Ovarian New Growth

I.
INTRODUCTION
She had suffered a great deal under the care of many doctors and had spent
all she had, yet instead of getting better she grew worse.
-Mark 5:26
Every individual aspires to be as healthy as they currently can, but as it
turns out, life is not that simple. It is not merely hand-me-downs but rather a
struggle that we continually strive for to provide at any given time a most
pleasant experience there is. Through life, we also have our unfavorable
experiences regarding health. To just sit back and think of it as an
unfortunate circumstance or a faulty decision made should not be the
primary reason we remain satisfied with what we have but rather prioritize on
how to manage such condition towards the betterment of ones health.
Throughout a womans life, various types of illnesses could come on her way.
Some of these diseases could even affect her ability to conceive, which one
of the very essence of a woman is. With this, she would seek health care by
all means with the hope of getting rid of the ailment.
One of the devastating diseases that a woman may have would be the
affectation of her reproductive organs and an example of this would be an
ovarian new growth or ovarian cyst.
The development of ovarian cysts is a common condition in which one
or more cysts form on the ovary or ovaries of a woman's reproductive
system. An ovarian cyst consists of a sac filled with fluid, blood, or tissue.
Ovarian cysts are generally not dangerous and often go away by themselves
within weeks to a few months. However, some ovarian cysts can remain and
cause serious problems to health or fertility.
During ovulation (the process during which the egg ripens and is
released from the ovary) the ovary produces a hormone to make the follicles
(sacs containing immature eggs and fluid) grow and the eggs within it
mature. Once the egg is ready, the follicle ruptures and the egg is released.
Once the egg is released, the follicle changes into a smaller sac called the
corpus luteum. Ovarian cysts occur as a result of the follicle not rupturing,
the follicle not changing into its smaller size, or doing the rupturing itself.
1 | CS: O.N.G.| Grp.10
Ovarian cysts can develop due to a woman's changing hormones that

normally occur during the monthly menstrual cycle. There are many types of
ovarian cysts, including endometriomas, dermoid cysts, and functional cysts.
Cysts vary in size, from the size of a pea to the size of a softball. When a
woman develops multiple ovarian cysts during each menstrual cycle that do
not go away, it is called polycystic ovarian syndrome or PCOS.
There are often no symptoms of ovarian cysts, but sometimes they can
result in abdominal pain, infertility and other health problems.
Ovarian cancer is the most common cause of cancer death from
gynecologic tumors in the United States. Early disease causes minimal,
nonspecific, or no symptoms. Therefore, most patients are diagnosed in an
advanced stage. Overall, prognosis for these patients remains poor. Standard
treatment involves aggressive debulking surgery followed by chemotherapy.
Many histological types of ovarian tumors are described. However, more than
90% of malignant tumors are epithelial tumors.
Ovarian cysts are found on transvaginal sonograms in nearly all
premenopausal women and in up to 18% of postmenopausal women.
Most of these cysts are functional in nature and benign. Mature cystic
teratomas or dermoids represent more than 10% of all ovarian neoplasms.
The incidence of ovarian carcinoma is approximately 15 casesper 100,000
women per year. Annually in the United States, ovarian carcinomas are
diagnosed in more than 21,000 women, causing an estimated 14,600 deaths.
Most malignant ovarian tumors are epithelial ovarian cyst adenocarcinomas.
Tumors of low malignant potential comprise approximately 20% of malignant
ovarian tumors, whereas fewer than 5% are malignant germ cell tumors, and
approximately 2% granulosa cell tumors.
Investigators at Purdue University are reporting that significant
progress has been made on developing a diagnostic technique to detect
circulating neoplastic cells through noninvasive scanning. Predictably, the
technology
uses tumor-specific
fluorescent
probes
for
detection.
The
technique uses a fluorescent tumor-specific probe that labels tumor cells in

2 | CS: O.N.G.| Grp.10
circulation. When hit by a laser, which scans across the diameter of the blood
vessel 1,000 times per second, the tumor cells glow and become visible. The
in vivo flow detection was performed on a two-photon fluorescence
microscope. The researchers compared several methods and found twophoton fluorescence provides the best signal to background ratio. The
technology is able to scan every cell that is pumped through the vessel.
Computed tomography, or CT, scans and magnetic resonance imaging,
or MRI, are the current methods used to track the spread of cancer. These
methods have a limited resolution, and a 1 millimeter tumor could go
undetected by CT or MRI. The Purdue-developed technology can achieve
single-cell resolution and can detect rare cell populations.
The laser
penetrates to a depth of 100 microns and is able to examine shallow blood

vessels near the surface of the skin. Advanced optical technology could be
incorporated into the technology platform and enable the method to reach
deeper vessels that handle larger volumes of blood.
Ovarian cancer could have been preventable, but the general public
despite of the powerful and inexpensive methods are now available for
communicating knowledge on a mass scale are ignorant of the various risk
factors for cancer. During adulthood even into old age, many of these factors
can be favorably influenced by modifying the lifestyle of a person, family
planning and contraception. The physical, mental and social well being of the
affected people would be much enhanced if the knowledge of those who care
for them could be improved and applied more precisely. These are the
reasons why the student nurses chose ovarian cancer as their case study and
as they traced the history of the client, the factors that could have
contributed to the occurrence of the disease were properly identified. The
treatment outcome of the study would also become a great help in
conducting health education to the public leading to better health promotion
and prompt prevention cancer related diseases especially among women.
Ovarian cancer is a disease condition that could have resulted from different
causes, thus in tracing the clients history, which included lifestyle, types of
activities, ovulatory cycles and pattern, may confirmed that such were the
causes of ovarian cancer.
3 | CS: O.N.G.| Grp.10
C. Objectives
Nurse-centered
General Objectives:
After the completion of this case study, the student nurses should have:
Discussed the management and treatment and provide better nursing

care and health teachings through the utilization of the nursing
process.
Analyzed and interpreted the different diagnostic and laboratory

procedures, its purpose and its essential relationship to the clients
disease condition, identified treatment modalities and its importance
like drugs, diet and exercise.
Interpreted the current trend and statistics regarding the disease

condition and relate the state of the client with her personal and
pertinent family history.
Formulated nursing care plans based on the prioritized health needs of

the client and maintained sound communication by making use of self
as a therapeutic agent.
Specific Objectives:
After the completion of this case study, the patient and the family shall have:
Define what Ovarian New Growth is and identified the manifestations.
Determine
the
different
factors
that
have
contributed
to
the
occurrence of Ovarian New Growth, both modifiable and nonmodifiable.
Identified
the
diagnostic
tests,
laboratory
results,
and
pathophysiology, medical and nursing management applicable to

manage Ovarian New Growth.
Identified and enumerated measures in the prevention of Ovarian New

Growth.
Patient-centered
General Objectives:
During the course of the study, the patient and the family shall have:
4 | CS: O.N.G.| Grp.10
Acquired knowledge on the risk factors that have contributed to the

development of Ovarian New Growth
Gained understanding and demonstrated compliance on the treatment

management rendered by the health care team to prevent recurrence
of the disease.
Specific Objectives:
During the course of the study, the patient and the family shall have:
Built a trusting relationship with the researchers as well as the other

members of the health care team.
Gained knowledge on the definition of Ovarian New Growth, its risk

factors, possible complications and prevention.
Received the best possible medical and nursing care, leading to a

feeling of security, comfort, and good prognosis of the disease
condition.
II.
NURSING ASSESSMENT
A. Personal History
5 | CS: O.N.G.| Grp.10
1. DEMOGRAPHIC DATA
To secure outmost confidentiality with our patient, she will be
referred to as Ms. Ovary throughout the study. Ms. Ovary is a 47 year old
Filipino citizen, single and is currently residing in 109 Concubierta st.,
Sunset Valley Cutcut, Angeles City, Pampanga. She is of Kapampangan
descent and was born in Angeles City on 10 th of September 1964. She is
53 tall and weighs 60 kg. She was admitted at a tertiary hospital in
Angeles city on August 1, 2012 at 6:14am.
2. SOCIO-ECONOMIC AND CULTURAL FACTORS
Ms. Ovary is a teacher and earns approximately 12,000 per month.
She is a college graduate and is affiliated in the Roman Catholic sect
which is also the religion of the rest of her family.
B. Family Health-Illness History
In the family of the Ms. Ovary, the hereditary disease that is visible
among them from the third generation up to her father is cancer. The said
disease scampers in the blood of her grandparents on her fathers side. In
the process of data collection, the student nurses draw the line between
the father and mother of Mommy Ova. Her mother does not have any
debilitating disease as of the moment and as to what she utters they do
not have any familial history of Ovarian Cancer. Mommy Ova is the 3 rd
among the siblings and among the five, she is the only one who suffers
the incapacitating disease.
6 | CS: O.N.G.| Grp.10
GRANDPA 1 (+)
GRANDPA 2 (+)
GRANDMA 1 (+)
Renal Cancer
GRANDMA 2 (+)
MOTHER
FATHER
Renal Cancer
HPN
BRO 1
SISTER 1
Patient
Ovarian new growth, Bilateral
BRO 2
BRO 3
(+) = deceased
7 | CS: O.N.G.| Grp.10
3. C. HISTORY OF PAST ILLNESS

4.
Ms. Ovary states that she had no other illnesses other than
having cough and colds for thrice a year or fever at least twice a year. Her
past illness states that she was once afflicted with chicken pox when she
was around 13 years old.
5. D. HISTORY OF PRESENT ILLNESS
6.
Six months prior to admission, the patient complained of right
lower quadrant pain that is sharp and is radiating to the back with
associated dysuria. She consulted with her private physician. Transvaginal
ultrasound was done revealing endometrioma. She was given antibiotic
and mefenamic acid, and was advised to seek consultation with an
obstetrician-gynecologist but was loss to follow up. Two months prior to
admission, the pain persisted. However, no weight loss is noted. She
consulted at Porac District Hospita; and was treated with Ofloxacin. Two
weeks prior to admission, she sought consultation with private physician
and was advised to have surgery. Hence, admitted for contemplated
procedure.
8 | CS: O.N.G.| Grp.10
7. Physical Examination upon Admission (August 1, 2012; as

lifted from the patients chart)
8.
9.
VITAL SIGNS
10.BP: 120/80 mmHg
13.
RR: 21 cpm
11.
14.
T: 36c/axilla
PR: 81 bpm
12.
15.General Appearance: weak, lethargic
16.Skin: Pale and dry
17.Eyes: anicteric sclera, pale palpebral conjuctiva, (+) PERRLA
18.
19.
1st Patient-Nurse Interaction
PHYSICAL EXAMINATION (August 3, 2012)

20.
21.
Ms. Ovary was seen lying on bed, conscious and appears

weak, with an IVF of #6 D5NM, 1 Liter regulated at 40-41 gtts/minute,
infusing well over the left metacarpal vein with an intact indwelling
foley catheter connected to urine bag draining reddish output @ 550
cc level, w/ dry intact wound dressing on the lower abdominal midline
with normal capillary refill of <3sec. Vital signs were taken and
recorded as follows:
22.
23.BP: 110/80 mmHg
25.
RR: 24 cpm
24.
26.
T: 36.6c/axilla
PR: 78 bpm
27.
Appearance and Mental Status
28.
29.
Ms. Ovary has proportionate body built. She is conscious of the
situation. She appeared weak and feels a little bit irritable, her mood is still
appropriate to the situation. She exhibits thought association and speaks in a
moderate and understandable way. She also has sense of reality.
30.
9 | CS: O.N.G.| Grp.10
The Integumentary
31.
32.
She has a fair complexion, smells normal, no body odor. After
being pinched, her skin goes back to its normal color. Her hair is long and
black. Her nails are clean and neatly cut. After performing Blanch Test, her
nails return to its original color in less than 3 seconds. Her nails are concave,
light pink and smooth.
33.
The Skull and Face
34.
35.
Clients skull is round and symmetrical in shape with absence of
masses and depressions. Color of face is uniform and palpebral fissures are
equal in size, facial hair evenly distributed with intact skin. No hollowness and
edema palpated.
36.
Eyes and Vision
37.
38.
Upon inspection, Ms. Ovarys eyebrow hair distribution is evenly
distributed. They are symmetrically aligned and equal in movement. The skin
is intact as well. Her eyelashes are equally distributed and are curled slightly
outward. Eyelids skin is intact and no discharges or any discoloration seen.
Her eyelids are closing symmetrically and blinks involuntary of about 19
blinks per minute. She has transparent bulbar conjunctiva and white sclera
with no lesions seen. Her palpebral conjunctiva is pinkish and shiny, texture is
smooth and no lesions noted. While palpating the lacrimal gland, there is no
tearing nor edema or tenderness felt. Cornea is transparent and its texture is
smooth and shiny. Pupils are black, equal in sizes of about 3 mm in diameter.
It has smooth borders. Iris, on the other hand, is flat and round.
39.
40.
41.
42.
The Ear and Hearing
10 | C S : O . N . G . | G r p . 1 0
43.
44.
Her auricles colors are the same as the facial skin color and are
aligned in the outer canthus of the eyes. They are mobile and firm. Pinna
recoils after it is folded.
45.
The Nose and Sinuses
46.
47.
Ms. Ovarys nose is symmetric and its color is same with facial
color. Air moves freely as the client breaths through both noses. No lesions
noted and maxillary; frontal sinuses are not tender and no pain upon
palpation.
48.
49.
The Mouth and Oropharynx
50.
51.
Lips are symmetric in contour, has uniformity in color, and
texture is dry. The inners lips and buccal mucosas color is pink and is uniform
in color. It is moist, soft and has a glistening texture. Teeth are slight yellowish
with some dental caries or tartar seen. Clients tongue is in central position
with color of pink and is moist. It has no lesions and can move freely. Both
smooth and hard palate are light pink in color but hard palate has a more
irregularity in texture. Uvula was seen midline of soft palate. Gag reflex not
present.
52.
The Neck
53.
54.
Muscles in the neck are equal in size and shape. Lymph nodes at
the back of the ear are not palpable. Her trachea is at the center of the neck
and its spaces are equal on both sides. The thyroid glands ascend during
swallowing bit is not visible.
55.
56.
57.
11 | C S : O . N . G . | G r p . 1 0
Thorax and Lungs

58.
59.
Ms. Ovarys chest is symmetrical in shape, spine vertically

aligned, spinal column straight, left and rights shoulders as well as the
hips are the same in height. She exhibits full symmetric chest
expansion when asked to take a deep breath by palpating for
expiratory excursion.
60.
Muscles
61.
Upon inspection, her muscles are equal on both sides of the

body. No tremors or contractures on muscles or tendons.
62.
Bases and Joints
63.
64.
No deformities, tenderness or swelling palpated on patients

bones and joints. She was able to move joints smoothly when she was
asked to move some selected body parts.
65.
66.
67.
68.
12 | C S : O . N . G . | G r p . 1 0
69.
DIAGNOSTIC AND LABORATORY PROCEDURES

A. RADIOGRAPHIC REPORT
70.
71.
DIA
72.
DA
GNOSTIC/
TE
LABORAT
ORDERED
ORY
73.
RES
RESULTS
80.
st X-ray
RE
76.
NO
SULTS
77.
IN
DO:
DI:
7-19-12
ANAL
RMAL
YSIS AND
VALUES
INTERPRET
ATION
78.
7-19-12
81.
75.
DA
TE
Che
IND
ICATIONS
PROCEDU
79.
74.
(Patie
nt-Based)
82.A chest x
ray is a
painless,
noninvasiv
e test that
creates
pictures of
the
structures
inside the
chest,
such
as
the heart,
lungs, and
blood
vessels.
84.Clear lung
fields,
heart
---
86.
Norma
l chest
not
enlarged,
diaphragm
and
85.
bony
thoracic
are intact.
findings.
83.This test is
done
to
find
the
cause
of
symptoms
such
as
shortness
of breath,
chest
pain, chro
nic
cough (a
cough that
lasts
a
long time),
as well as
fever.
87.
88.
Nursing Responsibilities:
89.
Prior:
Explain the procedure.

