General Objectives

The purpose of the presentation is to know related information and

knowledge about the patient’s case/ condition and disease. This presentation will
serve as guidelines for us student nurses in assessing and providing proper nursing
care to our patient with the same problem or disease.

Specific Objectives

 To understand condition of disease and associate it with the patient through

the introduction of the case

 To know the nursing history, personal data, health history and physical
assessment of the patient

 To illustrate the anatomy and physiology and pathophysiolgy of the affected

organ.

 To discuss and determine manifestation and complications

 To develop an effective skill on how to manage care in patient with the
disease
 To formulate a drug study with regards to the patients condition and
correlate lab results to its normal values.
 To provide the client a nursing care plan and discharge plan to assure for
clients total wellness during her hospitalization up to the time of her hospital
discharge .

Overview of the disease

Ovarian cysts are small fluid-filled sacs that develop in a woman's ovaries.
Most cysts are harmless, but some may cause problems such as rupturing,
bleeding, or pain; and surgery may be required to remove the cyst(s). It is
important to understand how these cysts may form.

Women normally have two ovaries that store and release eggs. Each ovary is
about the size of a walnut, and one ovary is located on each side of the uterus. One
ovary produces one egg each month, and this process starts a woman's monthly
menstrual cycle. The egg is enclosed in a sac called a follicle. An egg grows inside
the ovary until estrogen (a hormone), signals the uterus to prepare itself for the
egg. In turn, the uterus begins to thicken itself and prepare for pregnancy. This
cycle occurs each month and usually ends when the egg is not fertilized. All
contents of the uterus are then expelled if the egg is not fertilized. This is called a
menstrual period.
In an ultrasound image, ovarian cysts resemble bubbles. The cyst contains
only fluid and is surrounded by a very thin wall. This kind of cyst is also called a
functional cyst, or simple cyst. If a follicle fails to rupture and release the egg, the
fluid remains and can form a cyst in the ovary. This usually affects one of the
ovaries. Small cysts (smaller than one-half inch) may be present in a normal ovary
while follicles are being formed.
Ovarian cysts affect women of all ages. The vast majority of ovarian cysts
are considered functional (or physiologic). In other words, they have nothing to do
with disease. Most ovarian cysts are benign, meaning they are not cancerous, and
many disappear on their own in a matter of weeks without treatment. Cysts occur
most often during a woman's childbearing years.
Ovarian cysts can be categorized as noncancerous or cancerous growths.
While cysts may be found in ovarian cancer, ovarian cysts typically represent a
normal process or harmless (benign) condition.

Signs and Symptoms

Ovarian Cysts Causes
Oral contraceptive/birth control pill use decreases the risk of developing
ovarian cysts because they prevent the ovaries from producing eggs during
ovulation.

The following are possible risk factors for developing ovarian cysts:

• History of previous ovarian cysts

• Irregular menstrual cycles
• Increased upper body fat distribution
• Early menstruation (11 years or younger)
• Infertility
• Hypothyroidism or hormonal imbalance
• Tamoxifen therapy for breast cancer

Ovarian Cysts Symptoms

Usually ovarian cysts do not produce symptoms and are found during a
routine physical exam or are seen by chance on an ultrasound performed for
other reasons.

However, the following symptoms may be present:

• Lower abdominal or pelvic pain, which may start and stop and may be
severe, sudden, and sharp.
• Irregular menstrual periods
• Feeling of lower abdominal or pelvic pressure or fullness
• Long-term pelvic pain during menstrual period that may also be felt in the
lower back
• Pelvic pain after strenuous exercise or sexual intercourse
• Pain or pressure with urination or bowel movements
• Nausea and vomiting
• Vaginal pain or spots of blood from vagina
• Infertility
III. Personal data of Client

 Patient: case # 09091009

 Address: Brgy. San Francisco Lopez, Quezon
 Age: 42
 Sex: Female
 Civil Status: Single
 Religion: Roman Catholic
 Nationality: Filipino
 Chief Complaint: On and Off Hypogastric pain
 Admitting Date: Sept. 16, 2009

IV. Present Health History

She is a 42-year old female, single, and was admitted to Quezon

Medical Center, last September 16, 2009 due to on and off
hypogastric pain.

