Gynecological Nursing Considerations

Questions and Answers

What is required for all vaginal procedures in terms of counts?

Only a final count is required

Only an initial count is required

A minor count for initial, closing, and final counts is required (correct)

A major count is required for all vaginal procedures

Which instrument is primarily used to grab the cervix during vaginal procedures?

Uterine curettes

Weighted speculum

Tenaculum (correct)

Ovum forceps

In open surgical procedures, what type of count is mandatory?

Only an initial count is required

No counts are required

A major count and a closing count are required (correct)

Only a closing count is required

What instrument set is commonly used in laparoscopic approaches?

Laparoscopic Instrument set Signup and view all the answers

When is an additional closing the vault count required in surgical procedures?

When the cervix is removed or entered Signup and view all the answers

What is the purpose of forced-air warming blankets during surgery?

To reduce the risk of hypothermia Signup and view all the answers

What type of count is performed at the end of all open, laparoscopic, or combined procedures?

A final count and a major count Signup and view all the answers

Which instrument is specifically used for tough tissue during surgical procedures?

Long curved mayo scissors Signup and view all the answers

What is the primary indication for using a vaginal hysterectomy?

Small uteri with history of cancer Signup and view all the answers

Which medium should not be used during procedures involving cautery to avoid interference?

Normal saline Signup and view all the answers

What is a complication associated with procedures involving ablation?

Hyponatremia Signup and view all the answers

What type of laser is commonly used in procedures for endometrial ablation?

Nd:YAG Laser Signup and view all the answers

Which technique involves the use of a uterine mobilizer during hysteroscopy?

Blanching technique Signup and view all the answers

What is the role of dye medium in hysteroscopy?

To visualize the uterus and check for blockage Signup and view all the answers

Which sign is NOT associated with hyponatremia during ablation procedures?

Hypoglycemia Signup and view all the answers

What is required to visualize internal uterine cavity during hysteroscopy?

Normal saline Signup and view all the answers

What is the primary function of the ovaries?

To produce eggs and support embryo development Signup and view all the answers

Which assessment is NOT typically included in a patient's gynecological history?

Recent infections Signup and view all the answers

What positions are commonly used for patients undergoing laparoscopic surgeries?

Various lithotomy positions Signup and view all the answers

Which factor should be considered to prevent nerve injuries when positioning a patient in lithotomy?

Limiting hip flexion to no more than 90 degrees Signup and view all the answers

What is a potential complication that may require surgical intervention in the ovaries?

Ovarian cyst formation Signup and view all the answers

Why is it important to confirm blood product availability pre-, intra-, and post-operatively?

To manage potential extensive tissue dissection Signup and view all the answers

What should be done when removing the patient's legs from the stirrups after surgery?

Slowly and with coordinated support Signup and view all the answers

Which of the following is NOT a role of the perioperative nurse?

Performing surgical procedures independently Signup and view all the answers

What is a significant consideration when performing a radical hysterectomy?

Instruments used are kept isolated due to cervix contamination. Signup and view all the answers

What is the primary goal of a Bilateral Salpingo-Oophorectomy (BSO)?

To preserve both ovaries in women under 45 years old. Signup and view all the answers

In a radical hysterectomy, which structures are typically removed?

Uterus, cervix, fallopian tubes, ovaries, and supporting ligaments. Signup and view all the answers

What can cause a vesicovaginal fistula?

Injury during gynecologic surgery. Signup and view all the answers

What is the purpose of performing a major surgical count during gynecological surgeries?

To prevent leaving any foreign objects inside the patient. Signup and view all the answers

Why are absorbable sutures typically large size, such as 1 or 0 Vicryl, used in these procedures?

To withstand the stresses of deep dissection. Signup and view all the answers

What extensive procedure may be indicated for persistent carcinoma of the cervix?

Pelvic Exenteration. Signup and view all the answers

Which factor is associated with the decision to remove ovaries in women over 45 during a BSO?

Lower functional capacity of the ovaries. Signup and view all the answers

What is the purpose of using local vasoconstrictors during a surgical procedure?

To facilitate dissection and decrease bleeding Signup and view all the answers

Which type of sutures is typically used for vaginal repairs?

Large size absorbable sutures such as 1 or 0 Vicryl Signup and view all the answers

What condition is being corrected during a Cystocele repair?