Explain the purpose and what to expect.
Inquire whether the client may be pregnant to prevent exposure of the fetus to x-ray.
No food or fluid restrictions.
Remove all metal objects from the body.
Check that the patient has emptied the bladder before the test commences.
Allow the patient to use a protective lead shield.
90.
91.
During:
The client is generally required to stand for various views; if the client is unable to stand, views may be
obtained in a sitting position, or a portable x-ray may be obtained.
Instruct client to inspire deeply and hold the breath.
92.
After:
After the test, the patient should be returned to their normal activities if these have been disturbed, i.e.
eating and drinking, as quickly as possible.
Keep the past records especially the latest ones.
Document.
93.
94.
A. CLINICAL CHEMISTRY (FLUID AND ELECROLYTES)
95.
96.
DI
97.
99.
INDICATIONS
100.
101.
102.
ANA
AGNOST
ATE
ESULT
ORMAL
LYSIS AND
IC/
ORDER
VALUE
INTERPRE
LABORA
ED
TATION
TORY
98.
103.
(Pat
PROCED
ATE
ient-
URES
RESULT
Based)
S IN
104.
Ca
lcium
105.
O: 8-312
106.
I: 8-312
107.
Serum calcium
test is ordered to
screen for, diagnose,
and monitor a range
of conditions relating
to the bones, heart,
nerves, kidneys, and
teeth. Blood calcium
levels do not directly
tell
how
much
calcium is in the
bones, but rather,
how much calcium is
circulating
in
the
blood.
108.
110.
.02
112.
Ms.
.13-
Ovarys
1.32
serum
mmol/L
calcium
109.
111.
level is
below the
normal
range
indicative
of
hypocalce
113.
114.
agnesiu
O: 8-3-
12
115.
I: 8-312
116.
A magnesium
test checks the level
of magnesium in the
blood. Magnesium is
an
important electrolyte
needed for proper
muscle,
nerve,
and enzyme function.
It also helps the body
make and use energy
and is needed to
move
other electrolytes
(potassium
and
sodium) into and out
117.
119.
.60
118.
121.
mia.
Ms.
.73-
Ovarys
1.06
serum
mmol/L
magnesium
120.
level is
below the
normal
range
indicative
of
hypomagn
of cells.
122.
Po
tassium
123.
O: 8-312
124.
I: 8-312
131.
So
dium
133.
O: 8-3-
132.
12
134.
I: 8-312
esemia.
125.
A
potassium
test
checks
how
much potassium is in
the blood. Potassium
is
both
an electrolyte and a
mineral. It helps keep
the
water
(the
amount of fluid inside
and
outside
the
body's
cells)
and
electrolyte balance of
the body. Potassium
is also important in
how
nerves
and
muscles work.
126.
135.
A sodium test
checks how much
sodium
(an electrolyte and a
mineral) is in the
blood. Sodium is both
an electrolyte and
mineral. It helps keep
the
water
(the
amount of fluid inside
and
outside
the
body's
cells)
and
electrolyte balance of
the body. Sodium is
136.
128.
.70
130.
Ms.
.50-
Ovarys
5.50
potassium
mmol/L
level is
127.
129.
within
normal
range.
1
42
137.
138.
Ms.
35-150
Ovarys
mmol/L
sodium
level is
within the
normal
range.
also important in how

nerves and muscles
work.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
Prior:
Define and explain the test.

State the specific purpose of the test.
Explain that there is no special preparation.
149.
150. During:
Use the sterile technique.
151. After:
Keep the past records especially the latest ones.
Document.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.
A. COMPLETE BLOOD COUNT
162.
DIAG
163.
DAT
NOSTTIC/
LABORATOR
ORDERED
164.
165.
INDIC
166.
ATION(S)
RES
ULTS
167.
168.
ORMAL
NALYSI
VALUES
S AND
INTERP
DAT
PROCEDUR
RETATI
ES
RESULT(S)
ON
169.
Hema
tocrit (Hct)
IN
DO:
170.
8-3-12
171.
DI:
8-3-12
172.
The
hematocrit
174.
0.30
175.
0.
176.
36-0.45
s.
shows the
Ovarys
oxygen-
hemato
carrying
crit level
capacity of
is below
the blood.
the
This value
normal
also tells
range
whether the
which
blood is too
indicate
thick or too
s a low
thin.
concent
173.
Useful
as
177.
Hemo
178.
ration of
red
measuremen
blood
t of red blood
cells
cells only if
within
the hydration
the
of the client
blood
is normal.
179.
This is
181.
105
182.
globin
test
of
23-153
(Hgb)
measure
of
g/L
the
amount
total
of
volume.
183.
M
s.
Ovarys
hemoglo
bin is
hemoglobin
below
in the blood.
the
It is used as
normal
a rapid direct
range
measuremen
which is
t of the red
indicativ
blood
e of
cell
count.
It
is
repeated
serially
in
patients with
on
going
bleeding
or
as a routine
part
of
the
complete cell
blood count.
It
is
an
integral part
of
the
evaluation of
anemic
patients.
180.
Hemo
anemia.
globin
acts
as
an
important
acid-base
buffer
184.
Leuko
cytes
185.
system.
WBC or
leukocytes are
cells of the
immune system
186.
10.2
3
187.
4.
5011x10^
9/L
188.
189.
s.
Ovarys
leukocyt
which defend
e count
the body against
is within
both infectious
the
disease and
normal
foreign
range.
materials.
evaluates the
body capacity
to resist and
overcome
infection
to detect
leukemia
to determine
severity of
190.
Neutr
ophils
191.
infection.
192.
A
neutrophils
193.
0.77
194.
0.
18-0.70
195.
s.
test helps us
Ovarys
detect the
neutrop
levels of
hil count
neutrophils
is above
in our body.
the
These
normal
neutrophils
range
are an
which is
integral part
indicativ
of our
e of
immune
impaire
system and
through a
immune
process
system
called
suggesti
chemotaxis,
ng
they reach
acute
any place
bacteria
where an
infection has
infection
occurred.
These cells
take about
an hour to
reach the
site of
infection. In
fact, they are
one of the
main
components
of pus and
are to blame
for its whitish
color. It is
also
important to
go in for a
high
neutrophils
blood test as
they are
indicative of
extremely
high levels of
stress in an
196.
Lymp
hocytes
197.
individual.
198.
This
test
199.
0.18
200.
0.
10-0.48
201.
s.
measures
Ovarys
the number
lymphoc
of
yte
lymphocytes
count is
(a type of
within
white blood
the
cell) in blood.
normal
It is used to
range.
evaluate and
manage
disorders of
the blood or
the immune
system. It is
also used to
evaluate and
manage
certain types
of cancer
202.
Mono
cytes
203.
and tumors.
204.
This
test
205.
0.05
206.
0.
00-0.04
207.
s.
measures
Ovarys
the amount
monocyt
of monocytes
e count
in blood.
is
Monocytes
slightly
are a type of
above
white blood
the
cell (WBC).
normal
This test is
range
used to
which is
evaluate and
indicativ
manage
e of
blood
impaire
disorders,
certain
immune
problems
system
with the
as well
immune
as the
system, and
presenc
cancers,
e of
including
cancer.
monocytic
leukemia.
This test may
also be used
to evaluate
for the risk of
complication
s after a
heart attack.
208.
Platel
et Count
209.
212.
210.
A
platelet
count may
be used to
screen for or
diagnose
various
158
213.
1
50400x10
^9L
214.
215.
s.
Ovarys
platelet
count is
within
the
normal
diseases and
conditions
that affect
the number
of platelets
in the blood.
It may be
used as part
of the
workup of
a bleeding
disorder, bon
e marrow
disease,
or excessive
clotting
disorder, to
name just a
few.
211.
The
test may
used as a
monitoring
tool for
range.
people with
underlying
conditions or
undergoing
treatment
with drugs
known to
affect
platelets. It
may also be
used to
monitor
those being
treated for a
platelet
disorder to
determine if
therapy is
effective.
216.
217.
218.
219.
220.
Prior:
Explain the procedure.

Explain the purpose and what to expect.
No food or fluid restrictions.
Check the doctor's order.
221.
222. During:
Do not take the blood sample from hand or arm with receiving IVF.
The tourniquet should be less on a minute.
Do not squeeze the punctured site rightly.
Wipe away the first drop of blood.
223. After:
Label the specimen.
Secure the results.
Note for inflammation of punctured site.
Document.
224.
225.
226.
227.
228.
229.
230.
231.
III. ANATOMY AND PHYSIOLOGY OF THE FEMALE
REPRODUCTIVE SYSTEM
232.
233.
234.
235.
236.
237.
238.
239.
240.
241. The female reproductive system contains two main parts:
the uterus, which acts as receptacle for the males sperm, and the
ovaries which produce the female egg cells. These parts are internal:
the vagina meets the external organs at the vulva, which includes the
labia, clitoris and urethra. The vagina is attached to the uterus through
the cervix, while the uterus is attached to the ovaries via the fallopian
tubes. At the certain intervals, the ovaries release an ovum, which
passes through the fallopian tubes into the uterus.
242. The
purpose
of
the
female
reproductive
system
is
continuation of the human species by the production of offspring. The

female reproductive system produces gametes and provides for their
union through fertilization following sexual intercourse.
The female
reproductive system is also responsible for gestation of the offspring.

243. Sexual reproduction couldn't happen without the sexual
organs called the gonads. Although most people think of the gonads as
the male testicles, both sexes actually have gonads: In females the
gonads are the ovaries. The female gonads produce female gametes
(eggs); the male gonads produce male gametes (sperm). After an egg
is fertilized by the sperm, the fertilized egg is called the zygote.
244. When a baby girl is born, her ovaries contain hundreds of

thousands of eggs, which remain inactive until puberty begins. At
puberty, the pituitary gland, located in the central part of the brain,
starts making hormones that stimulate the ovaries to produce female
sex hormones, including estrogen. The secretion of these hormones
causes a girl to develop into a sexually mature woman.
245.
246.
The
Individual
Components
of
the
Female
Reproductive System
247.
Vulva
248. The external part of the female reproductive organs is

called the vulva, which means covering. The fleshy area located just
above the top of the vaginal opening is called the mons pubis. Two
pairs of skin flaps called the labia surround the vaginal opening. The
clitoris, a small sensory organ, is located toward the front of the vulva
where the folds of the labia join. Between the labia are openings to the
urethra which is the canal that carries urine from the bladder to the
outside of the body and vagina. Once girls become sexually mature,
the outer labia and the mons pubis are covered by pubic hair.
249. The vulva has a sexual function; these external organs are
richly innervated and provide pleasure when properly stimulated. Since
the origin of human society, in various branches of art the vulva has
been depicted as the organ that has the power both "to give life", and
to give sexual pleasure to humankind.
250.
Vagina
251. The vagina is a muscular, hollow tube that extends from

the vaginal opening to the uterus. The vagina is about 3 to 5 inches (8
to 12 centimeters) long in a grown woman. Because it has muscular
walls it can expand and contract. This ability to become wider or
narrower allows the vagina to accommodate something as slim as a
tampon and as wide as a baby. The vagina's muscular walls are lined
with mucous membranes, which keep it protected and moist. The

vagina has several functions: for sexual intercourse, as the pathway
that a baby takes out of a woman's body during childbirth, and as the
route for the menstrual blood to leave the body from the uterus.
252. A thin sheet of tissue with one or more holes in it called the
hymen partially covers the opening of the vagina. Hymens are often
different from person to person. Most women find their hymens have
stretched or torn after their first sexual experience, and the hymen
may bleed a little. Some women who have had sex don't have much of
a change in their hymens, though.
253.
Cervix
254. The cervix (from Latin "neck") is the lower, narrow portion
of the uterus where it joins with the top end of the vagina. Where they
join together forms an almost 90 degree curve. It is cylindrical or
conical in shape and protrudes through the upper anterior vaginal wall.
Approximately half its length is visible with appropriate medical
equipment; the remainder lies above the vagina beyond view.
255. During menstruation, the cervix stretches open slightly to
allow the endometrium to be shed. This stretching is believed to be
part of the cramping pain that many women experience. Evidence for
this is given by the fact that some women's cramps subside or
disappear after their first vaginal birth because the cervical opening
has widened.
256.
Uterus
257. The uterus is located in the pelvic cavity, superior to the

