SELF IDENTIFICATION DATA

Name: Monika Rani

Class: M.Sc (N) IST Year

Subject: Obstetrical and Gynecological Nursing

Ward: Civil Hospital, Maternity ward

Topic: Hysterectomy

DATA OF THE PATIENT:

Name Hardeep Kaur w/o Jaspal Singh

Age 35 years
Sex Female
Marital status Married
GPAL G1P1A0L1
Religion Sikh
Educational status 10th
Occupation Housewife
Income Rs 18000/month
Address Kartarpur, Jalandhar.
Date of admission 25 Feb 2019

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Diagnosis fibroid uterus
Doctor in charge Dr. Kulwinder Kaur

OBSTETRICAL HISTORY:

G1 P1 A0 L2

Contraceptive method used: Condom was used.

CHIEF COMPLAINTS:

Mrs. Hardeep is admitted in civil hospital, Jalandhar after completion of excessive bleeding or abdominal pain weakness and lethargy.

PAST MEDICAL AND SURGICAL HISTORY:

Past medical history: Patient has not any significant past medical history

Past surgical history: Patient had not significant past surgical history

PRESENT HISTORY:

Mrs. Hardeep suffering from pain after hysterectomy.

MENSTURAL HISTORY:

Age at puberty: - 14 years

Flow: - Regular Duration: - 4-5 days Menstrual cycle: - 28 - 33 days.

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MARITAL STATUS:

 Age at marriage: 20years

 Use of contraceptives: They are using temporary methods of contraception i.e. Condom
 Relationship with the husband: Good and healthy relation with husband and his family

OBSTETRICAL HISTORY:

a) Past obstetrical history:

Patient had not significant past obstetrical history

FAMILY HISTORY:

S .No NAME AGE RELATION OCCUPATION HEALTH STATUS

1. Mr. Satpal Sing 65years Father-in-law - Healthy
2. Mohinder Kaur - Mother- in- law - Dead
3. Mr. Jaspal Singh 37years Husband Salesman on shop Healthy
4. Mrs. Hardeep 35years Patient House wife Healthy
Kaur
5 14 Suriya 1 day Son - Healthy

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FAMILY TREE:

Satpal Singh Mohinder Kaur

65 years

Jaspal Singh 37 years Hardeep Kaur 35 year

Suriya 14 years

PERSONAL HISTORY: Patient is conscious and cooperative. Patient is neat and clean and well oriented to his surroundings.
Patient used condom for contraception.

Personal Habits: Habits of drinking water early in the morning, maintain personal hygiene, Watching T.V, cooked food in
hygienic conditions.

Dietary Habits: Vegetarian and taken meals 3 times a day. Patient takes light, nutritious, easily digestible diet and which is rich in
protein, minerals and vitamins. Doctor prescribed one iron tablet i.e. 45 mg as supplementary nutritional therapy but forget to taken.

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Sleeping Pattern: 1 hour in afternoon and 4 hours in night.

SOCIO-ECONOMIC DATA:

 Total number of family members: 3

 Number of earning members in the family: 1
 Monthly income: Rs 18000/month
 Housing conditions: Pucca house, proper water supply, hygiene conditions maintain by cleanliness and proper drainage
system.

GENERAL PHYSICAL ASSESSMENT:

Patient is a 35 years old female, with pulse rate of 80 beats per minute, respiratory rate of 20/ minute and a temperature of 37⁰C. She is
conscious and maintains interaction with others. She is comfortable and gives response to each question.

PHYSICAL EXAMINATION

General appearance:

Nourishment: Nourished

Body build: Thin

Health: Healthy

Activity: Dull due to fatigue

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  Height:163 cm
 Weight: 78 kg

Head:

Scalp: The scalp is free from dandruff

Hair: Black in colour

Pediculosis: Not present

Face:

Colour: Face colour is pallor

Eyes:

Vision: Normal and reaction to the light is normal.

Colour: Normal

Conjunctiva: Normal

Sclera: Pallorp

Eye brow: symmetrical

Eye lashes: Normal

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Her eyes are symmetrical, black in color. Eyelashes are equally distributed and skin around the eyes is intact. The eyes involuntarily
blink.

Nose:

External nostrils: Normal without any discharge

Nostrils: Normal

No swelling of the mucous membrane and nasal hairs are present.

Ears:

External ear: normal, no any discharge

Tympanic membrane: Normal with no perforation

Hearing: Normal

Ears are clean, no ear wax was noted and both ears are in same size and shape. Patient can hear normally.

