case study - ovarian new growth final.docx

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 one’s health.

Throughout a woman’s 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.

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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

circulation. When hit by a laser, which scans across the diameter of the blood

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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 two-

photon 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 client’s history, which included lifestyle, types of

activities, ovulatory cycles and pattern, may confirmed that such were the

causes of ovarian cancer.

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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 client’s

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 non-

modifiable.

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:

Acquired knowledge on the risk factors that have contributed to the

development of Ovarian New Growth

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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

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

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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 10th of September 1964. She is

5’3” 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 father’s 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.

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GRANDPA 1 (+)

Renal Cancer

GRANDMA 1 (+)

GRANDPA 2 (+)

GRANDMA 2 (+)

MOTHER FATHER Renal Cancer

HPN

BRO 3BRO 2PatientOvarian new

growth, Bilateral

SISTER 1BRO 1

(+) = deceased

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C. HISTORY OF PAST ILLNESS

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.

D. HISTORY OF PRESENT ILLNESS

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.

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

lifted from the patient’s chart)

VITAL SIGNS

BP: 120/80 mmHg

PR: 81 bpm

RR: 21 cpm

T: 36°c/axilla

General Appearance: weak, lethargic

Skin: Pale and dry

Eyes: anicteric sclera, pale palpebral conjuctiva, (+) PERRLA

1st Patient-Nurse Interaction

PHYSICAL EXAMINATION (August 3, 2012)

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:

BP: 110/80 mmHg

PR: 78 bpm

RR: 24 cpm

T: 36.6°c/axilla

Appearance and Mental Status

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.

The Integumentary

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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.

The Skull and Face

Client’s 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.

Eyes and Vision

Upon inspection, Ms. Ovary’s 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.

The Ear and Hearing

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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.

The Nose and Sinuses

Ms. Ovary’s 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.

The Mouth and Oropharynx

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

dry. The inners lips and buccal mucosa’s 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. Client’s 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.

The Neck

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.

Thorax and Lungs

Ms. Ovary’s chest is symmetrical in shape, spine vertically aligned,

spinal column straight, left and rights shoulders as well as the hips are the

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same in height. She exhibits full symmetric chest expansion when asked to

take a deep breath by palpating for expiratory excursion.

Muscles

Upon inspection, her muscles are equal on both sides of the body. No

tremors or contractures on muscles or tendons.

Bases and Joints

No deformities, tenderness or swelling palpated on patient’s bones and

joints. She was able to move joints smoothly when she was asked to move

some selected body parts.

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4. DIAGNOSTIC AND LABORATORY PROCEDURES

A. RADIOGRAPHIC REPORT

DIAGNOSTIC/

LABORATORY

PROCEDURES

DATE ORDERED

DATE RESULTS

IN

INDICATIONS RESULTS NORMAL

VALUES

ANALYSIS AND

INTERPRETATION

(Patient-Based)

Chest X-ray DO: 7-19-12

DI: 7-19-12

A chest x ray is a painless, noninvasive test that creates pictures of the structures inside the chest, such as the heart, lungs, and blood vessels.

This test is done to find the cause of symptoms such as shortness of breath, chest pain, chronic cough (a cough that lasts a long time), as well as fever.

Clear lung fields,

heart not

enlarged,

diaphragm and

bony thoracic

are intact.

--- Normal chest

findings.

Nursing Responsibilities:

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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.

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.

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.

B. CLINICAL CHEMISTRY (FLUID AND ELECROLYTES)

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DIAGNOSTIC/

LABORATORY

PROCEDURES

DATE

ORDERED

DATE

RESULTS IN

INDICATIONS RESULTS NORMAL

VALUES

ANALYSIS AND

INTERPRETATIO

N

(Patient-Based)

Calcium DO: 8-3-12

DI: 8-3-12

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.

1.02 1.13-1.32

mmol/L

Ms. Ovary’s

serum calcium

level is below the

normal range

indicative of

hypocalcemia.

Magnesium DO: 8-3-12

DI: 8-3-12

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 of cells.

0.60 0.73-1.06

mmol/L

Ms. Ovary’s

serum

magnesium level

is below the

normal range

indicative of

hypomagnesemia

.

Potassium DO: 8-3-12

DI: 8-3-12

A potassium test checks how much potassium is in the blood. Potassium is both an electrolyte and a

3.70 3.50-5.50

mmol/L

Ms. Ovary’s

potassium level is

within normal

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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.

range.

Sodium DO: 8-3-12

DI: 8-3-12

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 also important in how nerves and muscles work.

142 135-150

mmol/L

Ms. Ovary’s

sodium level is

within the normal

range.

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Prior:

Define and explain the test.

State the specific purpose of the test.

Explain that there is no special preparation.

During:

Use the sterile technique.

After:

Keep the past records especially the latest ones.

Document.

C. COMPLETE BLOOD COUNT

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DIAGNOSTTIC/

LABORATORY

PROCEDURES

DATE ORDERED

DATE RESULT(S)

IN

INDICATION(S) RESULTS NORMAL

VALUES1

ANALYSIS

AND

INTERPRETA

TION

Hematocrit (Hct) DO: 8-3-12

DI: 8-3-12

The hematocrit

shows the oxygen-

carrying capacity of

the blood. This

value also tells

whether the blood

is too thick or too

thin.

Useful as a

measurement of

red blood cells only

if the hydration of

the client is normal.

0.30 0.36-0.45 Ms. Ovary’s

hematocrit

level is below

the normal

range which

indicates a low

concentration

of red blood

cells within the

blood volume.

Hemoglobin

(Hgb)

This is a test of

measure of the

total amount of

hemoglobin in the

blood. It is used as

105 123-153 g/L Ms. Ovary’s

hemoglobin is

below the

normal range

which is

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a rapid direct

measurement of

the red blood 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.