urinary bladder and between the two ovaries. It is shaped somewhat
like an upside-down pear and is approximately 7.5 centimeters (3
inches) long and 5 centimeters (2 inches) wide. The uterus is covered
by the broad ligament. During pregnancy the uterus increases in size,
contains the placenta to nourish the embryo/fetus, and expels the baby
at the end of gestation. The upper portion of the uterus, above the
entry of the fallopian tubes, is the fundus.
The body is the large
central portion of the uterus. The cervix is the narrow, lower end of the
uterus that opens into the vagina. The outermost layer of the uterus,
also known as the serosa or epimetrium, is a fold of the peritoneum.
The smooth muscle layer of the uterus is the myometrium.
pregnancy,
the
cells
of
the
accommodate the growing fetus.
myometrium
increase
in
During
size
to
The myometrium contracts during
labor and delivery at the end of gestation. The endometrium, or lining

of the uterus, is composed of two layers. The basilar layer, which is
adjacent to the myometrium, is vascular but is very thin. The basilar
layer is a permanent layer. The functional layer of the endometrium is
regenerated and lost during each menstrual cycle.
Estrogen and
progesterone from the ovaries stimulate the growth of blood vessels to

thicken the functional layer in preparation for a possible embryo.
If
fertilization does not occur, then the functional layer is shed through
menstruation.
258.
Fallopian Tube
259. There are two fallopian tubes, each attached to a side of

the uterus. The fallopian tubes are about 4 inches (10 centimeters)
long and about as wide as a piece of spaghetti. The lateral end of each
Fallopian tube encloses an ovary. The medial end of each tube opens
to the uterus.
Fimbriae, found on the lateral end of each tube, are
fringe-like protrusions that generate currents in the fluid surrounding

the ovary. These currents pull the ovum into the Fallopian tube. Since
an ovum cannot move on its own, the structure of the Fallopian tube
ensures that the ovum will be moved to the uterus. A smooth layer of
muscle in the tube contracts, generating peristaltic waves that push
the ovum toward the uterus. The mucosa of the tube has many folds
and is made of ciliated epithelial tissue.
Within each tube is a tiny
passageway no wider than a sewing needle. At the other end of each

fallopian tube is a fringed area that looks like a funnel. This fringed
area wraps around the ovary but doesn't completely attach to it. When
an egg pops out of an ovary, it enters the fallopian tube. Once the egg
is in the fallopian tube, tiny hairs in the tube's lining help push it down
the narrow passageway toward the uterus.
260.
Ovary
261. The ovaries are a pair of oval-shaped organs located in the

pelvic cavity on either side of the uterus. Each ovary is approximately
4 centimeters (1.5 inches) in length. Extending from the medial side of
each ovary to the uterine wall are the ovarian ligaments. The broad
ligament is a section of the peritoneum covering the ovaries. These
ligaments assist in keeping the ovaries in place. Located within each
ovary are several hundred thousand primary follicles. These follicles
are present at birth.
262. The
ovary
contains
many
follicles
composed
of
developing egg surrounded by an outer layer of follicle cells. Each egg

begins oogenesis as a primary oocyte. At birth each female carries a
lifetime supply of developing oocytes, each of which is in Prophase I. A
developing egg (secondary oocyte) is released each month from
puberty until menopause, a total of 400-500 eggs.
263.
IV. THE PATIENT AND HIS ILLNESS
A. PATHOPHYSIOLOGY (Book- centered)

264.
1. Schematic Diagram
265.
266. Non- modifiable risk factors
-family history of ovarian cancer or heredity
267.
-family history of breast or colon cancer
268.
-advancing age
269.
-ethnicity or race: Northern and Western
270. Europe and American descent
271.
-Infertility
272. -Previous history of ovarian cysts
273.
274.
275.
Modifiable risk factors

-Medications: fertility drugs, hormone
therapy
- Talcum powder use
- Obesity in early adulthood
- Hormone replacement therapy
- Unhealthy diet (high in saturated fats)
-Occupational exposures (asbestos, arsenic,
benzene, silica)
-Unsafe intercourse
-Multiple sexual partners

-Smoking
276.
277.
Development defect in gonadogenesis
278.
279.
Formation of germ cells tumor (95%)
280.
281.
282. transformation of the germ cells
Malignant
283.
Tumors of totipotent cells
284.
Intratubular genn cell
neoplasia (IGCN) or
285.
carcinoma in situ (CIS)
Formation of non
seminatous tumor
Diffuse peritoneal
implantation of
the serosal
Rectum
surface
& large
Pressure
intestine
Alpha teta
Malignant tumor
on to
nearby
Embryonal Embryonic
Yolk sac tumor
levels
s are
ChoriocarciEndodermal
Nausea
&
Extend
other
protein (ATP) HCG
of the
ovaries
carcinoma
organs
Trophoblast
Extraembryonic
Teratoma
Dyspnea
Hyperthyroidis
ASCITES
Constipation
Peristalsis
pressed
noma
sinus tumor
tissue
Vomiting
peritoneal tissue
levels
Tumor
Enlarged
invadesovaries
the ovaries
m
Metastasis
Infiltration
of ovarian
tumor to
regional
lymph
Lymphadenodes
Back
pain
Nopathy
286.
287.
288.
289.
290.
291.
292.
293.
294.
295.
296.
297.
298.
299.
300.
301.
302.
303.
Uterine
contractility
304.
305.
306.
307.Sloughing of the endometrial
lining
Excessive amount if bleeding

TABHSO
ANEMIA
Weakness
Pallor
Cold clammy
skin
Hematolo
-gic
dissemina
Abdomi-tion
Anorexia
nal
pain
308.
309.
310.
311.
312.
313.
314.
315.
316.
317.
318.
319.
320.
321.
322.
323.
324.
325.
2.
2. Synthesis
of the disease
3. 2.1. Definition of the disease
4.
Cancer begins in cells, the building blocks that make up
tissues. Tissues make up the organs of the body. Normally, cells grow
and divide to form new cells as the body needs them. When cells grow
old, they die, and new cells take their place. Sometimes, this orderly
process goes wrong. New cells form when the body does not need
them, and old cells do not die when they should. These extra cells can
form a mass of tissue called a growth or tumor.
5. Tumors can be benign or malignant:
6. Benign tumors are not cancer:
Benign tumors are rarely life-threatening.
Generally, benign tumors can be removed. They usually do not

grow back.
Benign tumors do not invade the tissues around them.
Cells from benign tumors do not spread to other parts of the body.
7. Malignant tumors are cancer:
Malignant tumors are generally more serious than benign tumors.

They may be life-threatening.
Malignant tumors often can be removed. But sometimes they grow

back.
Malignant tumors can invade and damage nearby tissues and

organs.
Cells from malignant tumors can spread to other parts of the body.
Cancer cells spread by breaking away from the original (primary)
tumor and entering the lymphatic system or bloodstream. The cells
invade other organs and form new tumors that damage these
organs. The spread of cancer is called metastasis.
8.
9. Benign and malignant cysts
10.
An ovarian cyst may be found on the surface of an ovary
or inside it. A cyst contains fluid. Sometimes it contains solid tissue too.
Most ovarian cysts are benign (not cancer).
11.
Most ovarian cysts go away with time. Sometimes, a
doctor will find a cyst that does not go away or that gets larger. The
doctor may order tests to make sure that the cyst is not cancer.
12.Ovarian cancer
13.Ovarian cancer can invade, shed, or spread to other organs:
Invade: A malignant ovarian tumor can grow and invade organs

next to the ovaries, such as the fallopian tubes and uterus.
Shed: Cancer cells can shed (break off) from the main ovarian
tumor. Shedding into the abdomen may lead to new tumors forming
on the surface of nearby organs and tissues. The doctor may call
these seeds or implants.
Spread: Cancer cells can spread through the lymphatic system to

lymph nodes in the pelvis, abdomen, and chest. Cancer cells may
also spread through the bloodstream to organs such as the liver
and lungs.
14.When cancer spreads from its original place to another part of
the body, the new tumor has the same kind of abnormal cells and
the same name as the original tumor. For example, if ovarian
cancer spreads to the liver, the cancer cells in the liver are actually
ovarian cancer cells. The disease is metastatic ovarian cancer, not
liver cancer. For that reason, it is treated as ovarian cancer, not
liver cancer. Doctors call the new tumor "distant" or metastatic
disease.
15.
2.2. Modifiable Factors
1. Medications-Some studies show that women who have taken fertility

drugs, or hormone therapy after menopause, may have a slightly
increased
risk
of
developing
ovarian
cancer.
The
use
of
oral
contraceptive pills, on the other hand, seems to decrease a women's

chance of getting the disease.
2. Talcum powder use-Some studies report a slightly elevated risk of
ovarian cancer in women who regularly apply talcum powder to the
genital area. A similar risk has not been reported for corn starch
powders.
3. Obesity in early adulthood-Studies has suggested that women who
are obese at age 18 are at increased risk of developing ovarian cancer
before menopause. Obesity may also be linked to more aggressive
ovarian cancers, which can result in a shorter time to disease relapse
and a decrease in the overall survival rate.
4. Hormone replacement therapy (HRT)-Findings about the possible
link between postmenopausal use of the hormones estrogen and
progestin and risk of ovarian cancer have been inconsistent. Some
studies indicate a slightly increased risk of ovarian cancer in women
taking estrogen after menopause, but other studies show no significant
increase in risk. However, in a large study published in the Journal of
the National Cancer Institute in October 2006, researchers report that
women who haven't had a hysterectomy and who used menopausal
hormone therapy for five or more years face a significantly increased
risk of ovarian cancer.
5. Unhealthy diet-Up to 30% of cancers in developed countries may be
related to poor nutrition. Diets high in saturated fats and low in fruits
and vegetables increase the risk of having ovarian cancer.
6. Occupational exposures-Certain substance encounter at work are
carcinogens, including asbestos, arsenic, benzene, silica and secondhand tobacco smoke.
7. Unsafe intercourse- there is risk of direct infection because there is
no protection to protect the client from acquiring such disease
16.
8. Multiple sex partners- a woman whose partner has more than one
sex partner is at greater risk of developing PID, because of the
potential for more exposure to infectious agents.
17.
18.
2.3. Non-modifiable Factors
19.
1.
A family history of ovarian cancer or Heredity-Women who

have one or more close relatives with the disease have an increased
risk of developing ovarian cancer. Certain genes, such as the BRCA 1
and 2 genes are inherited and result in a high risk for development of
ovarian cancer.
2.
A family history of breast or colon cancer- Also confers an

increased risk for the development of ovarian cancer.
3.
Age-Women over 50 are more likely than younger women to get

ovarian cancer, and the risk is even greater after age 60. About 50% of
ovarian cancers occur in women over 63 years of age.
4.
Ethnicity or Race-The risk of having ovarian cancer varies

between racial and ethnic populations. Some of these differences are
attributable to genetic differenced but most are due to differenced in
lifestyle and exposure to cancer-causing agents.
5.
Sex/Gender-Certain cancer occurs in only one sex due to

different anatomy, e.g. ovarian cancer occurs only in female.
6.
Infertility-If you've had trouble conceiving, you may be at

increased risk. Although the link is poorly understood, studies indicate
that infertility increases the risk of ovarian cancer, even without use of
fertility drugs. The risk appears to be highest for women with
unexplained infertility and for women with infertility who never
conceive. Research in this area is ongoing.
7.
Ovarian cysts-Cyst formation is a normal part of ovulation in

premenopausal women. However, cysts that form after menopause
have a greater chance of being cancerous. The likelihood of cancer
increases with the size of the growth and with age.
8.
Hereditary- women are genetically predisposed to develop this

condition which is almost benign
20.
21.
22.
2.4. Signs and symptoms with rationale
23.
In the early stages of ovarian cancer, you may not
experience any obvious or painful symptoms. Unfortunately, due to a

lack of definitive symptoms, the majority of women with ovarian
cancer are not diagnosed until their cancer has reached an advanced
stage.
24.
However, some recent studies have indicated that the
majority of women with ovarian cancer actually do experience

symptoms before their diagnosis. Since symptoms may be subtle, and
vary from person to person, they may not be associated with the
symptoms of ovarian cancer. For example, back pain is the most
common early symptom of the disease, according to the American
Cancer Society.
Abdominal Pain- because of an increase uterine muscle contractility

there is an increase lactic acid formation which irritates the nerves
causing the abdominal pain

Excessive amount of bleeding- uterine Fibroids is one of the causes
of bleeding
Anemia- this is because of severe bleeding so the patient may
manifest pallor, weakness or cold clammy skin

Nausea and Vomiting- this is due to abdominal distention because of
an increase pressure of the pelvic area

DOB- due to increased abdominal pressure
Hyperthyroidism- due to increase HCG
similarities of the HCG alpha chain with alpha chains of FSH and TSH
Constipation- the large intestine is being compromised by the
level
and
structural
increasing size of the peritoneum which may cause narrowing of the

rectum and decrease peristalsis resulting to constipation.
25.
PATHOPHYSIOLOGY (Client-centered)
26.
1. Schematic Diagram
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
Non- modifiable risk factors

-family history of cancer
-advancing age
Modifiable risk factors

- Unhealthy diet (high in saturated fats)
-Smoking (8 pack years)
-Alcohol drinking
-Nulliparity
Development defect in gonadogenesis
Formation of germ cells tumor

