ABRA VALLEY COLLEGES Bangued, Abra

In Partial Fulfillment of the Requirements in NCM 104 (RLE)

A Case Study about UTERINE MYOMA

Submitted to: Ana Vi Ibaez, RN

Submitted by: GROUP II Christian D. Adres Josephine B. Barber Jhennyffer L. Barcena Creighton A. Bayongan Marife B. Delos Reyes Harmony Cristie V. Gonzalo

January 2011

OUTLINE I. Introduction Patients Profile

II.

III.

History of Past and Present Illness A. B. C. D. E. History of Past Illness History of Present Illness Familial History Social History Obstetrical History

IV.

Nursing Assessment A. Maslows Hierarchy of Needs B. Physical Assessment

V.

Anatomy and Physiology

VI.

Pathophysiology

VII.

Diagnostic Exams A. Ideal B. Actual

VIII. Nursing Management A. Ideal B. Actual

IX.

Nursing Care Plan

X.

Drug Study

XI.

Health Teachings

I.

INTRODUCTION

Significance of the Study 1. To discuss Uterine Myoma its causes, risk factors, complications and surgical management. 2. To know the Pathophysiology of Uterine Myoma. 3. To know the anatomy and physiology of the organ/s involved. 4. To be familiar with the medications given to our patient. 5. To effectively use the nursing process in providing holistic care to our patient. 6. To impart knowledge to fellow student nurses to help strengthen their role as health educators in all health care settings.

Brief Description A Uterine Fibroid (also called uterine leiomyoma, and fibroma) is Uterine a benign (non-

myoma, fibromyoma, leiofibromyoma,

fibroleiomyoma,

cancerous) tumor that originates from the smooth muscle layer (myometrium) and the accompanying connective tissue of the uterus. Myoma is a condition where there is a benign growth or tumor of smooth muscle in the wall of the uterus. The said growth is made up of fibrous tissue; hence it is often called a fibroid tumor. Uterine fibroids can be present and be in apparent. Fibroids vary in size and number, and are most often slow-growing and usually cause no symptoms. It may grow as a single nodule or in clusters, and may range in size from 1 mm to more than 20 cm in diameter. Myomas are the most frequently diagnosed tumor of the female pelvis, and the most common reason for hysterectomy. Although they are often referred to as tumors, they are not cancerous. Most myomas develop in women during their reproductive years. Myomas do not develop before the body begins producing estrogens. Myomas tend to grow very quickly during pregnancy when the body is producing extra estrogen. Once menopause as begun, the myoma generally stops growing and may begin to shrink due to the loss of estrogen. Fibroids may be removed if they cause discomforts or if they are associated with uterine bleeding. Approximately 25% of myomas will cause symptoms and need medical treatment.

Incidence Approximately 25 % of the myomas will cause symptoms and need medical treatment. Myomas that that do not produce symptoms, do not need to be treated. The said 25 % of women cause significant morbidity, including prolonged or heavy menstrual bleeding, pelvic pressure or pain, and in rare cases, reproductive dysfunction. In the Philippines, the estimated number of women is 86,241,697 squared, and the 4,312,084 had been affected of Myoma.

Causes The cause of Myomas is Unknown.

Risk Factors Age Fibroids are most common in women who are their 30s through early 50s. (After menopause, fibroids tend to shrink.) About 20 - 40% of women age 35 and older have fibroids of significant enough size to cause symptoms. Race and Ethnicity Uterine fibroids are particularly common in African-American women, and these women tend to develop them at a younger age than white women. Family History Family history, having a mother or sister who had fibroids, may increase risk. Obesity Hypertension

Signs and Symptoms Abnormal uterine bleeding Heavy or painful periods Abdominal discomfort and bloating Painful defecation Back ache Urinary frequency/retention Sudden pain Abdominal enlargement Impaired fertility Dyspareunia intercourse) (Pain during

