What should a nurse do after a patient has undergone a hysterectomy?

Post-Hysterectomy Nursing Care

Pain Management - First Priority

Nurses should immediately initiate scheduled multimodal non-opioid analgesia with acetaminophen 1000 mg every 6 hours plus an NSAID (ibuprofen, indomethacin, or meloxicam) for at least 48-72 hours postoperatively. 1, 2

Specific Medication Regimen

• Administer acetaminophen 1000 mg orally or intravenously every 6 hours for the first 72 hours, not as-needed 2
• Combine with scheduled NSAID dosing (ibuprofen 600-800 mg every 6-8 hours, indomethacin 25-50 mg every 8 hours, or meloxicam 15 mg daily) 1, 2
• This combination is superior to either medication alone and significantly reduces narcotic consumption 1, 2
• Use scheduled dosing rather than as-needed - this is more effective for pain control 1, 2

Antiemetic Management

• For patients at high risk of nausea/vomiting, administer phenothiazines (prochlorperazine or promethazine) as these are the only preemptive medications proven to reduce postoperative nausea and vomiting 1, 2

Opioid Use - Last Resort Only

• Reserve opioids only for breakthrough pain uncontrolled by multimodal non-opioid regimen 2, 3
• Avoid meperidine entirely due to poor efficacy and increased toxicity risk 3
• If opioids are necessary, use short-acting agents like morphine or hydromorphone in low doses 3

Vital Signs and Clinical Monitoring

Monitor respiratory rate, heart rate, blood pressure, oxygen saturation, level of consciousness, and surgical site regularly. 1

Key Parameters to Assess

• Respiratory rate and oxygen saturation - critical for detecting opioid-induced respiratory depression if opioids are used 4
• Level of consciousness and sedation - advancing sedation precedes respiratory depression 4
• Surgical site assessment for bleeding, hematoma formation, or signs of infection 1, 5
• Temperature monitoring - maintain core temperature ≥36°C 1

Pain Assessment Protocol

• Use numeric rating scale (0-10) for systematic pain assessment at regular intervals 6
• Document pain scores in nursing records - this creates a common language between patients and nurses 6
• Communicate pain assessments to physicians to guide analgesic adjustments 6

Early Mobilization and Recovery

Mobilize patients for 30 minutes on the day of surgery and 6 hours daily thereafter. 1

• Early mobilization reduces thromboembolic risk and promotes faster recovery 1
• Encourage oral fluid intake as soon as patient is lucid after surgery 1
• Advance to solid foods after 4 hours if tolerated 1

Catheter and Drain Management

Remove Foley catheter within 24 hours in the majority of cases, individualized only for patients at high risk of urinary retention 1

• Routine nasogastric tubes and drains are not recommended and should be avoided 1

Fluid Management

Discontinue intravenous fluids on postoperative day 1 and encourage oral intake 1

• Target near-zero fluid balance to optimize recovery 1

Critical Safety Considerations for NSAIDs

Screen patients before NSAID administration - contraindications include: 2

• Active peptic ulcer disease or history of GI bleeding
• Severe kidney or liver disease
• Known NSAID or aspirin allergy
• Heart failure or recent myocardial infarction

Use NSAIDs with caution in: 2

• Patients over 65 years old
• Hypertension or cardiovascular disease
• Concurrent blood thinners or corticosteroids
• History of stomach ulcers

Infection Prevention Monitoring

Monitor for signs of infection - infectious complications are the most common after hysterectomy, occurring in 9-13% of cases depending on surgical approach 5

• Assess surgical site for erythema, warmth, drainage, or dehiscence 5
• Monitor temperature trends 1
• Vaginal cuff dehiscence risk is highest after total laparoscopic hysterectomy (1.35%) compared to other approaches 5

Thromboembolic Prevention

Ensure appropriate VTE prophylaxis is continued as venous thromboembolism occurs in 1-12% of cases depending on detection method 5

• Early mobilization is critical for VTE prevention 1
• Monitor for signs of DVT or PE (leg swelling, chest pain, dyspnea) 5

Common Pitfalls to Avoid

• Never rely solely on opioids for pain control - they increase sedation without superior pain control compared to multimodal regimens 2, 3
• Do not use as-needed dosing for first 48-72 hours - scheduled dosing is more effective 1, 2
• Do not delay pain medication administration - preemptive and early postoperative analgesia is more effective than delayed treatment 1
• Do not underestimate pain in older patients - they communicate less about pain and require proactive assessment 6