Case Studies

Case 10: A woman with fibroid undergoing sub-total hysterectomy (Part 12 The female reproductive system)

Miss Angela Parker is a 48-year-old secretary and has no children. Two of Miss Parker's bothers live close by. Angela has usually enjoyed good health, with no previous medical or surgical history. Angela has been experiencing changes with her menstrual cycle for the last year or so and has been complaining of abdominal and suprapubic pain; this leads Angels to go and see her GP. She undergoes investigative surgery and it is revealed that Angela has large fibroids that are invading her uterine wall. Angela is to undergo a sub-total hysterectomy. Her ovaries will be conserved as she has not yet experienced the menopause.

The operation is performed abdominally; she has a nasogastric tube in situ that is to be aspirated and until bowel sounds can be confirmed she remains nil by mouth. There is an intravenous infusion in progress: one litre with normal saline and 20 mmols of potassium chloride; her urinary catheter is draining straw coloured urine. Her pain is being controlled with the use of patient-controlled analgesia containing morphine sulphate. Angela has returned to the ward with an abdominal dressing and a wound drain.

• 1. Explain the importance of pain control. What do you understand by the WHO analgesic ladder?

• 2. Why is it important to maintain fluid balance? How would you ensure this in this case?

• 3. How do you undertake a risk assessment associated with prevention of pressure sores?

• 4. What are leiomyomata?

Take some time and give careful consideration to the long-term implications for the woman who has undergone a sub-total hysterectomy. Consider this from a physical and psychosocial perspective.