Complications Effect on Fertility Most fibroids appear to have only a small effect on a woman ' s fertility. Female infertility is usually due to other factors than fibroids. Effect on Pregnancy Fibroids may increase pregnancy complications and delivery risks. These may include:
-

Cesarean section delivery Breech presentation (baby enters the birth canal upside down with feet or buttocks emerging first)

Preterm birth Placenta previa (placenta covers the cervix) Excessive bleeding after giving birth (postpartum hemorrhage)

Anemia Anemia due to iron deficiency can develop if fibroids cause excessive bleeding. Oddly enough, smaller fibroids, usually submucous, are more likely to cause abnormally heavy bleeding than larger ones. Most cases of anemia are mild and can be treated with dietary changes and iron supplements. However, prolonged and severe anemia that is not treated can cause heart problems.

Urinary Tract Infection Large fibroids that press against the bladder occasionally result in urinary tract infections. Pressure on the ureters may cause urinary obstruction and kidney damage.

Uterine Cancer Fibroids are nearly always noncancerous, even if they have abnormal cell shapes. Cancer of the uterus nearly always develops in the lining of the uterus (endometrial cancer). Only in rare cases (fewer than 0.1%) does cancer develop from a malignant change in a fibroid (called leiomyosarcoma). Nevertheless, rapidly enlarging fibroids in a premenopausal woman or even slowly enlarging fibroids in a postmenopausal woman need evaluation to rule out cancer.

II.

PATIENTS PROFILE

Hospital #: 926744 Name: Ms. Myoma Birthdate: July 26, 1976 Age: 34 Birthplace: Manila Address: Manila Sex: Female Civil Status: Single Religion: Roman Catholic Nationality: Filipino Date and Time of Admission: January 16, 2011 @ 1:05pm Chief Complaint: Abdominal Enlargement Ward: CS Ward Admitting Diagnosis: Myoma Uteri, G0P0 Final Diagnosis: Operation Done: Post Total Abdominal Hysterectomy Date and Time of Operation: January 17, 2011 @ 1:00pm Physician: Dr. RJ

III.

HISTORY OF PAST AND PRESENT ILLNESS

A. History of Past Illness The patient had no other serious illness, operations and accidents before admission. According to our patient this was her first hospitalization and operation. She also claims that he had no known allergies to food and medications. She sometimes encountered abdominal pain but she was ignoring it as an ordinary pain. B. History of Present Illness According to our patient, she only has her vacation here in Abra this month of January, then suddenly few days ago, she felt pain in her abdomen and whenever she eats, she observes enlargement of her abdomen and for the condition, her Auntie was alarmed and decided to take her to APH for check-up. Dr. Jalog was her admitting Physician and she requested her for ultrasound that done on January 7, 2011. Dr. Jalog diagnosed the case of our patient as Myoma Uteri and needs operation. Dr, Jalog scheduled the operation for her and that was on January 17, 2011 @ 1:00pm and the operation performed was Total Abdominal Hysterectomy. Our patient was forwarded to CS ward for further management. C. Familial History According to our patient, both his paternal and maternal side had no known serious diseases such as cancer, heart attack, diabetes mellitus, and hypertension. They had only experienced common illnesses such as cough and colds, and fever which they treated with medicines prescribed and sometimes with herbal medications. D. Social History Occasionally, our patient is alcohol drinker and smoker. She goes out with her friends from Manila every weekend. E. Obstetrical History According to our patient, she has a regular menstruation period and doesnt feel any discomfort during menstruation. She has a score of G0P0.

IV.

NURSING ASSESSMENT A. Maslows Hierarchy of Needs: 1. Physiologic Needs Our patient breaths normally and has an ongoing PLRS 1L x KVO @ full level, infusing well. Wasnt able to pass out stool and flatus. IFC was inserted draining to an approximately 50-100cc/hour which is yellowish in color. She remains silent when asked about her sexual life.

