Proceso de atención de enfermería en paciente sometida a histerectomía abdominal por leiomioma uterino

Abstract

Introduction: The uterus is a hollow muscular organ that is located in the female pelvis, between the bladder and the rectum. It is also considered a site of many conditions, both benign and malignant. The subserous uterine myoma is a benign tumor that can be asymptomatic in particular or compression symptoms may appear on the ureters, bladder, small intestine or colon, liver and retroperitoneal vessels, among others, depending on size and position. The growth they do towards the abdominal cavity, sometimes fixed by pedicles. Rarely, these tumors become malignant (<1%). At present it has not been detailed with certainty the causes that produce the appearance of fibroids in the uterus, other authors mention in their publications that there are risk factors related to this pathology of a benign nature, such as: age, overweight or obesity, nulliparity, estrogen-producing ovarian tumors and any other condition that increases exposure to estrogens and progestogens during the reproductive age of these women. Case presentation: A 39-year-old patient who attended an outpatient clinic at the Ángela Loayza Ollagüe Obstetric Hospital (HOALO) for scheduled surgery of a total abdominal hysterectomy due to uterine leiomyoma on 03/14/2018, at the assessment of pain in the hypogastric region. , constipation, flatulence, brings results of ultrasound that reports the presence of hypogenetic nodule of 5.25cm x 5.03 cm other than 1.97cm x 2.70cm located on the posterior and anterior side of the wall other than 1.77 x1.87cm located in the posterior submucosa. During the control of vital signs, all within normal limits, transvaginal bleeding is not evident. It coordinates for the performance of laboratory tests. She underwent surgery on 03/15, where the gynecologist removed multiple subserous uterine fibroids, consistent with the imaging study. The hospital stay was 4 days and his recovery was successful. General Objective: To analyze the case of a patient undergoing abdominal hysterectomy for uterine leiomyoma based on the Marjory Gordon Model by reviewing the clinical history and reviewing the literature for the development of nursing care plans. Method: A bibliographic search was carried out in the databases: PubMed Central (PMC), Cochrane, Scielo, Redalyc, ScienceDirect and NNNConsult. Results: Several risk factors were identified: hormonal imbalance, age, lifestyle, overweight, basic education and low socioeconomic status. In addition, the surgical time, the weight of the surgical piece, the intraoperative blood loss and the hospital stay, coincide significantly with that reported in the medical literature. Conclusions: The Natural History of the Disease, raised by Leavell and Clark, was taken as a basis for a better understanding of the health-disease process. The uterine leiomyoma with marked symptoms is the most frequent indication for abdominal hysterectomy, especially in premenopausal women. The M. Gordon Model was effectively adapted to the present case when proposing care plans based on the findings found during the nursing assessment. In the nursing process the fundamental thing is to assess the needs of patients (diagnoses, NANDA) with the primary objective of satisfying them (outcomes, NOC) through interventions (NIC), contributing significantly to their rapid recovery and reintegration into their home.