V. Past Health History

A. General Health
The patient is conscious and seems tiresome, quite passive yet
coherent and partly cooperative.

B. Childhood Illnesses
The patient had fever, flu and cough. She had no childhood
illness/es related to his present health status.

C. Immunization
She had incomplete vaccinations during childhood.

D. Major Illnesses Hospitalizations

She has Diabetes Mellitus which was diagnosed when she was 32
years old. She was hospitalized last August 8-11, 2009 with chief
complaint of abdominal pain.

E. Current Medication/s
Her medications are as follows:

VI. Physical Assessment

A. General Condition
The patient is in a lying position:
B. Skin
 Dark complexion
 With good skin turgor
 Partly rough yet tender
 Warm upon palpation

C. Hair
 Black and thin hair
 Evenly distributed

D. Head
 Symmetrical

E. Eyes
 No secretion noted
 Eyebrows symmetrically aligned
 Pupils are equally round and reactive to light and accommodation
 Pale conjunctiva; yellowish sclera

F. Ears
 Symmetrical
 Upper pinna of the ear in line with the outer canthus of the eyes
 No swelling noted
 Adequate responses to sounds

G. Nose
 Symmetrical and straight
 Without nasal discharges

H. Mouth and Lips

 Pale and dry lips
 Tongue centrally located
I. Throat
 No tonsilo-pharyngeal inflammation
 No difficulty of swallowing

J. Neck
Muscles equal in size and head centred

K. Chest
 Symmetrical upon inspection

L. Abdomen
 Symmetrical upon inspection
 With soft and non tender abdomen upon palpation

M. Extremities
 Symmetrical and proportion
 Not edematous

Anatomy and Physiology

Functional anatomy of the ovary

VIII. Pathophysiology
IX. Course in the Ward
 On day one Sept. 16 2009, the patient was admitted on OB ward and
under gone complete blood count, blood transfusion, urinalysis, and had
post anesthesia order. On day two Sept. 17 2009, the patient undergone
TAHBSO. On Sept. 18 2009, the patient was advise to have a repeat
CBC.

TAHBSO
Total Abdominal Hysterectomy with Bilateral Salphingo-oophorectomy

Types of Hysterectomy

All hysterectomies include removal of the uterus, but the type of procedure
used often depends on the condition being treated.

Complete or total hysterectomy

involves the removal of both the uterus and the cervix. This is the most
common type of hysterectomy performed.

Hysterectomy with bilateral salpingo-oophorectomy

is the removal of the uterus, cervix, fallopian tubes, and ovaries.

Surgical Procedures
Traditionally, hysterectomies have been performed using a technique known
as total abdominal hysterectomy (TAH).

In a total abdominal hysterectomy (TAH), the surgeon makes an incision

approximately five inches long in the abdominal wall, cutting through skin and
connective tissue to reach the uterus. The cut can be either vertical3 running from
just below the navel to just above the pubic bone, or horizontal—running across
the top of the public bone (known as a bikini-line incision).

Advantage of total abdominal hysterectomy is that the surgeon can get a complete,
unobstructed look at the uterus and surrounding area. There is also more room in
which to perform the procedure. This type of surgery is especially useful if there
are large fibroids or if cancer is suspected.

Disadvantages include more pain and a longer recovery time than other
procedures, and a larger scar.
 Total Abdominal Hysterectomy
With and Without Bilateral
Salpingo-oophorectomy

Total abdominal hysterectomy is utilized for benign and malignant disease

where removal of the internal genitalia is indicated. The operation can be
performed with the preservation or removal of the ovaries on one or both sides. In
benign disease, the possibility of bilateral and unilateral oophorectomy should be
thoroughly discussed with the patient. Frequently, in malignant disease, no choice
exists but to remove the tubes and ovaries, since they are frequent sites of
micrometastases.

The purpose of the operation is to remove the uterus through the abdomen,
with or without removing the tube and ovaries.

Physiologic Changes. The predominant physiologic change from removal

of the uterus is the elimination of the uterine disease and the menstrual flow. If the
ovaries are removed with the specimen, the predominant physiologic change noted
is loss of the ovarian steroid sex hormone production.

Abdominal hysterectomies take from one to three hours. The hospital stay is
three to five days, and it takes four to eight weeks to return to normal activities.