2. Safety and Security Our patient feel secured in the presence of her uncle and auntie so with her relatives who are always there to accompany her in performing activities of daily living such as toileting, feeding, and hygiene. But because of her condition, she was still not that safe because she is prone to infection and still complications may occur.

3. Love and Belongingness Aside from her uncle and auntie, our patient also felt the love rendered by the health care providers in the hospital. Rapport was established by the staffs and student nurses in order to obtain accurate information regarding his condition.

4. Self-Esteem Panu yan, baka mahihirapan na akong magtrabaho nyan? as verbalized by the patient which is an expression of diminishing self-esteem.

5. Self-Actualization According to our patient, she will be self-actualized if she will be easily recover from the operation without any complications and can go back to her usual work and ADLs.

B. Physical Assessment (January 18, 2010 @ 8:00am) 1. General Survey Our patient is a 34 years old, female and appears to be in her stated chronologic age. She is able to respond to tactile stimuli such as touch and pain, and is able to respond spontaneously when talked to. Likewise she is able to respond to sound and noises. Our patient is oriented to time, person and place since she is able to distinguish every person around him. In addition she is able to tell the time of the day. She has a good attention span and is able to relay experiences. Our patient is calm, alert and is irritable at times especially when she is in pain. She is able to verbalize her concerns and is cooperative to the treatments given to her by the health care providers. Vital signs: BP- 120 / 80 mmHg Temp- 36.7 C PR- 89 bpm RR- 19 cpm

2. Cephalocaudal Assessment Integumentary System: The patients skin is brownish in color and was observed with hypopigmentation and hyperpigmention in different parts of her body. Head: Round in shape. Hair is short, black with white hair noted and evenly distributed. No evidence of previous injuries. Eyes: Both eyes reveals that pupils are equally round reactive to light accommodation upon assessment. She reported no unusual sensations felt such as blind spot and flashing lights. Ears: Able to recognize hear and understand spoken words. No masses and tenderness were noted on both ears upon palpation. Decrease auditory capacities on both ears were not present in the patient as verbalized.

Nose: Nose is patent upon assessment. Upon palpation, no tenderness/masses were also noted. No sensations, such as anosmia were reported by the patient. Mouth and Lips: No lesions were found in the mouth but dry mouth is noted. No difficulty of swallowing was noted. Able to understand and initiate speech. The patient is able to distinguish different taste as verbalized. With complete set of teeth and some caries noted. Neck: Neck has strength when move from different directions with full ROM Chest: No reports of pain during the inhalation and exhalation. Absence of adventitious sounds upon auscultation. Respiratory Rate 19 breathes per minute from the normal range of 16-20 breaths per minute. Abdomen: Abdominal movement with respiraton. Presence of peristalsis during auscultation. Skin color is uniform. (+) incision covered with intact dressing. Genitourinary: IFC connected to urine bag was inserted which was draining to an approximately 50-100 cc/hour which is yellowish in color. Upper Extremities: With an ongoing IVF of PLRS 1L at full level x KVO @ the left cephalic vein. Infusing well. Presence of scars and lesions were noted. Warm to touch. Lower Extremities: Limited movement from the lower extremities due to operation done Post Total Abdominal Hysterectomy. Presence of scars and lesions were noted. Warm to touch.

V.

ANATOMY AND PHYSIOLOGY The female reproductive system consists of the ovaries, uterine tubes (or fallopian tubes), uterus, vagina, external genitalia, and

mammary glands. The internal reproductive organs of the female are located within the pelvis, between the urinary bladder and the rectum. The uterus and the vagina are in the midline , with an ovary to each side of the organ. The internal reproductive organs are held in place within the pelvis with ligaments. The most conspicuous is the brad ligament, which spreads out on both sides of the uterus and to which the ovaries and the uterine tubes attach.