(95%)
39.
40.
41.
Malignant transformation of the germ

cells
Tumors of totipotent cells
42.
43.
Intratubular genn cell
neoplasia (IGCN) or
44.
Formation of non
seminatous tumor
carcinoma in situ (CIS)
45.
46.
47.
48.A
B
B
Malignant tumor
Embryonal
of the ovaries
carcinoma
ChoriocarciEndodermal
Embryonic
Trophoblast
Extraembryonic
Teratoma
noma
sinus tumor
tissue
Tumor
Enlarged
invadesovaries
the ovaries
Diffuse peritoneal
implantation of
the serosal
surface
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
Sloughing of the endometrial

lining
63.
64.
65.
Uterine
contractility
Excessive amount if bleeding
66.
67.
68.
TAHBSO
(Aug.2, 2012)
ANEMIA
Aug. 3. 2012
Hct: 0.30; Hgb:
105
Weakness
Pallor
Cold clammy
skin
69.
2. Synthesis of the Disease (Client centered)
70.
2.1. Definition of the disease
71.
Cancer begins in cells, the building blocks that make up tissues.
Tissues make up the organs of the body. Normally, cells grow and divide to
form new cells as the body needs them. When cells grow old, they die, and
new cells take their place. Sometimes, this orderly process goes wrong. New
cells form when the body does not need them, and old cells do not die when
they should. These extra cells can form a mass of tissue called a growth or
tumor.
72.
2.2. Modifiable Factors
1. Unhealthy diet-Up to 30% of cancers in developed countries may be

related to poor nutrition. Diets high in saturated fats and low in fruits
and vegetables increase the risk of having ovarian cancer.
2. Tobacco use-Tobacco use is the main cause of cancer in the lungs and
may attribute to ovarian cancer.
3. Alcohol Use-Heavy alcohol use causes cancers. It can cause an
infection to the kidney and can affect its surrounding organ like the
ovary.
73.
74.
2.3. Non-modifiable Factors
75.
1. Heredity-Women who have one or more close relatives with the
disease have an increased risk of developing ovarian cancer. Certain
genes, such as the BRCA 1 and 2 genes are inherited and result in a
high risk for development of ovarian cancer.
76.
2. Age-Women over 50 are more likely than younger women to get

ovarian cancer, and the risk is even greater after age 60. About
50% of ovarian cancers occur in women over 63 years of age.
77.
3. Sex/Gender-Certain cancer occurs in only one sex due to

different anatomy, e.g. ovarian cancer occurs only in female.
78.
79.
80.
2.4. Signs and symptoms with rationale

In the early stages of ovarian cancer, you may not
experience any obvious or painful symptoms. Unfortunately, due to a

lack of definitive symptoms, the majority of women with ovarian
cancer are not diagnosed until their cancer has reached an advanced
stage.
81.
However, some recent studies have indicated that the
majority of women with ovarian cancer actually do experience

symptoms before their diagnosis. Since symptoms may be subtle, and
vary from person to person, they may not be associated with the
symptoms of ovarian cancer. For example, back pain is the most
common early symptom of the disease, according to the American
Cancer Society.
82.
83.
Abdominal Pain- because of increase uterine muscle contractility
there is an increase lactic acid formation which irritates the nerves causing
the abdominal pain
84.
85.
Excessive amount of bleeding- uterine Fibroids is one of the causes
of bleeding
86.
87.
Anemia- this is because of severe bleeding so the patient may
manifest pallor, weakness or cold clammy skin.
V.
THE PATIENT AND HIS CARE

1. MEDICAL MANAGEMENT
a. IVFs, BT, NGT feeding, Nebulization, TPN, Oxygen Therapy, etc.
88.
MEDICAL
89.
DATE
MANAGEMENT/TRE
ATMENT
92.
ORDERED
90.
DATE
GEBER
93.
AL
INDIC
CLIEN
ATON(S)
TS
DESCRIPTIO
RESPONSE
TO THE
PERFORME
D
91.
94.
TREATMENT
DATE
CHANGED/
1. Intravenous Fluid
100.
95.
D/C
DO: 82-12
96.
101.
2-12
D5LRS
97.
#1
98.
#2
99.
#4
DP: 8-
102.
DC: 82-12
103.
5%
Dextrose
107.
109.
The
prevent
patient
Lactated
electrolyte
responded
Ringers
imbalance
well
Solution
and serves as
treatment
(D5LRS)
fluid
and
and did not
caloric supply
manifest any
for
signs
104.
105.
LRS
in
To
the
It
to
the
of
contains
patient.
sodium,
also
chloride,
as a route for
imbalances.
potassium,
administratio
The
serves
dehydration
of electrolyte
patient
calcium
and
lactate.
Lactate
is
for
had
an
intravenous
effective
medication
fluid balance
metabolized
especially
if
during
in the liver to
the patient is
entire
form
for
therapy.
bicarbonate
preoperative.
saline
and
the
110.
108.
balanced
electrolyte
solution
commonly
are used to
restore
vascular
volume,
particularly
after trauma
or surgery.
PNSS/ 0.9 NaCl
115.
DO: 82-12
111.
116.
DP: 8-
106.
118.
Normal
Saline
sterile,
is
120.
It
is
121.
The
indicated
as
patient
of
responded
source
112. #1
113. #2
2-12
117.
114. #3
DC: 82-12
nonpyrogenic
water
solution
electrolytes.
treatment
It is also for
and did not
electrolyte
fluid
manifest any
replenishmen
electrolyte
signs
t. It contains
replenishmen
dehydration
no
t as well as
of electrolyte
antimicrobial
for
imbalances.
agents.
medication
The
patient
administratio
had
an
n.
effective
for
fluid
and
119.
and
and
well
to
the
of
fluid balance
during
the
entire
therapy.
Voluven
126.
2-12
123.
124. #2
DO: 8-
127.
DP: 82-12
125. #3
128.
DC: 82-12
129.
Voluve
132.
Indicat
n contains a
ed
synthetic
treatment
starch
the
of
The
patient
responded
that
hypovolemia
well
not
when plasma
treatment
in
volume
and did not
is
expansion
does
dissolve
water.
for
122.
133.
It
is
to
the
manifest any
made
by
required.
signs
of
linking
dehydration
individual
of electrolyte
starch
imbalances.
molecules
The
patient
together and
had
an
combining
effective
them with a
fluid balance
salt solution,
during
similar to the
entire
salt
therapy.
concentration
typically
found
in
blood.
Voluven
expands
volume
the
of
blood plasma
the
liquid
portion of the
blood and
134.
the
thus
draws
fluid
into
small
blood
vessels
known
as
capillaries.
130.
131.
It
is
not
substitute for
red
blood
cells
or
coagulation
factors
D5NM
140.
2-12
135.
136. #5
141.
139.
DP: 82-12
137. #6
138. #7
DO: 8-
142.
DC: 83-12
in
plasma.
143.
5%
Dextrose
146.
in
For
147.
The
parenteral
patient
Normosol-M
maintenance
responded
(D5NM)
of
well
144.
daily
145.
is
routine
fluid
to
the
treatment
D5NM
and
and did not
sterile,
electrolyte
manifest any
requirement
signs
nonpyrogenic
of
hypertonic
solution
of
balance
with minimal
dehydration
carbohydrate
of electrolyte
calories.
imbalances.
maintenance
The
patient
electrolytes
had
an
and
effective
5%
dextrose
injection
water
fluid balance
in
during
for
entire
injection.
therapy.
148.
149.
150.
151.
152.
153.
154.
155.
156.
157.
158.
159.
Prior:
Explain the procedure to the client to ensure her cooperation and to reduce anxiety.
the
Check the information on the label of the IV infusion container, including the patients name and room
number, type of solutions, time and date of each preparation, preparers name and order infusion rate.
Compare the doctors order with the solution label to verify that the solution is the correct one.
Wash hands thoroughly before and after the procedure.
Select the smaller gauge device that is appropriate to the infusion.
Place the IV solution with attached primed administration set on the IV pole.
Hang the IV solution with attached primed administration set on the IV pole.
Verify the patients identity by comparing the information on the solution container with patients
wristband or any identification item.
160.
During:
Select the puncture site.
Place the patient in a comfortable, reclining position, leaving the arm in a dependent position to
increase capillary refill of the lower hands and arms.
Apply a tourniquet about 4-6 inches above the intended puncture site to dilate the vein. Check for the
radial pulse.
Lightly palpate the vein with the index and middle fingers of your non-dominant hand.
Leaving the tourniquet in place for no longer than 3 minutes.
Clean the site with alcohol pads. Work in a circular motion outward from the site to a diameter of 2-4
inches. Allow the anti-microbial solution to dry.
Grasp the access cannula.
Using the thumb of your non-dominant hand, stretch the skin taut below the puncture site to stabilized
the vein.
Tell the patient when you are about to insert the device.
Hold the needle bevel up and enter the skin directly over the vein at a 15-25 degree angle.
Aggressively push the needle directly though the skin and into the vein in one motion.
Grasp the cannula hub to hold it in the vein and withdraw the needle.
To advance the cannula while infusing the IV solution, releases the tourniquet and remove the inner
needle. Using the sterile technique attached the IV tubing and begins the infusion. While stabilizing the
vein with one hand, use the other to advance the catheter into the vein. When the catheter is
advanced, decreases the IV flow rate.
161.
After:
After the venous access device has been inserted, clean the skin completely. Then regulate the flow
rate.
Cover the site with a sterile gauze pad or small adhesive bandage.
Label the last piece of tape with the type, gauge of the needle and length of cannula, date and time of
insertion and your initials.
Check frequently for impaired circulation to the infusion site.
162.
163.
164.
165.
MEDICAL
MANAGEMENT/T
REATMENT
166.
DATE
ORDERED
167.
DATE
PERFORMED
169.
GEBER
AL
170.
INDICA
TON(S)
171.
CLIENT
S
DESCRIPTIO
RESPONSE
TO THE
168.
DATE
TREATMENT
CHANGED/
172.
2. Foley
173.
Catheter
D/C
DO: 82-12
174.
DP: 82-12
175.
DC:
176.
Foley
177.
It
is
The
catheter is a
indicated
double-lumen
provide
able
catheter. The
bladder
tolerate
larger
lumen
drainage for a
foley catheter
drains
urine
patient who is
and
the
unable to void
experienced
spontaneously
relief
second,
after
the
bladder
smaller lumen
patient
had
distention
is
given
from
bladder.
used
inflate
balloon
to
to
the
she
from
she
was
near
is also used to
intolerance.
catheter
output
in
within
bladder.
precisely and
to
know
the
The balloon of
characteristic
retention
catheter
though
was
anesthesia. It
monitor
the
an
patient
the tip of the

place
to
178.
is
of
the
patient urine.
activity
sized by the
And
volume
facilitate
of
to
fluid used to
proper
inflate them.
hygiene of the
patient.
179.
180.
181.
Prior:
Read Doctors order.
Maintain sterile technique with insertion.
182.
During:
Check for patency of tubing.
Place the urinary bag lower than the patient.
183.
After:
Inform the pt that there will be slight discomfort after the insertion of the foley catheter.
Monitor urine output and color.
Document any unwanted signs of infection.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
MEDICAL
195.
MANAGEMENT/T
REATMENT
DATE
198.
ORDERED
196.
DATE
199.
AL
INDICA
200.
CLIEN
TON(S)
TS
DESCRIPTIO
RESPONSE
TO THE
PERFORMED
197.
GEBER
DATE
TREATMENT
CHANGED/
201.
3. Blood
206.
Transfusion
Fresh Whole
2-12
207.
DP: 82-12
Blood (FWB)
202. #1
D/C
DO: 8-
208.
DC: 8-
A blood
210.
Blood
transfusion is
transfusions
are
safe,
common
procedure
which
in
used
211.
The
patient
to
responded
replace blood
well
lost
treatment
during
to
the
you
surgery or a
and
did
not
204. #4
receive blood
serious injury.
manifest
any
205. #5
through
signs of blood
203. #3
3-12
209.
an
transfusion
intravenous
also might be
transfusion
(IV)
line
done if your
reactions.
inserted
into
body
can't
212.
one
of
your
blood vessels.
make
blood
properly
because of an
illness.
213.
214.
215.
216.
217.
218.
219.
220.
221.
222.
223.
Prior:
Assess laboratory values.
Verify the medical prescription.
Assess the clients vital signs, urine output, and history of transfusion reaction.
Obtain venous access. Use a central catheter or 19-gauge needle if possible.
Obtain blood products from a blood bank. Transfuse immediately.
With another registered nurse, verify the clients name and number check blood compatibility, and note
expiration time.
224.
During:
Administer the blood product using the appropriate filtered tubing.
If the blood product needs to be diluted, use normal saline solution.
Remain with the client for the first 15 to 30 minutes of the infusion.
Infuse the blood product at the prescribed rate.
Monitor vital signs.
225.
After:
When the transfusion is completed, discontinue infusion and dispose the bag and the tubing properly.
Document.
226.
227.
228.
b. Drugs
229.
230.
NA
232.
DAT
235.
ROU
ME OF
TE OF
DRUGS;
ORDERED
ADMINIST
231.
GE
233.
DAT
236.
GEN.
ACTION
237.
FUN
239.
IN
240.
CLIE
DICATIO
NTS
N(S)
RESPONS
RATION,
CTIONAL
E TO THE
NERIC
DOSAGE
CLASSIFIC
MEDICATI
NAME
TAKEN/GIV
AND
ATION
ON W/
AND
EN
FREQUENC
BRAND
234.
DAT
238.
MEC
HANISM
ACTUAL
SIDE
NAME
OF ACTION
EFFECT.
CHANGED/
241.
GE
243.
NERIC
NAME:
Nalbuphin
e
242.
D/C
DO:
8-2-12
244.
DT/D
G: 8-2-12
245.
BR
DC:
AND
NAME:
Nubaine
251.
252.
Prior:
246.
10mg
SIVP PRN
for severe
pain
Narcotic
agonistantagonist
analgesic
Nalbuphine
acts
as
an
agonist
at
specific opioid
receptors
in
the
CNS
to
produce
analgesia,
sedation
but
also acts to
cause
hallucinations
and
is
an
antagonist
at
receptors.
Relief
of
moderate to
severe pain
247.
Preoperativ
e analgesia,
as
a
supplement
to surgical
anesthesia,
and
for
obstetric
analgesia
during labor
and
delivery.
248.
249.
Read carefully the doctors order.

Review methods of administration/storage. Consume fluids; ensure adequate hydration.
Take for prescribed number of days even if symptoms subside.
250.
The
patient was
relieved of
pain.
Note history of sensitivity/reactions to this or related drugs.

Monitor circulatory and respiratory status and bladder and bowel function. Withhold dose and notify the nurse
if respirations are shallow or rate of below 12 breaths/minute.
253.
254.
During:
Observe patients reaction to drug while administering.

