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Eman Abu alfawarisEman Abu alfawaris

Gynecological surgical careGynecological surgical care Preoperative carePreoperative care--1 1 admission to hospital :admission to hospital :Usually two days prior to major elective surgery.Usually two days prior to major elective surgery.2-Ceasing of the “pill”:2-Ceasing of the “pill”: you must assure from the pills ceased at least 6 weeks prior to you must assure from the pills ceased at least 6 weeks prior to

admission, and if the patient still take it within that time, you must admission, and if the patient still take it within that time, you must notify the doctors to notify the doctors to avoid thrombosis.avoid thrombosis.

33- - date of the last menstrual perioddate of the last menstrual period always checked, to exclude any possibility of pregnancyalways checked, to exclude any possibility of pregnancy4- Consent forms:4- Consent forms:May require the signature of both patient and her husband May require the signature of both patient and her husband 5 5 -specific investigation:-specific investigation: - urine- urine - blood test- blood test -Chest x-ray-Chest x-ray - Vaginal examination- Vaginal examination

Specific Preparations:Specific Preparations:11 - -skin preparationskin preparation::

For abdominal operation abdomen and pubic areas are shovedFor abdominal operation abdomen and pubic areas are shoved.. For vaginal and perineal procedures pubic to anus , and vulva For vaginal and perineal procedures pubic to anus , and vulva

shave is done, extended to the mid – thighsshave is done, extended to the mid – thighs..

22 - -blood preparationblood preparation33 - -enema: 1200ml tap-water is usually given on evening before enema: 1200ml tap-water is usually given on evening before

surgerysurgery44 - -vaginal preparationvaginal preparation::

cleaning douches are done to remove excessive or cleaning douches are done to remove excessive or infective ,discharge I certain casesinfective ,discharge I certain cases

55 - -vaginal or cervix ulceration: it is treated by admission to the vaginal or cervix ulceration: it is treated by admission to the hospital several days prior to operation. Bed rest and twice daily hospital several days prior to operation. Bed rest and twice daily packing if the vagina with gauze soaked in a suitable antiseptic packing if the vagina with gauze soaked in a suitable antiseptic solutionsolution..

The postoperative periodThe postoperative period

1-unless there is a specific contraindication, and the women are 1-unless there is a specific contraindication, and the women are fully recovered consciousness , the nurse supported by 3-5 fully recovered consciousness , the nurse supported by 3-5 pillowspillowsزز

2- deep breathing and coughing2- deep breathing and coughing 3- early ambulation is encouraged3- early ambulation is encouraged 4- sips of fluid are offered hourly and increase as tolerated4- sips of fluid are offered hourly and increase as tolerated 5- close observation of the patient 5- close observation of the patient 6- voiding , specially in the patient who not need for 6- voiding , specially in the patient who not need for

catheterization , it is difficult to observe the distended bladder if catheterization , it is difficult to observe the distended bladder if the lower abdominal dressing are presentthe lower abdominal dressing are present

7- administer pain relief medication7- administer pain relief medication

Specific gynecological careSpecific gynecological care1-Vaginal packs1-Vaginal packs

The pack is removed after 24 hrs or as instructed. It must gently removed , The pack is removed after 24 hrs or as instructed. It must gently removed , giving as analgesic before removal help to reduce patient pain , the giving as analgesic before removal help to reduce patient pain , the nurse document the procedure ( removal) in the patient chart . Usually nurse document the procedure ( removal) in the patient chart . Usually after the removal some of the vaginal blood loss occur and must after the removal some of the vaginal blood loss occur and must carefully observed.carefully observed.

2- Bladder management:2- Bladder management:

urinary tract infection and retention of urine are the commonest urinary tract infection and retention of urine are the commonest problems encountered after pelvic surgery.problems encountered after pelvic surgery.

*health education to prevent that :*health education to prevent that :

1- fluid intake is encourage , it must be kept up to at least 3 l\day1- fluid intake is encourage , it must be kept up to at least 3 l\day

2- accurate recorded of the intake and output2- accurate recorded of the intake and output

3- urine frequency associated with burning may indicate for cystitis , that 3- urine frequency associated with burning may indicate for cystitis , that must good treated to prevent uterine and kidneys infectionmust good treated to prevent uterine and kidneys infection

4- most gynecological surgery followed by indwelling catheter 4- most gynecological surgery followed by indwelling catheter specially specially after anterior vaginal wall repair to prevent pain and dysuria, and after anterior vaginal wall repair to prevent pain and dysuria, and distention distention

The catheter usually removed after 3-5 days .The catheter usually removed after 3-5 days .

3- prevent constipation: it is important to avoid it , because it 3- prevent constipation: it is important to avoid it , because it associated starting can place under stress or suture associated starting can place under stress or suture line .medication assist bowel movement aren’t usually given at line .medication assist bowel movement aren’t usually given at the third night after surgery.the third night after surgery.