Ovaries The two ovaries are small organs suspended in the pelvic cavity by ligaments. The suspensory ligament extends from each ovary to the lateral body wall, and the ovarian ligament attaches the ovary to the superior margin of the uterus. In addition, the ovaries are attached to the posterior surface of the broad ligament by folds of the peritoneum called the mesovarium. The ovarian arteries, veins, and nerves

transverse the suspensory ligament and enter the ovary through the mesovarium. A layer of visceral peritoneum covers the surface of the ovary. The outer part of the ovary is made up of dense connective tissue and contains the ovarian follicles. Each of the ovarian follicles contains an oocyte, the female sex cell. Loose connective tissue makes up the inner part of the ovary, where blood vessels, lymphatic vessels, and nerves are located.

Uterine Tubes A uterine tube, fallopian tube, or oviduct (named after the italian anatomist, Gabriele Fallopio) is associated with each ovary. The uterine tubes extend from the area of the ovaries to the uterus. The open directly into the peritoneal cavity near each ovary and receive an oocyte. The opening of each uterine tube is surrounded by long, thin processes called fimbriae. The fimbriae nearly surround the surface of the ovary. As a result, as soon as the oocyte is ovulated, it comes into contact with the surface of the fimbriae. Cilia on the fimbriae surface sweep the oocyte into the uterine tube. Fertilization usually occurs in the part of the uterine tube near the ovary known as the ampulla.

Uterus The uterus is as big as the size of a medium-sized pear. It is oriented in the pelvic cavity with the larger, rounded portion directed superiorly. The part of the uterus superior to the entrance of the fallopian tubes is called the fundus. The main part of the uterus is called the body, and the narrower part is termed the cervix and is directed inferiorly. Internally, the uterine cavity in the fundus and uterine body continues through the cervix as the cervical canal, which opens into the vagina. The cervical canal is lined by mucous glands. The Uterine wall is composed of three layers: a serous layer or perimetrium of the uterus, consists of smooth muscle is quite thick and accounts for the bulk of the uterine wall. The inner most layer of the uterus is called the endometrium. The endometrium consists of simple columnar epithelium tissues with an underlying connective tissue layer. Simple tubular glands, called enometrial glands, are formed by folds of the endometrium. The superficial part os the endometrium is sloughed off during menstruation. The uterus is supported by the broad ligament and the round ligament. In addition to these ligaments that support the uterus, much support is provided inferiourly to the uterus by skeletal muscles of the pelvic floor. If ligaments that suppor the uterus or the muscles of the pelvic floor are weakened such as in childbirth, the uterus can

extend inferiorly into the vagina, a condition termed as a prolapsed uterus. Severe cases require surgical correction.

Vagina The vagina is the female organ of copulation and functions to receive the penis during intercourse. It also allows menstrual flow and childbirth. The vagina extends from the uterus to outside the body. The superior portion of the vagina is attached to the sides of the cervix so that a part of the cervix extends into the vagina. The wall of the vagina consists of an outer muscular layer and an inner mucous layer. The muscular layer is smooth muscle and contains many elastic fibers. Thus the vagina can increase in size to accommodate the penis during intercourse, and it can stretch greatly during childbirth. The mucous membrane is moist stratified squamous epitheliam that forms a protective surface layer. Lubricating fluid passes through the vaginal epithelium into the vagina. In young females, the vaginal opening is covered by a thin mucous membrane known as the hymen. The hymen can completely close the vaginal oriface in which case it must be removed to allow menstrual flow. More commonly, the hymen is perforated by one or several holes. The openings of the hymen are usually greatly enlarged during the first sexual intercourse. The hymen can also be perforated during a variety of activities including strenuous exercise. The condition of the hymen is therefore not a reliable indicator of virginity.

The External Genitalia The external female genitalia, also called the vulva, or pudendum, consists of the vestibule and its surrounding structures. The vestibule is the space into which the vagina and urethra open. The urethra opens just anterior to the vagina. The vestibule is bordered by a pair of thin, longitudinal skin folds called the labia minora. A small erectile structure called the clitoris is located in the anterior margin of the vestibule. The two labia minora unite over the clitoris to form a fold of skin known as the prepuce.

