it off, I shake it off,
I, I, I shake it off, I shake it off
Hey, hey, hey
Just think while you've been getting down and out about the liars
and the dirty, dirty cheats of the world,
You could've been getting down to this sick beat.
My ex-man brought his new girlfriend
She's like "Oh, my god!" but I'm just gonna shake.
And to the fella over there with the hella good hair
Won't you come on over, baby? We can shake, shake, shake
Yeah ohhh
'Cause the players gonna play, play, play, play, play
And the haters gonna hate, hate, hate, hate, hate (haters gonna
hate)
I'm just gonna shake, shake, shake, shake, shake
I shake it off, I shake it off
Heart-breakers gonna break, break, break, break, break (mmmm)
And the fakers gonna fake, fake, fake, fake, fake (and fake, and
fake, and fake)
Baby, I'm just gonna shake, shake, shake, shake, shake
I shake it off, I shake it off
Shake it off, I shake it off,
I, I, I shake it off, I shake it off,
I, I, I shake it off, I shake it off
I, I, I shake it off, I shake it off

But I keep cruising

Can't stop, won't stop grooving
It's like I got this music
In my mind
Saying, "It's gonna be alright."

Shake it off, I shake it off,

I, I, I shake it off, I shake it off,
I, I, I shake it off, I shake it off,
I, I, I shake it off, I shake it off

'Cause the players gonna play, play, play, play, play

And the haters gonna hate, hate, hate, hate, hate
Baby, I'm just gonna shake, shake, shake, shake, shake
I shake it off, I shake it off

Shake it off, I shake it off,

I, I, I shake it off, I shake it off (you've got to),
I, I, I shake it off, I shake it off,
I, I, I shake it off, I shake it off