Herniation of the bladder causing anterior wall bulging Signup and view all the answers

What instrument is used during Laparoscopically-Assisted Vaginal Hysterectomy (LAVH) to cut tissue?

Endo GIA stapler Signup and view all the answers

Which ligament is NOT typically cut during a Total Abdominal Hysterectomy (TAH)?

Uteroovarian ligament Signup and view all the answers

What must the surgical team be prepared for during LAVH?

To convert to an open hysterectomy if needed Signup and view all the answers

What is the primary aim of doing an anterior or posterior repair?

To restore the bladder and rectum to their proper positions Signup and view all the answers

What is required for the surgical count during a Total Abdominal Hysterectomy?

A major count for initial and closing counts Signup and view all the answers

Study Notes

Ovaries

Positioned on either side of the uterus, connected by the ovarian ligament.
Crucial for fertilized ovum implantation and embryo development.
Ovarian cysts may occur, potentially requiring surgical intervention (ovarian cystectomy).

Vagina

Musculomembranous tube facilitating menstrual blood flow, sexual intercourse, and part of the birth canal.
Comprises anterior and posterior walls; anterior wall is near the bladder, and the posterior wall is adjacent to the rectum.
Surrounded by pelvic floor muscles, specifically the levator ani.

Perioperative Nursing Considerations

Comprehensive assessment of gynecological history including Pap smears, HPV testing, past surgeries, and menstrual history.
Pain tolerance evaluation to guide postoperative pain management.
Blood replacement may be necessary due to extensive dissection in vascular regions; confirm blood product availability pre-, intra-, and post-operation.

Patient Positioning

Supine position with slight Trendelenburg tilt for open hysterectomies; various lithotomy positions for laparoscopic surgeries.
Ensure safety and support during positioning, especially with stirrups to prevent nerve injuries and muscle strains.

Instrumentation and Counting

Four surgical approaches in gynecology: Vaginal, Open, Laparoscopic, and Combined (LAVH).
Unique instrument requirements for each approach; common instruments include weighted speculum, tenaculum, D&C sets, and laparoscopic tools.
Minor counts for vaginal procedures, and major counts for open/laparoscopic cases, including specific counts if cervix is handled.

Equipment

Forced-Air Warming Blankets to minimize hypothermia risk during procedures.
Operating Room Table adjustments for various surgical positions.
Ablation equipment used for treating abnormal uterine bleeding, serves as an alternative to hysterectomy.

Hysteroscopy

Endoscopic method for observing the internal uterine cavity.
Uses normal saline as a medium; Valtchev's uterine mobilizer assists in procedures like tubal ligation.

Vaginal Surgeries

Endometrial Ablation: Removes endometrium for menorrhagia; uses non-electrolytic ionic media during cautery.
Vaginal Hysterectomy: Removal of the uterus via vaginal incision; indicated for small uteri; requires a surgical count.

Pelvic Floor Repairs

Cystocele: Bladder herniation causing bulge in anterior wall; Rectocele: Protrusion of rectal wall into the vagina.
Minor count for surgical repairs; local vasoconstrictors may aid in procedures.

Laparoscopic Procedures

LAVH: Minimally invasive uterine removal via endoscope; allows for lymph node biopsy; major emphasis on teamwork for potential conversion to open surgery.
Abdominal Hysterectomy: Uterus removal through abdominal incision; major counts required; careful handling of ligaments and ureters during surgery.

Radical Hysterectomy

Extensive removal of uterus, cervix, fallopian tubes, ovaries, and pelvic lymph nodes for malignancies. Long deep instruments utilized for dissection.

Bilateral Salpingo-Oophorectomy (BSO)

Removal of fallopian tubes and majority of ovaries. Typically preserves ovaries in patients under 45, removes them from patients over 45 due to decreased function.

Vesicovaginal Fistula

Abnormal connection between the bladder and vagina causing involuntary urination; often results from gynecologic surgeries like hysterectomies.

Ovarian Cancer and Pelvic Exenterations

Involves extensive removal of pelvic organs and structures; indicated for advanced cervical cancer treatment; may include complete removal of pelvic cavity organs.

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Description

This quiz covers critical aspects of gynecological nursing, focusing on the anatomy and functions of the ovaries and vagina, as well as important perioperative nursing considerations. Key topics include patient positioning, assessment of gynecological history, and management strategies related to ovarian conditions. Test your knowledge in this vital area of women's health care.