The advantages of an abdominal hysterectomy are that the uterus can be

removed even if a woman has internal scarring (adhesions) from previous surgery
or her fibroids are large. The surgeon has a good view of the abdominal cavity and
more room to work. Also, surgeons have the most experience with this type of
hysterectomy. The abdominal incision is more painful than with vaginal
hysterectomy and the recovery period is longer.

Purpose

The most frequent reason for hysterectomy in American women is to remove

fibroid tumors, accounting for 30% of these surgeries. Fibroid tumors are non-
cancerous (benign) growths in the uterus that can cause pelvic, low back pain, and
heavy or lengthy menstrual periods. They occur in 30–40% of women over age 40.
Fibroids do not need to be removed unless they are causing symptoms that
interfere with a woman's normal activities.

In addition to a total hysterectomy, a procedure called a bilateral salphingo-

oophorectomy is sometimes performed. This surgery removes the ovaries and the
fallopian tubes. Removal of the ovaries eliminates the main source of the hormone
estrogen, so menopause occurs immediately. Removal of the ovaries and fallopian
tubes is performed in about one-third of hysterectomy operations, often to reduce
the risk of ovarian cancer.
 X. Laboratory/Diagnostic Examination
September , 2009

Complete Blood Count Results Normal Values

Hemoglobin 13.7 14-18gm/gl

Hematocrit 41 40-50vol

WBC count 16,000 5,000-10,000 cumm

Differential Count
Neutrophils 78 40-60

Lymphocyte 32 35-40

Eosinophils 3 2-4

September , 2009

NCP
Nursing Care Plan
 ASSESSMEN NURSING PLANNIN INTERVENTIO RATIONALE EVALUATIO
T DIAGNOSI G N N
S
S: Alteration At the end  Assess the  toassess Goal met as
“Kumikirot in comfort of the characterist etiology/precipita evidenced
ang tahi ko” related to shift the ics of pain ting contributory by the
as verbalized surgical patients factors patient’s
by the incision levelof  Encourage  to determine verbalizatio
patient site pain will verbalizatio client response to n of the
O: > with reduced n of pain situation lessening
limited range from 7 out feelings pain from 7
of motion of 10 to 3  proper  for patient’s out of 10 to
> weak in out of 10 positioning comfort 3 out of 10
appearance provided
> unable to  adequate  to promote
move rest periods peristalsis
without  encourage  to decrease stress
assistance early
> with facial ambulation
grimace  promoted
> with comfort
guarding measures
attitude in  administer
the post- medication
operative as indicated
site
> with pain
scale of 6
out of 10

ASSESSMENT NURSING PLANNING INTERVENTIO RATIONALE EVALUATION

DIAGNOSIS N
S: “ Hindi ako Sleep pattern at the end  maintain  Sleep is Goal met as
makatulog ng disturbance of the shift slightly difficult evidenced by
maayos maya’t related to the patient dark, quiet without the patient’s
maya ako environmenta will be and well relaxation the verbalization
nagigising” as l changes able to ventilated unfamiliar of the
verbalized by the report environmen hospital lessening
patient satisfactory t environment pain from 7
O: > redness of of sleep  scheduled can hinder out of 10 to
the conjuctiva or relaxation 3 out of 10
 dark circles organized  In order to
around the nursing care feel rested. A
eyes through: person usually
 decrease  elimination must complete
attention of non- an entire sleep
span essential cycle
 frequent nursing  A familiar
yawning actions bedtime ritual
 restless in  prepare may promote
appearance patient for relaxation and
necessary sleep
anticipated
interruption
to her sleep
 Assist
patient in a
comfortable
position
 Provide
health
teaching
such as:
 Increase
physical
activities
 Avoid fluid
and food
before
bedtime

