# A 58-year-old postmenopausal woman is scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. What is the most important preoperative nursing intervention?

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## 문제

A 58-year-old postmenopausal woman is scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. What is the most important preoperative nursing intervention?

## 보기

1. Assess the patient's understanding of the surgical procedure and provide emotional support **✔ 정답**
2. Administer prophylactic antibiotics as ordered to prevent infection
3. Insert an indwelling urinary catheter to monitor urine output
4. Obtain baseline vital signs and weight for preoperative assessment

**정답: 1**

## 해설

Assessing understanding and providing emotional support is most important as it addresses psychosocial needs before major cancer surgery. Other interventions like antibiotics or catheter insertion are routine but secondary.

## 심화 해설

Understanding the Priority: Preoperative Psychosocial Assessment

For a patient scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer, the most important *preoperative nursing intervention* is to assess the patient's understanding of the surgical procedure and provide emotional support. While all listed interventions are components of preoperative care, the psychosocial and educational assessment takes priority because it directly addresses the immediate, multidimensional distress caused by a cancer diagnosis and the impending loss of reproductive organs, which fundamentally impacts the patient's ability to cope and participate in care.

Why This is the Priority: Evidence of Psychological Distress

The diagnosis of a gynecologic malignancy and the prospect of definitive surgery create a unique and severe psychological burden. A randomized controlled trial on patients undergoing total hysterectomy demonstrated that structured psychological nursing interventions significantly reduce self-perceived burden and improve psychological state, self-efficacy, and quality of life [2]. This evidence confirms that psychological distress is not a minor side effect but a primary patient problem that impairs recovery. Before performing any physical task, the nurse must first establish a therapeutic relationship by gauging the patient's emotional state and comprehension. A patient in a state of high anxiety or with misconceptions about the surgery cannot effectively provide informed consent, retain postoperative instructions, or participate in early mobilization, which are all critical for preventing complications.

The Interplay of Knowledge Deficit and Emotional Support

The intervention combines assessment of understanding with emotional support because these two elements are clinically inseparable. A longitudinal qualitative study on the perioperative journey of patients with cervical cancer revealed that patients have dynamic and evolving symptoms and needs that begin in the preoperative phase [3]. The study, framed by Maslow's hierarchy of needs, highlights that unmet psychological and informational needs before surgery can dominate the patient's experience and hinder their progression. By assessing understanding first, the nurse identifies specific knowledge deficits, catastrophic thinking, or unrealistic expectations. The subsequent provision of tailored information and empathetic support directly mitigates the psychological distress that would otherwise amplify postoperative pain, prolong recovery, and decrease patient satisfaction.

Why Other Options Are Not the First Priority

The other options represent important, but secondary, task-oriented interventions. Administering prophylactic antibiotics (Option 2) is a dependent nursing function that follows a medical order and is timed immediately before the surgical incision, not as the initial independent nursing action. Inserting an indwelling urinary catheter (Option 3) is an invasive procedure typically performed in the operating room after anesthesia to minimize patient discomfort and is not a preoperative priority on the unit. Obtaining baseline vital signs and weight (Option 4) is a standard component of the physical preoperative assessment, but it is a data-collection task. The data from a psychosocial assessment is more immediately critical because it dictates the entire plan of care, including how the nurse will approach the patient during physical tasks and how the team will structure postoperative support. A systematic review on hysterectomy outcomes provides a broader context, noting that the procedure is associated with long-term risks like urinary incontinence . This underscores the importance of a thorough preoperative discussion where the nurse can verify the patient's understanding of such potential long-term surgical sequelae, ensuring her consent is truly informed and her emotional preparation is comprehensive.

The nurse's initial focus must be on the patient as a person facing a life-altering event. Addressing the psychological and educational needs first builds the trust and understanding necessary for all subsequent physical care to be effective and patient-centered.References (research sources)

- [2]The Impact of Rosenthal Effect-Based Psychological Nursing on Psychological State, Self-Efficacy, and Quality of Life in Patients Undergoing Total Hysterectomy for Uterine Fibroids: A Randomized Controlled Trial.RCT/clinical trialXiang J, Li C, Zhu X. (2026) · DOI: 10.2147/ijwh.s598690

- [3]A Longitudinal Qualitative Study on the Perioperative Symptom-Demand Journey Map of Patients with Cervical Cancer.Research articleZhang Y, Wu Y, Yuan J, Yang J, Zhu W, Chen L, Xu C. (2026) · DOI: 10.2147/ijwh.s603381

## 임상 시나리오

Preoperative Psychosocial PriorityAddressing distress before physical tasks in gynecologic oncology surgery
For a patient facing a cancer diagnosis and loss of reproductive organs, the nurse's first priority is assessing understanding and providing emotional support. This establishes a therapeutic relationship and reduces anxiety, which directly impacts the patient's ability to cope and participate in care.

Evidence shows that structured psychological interventions significantly improve self-efficacy and quality of life post-hysterectomy. A patient with high anxiety or misconceptions cannot effectively learn or consent, making this the foundational step before physical preparation like obtaining vital signs or administering medications.

CautionDo not delegate psychosocial assessment. Use open-ended questions and active listening to gauge the patient's specific fears, such as concerns about body image, sexuality, or cancer recurrence, before providing tailored education.

## 핵심 개념

- **Total Abdominal Hysterectomy** — Surgical removal of the uterus through an abdominal incision.
- **Bilateral Salpingo-Oophorectomy** — Surgical removal of both fallopian tubes and ovaries.
- **Preoperative Nursing Intervention** — Actions performed by a nurse before surgery to prepare a patient physically and psychologically.
- **Psychosocial Assessment** — Evaluation of a patient's mental, emotional, and social well-being and support systems.
- **Self-Perceived Burden** — A patient's perception of being a burden to their caregivers, often causing emotional distress.

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