Mouth and pharynx:

Lips: Dry.

Odour of mouth: No foul smell observed from mouth.

Teeth: Normal in colour and without any dental caries

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Tongue: Not coated

She has a complete set of teeth and no dental caries noted. Oral mucosa and gingival are pink in color, moist and there were no lesions
and inflammation noted. Tongue is normal in colour and is free of swelling and lesions. Lips are symmetrical, pink in colour and
appear dry upon observation.

Skin colour:

Colour: Pallor

Texture: Dry skin, no lesions and wound is present.

Neck:

Thyroid Gland: No enlargement, no neck rigidity.

No lymph nodes noted.

ROM - Normal

Upper extremities: Normal range of motion.

Edema is not present.

Nails:

Nail bed: Normal in colour

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Nail plate: Normal in shape

Breast:

Inspection:

 Both breasts are symmetrical.

 Discharge from nipple –no
 No sign of infection.
 Secondary areola present.

Palpation: No any lump or cyst is present

Lower extremities: Normal range of motion.

Edema is not present.

Pain in joint

Abdomen:

Normal

Back: Lordosis is not present. Back pain absent

Genitalia: Bleeding are present

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Vulva – Normal No edema

VITAL SIGNS:

S. No VITAL SIGN NORMAL PATIENT’S VALUE REMARKS

VALUE
1. Blood pressure 120/80mmHg 110/70mmHg Normal
2. Pulse 72/min. 80/min. Normal

3. Respiration 16-24/min. 20/min. Normal

4. Temperature 98.6oF 98oF Normal

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INVESTIGATIONS:

Sr. LABORATOR NORMAL VALUE PATIENT VALUE REMARKS

No. Y
INVESTIGATI
ONS
1. Hemoglobin 12-16gm/dl 11.2 gm/dl Normal
2. TLC 4000-10,000/cumm 8400/cumm Normal
3. Platelets 1.50-4 lakh/cumm .1.35000/cumm Decreased
4. RBC 3.5-5.5/cumm 2.43/cumm Decreased
5. Blood urea 10-45mg% 29mg% Normal
6. S. Creatinine 0.5-1.4mg/dl 1.2mg/dl Normal
7. DLC
Neutrophil 40-75% 53% Normal
Lymphocyte 20-40% 22% Normal
Basophil 2-10% 3% Normal
Monocyte 1-6% 01% Normal

Blood gp B+ve

USG Report fibroid uterus

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 MEDICATIONS:

Sr. NAME OF ACTION DOSE ROUTE INDICA- NURSING

No. DRUG/ TION RESPO-NSIBI-LITIES
TRADE/
CHEMICAL
1. Tab. Folic Multivitamin 4 P/O Treat anaemia by Do not take this medication for more
acid mg/day increase level of than 6 months without checking with
haemoglobin. doctor.
2. Inj. Red Multivitamin 200mg I/V Infusion For anaemic women Caution needed in patients with folic
(Ferric) acid-dependent tumors.
3. Tab. Ferrous Treat iron 325 mg P/O It replaces iron in the Avoid use in patients with active peptic
Fumarate deficiency body when the body ulcer, repeated blood transfusion,
anaemia does not produce regional enteritis and intestinal ulcer.
enough on its own.

4. Tab.Ciproflox Anti- 250 mg P/O For preventing infection It may cause drowsiness, dizziness,
acin infectives blurred vision or lightheadedness, do
not operate machinery while taking this
medication.

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NURSING MANAGEMENT:

ASSESSMENT:

 Complete history of the patient is taken.

 Vitals are checked and recorded.
 Medication is done.
 Education is given regarding the care of both babies.
 Education is given to feed the both babies in proper position.

NURSING DIAGNOSIS: For mother

1) Acute pain related to hysterectomy incision as evidenced by facial expression and verbal communication.
2) Risk for infection related to hysterectomy incision as evidenced by observing the condition of the patient.
3) Impaired sleeping pattern related to hysterectomy pain as evidenced by communication with patient.
4) Anxiety related to surgical procedure
5) Knowledge deficit related to how to care surgical wound

PLANNING:

SHORT TERM GOALS:

1) To reduced pain level of the patient.

2) To maintain effective tissue perfusion

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3) To maintain body temperature

4 To prevent from infection.

5) To maintain sleeping pattern of the patient.

LONG TERM GOALS:

1) To maintain good IPR with the patient.