255.
256.
After:
Reassess patients level of pain at least 15 and 30 minutes after parenteral administration.
Note characteristics of signs and symptoms.
Identify onset, severity, location, and other associated factors.
Caution ambulatory patient about getting out of bed or walking. Warn outpatient to avoid driving and other
hazardous activities that require mental alertness until drugs CNS effects are known.
Teach patient how to manage troublesome adverse effects such as constipation.
Document.
257.
258.
260.
DAT
263.
ROU
AME OF
TE OF
DRUGS;
ORDERED
ADMINIST
259.
ENERIC
261.
DAT
E
264.
GEN.
ACTION
265.
FUN
267.
INDI
CATION(S)
268.
CLI
ENTS
RESPONS
RATION,
CTIONAL
E TO THE
DOSAGE
CLASSIFIC
MEDICATI
NAME
TAKEN/GI
AND
AND
VEN
FREQUENC
BRAND
262.
NAME
DAT
ATION
266.
ON W/
MEC
ACTUAL
HANISM
SIDE
OF ACTION
EFFECT.
CHANGED
269.
/ D/C
271.
DO:
ENERIC
NAME:
Cefoxitin
270.
RAND
8-2-12
272.
DT/
DG: 8-2-12
273.
DC:
NAME:
Mefoxin
277.
278.
279.
274.
500
mg q8
Antibiotic
Cephalosporin
(2nd
generation)
275.
Bactericidal:
Inhibits
synthesis
of
bacterial
cell
wall,
causing
cell death.
Lower
respiratory
infections
Skin and skin
structure
infections
UTI
Uncomplicated
gonorrhea
Intraabdominal
infections
Gynecologic
infections
Septicemia
Perioperative
prophylaxis
276.
The
patient did
not
anymore
manifest
any signs
and
symptoms
of
infection.
280.
Prior:

Obtain ANST before administering.
281.
282.
During
Observe patients reaction to drug.

Monitor for nephrotoxicity.
283.
284.
After

Identify onset, severity, location, and other association factors.
Instruct patient to avoid alcohol while taking this drug and for 3 days after because severe reactions often
occur.
Report severe diarrhea, difficulty of breathing, unusual tiredness or fatigue, pain at injection site.
Document.
285.
286.
287.
NA
ME OF
289.
DATE
ORDERED
292.
ROU
TE OF
293.
GEN.
ACTION
296.
NDICAT
297.
CLIE
NTS
DRUGS;
288.
GE
290.
ADMINIST
EN
DOSAGE
CLASSIFIC
MEDICATI
AND
ATION
ON W/
291.
DATE
BRAND
D/C
300.
NERIC
Ketorolac
299.
BR
AND
NAME:
Acular LS,
Acular PF
306.
RESPONS
E TO THE
FREQUENC
NAME:
ION(S)
CTIONAL
CHANGED/
NAME
GE
FUN
RATION,
AND
298.
294.
TAKEN/GIV
NERIC
NAME
DATE
DO:
8-2-12
301.
DT/D
G: 8-2-12
302.
DC:
303.
295.
MEC
ACTUAL
HANISM
30
mg IV q6 (-)
ANST
OF ACTION
Antipyretic
Nonopioid
analgesic
NSAID
304.
Antiinflammatory
and analgesic
activity;
inhibits
prostaglandins
and leukotriene
synthesis.
SIDE
Short-term
manageme
nt of pain
(up to 5
days)
Ophthalmic
: Relief of
ocular
itching due
to seasonal
conjunctivit
is and relief
of
postoperati
ve
inflammatio
n
after
cataract
surgery.
EFFECT.
305.
The
patient did
not
manifest
any
signs
and
symptoms
of
inflammati
on.
307.
308.
309.
Prior:

310.
311.
During

312.
313.
After

occur.
Document.
314.
316.
NA
318.
DA
315.
321.
STAT MEDICATIONS
RO
322.
GE
325.
IN
326.
CLI
ME OF
TE
UTE OF
N.
DICATIO
ENTS
DRUGS;
ORDERE
ADMINIS
ACTION
N(S)
RESPON
TRATION
317.
GE
NERIC
319.
DA
323.
FU
SE TO
NCTIONA
THE
NAME
TE
DOSAGE
MEDICAT
AND
TAKEN/G
AND
CLASSIFI
ION W/
BRAND
IVEN
FREQUE
CATION
ACTUAL
NAME
327.
GE
NERIC
NAME:
320.
DA
CHANGE
M OF
D/ D/C
329.
DO
: 8-1-12
330.
DT/
ole
12
AND
NAME:
Omepron
ME
CHANIS
DG: 8-1-
BR
324.
TE
Omepraz
328.
NCY
331.
DC
: 8-2-12
332.
40
mg/cap
HS 8pm
ACTION
Antisecretory
SIDE
EFFECT.
Short-term
334.
The
treatment of
patient
active
responde
inhibitor
duodenal
333.
ulcer
with
drug
Proton pump
Gastric acid-
Treatment of
well
the
medicatio
pump
heartburn or
n.
inhibitor:
symptoms of
symptom
Suppresses
GERD
gastric
acid
Long-term
No
of
medicatio
secretion by
therapy:
specific
Treatment of
reactions
pathologic
were
the
hypersecreto
noted.
hydrogen-
ry conditions
inhibition
of
potassium
Zegerid
ATPase
suspension:
enzyme
Reduction of
system
at
GI
surface
in critically ill
of
patients;
parietal cells;
includes
blocks
sodium
the
acid
production.
337.
338.
339.
340.
bleeding
gastric
final step of
336.
risk of upper
the secretory
the
335.
oral
bicarbonate.
341.
342.
343.
344.
Nursing Responsibilities
345.
346.
Prior:

Administer before meals.
Assess other medications patient maybe taking for effectiveness and interaction.
Administer with antacids, if needed.
347.
348.
During

Monitor therapeutic effectiveness and adverse reaction at the beginning of therapy and periodically
throughout the therapy.
349.
After

Assess GI system: check bowels sounds every 8 hours, abdomen for pain and swelling, appetite loss.
Instruct patient to have regular medical follow-up visits.
Document.
350.
351.
NA
353.
DAT
356.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
352.
GEN
354.
360.
. ACTION
358.
INDI
361.
CLIE
CATION(S
NTS
RESPONS
FUN
RATION,
CTIONAL
E TO THE
DOSAGE
CLASSIFI
MEDICATI
NAME
TAKEN/GI
AND
CATION
ON W/
AND
VEN
FREQUEN
355.
GEN
OF
EFFECT.
CHANGED
ACTION
ERIC
NAME:
Bisacodyl
BRA
ND
NAME:
Dulcolax
ACTUAL
E
/ D/C
DO:
8-1-12
365.
CY
MEC
SIDE
364.
DAT
359.
HANISM
NAME
363.
GEN
ERIC
BRAND
362.
DAT
357.
367.
rectal
DT/
suppositor
DG: 8-1-12
y @ 10pm
366.
DC:
8-2-12
Stimulant
Short
term
The
patient
Laxatives
release
368.
constipation,
responded
either chronic
well
on the bowels,
or
the
stimulating
onset,
the
bowel
whenever
to
stimulant
It acts directly
muscles
cause a bowel
of
laxative
of
369.
recent
with
medication
a
No
symptoms
is
of
medication
movement.
required.
reactions
Bowel
were
noted.
clearance
before surgery
or radiological
investigation.
Replacement
of
the
evacuant
enema in all
its indications.
370.
371.
372.
373.
374.
375.
376.
377.
378.
379.
380.
381.
382.
383.
384.
385.
386.
387.
388.
Prior:

Assess other medications patient maybe taking for effectiveness and interaction.
Administer in the evening or before breakfast because of action time required.
Do not give within 1 hour of antacids or milk.
389.
During

390.
After

Assess patient for bowel distention, presence of bowel sounds, and usual pattern of bowel function.
Assess color, consistency and amount of stool produced.
Evaluate periodically patients need for continued use of drug; Bisacodyl usually produces 1 or 2 soft
formed stools daily.
Add high-fiber foods slowly to regular diet to avoid gas and diarrhea.
Instruct patient to take adequate fluid intake at least 6-8 glasses/day.
Document.
391.
392.
NA
394.
397.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
393.
GEN
395.
DAT
398.
GEN
. ACTION
399.
FUN
401.
INDI
402.
CLIE
CATION(S
NTS
RESPONS
RATION,
CTIONAL
E TO THE
ERIC
DOSAGE
CLASSIFI
MEDICATI
NAME
TAKEN/GI
AND
CATION
ON W/
AND
VEN
FREQUEN
BRAND
396.
GEN
OF
EFFECT.
CHANGED
ACTION
ERIC
NAME:
Metronidaz
ole
ACTUAL
E
/ D/C
DO:
8-2-12
406.
DT/
DG: 8-2-12
407.
DC:
CY
MEC
SIDE
405.
DAT
400.
HANISM
NAME
403.
DAT
408.
500
mg/tab @
12am
Amebicide
Antibacterial
Antibiotic
Antiprotozoal
409.
Acute
infection with
susceptible
anaerobic
bacteria
Acute
intestinal
410.
The
patient
responded
well
the
with
404.
BRA
ND
NAME:
Flagyl
8-3-12
Bactericidal:
Inhibits
DNA
synthesis
in
specific
(obligate)
anaerobes,
causing
cell
death;
antiprotozoaltrichomonacid
al, amebicidal:
Bio-chemical
mechanism of
action is not
known.
amebiasis
Amebic liver
abscess
Trichomoniasi
s (acute and
partners
of
patients with
acute
infection)
Bacterial
vaginosis
Preoperative,
intraoperative
,
postoperative
prophylaxis
for
patients
undergoing
colorectal
surgery
Unalabeled
use:
Prophylaxis
for
patients
undergoing
gynecologic,
abdominal
surgery;
hepatic
medication
.
No
symptoms
of infection
and
medication
reactions
were
noted.
encephalopat
hy;
Crohns
disease
411.
412.
413.
414.
415.
416.
417.
418.
419.
Prior:

Obtain C&S before beginning drug therapy to identify if correct treatment has been initiated.
Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty
swallowing.
Inform patient that medication may cause unpleasant metallic state.
Inform patient that medication may cause urine to turn dark.
420.
421.
During
Obtain baseline information on patients infection: fever, wound characteristics, vaginal secretions, WBC
count (>100,000/mm3) and regular assess during treatment.
422.
After

Advise patient to consult health care professional if no improvement in a few days or if signs and
symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).
Document.
423.
424.
NA
DAT
429.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
425.
GEN
427.
DAT
430.
GEN
. ACTION
431.
433.
INDI
434.
CLIE
CATION(S
NTS
RESPONS
FUN
RATION,
CTIONAL
E TO THE
ERIC
DOSAGE
CLASSIFI
MEDICATI
NAME
TAKEN/GI
AND
CATION
ON W/
AND
VEN
FREQUEN
BRAND
NAME
435.
426.
GEN
428.
DAT
MEC
ACTUAL
HANISM
SIDE
OF
EFFECT.
CHANGED
ACTION
/ D/C
437.
DO:
CY
432.
440.
---
Laxatives
441.
For
442.
The
ERIC
NAME:
8-2-12
of
patient
DT/
occasional
responded
DG: 8-2-12
constipatio
well
n or bowel
the
cleansing
medication
Sodium
before
Phosphate
rectal
symptoms
examinatio
of
ns.
medication
Sodium
Biphosphat
438.
relief
439.
e and
436.
DC:
8-3-12
BRA
ND
NAME:
Fleet
Enema
443.
444.
445.
446.
447.
448.
449.
450.
451.
Prior:
Verify the doctors order.

Prepare the necessary equipments.
with
No
reactions
were
noted.
Wash hands and put on gloves.

452.
During:
Help the patient into a position that is comfortable for them.

Place a bedpan.
Place bed protector or towels under buttocks.
Ask the client to take deep breaths to relax the abdomen throughout the procedure.
Massaging the clients stomach may encourage further cleansing.
453.
After:
Discard disposable materials as bio-hazardous wastes.

Remove gloves and discard as bio-hazardous waste. Wash hands.
Give the client soap, water and towel to wash her hands.
Document.
454.
455.
456.
457.
458.
459.
460.
NA
462.
DAT
465.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
461.
GE
463.
DAT
RATION,
466.
GEN
. ACTION
467.
FUN
CTIONAL
469.
INDI
CATION(S)
470.
CLI
ENTS
RESPONS
E TO THE
NERIC
DOSAGE
CLASSIFI
MEDICATI
NAME
TAKEN/GI
AND
CATION
ON W/
AND
VEN
FREQUEN
BRAND
464.
471.
GE
OF
EFFECT
CHANGED
ACTION
NERIC
NAME:
Cefoxitin
472.
NAME:
Mefoxin
480.
481.
/ D/C
DO:
8-2-12
474.
DT/
DG: 8-2-
BRA
ND
ACTUAL
SIDE
473.
12
475.
DC:
8-3-12
CY
MEC
HANISM
NAME
DAT
468.
476.
16/I
V (+)
ANST/1 hr
prior to OR
Antibiotic
Cephalosporin
(2nd
generation)
477.
Bactericidal:
Inhibits
synthesis
of
bacterial cell
wall, causing
cell death.
Lower
respiratory
infections
Skin and skin
structure
infections
UTI
Uncomplicated
gonorrhea
Intraabdominal
infections
Gynecologic
infections
Septicemia
478.
Perio
perative
prophylaxis
479.
The
patient did
not
anymore
manifest
any signs
and
symptoms
of
infection.
482.
483.
484.
Prior:

485.
486.
During

487.
488.
After

occur.
Document.
489.
490.
491.
NA
493.
DAT
496.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
492.
GE
494.
DAT
497.
GEN.
ACTION
498.
500.
INDI
501.
CATION(S)
FUN
CLI
ENTS
RESPONS
RATION,
CTIONAL
E TO THE
NERIC
DOSAGE
CLASSIFIC
MEDICATI
NAME
TAKEN/GI
AND
ATION
ON W/
AND
VEN
FREQUEN
BRAND
495.
NAME
DAT
499.
CY
MEC
ACTUAL
HANISM
SIDE
OF ACTION
EFFECT
CHANGE
502.
GE
D/ D/C
504.
DO:
NERIC
NAME:
8-2-12
505.
DT/
Hydrocorst
DG: 8-2-
isone
12
503.
BRA
ND
NAME:
Cortef
506.
507.
100
ml/IV 1hr
prior to OR
Adrenocortical
steroid
therapy
8-3-12
509.
in
The
patient
Corticosteroid
adrenal
responded
(short-acting)
cortical
well
insufficiency
the
Glucocorticoid
DC:
Replacement
Allergic states-
Hormone
severe
508.
or
with
medicatio
n.
No
incapacitating
symptoms
cells and binds
allergic
of
to cytoplasmic
conditions
medicatio
Enters
target
receptors;
Hypercalcemia
n
reactions
initiates many
associated
were
complex
with cancer
noted.
reactions
that
Short-term
are responsible
inflammatory
for
and
its
anti-
allergic
inflammatory,
disorders,
immunosuppre
such
ssive
rheumatoid
glucocorticoid),
arthritis,
and
collagen
salt-
as
retaining
disease (SLE),
(mineralocortic
dermatologic
oid)
diseases
Some
actions.
actions
may
be
undesirable,
depending
drug use.
(pemphigus),
status
asthmaticus,
on
and
autoimmune
disorders.
Hematologic
disorders
thrombocytop
enic
purpura,
erythroblastop
enia
Anorectal
cream,
suppositories:
To
relieve
discomfort
of
hemorrhoids
and
perianal
itching
irritation.
510.
511.
512.
513.
514.
515.
516.
517.
518.
519.
520.
or
521.
522.
523.
524.
Prior:

Assess for contraindications.
Assess body weight, skin color, vital signs, urinalysis, serum electrolytes, x-rays, CBC.
Arrange for increased dosage when patient is subject to unusual stress.
Do not five live vaccines with immunosuppressive doses of hydrocortisone.
Observe the 15 rights to drug administration.
525.
During:
Give daily before 9am to mimic normal peak diurnal corticosteroid levels.
Space multiple doses evenly throughout the day.
Use minimal doses for minimal duration to minimize adverse effects.
Do not give IM injections if patient has thrombocytopenic purpura.
Taper doses when discontinuing high-dose or long-term therapy.
526.
After:
Monitor client for at least 30 minutes.

