N201 Renal Reproductive

• Hysterectomy


  • Total Abdominal Hysterectomy
  • Vaginal Hysterectomy
  • Lap assisted Vag Hysterectomy
  • Vaginal Hysterectomy with Bilateral Salpingo-Oopherectomy (TAH-BSO)
  • Surgical removal of the cervix, uterus, fallopian tubes and ovaries through an incision in vaginal wall
  • Laparoscopic Hysterectomy with Salpingectomy
  • Robot Assisted Laparoscopic Hysterectomy
• Indications for Hysterectomy


  • Malignancy
  • Fibroids; Benign tumors with symptoms – pain, bleeding, anemia
  • Elective – decrease risk of ovarian Cancer
  • Uterine prolapse
  • Endometriosis
  • Pelvic inflammatory disease – symptomatic
• Post Operative Assessment


  • S&S of infection
  • Vaginal bleeding; watch for hemorrhage
  • Emotional support
  • Pain management
  • Treat PONV
• Complications PO


  • Urinary retention – d/t temporary bladder atony from manipulation, edema, nerve trauma
  • Surgically induced menopause – estrogen deficiency
  • Ligation of ureter – may present with decreased UO, backache, severe abdominal pain as a result of laparoscopic hysterectomy
• Discharge teaching


  • Vaginal packing removed POD1 (vag hyst) prior to D/C; more recently see removal of foley and packing 6 hrs PO
  • Pain management
  • Avoid strenuous exercise, heavy lifting, heavy housework for 6 weeks
  • Patient may drive after 2-3 weeks post surgery (check with surgeon)
  • Return to work – 4-6 weeks (also check with surgeon)
  • Resume sexual intercourse in 6 weeks (or wait until PO check up and physician approval)
  • Avoid tub baths
  • Sanitary pad use for vag bleeding – may last a few weeks (vag Hyst)
  • No tampons
  • Disturbed body image; loss of ability to conceive
  • Seek physician help w signs of depression/poor coping
• Anterior/Posterior Vaginal Repair with Transvaginal Obturator Taping

  • The vaginal wall can become torn or stretched due to either bladder prolapse (cystocele) or rectal prolapse (rectocele).
  • Prolapse is when an organ protrudes into another anatomical space due to the weakening or collapse of its supporting tissues & muscles.
  • Cystocele and Rectocele repair are commonly referred to as Anterior/Posterior Vaginal Repair surgery.
  • These two prolapses can occur at the same time or individually
  • Done mainly to relieve stress incontinence
• Anterior/Posterior Vaginal Repair with Transvaginal Obturator Taping

  1. During the surgical process, the vaginal wall will be repaired via sutures, while the bladder and rectum are lifted back up into their proper anatomical space.

  2. Transvaginal obturator taping is used to lift the bladder back into its correct anatomical space, preventing recurrent prolapse or hernia of the bladder through the vaginal wall.

  3. Mesh may be used to repair the posterior vaginal wall to support the rectum after it has been lifted.
• Who is at risk?

  • Females who have experienced bladder or rectal prolapse from the following:
  • Post-child birth
  • Menopausal women (45+)
  • Heavy lifting
  • Post hysterectomy
  • Chronic constipation (rectocele)
• Discharge


  • PO – prevent straining for a bowel movement
  • May need progression from liquid to low residue diet initially
• Nephrectomy


  • Performed to remove cancer (renal tumour), diseased or infected kidney, polycystic kidney, traumatic injury to kidney
  • Healthy kidney for transplant
• Nephrectomy Approaches


  • Open Nephrectomy – Flank incision
  • Laparoscopic Radical Nephrectomy – 5 puncture sites
• Advantages of Laparoscopic Nephrectomy

  • Less painful
  • Requires no sutures or staples
  • Shorter hospital stay
  • Faster recovery
• Diagnostics/postoperative assessment


  • eGFR – kidney filtration
  • Creatinine
  • Blood Urea levels
  • Hydration
  • Monitor intake and output
  • Foley catheter – may be removed POD1 or 2
  • Often have a JP drain – watch sanguineous output
• Complications of Nephrectomy


  • Pain management – may have epidural infusion/PCA
  • F&E imbalances d/t kidney's role in regulation
  • Urinary retention
  • Hydronephrosis
  • Infection
  • Hemorrhage: Decreased U/O, decreased BP
• Cystectomy with Ileal Conduit

  • Radical cystectomy – removal of bladder, prostate, seminal vesicles in men; bladder, uterus, cervix, urethra and ovaries in women
  • Ileal conduit – urinary diversion to the skin requiring an appliance
  • Incontinent urinary diversion procedure
  • Ileal loop – segment of ileum is converted into a conduit for urinary drainage
  • Ureters anastomosed to one end; other end is brought to abdominal wall to form a stoma
  • Requires a permanent external collecting device
• Nursing assessment


  • Skin integrity around stoma – prevent leakage of urine
  • Color, warmth of stoma
  • Urine output into urostomy bag – color, amount
  • Surgical site
  • Expected fining: mucus shreds present in urine – secreted by intestines d/t irritation of urine
• Complications


  • abdominal distention
  • paralytic ileus- d/t bowel manipulation/removal
• PO Management