The clitoris consists of a shaft and a distal glans. Like the glans penis, the clitoris is well supplied with sensory receptors, and it is made up of erectile tissue. An additional erectile tissue is located on either side of the vaginal opening. On each side of the vestibule, between the vaginal opening and the labia minora, are openings of the greater vestibular glands. These glands produce a lubricating fluid that helps maintin the moistness of the vestibule. Lateral to the labia minor are two prominent rounded folds of skin called the labia majora. The two labia majora unite anteriorly at the elevation of tissue over thepubic symphysis calle dthe mons pubis. The lateral surfaces of the labia majora and the surface of the mons pubis are covered with coarse hair. The medial surfaces of the labia minora are covered with numerous sebaceous and sweat glands. The space between the labia minor is called the pudendal cleft. Most of the time, the labia minora are in contact with each other across the midline , closing the pudendal cleft and covering the deeper structures within the vestibule. The region between the vagina and the anus is the clinical perineum. The skin and muscle of this region can tear during childbirth. To preven such tearing, an incision called an episiotomy is sometimes made in the clinical perineum. Traditionally, this clean, straight incision is thought to result in less injury, and less trouble in healing, and less pain. However, many studies indicate that there is less injury and pain when no episiotomy is performed.

Menstrual Cycle Menstruation is the shedding of the lining of the uterus (endometrium) accompanied by bleeding. It occurs in approximately monthly cycles throughout a woman's reproductive life, except during pregnancy. Menstruation starts during puberty (at menarche) and stops permanently at menopause. By definition, the menstrual cycle begins with the first day of bleeding, which is counted as day 1. The cycle ends just before the next menstrual period. Menstrual cycles normally range from about 25 to 36 days. Only 10 to 15% of women have cycles that are exactly 28 days. Usually, the cycles vary the most and the intervals

between periods are longest in the years immediately after menarche and before menopause. Menstrual bleeding lasts 3 to 7 days, averaging 5 days. Blood loss during a cycle usually ranges from to 2 ounces. A sanitary pad or tampon, depending on the type, can hold up to an ounce of blood. Menstrual blood, unlike blood resulting from an injury, usually does not clot unless the bleeding is very heavy. The menstrual cycle is regulated by hormones. Luteinizing hormone and folliclestimulating hormone, which are produced by the pituitary gland, promote ovulation and stimulate the ovaries to produce estrogen and progesterone stimulate the uterus and breasts to prepare for possible fertilization. The cycle has three phases: follicular (before release of the egg), ovulatory (egg release), and luteal (after egg release).

VI.

PATHOPHYSIOLOGY

Predisposing factors Age (34) Gender (female)

Precipitating factors Lifestyle Diet (high fat) Anxiety/Stress

Etiology: Unknown Estrogen Dominance or increase in Estrogen production

Proliferation of cells in uterus* (Sub mucous)

Overgrowth the endometrial lining

Myoma: Development of uterine fibroid Uterine Cavity begins to stretch or increase in size

Interference in the vascular supply

Degeneration of the interior part of fibroid

S/S: Abdominal enlargement Abdominal Pain Constipation

VII.

DIAGNOSTIC EXAMS Transvaginal Ultrasound A transvaginal ultrasound is a specialized ultrasound technique. The sonic probe is placed directly into the vagina. This allows the transvaginal ultrasound to view the uterus with greater clarity than an abdominal ultrasound. Magnetic Resonance Imaging Scan (MRI) An MRI scan makes detailed images of the uterus. It can show the location of fibroids. An MRI can usually tell the difference between adenomyosis and fibroids. Hysterosapingography (HSG) A hysterosalpingogram, or HSG, is an x-ray procedure that checks the shape of the uterus. During a hysterosalpingogram, the uterus is filled with iodine, allowing the organ to show up on an x-ray in greater detail. Possible side effects of HSG include infections, and spotting for a couple of days following the procedure. In the rare occasion when the spotting worsens into blood flow, seek immediate medical care. Hysteroscopy During a hysteroscopy, a hollow, thin tube called a hysteroscope is passed through the vagina and the cervix, into the uterus. The hysteroscope lights up the interior of the uterus, and relays pictures to a television screen. Hysteroscopy also allows tissue samples (biopsies) to be taken for microscopic analysis. Urinalysis This test detects ion concentration of the urine. Small amounts of protein or ketoacidosis tend to elevate results of the specific gravity. Specific gravity is an expression of the weight of a substance relative to the weight of an equal volume of water. Water has a specific gravity of one. The specific gravity of your urine is