Educate client on the side effects of the medication and what to expect.
Instruct client to report paint at injection site.
Instruct client to take drug exactly as prescribed.
Dispose of used materials properly.

Document.
527.
528.
NA
530.
533.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
529.
GEN
531.
RATION,
GEN
. ACTION
535.
538.
INDI
CLIE
CATION(S
NTS
RESPONS
FUN
CTIONAL
E TO THE
DOSAGE
NAME
TAKEN/GI
AND
SSIFICATI
ON W/
AND
VEN
FREQUEN
ON
ACTUAL
532.
GEN
Famotidine
BRA
ND
CY
537.
CLA
HANISM
CHANGED
OF
/ D/C
542.
DO:
8-2-12
543.
DT/
DG: 8-2-12
544.
DC:
8-3-12
545.
20m
g/IV
MEDICATI
MEC
ERIC
NAME:
DAT
536.
539.
NAME
540.
DAT
534.
ERIC
BRAND
541.
DAT
ACTION
Histamine-2
SIDE
EFFECT
Relief
of
The
patient
(H2) receptor
symptoms
antagonist
heartburn,
responded
546.
acid
well
indigestion,
the
sour stomach
medication
Competitively
blocks
the
NAME:
action
of
Pepcid
histamine
at
of
547.
Unlabeled
uses: Part of
with
No
symptoms
the
H2
receptors
of
combination
therapy
of
of
the
parietal
Helicobacter
reactions
cells
of
pylori,
were
perioperative
noted.
the
stomach;
inhibits
basal
gastric
acid
suppression of
gastric
acid
secretion and
secretion,
chemically
prevention of
induced
stress
gastric
secretion.
acid
ulcers,
prevention of
aspiration
pneumonitis,
treatment
of
some urticaria
548.
549.
550.
551.
552.
553.
554.
555.
medication
556.
557.
558.
559.
560.
561.
562.
Prior:

If using one dose a day, administer drug HS.
563.
During:
Take this drug at bedtime or in the morning.

Assess for medication reactions.
Take antacid exactly as prescribed, being careful of the times of the administration.
Take OTC drug 1 hr before eating to prevent indigestion. Do not take more than two per day.
Therapy may continue for 46 wk or longer. Place rapidly disintegrating tablet on tongue and swallow with or
without water.
564.
After:
Instruct patient to have a regular medical follow-up while using this drug to evaluate response.
Instruct patient to report sore throat, fever, unusual bruising or bleeding, severe headache, muscle or joint
pain.
Arrange for administration of concurrent antacid therapy to relieve pain.
Document.
565.
566.
567.
568.
569.
570.
571.
NA
573.
576.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
572.
GEN
574.
DAT
577.
GEN
. ACTION
578.
580.
INDI
581.
CLIE
CATION(S
NTS
RESPONS
FUN
RATION,
CTIONAL
E TO THE
ERIC
DOSAGE
CLASSIFI
MEDICATI
NAME
TAKEN/GI
AND
CATION
ON W/
AND
VEN
FREQUEN
BRAND
575.
582.
GEN
OF
EFFECT
CHANGED
ACTION
ERIC
NAME:
Furosemid
e
8-2-12
585.
DT/
DG: 8-2-12
586.
BRA
ACTUAL
E
/ D/C
DO:
DC:
8-3-12
CY
MEC
SIDE
584.
DAT
579.
HANISM
NAME
583.
DAT
587.
----
Loop Diuretic
Treatment
of
589.
The
edema
patient
Category C
associated
responded
588.
with
well
Pregnancy
Rapid-acting
cirrhosis
liver,
CHF,
of
and
with
the
medication
ND
NAME:
Lasix
potent
kidney
sulfonamide
disease,
symptoms
loop diuretic
including
of
and
nephrotic
medication
antihypertensi
syndrome.
reactions
ve
with
May be used
pharmacologi
for
c effects and
management
uses
of hypertensio
almost
noted.
identical
to
n alone or in
those
of
combination
ethacrynic
with
acid.
antihypertensi
Exact
other
mode
of
ve agents.
action
not
Treatment
of
clearly
hypercalcemia
defined;
decreases
Has
been
renal vascular
used
resistance and
concomitantly
may increase
with mannitol
renal
for treatment
blood
were
No
flow.
of
severe
cerebral
edema,
particularly in
meningitis.
590.
591.
592.
593.
594.
595.
596.
Prior:

Give early in the day so that increased urination will not disturb sleep.
Do not expose to light, may discolor tablets or solutions; do not use discolored drug or solutions.
Avoid IV use if oral use is at all possible.
597.
During:
Observe patients receiving drug carefully; close monitor BP and vital signs.
Monitor for signs and symptoms of hypokalemia.
Administer with food or milk to prevent GI upset.
598.
After:
Monitor BP during periods of diuresis and through period of dosage adjustment.
Instruct patient to consult phyisician regarding allowable salt and fluid intake.
Instruct patient to ingest potassium-rich foods daily to reduce or prevent potassium depletion.
Instruct patient to not breast feed while taking this drug.
Avoid replacing fluid losses with large amounts of water.
Measure and record weight to monitor fluid changes.
Document.
599.
600.
601.
602.
603.
NA
605.
608.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
604.
GEN
606.
DAT
609.
GEN
. ACTION
610.
612.
INDI
613.
CLIE
CATION(S
NTS
RESPONS
FUN
RATION,
CTIONAL
E TO THE
ERIC
DOSAGE
CLASSIFI
MEDICATI
NAME
TAKEN/GI
AND
CATION
ON W/
AND
VEN
FREQUEN
BRAND
607.
GEN
ACTUAL
OF
EFFECT
CHANGED
ACTION
/ D/C
DO:
CY
MEC
SIDE
616.
DAT
611.
HANISM
NAME
614.
DAT
619.
---
Antacid
Dietary
621.
The
ERIC
NAME: Ca
Gluconate
615.
BRA
ND
NAME:
Cal-G
8-2-12
617.
DT/
DG: 8-2-12
618.
DC:
8-3-12
Electrolyte
620.
Essential
element
the
of
body;
helps
maintain
the
the
patient
when calcium
responded
intake
well
of
nervous
is
inadequate.
Prevention
the
of
medication
.
during
symptoms
of
transfusions.
medication
reactions
were
systems;
noted.
maintain
cardiac
function,
blood
coagulation; is
an
enzyme
cofactor
and
affects
the
secretory
No
of
and muscular
helps
with
hypocalcemia
exchange
functional
integrity
supplement
activity of the
endocrine and
exocrine
glands;
neutralizes or
reduces
gastric acidity
(oral use).
622.
623.
624.
625.
626.
627.
628.
629.
630.
Prior:

Take drug in between meals and at bedtime.
631.
During:
Do not administer oral drugs within 1-2 hours of antacid administration.

Have patient chew antacid tablets thoroughly before swallowing; follow with a glass of water or milk.
Give calcium carbonate antacid 1 and 3 hours after meals and at bedtime.
Warm calcium gluconate if crystallization occurs.
Monitor serum phosphorus levels periodically during long-term oral therapy.
Monitor cardiac response closely during parenteral treatment with calcium.
632.
After:
Have patient remain recumbent for a short time after IV injection.

Instruct patient to report any pain or discomfort at the injection site as soon as possible.
Document.
633.
634.
635.
636.
637.
638.
639.
NA
641.
DAT
644.
RO
ME OF
UTE OF
DRUGS;
ORDERED
ADMINIST
640.
GEN
642.
DAT
645.
GEN
. ACTION
646.
FUN
648.
INDI
CATION(S)
649.
CLI
ENTS
RESPONS
RATION,
CTIONAL
E TO THE
ERIC
DOSAGE
CLASSIFI
MEDICATI
NAME
TAKEN/GI
AND
CATION
ON W/
AND
VEN
FREQUEN
BRAND
643.
DAT
CY
647.
ME
CHANISM
ACTUAL
SIDE
NAME
650.
GEN
OF
CHANGED
ACTION
652.
ERIC
NAME:
/ D/C
DO:
8-3-12
653.
DT/
655.
SIVP
---4PM
Antiepileptic
Laxative
mia,
responded
replacement
well
therapy
the
m Sulfate
12
Cofactor
ND
NAME:
Epsom Salt
DC:
The
patient
656.
654.
657.
Hypomagnese
DG: 8-3-
BRA
IV:
Electrolyte
Magnesiu
651.
EFFECT
of
many enzyme
systems
involved
in
neurochemica
IV
or
IM:
or eclampsia
symptoms
PO: Short-term
treatment
and muscular
constipation
prevents
of
the
by
blocking
neuromuscula
colon
bowel
examinations
To
correct
No
of
medication
reactions
for rectal and
controls
seizures
for
PO: Evacuation
or
medication
Preeclampsia
l transmission
excitability;
with
or
prevent
transmission;
hypomagnese
were
noted.
attracts
and
retains
water
in
the
intestinal
Inhibition
distends
the
premature
and
to
relieve
constipation.
658.
659.
660.
661.
662.
663.
664.
665.
Prior:
nutrition.
and
movement
667.
parenteral
lumen
promote mass
on
Unlabeled use:
bowel
666.
mia in patients
Assess for contraindicated conditions:

Monitor knee-jerk reflex before repeated parenteral administration.
labor
(parenteral)
of
Give laxative as temporary measure.

Reserve IV use in eclampsia for life-threatening situations.
Observe the 15 rights in drug administration.
668.
During:
Give IM route by deep IM injection.

Monitor serum magnesium levels.
Do not give oral MgSO4 with abdominal pain, nausea or vomiting.
Do not administer if knee-jerk reflexes are suppressed.
Monitor bowel function.
669.
After:
Arrange to discontinue administration as soon as levels are within normal range and desired clinical response
is obtained.
Discontinue if diarrhea or cramping occurs.
Arrange for dietary measures, exercise and environmental control to return to normal bowel activity.
Instruct patient to report sweating, flushing, muscle tremors of twitching, inability to move extremities.
Maintain urine output at a level of 100 ml every 4 hours during parenteral administration.
Document.
670.
B. SURGICAL MANAGEMENT (Client-centered)
671.
A. Description
672. Total
Abdominal
Hysterectomy
Bilateral
Saphingo-
Oophorectomy (TAHBSO) is a surgical procedure in which the health

care provider removes the uterus including the cervix and the ovaries
including the fallopian tubes. To break the term down:
673. A hysterectomy is the surgical removal of the uterus. It
may be total, as removing the body and cervix of the uterus or partial.
674. Salphingo refers specifically to the fallopian tubes which
connect the ovaries to the uterus.
675. Oophorectomy is the surgical removal of an ovary or
ovaries.
676. The scar may be horizontal or vertical, depending on the
reason the procedure is performed, and the size of the area being
treated. It is performed to treat cancer of the ovary(s) and uterus,
endometriosis, and large uterine fibroids. TAHBSO may also be done in
some unusual cases of very severe pelvic pain, after a very thorough
evaluation to identify the cause of the pain, and only after several
attempts at non-surgical treatments. Clearly a woman cannot bear
children herself after this procedure, so it is not performed on women
of childbearing age unless there is a serious condition, such as cancer.
TAHBSO allows the whole abdomen and pelvis to be examined, which
is an advantage in women with cancer or investigating growths of
unclear cause.
677. Before any type of hysterectomy, women should have the
following tests in order to select the optimal procedure:
Complete pelvic exam including manually examining the ovaries

and uterus.
Uptodate Pap smear.
Pelvic ultrasound may be appropriate, depending on what the

physician finds on the above.
A decision regarding whether or not to remove the ovaries at the

time of hysterectomy.
A complete blood count and an attempt to correct anemia if

possible
678.
679.
B. Nursing Responsibilities prior to, during, and after the
operation.
680.
Prior
Before starting the procedure, it is important to observe the course of

the ureter of the patient as it crosses the external iliac artery near the
bifurcation of the common iliac artery at the pelvic brim.
On the evening before the operation, the patient should eat a light
dinner, and then take nothing by mouth, including water or other
liquids, after midnight.
The nurse should monitor the patients vital signs to assess the
patients condition before the surgery.
The nurse should explain the invasive procedure within the patients
understanding and let the client sign consent.
681.
During
Patient should be in steep trendelenburg and lithotomy position. One