2) To provide psychological support to patient.

3) To maintain health status of the patient.

4) To rehabilitate the patient.

5) To reduce anxiety level of the patient.

APPLICATION OF THEORY
Nursing care of Hardeep age 35 years old female diagnosed as having fibroid uterus based on sister Calista Royal adaptation model.

The focus for the set of processes by which a person adapts to environmental stressors, Roy’s view the person as an adoptive system that function
as a whole through interdependence of its parts. The system consists of input, control processes, output and feedback.

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PHYSIOLOGICAL

FUNCTION

COPING MECHANISM

STIMULI ADAPTATION

ADAPTATION

INEFFECTIIVE REGULATOR SELF CONCEPT

LEVEL

INEFFECTIVE

RESPONSE

CONGNATOR

ROLE FUNCTION

INTERDEPANDENCE

FEED BACK

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INPUT:
Input are stimuli from external environment and internal environment including information from pregnant women and regulator mechanism for
this patient input were the hospitalization and disease condition (Twince pregnancy)

CONTROL PROCESS:

The control process include both biological and psychological coping mechanism of the person as well as pregnancy and regulator responses this
patient is taking treatment in hospital for twince pregnancy.

OUTPUT:

Output is the adoptive and ineffective behavioral responses of the person. Here the patient may relieved by signs and symptoms.

FEED BACK:

Feed back is information regarding the behavioral responses that is conveyed as input in the system.

STIMULI:-

Each person as input in the system called stimuli.

(i) Focal stimuli:

Is a large immediately confronting the person, these reassure an adoptive response.

(ii) Contextual stimuli:

Is all other stimuli present in the person or environment or environment.

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 (iii) Residual stimuli:-

There beliefs, attitude that affect the person’s present situation.

The person’s behavioral response is a modem determines whether the adaption is an effective or ineffective response to the stimuli.

PHYSIOLOGIC
SELF CONCEPT
AL
GROUP IDENTITY
MODE
MODE

COPING

PROCESS

INTERDEPENDENCE

MODE ROLE

FUNCTION

17 MODE
 PHYSIOLOGICAL MODE:

Includes oxygenation, nutrition, elimination activity and rest, skin integrity, senses; fluid and electrolyte balance, neurological and endocrine
function.

REGULATOR SUB SYSTEM:

It receives and processes changing stimuli from the external environment and internal self through neural – chemical endocrine channels.

COGNITOR SYSTEM:

It receives varying internal and external stimuli involving psychological and social factors physical & psychological factors including bodily
response from the system are also included.

The behavior responses of the person is 4 modes

- Physiological
- Self concept
- Role function
- Interdependence

SELF CONCEPT:

Mode consist of the individual’s feeling and belief at a given period that influence behavior of the person It includes psychiatric integrity, Physical
self , Personal self, self consistency, self idea moral –ethical, spiritual self learning, self concept and self esteem.

ROLE FUNCTION:

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This mode includes role position, sole performance, role mastery, social integrity primary role, secondary adverbially role and also instrumental
and expressive behavior.

INTERDEPENDENCE MODE:

Addresses the ability to love, respect and value others and to respond to other is a similar manner.

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 NURSING CARE PLAE on hysterectomy

S NO Nursing Expected Planning Implementation Rationale Evaluation

diagnose outcome
1. Acute pain Pain level will be Assess the pain Pain level of the patient was It will help to collect Pain was reduced
related to reduced to some level of the assessed by wong bakeis scale =7 baseline data of the up to some extent.
hysterectomy extent after 2-3 patient. patient.
incision as hours by applying
evidenced by nursing action.
verbal
communication Provide Comfortable position and warm It will help in
and facial comfortable environment was given to the providing comfort
expression position and patient. patient.
warm
environment to
the patient.

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 Provide Comfortable devices like pillows It will help in
comfort were provided to the patient. providing comfort
devices to the and relaxation.
patient

Give Patient was advice to do prayer. It will help in

diversional diverting the mind of
therapy to the the patient.
patient.

Administer Drug PCM was administered to the For relief the pain.
PCM drug patient.
prescribed by
the doctor.