Drug Study
Name of the Action Indication Dosage Adverse Nursing
Drug &Preparatio Reaction Responsibility
n
Mefenamic Produces Mild to 500mg q6 CNS: >Observe 10
Acid anti- moderate drowsiness, rights in giving
inflammatory, pain, dizziness, medication
analgesic & dysmenorrhe nervousness > Administered
antipyretic a CV: edema with food to
effects GI: nausea, minimize GI
possibly vomiting, adverse reactions.
through diarrhea, >Contraindicated
inhibition of peptic in GI ulceration r
prostaglandin ulceration, inflammation.
synthesis. hemorrhage >Teach patient
GU:dysuria, sign and
hematuria, symptoms of GI
nephrotoxicit bleeding, and tell
y patient to report
Hepatic: these to the doctor
hepatotoxicity immediately.
Skin:rash, >Severe hemolytic
urticaria anemia may occur
with prolonged
use. Monitor CBC
periodically.
>Stop drug if rash,
visual
disturbances,
diarrhea develops.
 Name of the Action Indication Dosage and Adverse Reaction Nursing
Drug Preparation Responsibility
Metronidazole >Direct –acting The indication 1g / rectum CNS: headache, >Always observe
(Flagyl) trichomonacide are based on 1hr prior to seizures, fever, the 10 Rights
ANTI- and amebicide the anti- OR vertigo, ataxia, when giving
medication.
INEFECTIVES that works inside parasitic and dizziness,
>Give oral form
(amebicides& and outside in the antibacterial confussion,depression with meals to
antiprotozoals) intestines. It’s activity. , irritability minimize GI
thought to enter >Amebic liver Vision disorder: upset
the cells of abscess, transient vision >Tell pt. he may
microorganisms Intestinal disorders such as experience a
that contain amebiasis, diplopia, myopia metallic taste and
have dark or red-
nitroreductase, Trichomoniasis GI: epigastric pain,
brown urine.
forming unstable >Bacterial pain, nausea, >Instruct pt in
compounds that infections vomiting, diarrhea, proper hygiene
binds DNA and caused by metallic taste, dry >Tell pt to avoid
inhibits aerobic mouth alcohol during
synthesis, microorganisms Hypersensitivity metronidazole
causing cell >To prevent Reactions: rash, therapy and for
atleast one day
death. postoperative pruritus, flushing,
afterwards beause
infection in urticaria, anaphylactic of possibility of
contaminated shocks dislfiram-like
colorectal GU: darkened urine, (Antabuse effect)
surgery polyuria, dryness of reaction.
>Bacterial vagina,dysuria >May cause
transient visual
Vaginosis
disorder,
>Clostridium dizziness&
difficle- confusion avoid
associated activities
diarrhea and requiring
colitis alertness like
>Pelvic driving a vehicle.
Inflammatory
disease

Name of Action Indication Dosage Adverse Reaction Nursing

the &Preparation Responsibility
Drug
Bisacody Stimulant Chronic 2 tablets (hours CNS: dizziness, >Give drugs at
l laxative that constipation; of sleep) faintness, muscle times that don’t
increases preparation weakness with excessive interfere with
peristalsis, for child use scheduled
probably by birth, GI: abdominal cramps, activities or
direct effect surgery, or burning sensation in sleep.
on smooth rectal or rectum with >Before giving
muscle of bowel suppositories, nausea for
the intestine, examination. and vomiting constipation,
by irritating METABOLIC: determine
the muscle alkalosis, fluid and whether patient
or electrolyte imbalance, has adequate
stimulating hypokalemia. fluid intake
the colonic MUSCULOSKELETAL exercise and
intramural : tetany diet.
plexus. >Tablets and
Drug also suppositories
promotes are use together
fluid to clean the
accumulation colon before
in colon and and after
small surgery and
intestine. before barium
enema.
>Insert
suppository as
high as possible
in to the
rectum, and try
to position
suppository
against the
rectal wall.
Avoid
embedding
within fecal
material
because doing
so may delay
onset of action.
>Bisco-Lax
may contain
tartazine.

