Nursing Care for a Patient with Uterine Fibroids Undergoing Abdominal Surgery Complicated by Anemia: A Case Study.
Keywords:
Myoma Uteri, Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH with BSO), Postoperative Nursing Care, Surgical MenopauseAbstract
This case study aimed to describe comprehensive nursing care across the preoperative, postoperative, and discharge planning phases for a patient undergoing TAH with BSO. A 50-year-old Thai female diagnosed with myoma uteri with hypermenorrhea was admitted for scheduled TAH with BSO and appendectomy. Assessment revealed key health problems Preoperative phase: High level of anxiety regarding the surgical procedure, physical alterations, loss of fertility, and post-hysterectomy sexual performance, as well as sleep pattern disturbance due to nocturia caused by tumor pressure on the bladder. Postoperative phase: Acute incisional pain from a 16-cm abdominal wound (pain score = 8/10), risk of anemia and hypoxia secondary to an intraoperative blood loss of 600 mL (postoperative HCT 27%), post-surgical abdominal distension due to decreased intestinal motility, and risk of surgical site infection. Discharge planning phase: Anxiety regarding surgical menopause and changes in sexual health patterns, alongside a deficit in knowledge regarding post-discharge self-care.
Result: Patient-centered nursing care was implemented. Preoperatively, therapeutic communication, emotional support, and surgical education successfully alleviated anxiety, stabilizing vital signs. Postoperatively, pain management reduced the pain score to 2–3/10, allowing early ambulation. Packed red blood cell (PRC) transfusion (1 unit) safely corrected anemia (HCT increased to 30%) with no hypoxic signs. Early ambulation and antiflatulents promoted bowel motility, relieving abdominal distension. Aseptic wound care prevented surgical site infection, and the wound healed well. Discharge preparation using the D-METHOD enabled the patient and her spouse to demonstrate a correct understanding of home care, surgical menopause management, sexual health guidelines, and red-flag symptoms prior to safe discharge.
References
National Center for Biotechnology Information. (2026). Uterine leiomyomata. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546680/
Ozbey, G., & Yilmaz, E. (2025). Myoma uteri: Pathogenesis, clinical presentation, and current management strategies. European Archives of Medical Research, 41(2), 61–68. https://doi.org/10.14744/eamr.2025.37267
Marsh, E. E., Al-Hendy, A., Kappus, D., Galen, D. I., & Taylor, H. S. (2024). Burden, diagnosis, and management of uterine fibroids. JAMA, 331(18), 1561–1571. https://doi.org/10.1001/jama.2024.3120
American College of Obstetricians and Gynecologists. (2021). Management of symptomatic uterine leiomyomas (ACOG Practice Bulletin No. 228). Obstetrics & Gynecology, 137(6), e100–e115. https://doi.org/10.1097/AOG.0000000000004401
Mays, R. M., & Le, C. Q. (2022). Psychological impacts, body image concerns, and sexual health after hysterectomy for benign conditions: A systematic review. Journal of Women's Health & Gynecological Care, 7(1), 15–24.
สิริพร สุวรรณฉัตร, พรนภา หอมกลิ่น, และ รัตนาภรณ์ อาษา. (2564). ผลของโปรแกรมการส่งเสริมการรับรู้และความรู้ต่อการปรับตัวหลังผ่าตัดในผู้ป่วยเนื้องอกมดลูกที่ได้รับการผ่าตัดตัดมดลูก. วารสารการพยาบาลและการดูแลสุขภาพ, 39(2), 45–54.