The effect of any disorder on the patient’s view of her own sexualityThe effect of any disorder on the patient’s view of her own sexuality--it is important to assess the mobility of the patient’s hips and check for it is important to assess the mobility of the patient’s hips and check for

any spinal problems so she can safely placed into lithotomy position any spinal problems so she can safely placed into lithotomy position for surgeryfor surgery

@ @ Postoperative carePostoperative care:: 11 - -assess the degree of blood lossassess the degree of blood loss

22 - -assure that patient pass urine before dischargeassure that patient pass urine before discharge note” when slight to moderate blood loss observed , the pad should note” when slight to moderate blood loss observed , the pad should

changed on at least ever other occasion , but when blood loss is changed on at least ever other occasion , but when blood loss is heavy must change the pad frequently and must notify the doctorsheavy must change the pad frequently and must notify the doctors. .

@ @ discharge advicedischarge advice: : 11 - -bleeding usually continue for about 10-14 days post- operatively. bleeding usually continue for about 10-14 days post- operatively.

If it persists or become heavy and bad odors the patient must inform If it persists or become heavy and bad odors the patient must inform the doctorsthe doctors. .

22 - -patient may resume work 4-7 days after the surgerypatient may resume work 4-7 days after the surgery 33--patient may resume her sexual activity after 14 days or when bleedind patient may resume her sexual activity after 14 days or when bleedind

ceasedceased..44 - -follow up in the outpatient clinic 6 weeks after dischargefollow up in the outpatient clinic 6 weeks after discharge

Wound careWound care

1- the dressing should provide a warm, moist, acidic environment at the 1- the dressing should provide a warm, moist, acidic environment at the wound surfacewound surface

2- the best cleansing solution is warmed normal saline2- the best cleansing solution is warmed normal saline

3- purpose of wound cleaning is to remove the debris and microorganisms 3- purpose of wound cleaning is to remove the debris and microorganisms that might delay healing or cause infectionthat might delay healing or cause infection

4- the wound should not left exposed either , as it best kept at a 4- the wound should not left exposed either , as it best kept at a temperature of 37ctemperature of 37c

5- repeated cleaning could do more harm than good , unnecessary 5- repeated cleaning could do more harm than good , unnecessary cleaning and dressing traumatize new delicate tissue, cool the wound cleaning and dressing traumatize new delicate tissue, cool the wound and remove the bactericidal exudatesand remove the bactericidal exudates

DrainsDrains

1- removal is determined by the decreasing in 1- removal is determined by the decreasing in amount of drainage amount of drainage

2- aseptic technique is employed the suture 2- aseptic technique is employed the suture cut or safety pin removed and the drain cut or safety pin removed and the drain carefully slid out , while the patient takes a carefully slid out , while the patient takes a series of deep breathsseries of deep breaths..

3- the sit is likely to seep for a while ,so an 3- the sit is likely to seep for a while ,so an absorbent dressing needs to be applied. absorbent dressing needs to be applied.

Blood transfusionBlood transfusion

The patient will be observed for the signs and The patient will be observed for the signs and symptoms of adverse reaction or any complication of symptoms of adverse reaction or any complication of blood transfusion:blood transfusion:

1- Allergic reaction 1- Allergic reaction

2- circulatory overload2- circulatory overload

3- disease3- disease transmission transmission

4- a pyrogenic reaction 4- a pyrogenic reaction

5- bacterial contamination5- bacterial contamination

6- hemolytic reaction and incompatibility6- hemolytic reaction and incompatibility

7- hyperkalaemia 7- hyperkalaemia

8- hypocalcaemia , air embolism 8- hypocalcaemia , air embolism

Post- operative nutritional carePost- operative nutritional care

Protein Protein several reason exists for this increased protein demand :several reason exists for this increased protein demand :1- building tissue , the process of wound healing 1- building tissue , the process of wound healing 2- controlling shock , sufficient supply of plasma protein id necessary to 2- controlling shock , sufficient supply of plasma protein id necessary to

protect the blood volume, and the shock symptoms result from a protect the blood volume, and the shock symptoms result from a shrinking blood volume and the body effort to restore it . shrinking blood volume and the body effort to restore it .

3- controlling edema : when the serum protein level is low , edema will 3- controlling edema : when the serum protein level is low , edema will develop and generalize edema may effect heart and lungdevelop and generalize edema may effect heart and lung

4- healing bone: it is essential for bone formation4- healing bone: it is essential for bone formation5- resisting infection: protein provide defense against infection 5- resisting infection: protein provide defense against infection

*food sources of protein *food sources of protein - animal source: as milk, meat, egg- animal source: as milk, meat, egg plant sources as cereal, bread, legumes, vegetables, and fruits plant sources as cereal, bread, legumes, vegetables, and fruits

Water

sufficient fluid intake is necessary to prevent dehydration. During post operative period , large water losses may occur from vomiting , hemorrhage, fever .