[LizzyL&DRN]

We occasionally get gyn patients up on our OB floor (hysterectomies, anterior and posterior repairs, etc). I've never actually cared for one, but lately we've seen an increase in how many we get. I assume caring for the abdominal hysterectomies is much like caring for c sections minus the lochia. What about the A&P repairs? What are complications that we need to watch them for? Do they have a lot of bleeding and/or pain? Anyone cared for GYN patients that had any severe problems? Thanks for your experiences. I feel so uneasy when i'm assigned to a patient that i'm not familiar w/ taking care of. Thats why I HATE being floated to NICU or PEDS.

[SmilingBluEyes]

The big thing I see w/GYNs is often they are older with comorbidities, unlike most healthy and young OB pts. SO they can get to be a lot like med-surg patients. They have a laundry list of meds and medical problems you have to watch, not just the surgical concerns. Also, too, you have to watch certain GYNs if they have had bladder slings or repairs for prolapses. You have to make sure they can void and how well they do. We have to do voiding trials for such patients. If they have residual urine, we have to re-cath them. We use a bladder scanner for post-void residual checks. This is something you will have to do for all bladder surgical pts. Bleeding is not usually a huge issue with them, thankfully. Maybe mild/light hematuria, but even that is unusual to rare.

Hysterectomy patients are not that hard to care for---like you said, much like c/sections. Watch for the usual concerns: bleeding, infection, etc. Make sure if they are getting narcs they get stool softeners and pay attention to bowel status---e.g. passing flatus, etc. You watch the wound much like you do a c/section one. Where I am, we are to d/c the abd bandage the 1st day post op. as well as get them up to ambulate the evening after surgery or early the next morning. Make sure they are doing their incentive spirometry as instructed. It's important they cough and deep breathe often to avoid atelectasis/pneumonia complications. They also will often come up with Ted hose/sequential compression devices (SCDs) to prevent clotting in the legs. I recommend getting them up to ambulate early and often----then they can lose the SCDs, with their pumping that annoys the heck out of so many. Walking/moving is CRITICAL for these folks---esp since some of them are neither young nor healthy.

For vaginal hysterectomies, often, they come up with vaginal packing that is only barely visible by a "pigtail" at the introitus---so watch this. Be sure to ask if they do have it or not. IF so, ask when you are to d/c this packing, or is the doctor going to do so. Never remove the packing unless ordered by the doctor. Warn the pts they may feel like they have full bowels---that is a normal sensation with vaginal packing and will subside when it is removed, usually the next morning.

For all hysts, watch vaginal bleeding---how many pads used/clots, etc. Vaginal hysterectomy pts tend to do better----they get up sooner and move better but they cramp like the DICKENS---so have the toradol/motrin handy as well as warm blankets/warm packs for the abdomen.

Pain control can be an issue like with c/section pts. Ours usually come up with morphine or fentanyl PCA pumps and toradol 30 mg IVP/IM every 6 hours for post op pain control. Make sure you are aware of how much medication for pain was used in PACU----some come up still quite sedated from a LOT of pain meds in the PACU so watch their O2 sats like a hawk. ALL our GYN pts must be on sat monitors at least overnight and for the duration of PCA use. Some will need supplemental oxygen to keep sats up. Make sure all alarms are clearly heard from nurses' station. Oversedation, while not an everyday thing, is not uncommon in these pts as they get a lot meds immediately post op for nausea and pain. Just be ready. Be prepared for a lot of nausea---sometimes from the morphine, other times, due to general anesthesia. N/V is very common for these poor ladies. So go slow on the diet advances and make sure you have lots of nausea meds ordered for them.

Where I work, we do all kinds of GYN surgical pts, hysts, bladder slings, posterior/anterior repairs, etc. It does make it nice in that there is variety to my day.

Does this help?

[daisybaby]

Smilingblueyes hit everything on the button. Perfectly explained!

[cisco]

I worked GYN surgeries for 10 years. The worst case senarios I saw were retroperitoneal bleeding and PE's...so of course, watch for changes in vitals, coloring, abdominal girths, and any unusual anxiety, SOB. Remind them often to do their IS, TCDB and ambulation tid.

[Almabella]

Originally Posted by cisco

I worked GYN surgeries for 10 years. The worst case senarios I saw were retroperitoneal bleeding and PE's...so of course, watch for changes in vitals, coloring, abdominal girths, and any unusual anxiety, SOB. Remind them often to do their IS, TCDB and ambulation tid.

TCDB? what's that?

[SmilingBluEyes]

TCDB means:
Turn
Cough
Deep-Breathe.