Name of Action Indication Dosage Adverse Reaction Nursing

the Drug &Preparatio Responsibility
n
Morphine Binds with >Severe 3mg through CNS: dizziness, >Reassess patient’s
Sulfate opiate pain Epidural euphoria, light- level of pain at
receptor in >Moderate catheter q12 x 3 headedness, least 15 to 30
the CNS, to severe nightmares, minutes.
altering pain sedation, >Keep opioid
perception requiring somnolence, anatagonist
of and continuous, seizures, (naloxone) and
emotional around the depression, resuscitation
response to clock opioid hallucinations, equipment
pain. >Single nervousness, available.
dose, physical >Monitor
epidural dependence. circulatory,
extended CV: respiratory, bladder
pain relief bradycardia, cardiac and bowel function
after major arrest, shock, carefully.
surgery. hypertension, >Oral solutions of
tachycardia various
GI: constipation, concentrations and
nausea and an intensified oral
vomiting, anorexia, solution are
biliary tract spasm, available.
dry mouth, ileus >Oral capsules
GU: urine may be carefully
retention, opened and the
HEMATOLOGIC: entire contents
thrombocytopenia poured into cool
RESPIRATORY: soft foods such as
apnea, respiratory water, orange juice,
arrest, respiratory apple sauce or
depression pudding.
SKIN: >Morphine is drug
diaphoresis, edema, of choice in
pruritus and skin relieving MI pain;
flushing may cause transient
OTHER: decrease in blood
decreased libido pressure.

Name of the Action Indication Dosage Adverse Nursing

Drug &Preparation Reaction Responsibility
Cefuroxime Second >Serious 1.5 qm IVP after CV: phlebitis, > Before giving
generation lower negative skin thrombophlebiti drug ask patient
cephalospori respiratory testing s if she is allergic
n that tract infection, GI: diarrhea, to penicillin or
inhibits cell UTI, skin or pseudo- cephalosporin.
wall skin structure membranous >Obtain
synthesis infections, colitis, nausea, specimen for
promoting bone or joint anorexia and culture and
osmotic infections, vomiting sensitivity test
instability; septicemia, GU: urine before giving
usually meningitis and retention, first dose.
bactericidal gonorrhea HEMATOLOGI >Absorption of
>Pre-operative C: oral drug is
prevention thrombocytopen enhanced
>Bactericidal ia, hemolytic >Tablets may be
exarbations of anemia, crushed, if
chronic transient absolutely
bronchitis or neutropenia, necessary for
secondary eosiniphilia. patient who can’t
bacterial RESPIRATORY swallow tablets.
infection of : apnea,
acute respiratory
bronchitis arrest,
>Acute respiratory
bacterial depression
maxillary SKIN:
sinusitis maculopapular
>Pharyngitis and
and tonsillitis erythematous
>Otitis media rashes, urticaria,
pain, induration,
sterile
abscesses,
temperature
elevation, tissue
sloughing at IM
injection site
OTHER:
anaphylaxis,
hypersensitivity
reactions, serum
sickness

XIII. Discharge Plan

Medication
Oral contraceptives: Birth control pills may
be helpful to regulate the menstrual cycle, prevent
the formation of follicles that can turn into cysts, and
possibly reduce the size of an existing cyst.
Pain relievers: Anti-inflammatories such as
ibuprofen (for example, Advil) may help reduce
pelvic pain. Narcotic pain medications by
prescription may relieve severe pain caused by
ovarian cysts.

Exercise
 Relaxation exercise
 turning to sides every 2 hours if lying in bed for
long hours
 do light activities such as walking, or sitting
down
 Exercise social interaction with the family

Treatment
Surgical treatments for Ovarian Cysts
Functional ovarian cysts are the most
common type of ovarian cyst. They usually
disappear by themselves and seldom require
treatment. Growths that become abnormally large or
last longer than a few months should be removed or
examined to determine if they are in fact something
more harmful.
Self-Care at Home
 Pain caused by ovarian cysts may be treated at
home with pain relievers, including nonsteroidal
anti-inflammatory drugs such as ibuprofen (Motrin),
acetaminophen (Tylenol), or narcotic pain medicine
(by prescription). Limiting strenuous activity may
reduce the risk of cyst rupture or torsion.

Medical Treatment
Ultrasonic observation or endovaginal
ultrasound are used repeatedly and frequently to
monitor the growth of the cyst.

Health Teachings:

 Proper hygiene.
 Proper diet such as eating nutritional foods that
are rich in protein and Vit. C to promote well-
being.
 Increase physical activities.
 Avoid eating sweet foods.
 Adequate rest and sleep.

OPD (follow up)

7 days after the patient was discharge,
patient should have his follow up check up on the
nearest health center or hospital
Diet
Increase oral fluid intake
Prevent eating of sweet foods
Have a high fiber diet