A. Ideal

measured by using a urinometer. Knowing the specific gravity of your urine is very important because the number indicates whether you are hydrated or dehydrated. If the specific gravity of your urine is under 1.007, you are hydrated. If your urine is above 1.010, you are dehydrated. Complete Blood Count A complete blood count (CBC), also known as full blood count (FBC) or full blood exam (FBE) or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood. A scientist or lab technician performs the requested testing and provides the requesting medical professional with the results of the CBC. Blood studies show elevated blood urea nitrogen, serum creatinine, and potassium levels; decreased arterial pH and bicarbonate; and low hemoglobin (Hb) level and hematocrit (HCT). Computed Tomography Scan (CT Scan) Like the MRI, a computed tomography scan (CT scan, CAT scan) is occasionally used to diagnose fibroids. The CT scan takes multiple x-rays of the uterus, which are compiled into a 3-dimensional image by computer.

B. Actual URINALYSIS LAB TEST COLOR TRANSPARENCY ALBUMIN PUS CELLS RBC BACTERIA EPITHELIAL CELLS Interpretation: Laboratory results revealed that there is the presence of albumin in the blood which indicates that the glomerulus cannot filter large molecules such as that of albumin. It also revealed that there is bacterial infection as evidenced by the presence of bacteria, pus cells and red cells in the urine. HEMATOLOGY RESULT WBC RBC HGB HCT PLT PCT MCV MCH MCHC RDW MPV PDW 7.4 103/mm3 2.23 L 10 6/mm3 6.8 L g/dL 18.3 L % 241 10 3/ mm3 .179 % 82 um3 30.3 pg 36.9H g/dL 17.7H % 7.4 u m3 174% NORMAL VALUES 4.0-11.0 3.80-5.80 12.0-17.0 36.0-52.0 150-450 .100-.500 80-97 26.5-33.5 31.5-35.0 10.0-15.0 6.5-11.0 100-180 SIGNIFICANCE Non-significant Significant Significant Significant Non-significant Non-significant Non-significant Non-significant Significant Significant Non-significant Non-significant RESULT Straw , light yellow Slightly turbid +++ 1-2/hpf 1-3/hpf ++ + NORMAL VALUE Amber straw Clear Negative 0-1hpf Negative Negative Negative SIGNIFICANCE significant significant significant significant significant significant Significant

VIII. MANAGEMENT A. Ideal Management 1. Medical NSAIDs to reduce painful manses. Oral contraceptive pills are prescribed to reduce uterine bleeding and cramps. Levonorgestrel intrauterine devices are highly effective in limiting menstrual blood flow. Danazol is an effective treatment to shrink fibroids and control symptoms. Its use is limited by unpleasant side effects. Mechanism of action is thought to be antiestrogenic effects. Recent experience indicates that safety and side effect profile can be improved by more cautious dosing. Dostinex in a moderate and well tolerated dosis has been shown in 2 studies to shrink fibroids effectively. Mechanism of action is completely unclear. Gonadotropin-releasing hormone analogs cause temporary regression of fibroids by decreasing estrogen levels. Aromatase inhibitors have been used experimentally to reduce fibroids. The effect is believed to be due partially by lowering systemic estrogen levels and partially by inhibiting locally overexpressed aromatase in fibroids. Progesterone antagonists have been shown in small studies to decrease the size of uterine fibroids. Mifepristone was effective in a placebo-controlled pilot study. The selective progesterone receptor modulator Asoprisnil is currently tested with very promising results as a possible use as a treatment for fibroids - the hope is that it will provide the advantages of progesterone antangonitst without their adverse effects. 2. Surgical Hysteroscopic Myomectomy In a hysteroscopic myomectomy, the fibroid is removed by the use of a resectoscope, anendoscopic instrument that can use high-frequency electrical energy to cut tissue. Hysteroscopic myomectomies can be done as an outpatient procedure, with either local or general anesthesia used.