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SN Nursing Expected Planning Implementation Rationale Evaluation
diagnose outcome
2
Risk for infection Risk of infection Monitor vital Condition of the patient as assessed This will help to Reduced chances
related to will be reduced sign of the of temp =98.6 collect baseline data of infection at
hysterectomy as up to some extent the patient and of the patient some extend
evidenced by after Appling care assess the
observing condition of .
condition of the the patient
patient. Educate the Patient was advised and assessed to It will maintain
client about do for personal hygiene and personal hygiene and
personal hysterectomy care hysterectomy care.
hygiene and
hysterectomy
care patient

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 Educate the Patient was advised to change pad It will help to prevent
client about after 2 hours infection and further
vulvae pad complication.
change at
require interval
after 2 hours

Educate the Patient was advised to change It will help to prevent

patient about undergarment daily infection and giving
change daily the sense of
undergarment wellbeing.

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SN Nursing Expected Planning Implementation Rationale Evaluation
diagnose outcome

3 Impaired Sleeping pattern Assess the Sleeping pattern of the patient was It helps in collecting Sleeping pattern of
sleeping pattern of the patient was sleeping assessed she took 4-5 hours’ sleep. baseline data. patient was
related to maintained up to pattern of the maintained within
hysterectomy some extent patient. 2-3 hours.
pain as evidenced within 5 days.
by
communication
with patient and Provide noise Noise free environment was It will help in
by facial free and calm provided to patient. inducing sleep.
expression environment to
the patient.

Restrict the Entry of visitor was restricted in It will help in

entry of the patient room by limiting visiting preventing
visitors in hours. disturbance.
patient room.

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 Advised Patient was advised not to take It will promote sleep
patient not to caffeine at night time daily schedule easy.
take caffeine was provided
and meal
before 2 hours
going to sleep.

Involve the Patient was involved day care It will help in induced
patient in care activities. sleep at night.
activities

HEALTH EDUCATION:

1. Patient is educated about the adequate care for treating of any kind of infection.

Diet:

2. Patient is educated about the improvement of living conditions by avoidance of open air defection, hygienic measures, and balanced
diet.

3. Patient is educated about taking Iron folic acid supplementation and iron-rich diet and follows the menu plan.

4. Advised her to start from bland diet. The diet should contain plenty of protein, meat, fresh fruits and green vegetables.

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5. Rest and sleep – Educated for proper rest and sleep.

6. Care of bladder and bowel – encouraged to void frequently to avoid bladder extention and to drink plenty of fluids to prevent
constipation.

7. Follow up- Educated about regular checkups and regularly taking medication as prescribed by doctor.

BIBLIOGRAPHY:

Dutta D.C; “Textbook of gynecology” Edition 6th (2009); Published by new central agency.

Galannick myers; “Textbook of nursing care plan” Edition 5th (2009); Published by Elsevier, Page no. 160-169.

Lowder milk deitra leonard, Perry Shannon E; “Textbook of maternity and women’s health care” Edition 5 th (2007); Published by
mosby; Page no. 782-786.

Myles; “Atextbook for midwives” Edition 14th (2007); Published by Elsevier; Page no. 564-569.

Abstract
Objective
To evaluate fibroid uterine volume reduction, symptom relief, and patient satisfaction with uterine artery embolization (UAE) for
symptomatic fibroids.

Design
Multicenter, prospective, single-arm clinical treatment trial.

Setting
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Eight Ontario university and community hospitals.

Patient(s)
Five hundred thirty-eight patients undergoing bilateral UAE.

Intervention(s)
Bilateral UAE performed with polyvinyl alcohol particles sized 355–500 μm.

Main outcome measure(s)

Three-month follow-up evaluations including fibroid uterine volume reductions, patient reported symptom improvement (7-point
scale), symptom life-impact (10-point scale) reduction, and treatment satisfaction (6-point scale).

Result(s)
Median uterine and dominant fibroid volume reductions were 35% and 42%, respectively. Significant improvements were reported for
menorrhagia (83%), dysmenorrhea (77%), and urinary frequency/urgency (86%). Mean menstrual duration was significantly reduced
after UAE (7.6 to 5.4 days). Improvements in menorrhagia were unrelated to pre-UAE uterine size or post-UAE uterine volume
reduction. Amenorrhea occurring after the procedure was highly age dependent, ranging from 3% (1%–7%) in women under age 40 to
41% (26%–58%) in women age 50 or older. Median fibroid life-impact scores were significantly reduced after UAE (8.0 to 3.0). The
majority (91%) expressed satisfaction with UAE treatment.

Conclusion(s)
UAE reduced fibroid uterine volume and provided significant relief of menorrhagia that was unrelated to initial fibroid uterine size or
volume reduction. Patient satisfaction with short-term UAE treatment outcomes was high.

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