assistant should remain between the legs of patient to do uterine
manipulation whenever required.
Vital signs, including internal or external temperature monitoring, will

be recorded every 5 minutes and as needed.
682.
683.
After
At the end of the procedure, the operative field is inspected and

any clots are removed with a suction-irrigator or grasping
forceps. Pedicles are inspected under water and with decreased
pneumoperitoneum and any bleeding if present can be controlled
with bipolar electrocoagulation.
The nurse should know that the recovery of the surgical

procedure done takes three to six weeks for full recovery.
Nurse should know that the patient is placed under NPO until
flatus is positive.
Nurse should assess patients surgical incision, noting for

infection and edema around the surgical suture .
There may be some discomfort around the incision for the first
few days after surgery, but most women are walking around by
the third day. Within a month or so, patients can gradually
resume normal activities such as driving, exercising, and
working.
Immediately following the operation, the patient should avoid

sharply flexing the thighs or the knees. Persistent back pain or
bloody or scanty urine indicates that a ureter may have been
injured during surgery.
Encourage the patient to practice deep breathing and coughing

exercise
684.
685.
686.
C. NURSING MANAGEMENT
687.
1. Nursing Care Plans
688.
Problem No. 1: Infection related to Presence of Incision Site Secondary to Surgical
Procedure
689.
AS
SESSME
NT
697.
S
>
698.
O
>
The
patient
manifest
ed:
Increase
WBC count :
Neutrophils
of
0.77;
Monocytes
of 0.05
Redness
Pain on the
incision site
Irritation
690.
N
URSIN
G
DIAGN
OSIS
691.
719.
R
isk for
infectio
n
r/t
presenc
e
of
incision
site
second
ary to
surgical
proced
ure
692.
SCI
ENTIFIC
EXPLANA
TION
693.
O
BJECTIV
ES
694.
INTE
RVENTION
S
695.
RA
TIONALE
696.
E
XPECTE
D
OUTCO
MES
720.
TAH
BSO is a
surgical
invasive
procedure,
which
means it
requires
an incision
site to end
the
procedure,
721.
Bre
akage
in
the
skin
integrity
decrease
the
first
722.
SH
ORT
TERM:
723.
Aft
er
2
hours of
nursing
intervent
ion,
patient
will
be
able
to
identify
intervent
ions
to
prevent
infection
from
1. Instruct
the
patient to give
time to rest on
bed
1. This will help

the patient
to
prevent
injury
730.
2. Encourage the
patient to eat
foods rich in
Vitamin
C,
protein
and
carbohydrates
748.
2. These foods
will help for
the
regeneration
and repair of
tissues,
energy
production
for
unassisted
movement
and
752.
S
HORT
TERM:
753.
754.
Af
ter
NI
and
health
teaching
s,
the
patient
shall
have
been
able to
identify
interven
tions to
731.
732.
733.
734.
735.
699.
Th
e patient
may
manifest:
Swelling of
the incision
site
700.
701.
702.
703.
704.
705.
706.
707.
708.
709.
710.
711.
712.
713.
714.
715.
716.
717.
718.
line
of
defense of
the body
which
make the
body more
susceptibl
e
in
acquiring
infection
brought
about by
invading
microorga
nism
which
is
transmitte
d through
direct
or
indirect
contact
that could
proliferate
in
a
traumatize
tissue
breakage
in the skin
occurrin
g.
724.
725.
726.
727.
LO
NG
TERM:
728.
Aft
er
2-4
days of
nursing
intervent
ion, the
patient
will
remain
free
of
infection
.
729.
736.
737.
738.
3. Encourage the
patient
to
increase fluid
intake
739.
4. Instruct the SO
to give patient
a
good
personal
hygiene
740.
741.
742.
743.
744.
5. Instruct
the
patient to give
importance for
wound care
745.
746.
6. Changed
dressings
needed
as
infection
prevention
3. To
prevent
dehydration
749.
750.
4. This will help
the patient
to
prevent
infection
related
to
poor
personal
hygiene
because of
microorganis
m
spread
5. This will help
the patient
to
have
faster
healing
of
the wound
751.
6. To
prevent
the dressing
from
prevent
infection
from
occurrin
g.
755.
756.
L
ONG
TERM:
757.
758.
Af
ter
nursing
interven
tions,
the
patient
shall
have
been
free
from
infection
.
747.
759.
760.
761.
762.
763.
764.
765.
766.
767.
768.
769.
770.
771.
772.
773.
774.
775.
776.
777.
778.
779.
780.
781.
782.
Problem No. 2: Acute Pain
783.
SSESS
784.
URSIN
785.
CIENTI
786.
BJECTI
787.
soaking with
secretions.
URSIN
788.
ATION
789.
XPECT
MENT
790.
FIC
DIAGN
EXPLA
INTERV
OUTC
OSIS
NATIO
ENTION
OME
792.
794.
VES
795.
1. Established
ALE
805.
ED
819.
: ali
cute
hen the
hort
Rapport
. To
hort
ken,
Pain
abdome
Term:
801.
gain
Term:
me-
793.
n is
opera
incision
ku kasi,
ed cells
masakit
called
nocicept
791.
: patient
manifes
ted:
ors
sense
damage
and
send an
facial
impulse
grimace
a pain
via a
sensory
scale of
nerve to
8/10
the
796.
2. Monitored
fter
and
4hrs. of
Recorded
Nursing
VS.
interven
tions
the
patient
will
verbaliz
ed
underst
anding
of
3. Assess pain
trust.
820.
4hrs. of
806.
807.
. To
cs such as
baselin
quality,seve
e data.
et, duration
Nursing
interve
ntions
obtain
location,ons
fter
characteristi
rity
the
patient
shall
have
808.
verbaliz
809.
and used
. To
pain scale
obtain
0/10.
baselin
ed
underst
anding
weakness
dorsal
health
horn
teachin
adequate
region
gs.
rest periods
of the
spinal
cord.
This
process
es the
signal
and
4. Encourage
802.
797.
799.
to eat
L
nutritious
ong
foods and
Term:
rich in
800.
fter 2-3
another
days of
6. Provided
signal
Nursing
clients
down
Interven
safety.
the
tions,
abdome
patient
n via
will
amotor
821.
813.
822.
814.
823.
4
prevent
fatigue.
7.
ong
Term:
824.
fter 2-3
days of
816.
817.
804.
gs.
. To
803.
sends
teachin
812.
815.
protein.
of
health
810.
811.
5. Encourage
798.
e data.
Nursing
5
interve
. For
ntions,
Provided
tissue
the
demons
quiet
regener
patient
nerve
trate/
environ
ation of
shall
causing
report
ment
wound.
have
abdomi
that
demons
nal
pain is
trated/
muscles
controll
reporte
to pun
ed. AEB
d that
away
decreas
from
e in
the
pain
source
scale
of
from
injury.
8/10 to
pain is
6. To protect
controll
client from
ed. AEB
injuries
decreas
818.
2/10.
e in
7. To have
pain
calm
scale
activities.
from
8/10 to
2/10.
825.
826.
827.
828.
Problem No.3: Impaired Physical Mobility related to pain.

A
829.
830.
831.
832.
833.
834.
SSESS
URSIN
CIENTI
BJECTI
URSIN
ATION
XPECT
MENT
FIC
VES
ALE
ED
DIAGN
EXPLA
INTERV
OUTCO
OSIS
NATIO
ENTIO
ME
N
835.
840.
841.
842.
NS
1. Monitor
1. For
865.
>
836.
> the
patient
mpaired
ue to
HORT
physical
the
TERM:
mobility
surgical
R/T pain
procedu
843.
and record
A
fter 2
may
re
hours of
manifes
perform
nursing
baseline
HORT
vital signs
2. Teach
data
TERM:
method to
852.
increase
activity
conserve
level.
energy
t:
ed, the
interve
837.
patient
ntions
Weakness
lost the
and
and fatigue
Discomfort
energy
health
reserve
teachin
d and
gs, the
increas
patient
es the
will be
848.
need to
able to
4. Provide
adapt
use
positive
the pain
identifie
atmospher
thus
limiting
techniq
clients
ue to
movem
enhanc
ent.
on
movement
Limited
range of
motion
Restless
Irritable
838.
839.
he
patient
may
2. To
3. Plan care
with rest
periods
between
activities
he
patient
shall
have
used
854.
the
855.
identifie
856.
3. To reduce
857.
858.
859.
860.
4. To
5. Assist with
853.
fatigue
849.
866.
minimize
frustrations
activities
861.
techniq
ue to
enhanc
e
activity
intolera
nce.
867.
868.
869.
870.
manifes
activity
850.
t:
intolera
6. Promote
Decreased
walking
speed
Difficulty
turning
nce.
comfort
844.
845.
measures
L
ONG
7. Encourage
TERM:
participatio
846.
847.
851.
fter 3
days of
nursing
n and
diversion
of activities
871.
5. To protect
from injury
862.
6. To reduce
pain
ONG
TERM:
872.
873.
he pt.
shall
863.
will
864.
maintai
7. To
n or
minimize
increas
pain
interve
strengt
ntions,
h and
the pt.
function
will
of
maintai
affected
n or
body
increas
part.
e
strengt
h and
874.
function
of
affected
body
part.
875.
876.
877.
878.
879.
880.
881.
882.
883.
884.
Problem No. 4: Impaired Skin Integrity relatd to Skin Trauma Secondary to TAHBSO
ASS
ESSMENT
891.
S>
885.
886.
887.
888.
889.
890.
URSIN
CIENTIF
BJECTI
NTERV
ATION
XPECTE
IC
VES
ENTIO
ALE
DIAGN
EXPLAN
OSIS
910.
I
ATION
911.
Li
NS
OUTCO
ME
913.
S 1. Establish
1. To gain
961.
mpaire
ke any
HORT
rapport
patients
HORT
d skin
other
TERM:
with the
trust and
TERM
The
integrit
surgical
914.
patient
y r/t
procedur
915.
manifested
skin
es,
892.
O>
fter 3
patient.
919.
A
2. Monitor
and record
cooperatio
n
2. to get the
962.
963.
Th
e patient
:
Destruction of
trauma
TAHBSO
hours
second
includes
of
skin layers
ary to
surrounding
TAHBS
the abdominal
incision
Disruption of
skin surface
Pain on the
incision site
893.
The
patient
may
manifest:
Invasion of
Pathogen
894.
895.
896.
897.
898.
899.
invasion
of the
nursing
interve
inside
ntions
body,
the
requiring
a
patient
will
surgical
demon
incision
strate
to
partici
perform
the
pation
and
specified
unders
surgical
tandin
procedur
g of
the
(TAHBSO
preven
).
tive
912.
measur
pon
es and
incision,
treatm
vital signs
3. Inspect the
incision
site every
shift using
health
shall
status of
have
the
demonst
patient
3. Frequent
REEDA
assessme
(redness,
nt can
edema,
detect
ecchymosi
sign and
s,
symptoms
discharge
of possible
and
infection
approxima
tion
method)
4. Assist the
patient in
understan
rated
participa
tion and
understa
nding of
the
preventi
ve
measure
939.
s and
940.
treatme
941.
nt
942.
program
4. To
on
ding and
promote
taking
following
wellness
care of
medical
regimen
and
the
943.
944.
945.
surgical
incision.
900.
there
ent
developing
946.
964.
901.
will be
progra
program of
947.
965.
902.
impairm
m on
preventive
948.
903.
ent of
taking
case and
949.
966.
904.
the skin
care of
daily
950.
967.
905.
integrity
the
maintenan
951.
NG
906.
causing
surgica
952.
TERM:
907.
damage,
ce
5. Performed
908.
909.
Causing
impairm
ent of
the skin
integrity.
the
incisio
prescribed
n.
treatment
916.
917.
regimen
953.
968.
954.
969.
5. Cleaning
LO
Th
e pt.
the incised
shall
part
have
ONG
920.
decreases
manifest
TERM:
921.
bacterial
ed an
After
922.
concentrat
intact
24
923.
ion thus
skin
hours
924.
aiding in
integrity
of
925.
the
and
nursing
6. Monitor
healing
absence
interve
the
process
of any
ntions
progress
the
and report
955.
6. Monitoring
signs
and
patient
for
the
sympto
will
favorable
response
ms of
manife
and
to
infection
st an
adverse
treatment
intact
response
can help
970.
identify a
971.
skin
integrit
y and
absenc
e of
any
signs
and
sympto
ms of
infectio
n.
918.
926.
927.
928.
929.
930.
931.
7. Instruct
possible
need for
alternative
interventio
ns
7. Proper
and assist
hand
the patient
washing is
with
the most
general
effective
hygiene
way for
including
disease
hand
prevention
washing
. Bacteria
and
from the
toileting
hands can
practices
932.
933.
934.
935.
8. Help the
patient
easily
contamina
te the
incision
area.
956.
8. To
assume
decrease
comfortabl
incidence
e position
of pain
936.
937.
938.
9. Inform the
patient of
and
induce
immobility
957.
9. To
the
increase
purpose of
complianc
self care
practices
10.Instruct
958.
the patient
959.
and
960.
significant
others on
reporting
the
of danger
possible
signs and
danger
symptoms
signs and
may help
symptoms
prevent
that
major
should be
complicati
reported to
ons
the
physician
immediate
ly
972.
973.
974.
975.
976.
977.
978.
979.
980.
981.
10.Prompt
982.
983.
984.
985.
986.
987.
988.
Problem No. 5: Constipation related to Decrease In Physical Movement