  • High fluid intake – flush the ileal conduit
  • Encourage mobilizing
  • DB&C to prevent atelectasis
  • Bowel protocol
  • Pain management
  • Body image/acceptance; patient fear of stoma; teaching & support
• TUPR/TURP


  • Transurethral Prostatectomy
  • Surgical removal of prostate tissue using a resectoscope; variation using laser
  • Purpose – to treat BPH – benign prostatic hyperplasia
• TUPR interventions

  1. 3-way foley catheter inserted – to provide hemostasis, and promote urinary drainage

  2. CBI – continuous bladder irrigation established PO for approx. 12 hours prior to d/c to prevent obstruction of urethra from blood clots

  3. Overnight stay for patients with OSA

  4. May go home with foley for 48 hrs; Instructions on cutting balloon port to deflate balloon and remove foley at home
• D/C teaching: TUPR/TURP


  • Push fluids, watch for urinary retention
• Radical Retropubic Prostatectomy


  • Removal of entire prostate gland, seminal vesicles, part of the bladder neck; lymph node dissection
  • Reason – cancer
• Radical Retropubic Prostatectomy Approaches

  • Retropubic - low Midline abdominal incision
  • Suprapubic – midline abdominal incision
• Radical Retropubic Prostatectomy


  • Brief hospital stay
  • Patient goes home with a catheter for 2-3 weeks
  • Most common LT complication=Incontinence
  • May have a JP drain – removed pre D/C
  • Typical hospital stay 2-3 days
• Two Major Complications of urethral reconstruction


  • Erectile dysfunction - Procedure destroys the nerves responsible for erection; Incidence is dependent on the client's age, preoperative sexual functioning, and whether nerve-sparing surgery was performed
  • Incontinence - Expected for first few months d/t surgical reattachment of bladder to urethra after the prostrate is removed
• Other complications


  • Hemorrhage
  • Urinary retention
  • Infection
  • Wound dehiscence
  • DVT
  • PE
• Mastectomy


  • Modified radical mastectomy with or without reconstruction are currently the most common options for resectable breast cancer (Lewis)
  • Modified Radical Mastectomy – removal of the breast and axillary lymph nodes preserving the pectoralis major muscle
  • Radical – includes pectoral muscles, all fat and adjacent tissue
• Mastectomy


  • Day surgery; usually D/C POD1
  • Expect 1-2 JP drains – to remove blood and lymph fluid accumulation at surgical site
  • Typically pt goes home with drains in place
• PO Nursing Management: Mastectomy

  • Pain management; wound assessment; VS
  • Drain assess – observe, empty, record drainage/teach pt
  • Patient in semi-fowlers
  • Protect surgical arm – no BP readings, venipuncture, injections
• PO complication


  • Lymphedema- d/t removal of lymph nodes
  • Post-mastectomy pain syndrome – chest, upper arm pain, tingling down arm, numbness, shooting pain, itching persists > 3 months
• Patient teaching


  • on drain care – remains in 1-2 weeks post surgery
  • Exercises to restore arm function and prevent contractures
  • Resources, support for altered body image; refer to community supports
  • NO BP on Side of Mastectomy
• Standard PO assess


  • Systems – head to toe assessments
  • Monitor VS; incision
  • Watch for Signs of Infection
  • Pain management
  • Monitor Lab Values
  • DB&C
  • Mobilizing
  • Patient teaching pre discharge
• General anesthetic most common; some surgery done under spinal
• Standard D/C teaching


  • Incisional care; S&S of infection
  • Follow up appointment with surgeon; family doctor
  • Prevent constipation
  • Hydration; Fluid intake
  • Urinary Retention
  • Often recommend showering, no bathing
  • Avoid heavy lifting/straining
  • 6 weeks recovery
  • Catheter care; leg bag instructions for RRP; TURP
• Gender affirming surgery


  • Surgical procedures that alter the physical characteristics of individuals to align with their gender identity.
  • Part of a broader approach to gender-affirming care, which includes hormone therapy, mental health support, and social transition
• Gender affirming surgery


  • Top Surgery (Chest Reconstruction)
  • Bottom Surgery (Genital Reconstruction)
• Postoperative care: Top surgery

  • Monitor for postoperative complications such as bleeding, infection, and hematoma formation., golf size lump close to the incision site (report to surgeon).
  • Provide wound care and assess for proper healing of incisions.
  • Educate patients on chest binding techniques (if applicable) and proper care of surgical drains, if used.
  • Manage pain effectively with appropriate analgesics.
  • Assist with mobility and positioning to promote comfort and prevent complications.
  • Monitor for psychological well-being and provide emotional support during the recovery period.
• Postoperative care: bottom surgery

  • Monitor closely for surgical site complications such as infection, dehiscence, and necrosis.
  • Provide wound care and assess for proper healing of surgical incisions.
  • Educate patients on dilation protocols (if applicable) and proper hygiene practices for the surgical area.
  • Manage pain and discomfort with appropriate pain management strategies.
  • Assist with urinary catheter care and management of drains, if present.
  • Monitor for signs of urinary retention or other urinary complications.
  • Provide education on sexual function and intimacy post-surgery, including potential changes and adaptations.
  • Provide privacy for initial viewing and provide space for the client to express feelings and emotions.