Hysteroscopic myomectomy is most often recommended for submucosal fibroids. A French study collected results from 235 patients suffering from submucous myomas who were treated with hysteroscopic myomectomies; in none of these cases was the fibroid greater than 5 cm. Llaparoscopic Myomectomy A laparoscopic myomectomy requires a small incision near the navel. The physician then inserts a laparoscope into the uterus and uses surgical instruments to remove the fibroids. Studies have suggested that laparoscopic myomectomy leads to lower morbidity rates and faster recovery than does laparotomic myomectomy. As with hysteroscopic myomectomy, laparoscopic myomectomy is not generally used on very large fibroids. A study of laparoscopic myomectomies conducted between January 1990 and October 1998 examined 106 cases of laparoscopic myomectomy, in which the fibroids were intramural or subserous and ranged in size from 3 to 10 cm Laparotomic Myomectomy A laparotomic myomectomy (also known as

an open or abdominal myomectomy) is the most invasive surgical procedure to remove fibroids. The physician makes an incision in the abdominal wall and removes the fibroid from the uterus. A particularly extensive laparotomic procedure may necessitate that any future births be conducted by Caesarean section. Recovery time from a laparatomic procedure is generally expected to be four to six weeks Hysterectomy A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body while leaving the cervix intact; also called "supracervical"). It is the most commonly performed gynecological surgical procedure. Types: Radical hysterectomy - complete removal of the uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph

nodes, ovaries and fallopian tubes are also usually removed in this situation. Total hysterectomy - complete removal of the uterus and cervix. Subtotal hysterectomy - removal of the uterus, leaving the cervix in situ. B. Actual 1. Medical Management PLRS 1L x KVO @ the left cephalic vein IFC draining to urine bag @ approximately 50-100cc/hour which is yellowish in color. Meds. Ketorolac 30mg/ml IV q 8 Ampicilin 500mg IV q 6 Gentamicin 40mg/ml IV q 8 Omeprazole 20mg PO OD

2. Nursing Management Nurse patient interaction established Monitored vital signs and recorded Recognize the patient for risk of recurrence for infection Monitored Intake & Output Monitored V/S every hour to serve as baseline data Advised pt. to have adequate rest and eat nutritious foods Advised the pt. to always change the bandage gauze of the affected area to prevent infection Instructed to do deep breathing relaxation to promote generalized relaxation Promoted safety and comfort Administered medications as ordered.

 Actual Surgical Management Total Hysterectomy A total hysterectomy, sometimes called a simple hysterectomy, removes the entire uterus and the cervix. The ovaries are not removed and continue to secrete hormones. Total hysterectomies are usually performed in the case of uterine and cervical cancer. This is the most common kind of hysterectomy. In addition to a total hysterectomy, a procedure called a bilateral salpingooophorectomy 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.

XII.

HEALTH TEACHINGS Instructed patient to have enough rest to gain strength. Instructed to eat nutritious foods (high in calorie diet) to strengthen the immune system. Advised to eat food before drinking fluids to alleviate dry mouth. Emphasized the importance of proper hygiene to promote comfort. Instructed patient to avoid heavy lifting. Instructed proper wound care. Emphasized proper hand washing before and after cleaning the operation site. Instructed to continue medication as prescribed for faster recovery and to minimize postpartum complications. Advised to drink adequate fluid of at least 8 glasses a day.