A
989.
990.
991.
992.
993.
994.
SSESS
URSIN
CIENTI
BJECTI
NTERV
ATIONA
XPECTE
MENT
FIC
VES
ENTION
LE
DIAGN
EXPLA
OSIS
1011.
C
NATION
1012.
C
onstipat
onstipat
HORT
ion r/t
ion is
TERM:
decreas
the
After 4-
> The
decreas
6 hours
pt may
physical
e in
of
manifes
activity
normal
nursing
frequen
interven
998.
cy of
tions,
Abdomi
defecati
the
1021.
nal
on. It
patient
1022.
tendern
occurs
will
1023.
ess or
when
verbaliz
995.
>
996.
997.
t:
1013.
1. Establish
rapport
1018.
1019.
1020.
2. Assess
OUTCO
1. To gain
patients
HORT
trust and
TERM:
confidence
After
1029.
2. To
patients
determine
condition
what
3. Monitor
MES
1035.
S
interventio
n will be
perform
3. To obtain
baseline
nursing
interven
tions,
the
patient
shall
have
verbaliz
ed
pain
the
and record
and
movem
underst
vital signs
feeling
ent of
anding
of rectal
feces
of risk
through
factors
the
and
large
appropri
intestin
ate
e is
interven
1025.
slow,
tions r/t
1026.
thus
individu
allowing
al
time for
addition
fullness
Change
in bowel
patterns
Decreas
ed
frequen
cy and
stool
volume
strainin
1024.
4. Instruct
data
1030.
4. To facilitate
absorption
patient to
of sufficient
increase
amount of
fluid intake
fluid in the
intestines
5. To facilitate
of risk
factors
and
appropri
ate
interven
tions r/t
individu
of soft
al
patient to
consistency
situatio
situatio
eat foods
of stools.
n.
rich in fiber
Fiber
1036.
such as
absorbs
1037.
bread,
water
ONG
TERM:
5. Instruct
al re-
1014.
possibly
absorpti
1015.
pain
on of
ONG
whole
which add
during
fluid
TERM:
grains.
softness to
defecati
from
Fruits and
stools
on
the
ter 1-2
large
days of
intestin
nursing
1000.
anding
expulsion
g and
999.
underst
1016.
Af
1031.
1028.
Af
ter
nursing
vegetables
1027.
1038.
6. To facilitate
feces
interven
tion
1001.
interven
1002.
accomp
tions,
ambulation
1003.
anied
the
within
1004.
by
patient
individuals
1005.
difficult
will
1006.
or
establis
1007.
incompl
1008.
ete
normal
1009.
passage
pattern
1010.
of stool
of bowel
and/or
eliminat
passage
ion
of
excessiv
ely hard
and dry
stool.
Due to
decreas
e
physical
activity
1017.
6. Encourage
ability
7. Administer
medication
as ordered
expulsion
1032.
7. To facilitate
expulsion
of soft
stools
1033.
1034.
patient
establis
h
normal
bowel
function
ing
the
movem
ent of
feces
through
the
large
intestin
e is low,
thus,
the may
patient
manifes
t
difficult
y or
decreas
e
frequen
cy in
defecati
on.
2. Actual SOAPIERs
1039.
1040.1041.
S
1042.1043.
Received patient on supine position, conscious, with an ongoi
of D5NM 1Lx40-41 gtts/min @ 500 cc level infusing well over the lef
metacarpal vein; with an intact indwelling foley catheter connected
bag draining reddish urine @ 550 cc level, with dry intact wound dre
the lower abdominal midline; with normal capillary refill of <3sec; w

taken and recorded as follows:
1044.
1045.1046.
BP: 110/80 mmHg, T: 36.6 c/axilla, PR: 78bpm; RR:24cpm

Impaired skin integrity r/t break in the skin 2 to post-operati
A
incision
1047.1048.
After 4 hrs of nursing intervention, the patient will be able to
P
techniques on how to practice proper wound cleaning technique and
demonstrate behaviors to achieve timely wound healing.

1049. Established rapport
I
Monitored and recorded vital signs

Assessed general condition
Assessed post-operative site, noting for color and presence of disch

Encouraged adequate rest periods
Emphasized proper hygiene
Encouraged frequent hand washing before and after wound cleaning

Promoted safety measures such as placing pillows in pts side
Encouraged early ambulation w/in clients level of tolerance
Instructed to eat foods high in Proteins such as fish, meat and foods
Vitamin C. such as citrus fruits once on DAT
Instructed and encouraged proper wound care, 2x a day.
Encouraged deep breathing and coughing exercises w/ proper splint
Regulated IVF accordingly

1050.1051.
Goal met. The patient was able to verbalize techniques on ho
E
practice proper wound cleaning technique and will demonstrate beh

achieve timely wound healing.
VI.
PATIENTS DAILY PROGRESS IN THE HOSPITAL

1. Clients Daily Progress Chart
1052.
1053.
DAYS
1060.
Nursing
1054.
ADMISSION
1055.
1061.
Problems
(8-1-12)
1062.
1056.
2ND DAY
1058.
3RD DAY
1057.
1063.
(8-2-12)
1059.
1068.
(8-3-12)
1064.
1. Anxiety
1069.
1065.
2. Risk for fluid
1066.
volume deficit
1067.
1070.
1071.
1072.
3. Risk for injury
1073.
4. Impaired skin
integrity
1074.
Vital Signs
1075.
PR: 81 bpm
1079.
PR: 80 bpm
1083.
PR: 78 bpm
1076.
RR: 21 cpm
1080.
RR: 22 cpm
1084.
RR: 24 cpm
1077.
BP: 120/80
1081.
BP: 100/70
1085.
BP: 110/80
mmHg
1078.
1087.
OXC/Lab.
Procedures
9. Clinical Chemistry
(Fluid and
1088.
T: 36c/axilla
mmHg
1082.
mmHg
T:
1086.
T:
36.3c/axilla
1089.
36.6c/axilla
1092.
1090.
1093.
1091.
1094.
1095.
Electrolytes)
10.
1096.
Complete
1097.
Blood Count
1098.
Medical
1099.
1103.
1112.
Management
1100.
1104.
1113.
11.
IVFs
1101.
D5LRS
1105.
1102.
1114.
1106.
1115.
PNSS
1107.
Voluven
1108.
1116.
1117.
1109.
D5NM
12.
1110.
BT
1111.
Fresh Whole Blood

(FWB)
1118.
DRUGS
1121.
1129.
1145.
Nalbuphine
1122.
1130.
1146.
Cefoxitin
1123.
1131.
1147.
Ketoroloac
1124.
1132.
1148.
1119.
1125.
1133.
1149.
1126.
1134.
1150.
1135.
1151.
1120.
Stat Meds
Omeprol
1127.
Dulcolax
1128.
Metronidazole
1136.
1152.
1137.
1153.
1138.
1154.
Fleet Enema
1139.
1155.
Cefoxitin
1140.
1156.
1157.
Hydrocorstisone
Famotidine
1141.
Lasix
1142.
Ca Gluconate
1143.
MgSO4
1161.
1144.
Diet
1162.
NPO
1158.
1159.
1160.
1163.
NPO
1164.
Foods rich in
Protein and Vitamin

1165.
Activity/Exer
cise
1166.
----
1167.
1172.
C once on DAT
1169.
Deep
breathing and coughing
breathing and coughing
exercise with proper
exercise with proper
splinting
splinting
1168.
1171.
Deep
1170.
1173.
VII. DISCHARGE PLANNING
1174.
A. General Condition of the Client upon Discharge
1175.
* Did not observed
1176.
1177.
B. Method
1178.
1179.
M- Instructed to take the ffg medications:
1180.
Nalbuphine 10mg whenever necessary for severe pain
1181. Cefoxitin 500mg every 8 hours

1182. Ketoroloac 30 mg every 6 hours
1183.
E- Encourage to do Ambulation
1184.
T- Encouraged to continue home medication/treatment regimen
1185.
H- Advised to eat foods rich in protein such as fish, soft meat,
and Vitamin C rich foods such as citrus fruits.

1186.
O-
1187.
D- Explained Soft Diet
1188.
1189.
1190.
VIII. CONCLUSION
1191.
A woman with ovarian cysts can experience bloating,
pelvic or abdominal pain, difficulty in eating or feeling full quickly,

urinary symptoms (urgency or frequency) ovarian cancer is called a
silent killer because symptoms were not thought to develop until the
disease had advanced and the chance of cure or remission poor.
Ovarian cancer is the fifth leading causes of cancer deaths in women,
the leading cause of deaths from gynecological malignancy, and the
second most gynecological malignancy. The exact cause is usually
unknown.
1192. Learning is a continuous process and patients are given with the
most basic facts regarding ovarian cancer. As student nurses, it is suggested
to encourage patients to continuously read and learn about their disorder and
to keep abreast of new developments in the field. Comprehension and
buoyancy go hand in hand. The more the pt. knows about ovarian cancer, the
easier it will be for them to accept the condition, control the disorder and the
live a normal productive life.
1193. Furthermore, our role as future nurses as health teachers we
should make sure we provide the public with information that is applicable for
them and encourage them to apply it in their day to day activities.
1194. For student nurses, we should be equipped with proper and
adequate knowledge or information about the disease so the proper care
could be given to the patient and family with ovarian cancer.
1195. For the nurses, they should give the patient information about
disease so she will know her condition. At the same time, giving out health
teachings is very essential so that she will cautious the next time she or her
friends and relatives might acquire.
1196. For the public, for them to know a knowledge regarding the
disease so that occurrence could be reduced through proper understanding
specifically the signs and symptoms, the initial intervention to be given and
prevention of reoccurrence of the said disease.
1197. Lastly, for the future researchers to make similar studies of this
case, in order for us to have a broaden understanding of the disease, how it
occurs, why and of course how it could be prevented. Also to be updated
about the current trends if the disease since of its growing popularity with
this information it would help us to reflect upon our daily habits.
1198.
1199.
IX. BIBLIOGRAPHY
1200.
Published Sources
1201.
Black, J.M,. et.al. Medical Surgical Nursing: Clinical
Management for Positive Outcomes.7th ed.

1202.
Doenges, M. E.2004.Nurses Pocket Guide: Diagnoses,

Rationales.9th ed. F.A. Davis Co.
Interventions and
1203.
Handbook of diseases. 3rd ed.
1204.
Karch, A.M. (2011), 2011 Lippincotts: Nursing Drug Guide. New
York: Lippincott
1205.
Pilliteri, A. Maternal and Child Health Nursing Care of the
Childbearing
1206.
Williams & Wilkins
and Child Rearing Family. 5th ed.
Smeltzer, S.C. et. Al. Brunner and Suddarths Textbook of
Medical Surgical Nursing.11th ed.

1207.
1208.
Online Sources
1209.
http://nurseslabs.com/tahbso-surgical-procedure-and-
perioperative-
management/
1210.
http://nursingcrib.com/drug-guides/hydrocortisone/
1211.
http://nursingcrib.com/drug-guides/metronidazole-2/
1212.
http://web.squ.edu.om/med- lib/med_cd/e_cds/Nursing
%20Drug%20Guide/mg/famotidine.htm
1213.
http://www.emedicinehealth.com/ovarian_cysts/article_em.
htm
1214.
http://www.medicinenet.com/famotidine/article.htm
1215.
http://www.medpill.info/bisacodyl-1108.htm
1216.
http://www.scribd.com/doc/13095017/Calcium-Gluconate-
Drug-Summ
1217.
http://www.scribd.com/doc/17100240/Bisacodyl
1218.
http://www.scribd.com/doc/22828269/Hydrocortisone
1219.
http://www.scribd.com/doc/22828270/Magnesium-Sulfate
1220.
http://www.scribd.com/doc/25880841/What-is-TAH-BSO-
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I.

Ovarian cysts can develop due to a woman's changing hormones that

technique uses a fluorescent tumor-specific probe that labels tumor cells in

penetrates to a depth of 100 microns and is able to examine shallow blood

Discussed the management and treatment and provide better nursing

Analyzed and interpreted the different diagnostic and laboratory

Interpreted the current trend and statistics regarding the disease

Formulated nursing care plans based on the prioritized health needs of

Define what Ovarian New Growth is and identified the manifestations.

occurrence of Ovarian New Growth, both modifiable and nonmodifiable.

pathophysiology, medical and nursing management applicable to

Identified and enumerated measures in the prevention of Ovarian New

Acquired knowledge on the risk factors that have contributed to the

Gained understanding and demonstrated compliance on the treatment

Built a trusting relationship with the researchers as well as the other

Gained knowledge on the definition of Ovarian New Growth, its risk

Received the best possible medical and nursing care, leading to a

5 | CS: O.N.G.| Grp.10

6 | CS: O.N.G.| Grp.10

7 | CS: O.N.G.| Grp.10

3. C. HISTORY OF PAST ILLNESS

Six months prior to admission, the patient complained of right

8 | CS: O.N.G.| Grp.10

7. Physical Examination upon Admission (August 1, 2012; as

10.BP: 120/80 mmHg

1st Patient-Nurse Interaction

PHYSICAL EXAMINATION (August 3, 2012)

Ms. Ovary was seen lying on bed, conscious and appears

Ms. Ovary has proportionate body built. She is conscious of the

She has a fair complexion, smells normal, no body odor. After

Clients skull is round and symmetrical in shape with absence of

Upon inspection, Ms. Ovarys eyebrow hair distribution is evenly

Lips are symmetric in contour, has uniformity in color, and

Thorax and Lungs

Ms. Ovarys chest is symmetrical in shape, spine vertically

Upon inspection, her muscles are equal on both sides of the

No deformities, tenderness or swelling palpated on patients

DIAGNOSTIC AND LABORATORY PROCEDURES

Explain the procedure.

also important in how

Define and explain the test.

the body against

Explain the procedure.

III. ANATOMY AND PHYSIOLOGY OF THE FEMALE

continuation of the human species by the production of offspring. The

reproductive system is also responsible for gestation of the offspring.

244. When a baby girl is born, her ovaries contain hundreds of

248. The external part of the female reproductive organs is

251. The vagina is a muscular, hollow tube that extends from

with mucous membranes, which keep it protected and moist. The

257. The uterus is located in the pelvic cavity, superior to the

entry of the fallopian tubes, is the fundus.

The body is the large

accommodate the growing fetus.

The myometrium contracts during

labor and delivery at the end of gestation. The endometrium, or lining

progesterone from the ovaries stimulate the growth of blood vessels to

259. There are two fallopian tubes, each attached to a side of

Fimbriae, found on the lateral end of each tube, are

fringe-like protrusions that generate currents in the fluid surrounding

Within each tube is a tiny

passageway no wider than a sewing needle. At the other end of each

261. The ovaries are a pair of oval-shaped organs located in the