Hemoglobin acts as

an important acid-

base buffer system.

indicative of

anemia.

Leukocytes WBC or

leukocytes are

cells of the

immune system

which defend

the body against

10.23 4.50-11x10^9/L

Ms. Ovary’s

leukocyte

count is within

the normal

range.

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both infectious

disease and

foreign

materials.

evaluates the

body’ capacity

to resist and

overcome

infection

to detect

leukemia

to determine

severity of

infection.

Neutrophils A neutrophils test

helps us detect the

levels of

neutrophils in our

body. These

neutrophils are an

integral part of our

immune system

0.77 0.18-0.70 Ms. Ovary’s

neutrophil

count is above

the normal

range which is

indicative of

impaired

immune

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and through a

process called

chemotaxis, they

reach any place

where an infection

has 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

system

suggesting

acute bacterial

infection.

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an individual.

Lymphocytes This test measures

the number of

lymphocytes (a

type of white blood

cell) in blood. It is

used to evaluate

and manage

disorders of the

blood or the

immune system. It

is also used to

evaluate and

manage certain

types of cancer and

tumors.

0.18 0.10-0.48 Ms. Ovary’s

lymphocyte

count is within

the normal

range.

Monocytes This test measures

the amount of

monocytes in

blood. Monocytes

are a type of white

blood cell (WBC).

0.05 0.00-0.04 Ms. Ovary’s

monocyte

count is

slightly above

the normal

range which is

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This test is used to

evaluate and

manage blood

disorders, certain

problems with the

immune system,

and cancers,

including monocytic

leukemia. This test

may also be used

to evaluate for the

risk of

complications after

a heart attack.

indicative of

impaired

immune

system as well

as the

presence of

cancer.

Platelet Count A platelet count

may be used to

screen for or

diagnose various

diseases and

conditions that

affect the number

of platelets in the

blood. It may be

158 150-400x10^9L

Ms. Ovary’s

platelet count

is within the

normal range.

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used as part of the

workup of

a bleeding

disorder, bone

marrow disease,

or excessive

clotting disorder, to

name just a few.

The test may used

as a monitoring tool

for 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.

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Prior:

Explain the procedure.

Explain the purpose and what to expect.

No food or fluid restrictions.

Check the doctor's order.

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.

After:

Label the specimen.

Secure the results.

Note for inflammation of punctured site.

Document.

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III. ANATOMY AND PHYSIOLOGY OF THE FEMALE

REPRODUCTIVE SYSTEM

The female reproductive system contains two main parts: the

uterus, which acts as receptacle for the male’s 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.

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.

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.

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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.

The Individual Components of the Female Reproductive System

Vulva

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.

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.

Vagina

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

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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.

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.

Cervix

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.

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.

Uterus

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

28 | C S : O . N . G . | G r p . 1 0

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. During pregnancy, the

cells of the myometrium increase in size to accommodate the growing

fetus. 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.

Fallopian Tube

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

29 | C S : O . N . G . | G r p . 1 0

is in the fallopian tube, tiny hairs in the tube's lining help push it down

the narrow passageway toward the uterus.

Ovary

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.

The ovary contains many follicles composed of a 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.

30 | C S : O . N . G . | G r p . 1 0

IV. THE PATIENT AND HIS ILLNESS

A. PATHOPHYSIOLOGY (Book- centered)

1. Schematic Diagram

31 | C S : O . N . G . | G r p . 1 0

Non- modifiable risk factors-family history of ovarian cancer or heredity

-family history of breast or colon cancer-advancing age

-ethnicity or race: Northern and Western Europe and American descent

-Infertility-Previous history of ovarian cysts

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

Development defect in gonadogenesis

Formation of germ cells tumor (95%)

Tumors of totipotent cellsMalignant transformation of the germ cells

Intratubular genn cell neoplasia (IGCN) or

carcinoma in situ (CIS)Formation of non seminatous tumor

Diffuse peritoneal implantation of

the serosal surface

Metastasis

Malignant tumor of the ovaries

Embryonal carcinoma

Yolk sac tumor

HCG levelsExtend to other peritoneal tissue

32 | C S : O . N . G . | G r p . 1 0

Extend to other peritoneal tissue

Uterine contractility

Sloughing of the endometrial lining

Excessive amount if bleeding

Weakness

Pallor

Hematolo

33 | C S : O . N . G . | G r p . 1 0

Hematolo

2. Synthesis of the disease

2.1. Definition of the disease

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.

Tumors can be benign or malignant:

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.

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.

Benign and malignant cysts

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).

34 | C S : O . N . G . | G r p . 1 0

http://www.medicinenet.com/script/main/art.asp?articlekey=7738



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.

Ovarian cancer

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.

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.

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

35 | C S : O . N . G . | G r p . 1 0







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 second-

hand tobacco smoke.

7. Unsafe intercourse- there is risk of direct infection because there is

no protection to protect the client from acquiring such disease

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.

2.3. Non-modifiable Factors

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.

36 | C S : O . N . G . | G r p . 1 0


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

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.

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

37 | C S : O . N . G . | G r p . 1 0



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 level and structural

similarities of the HCG alpha chain with alpha chains of FSH and TSH

Constipation- the large intestine is being compromised by the

increasing size of the peritoneum which may cause narrowing of the

rectum and decrease peristalsis resulting to constipation.

38 | C S : O . N . G . | G r p . 1 0

PATHOPHYSIOLOGY (Client-centered)

1. Schematic Diagram

39 | C S : O . N . G . | G r p . 1 0

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%)

Tumors of totipotent cellsMalignant transformation of the germ cells

Intratubular genn cell neoplasia (IGCN) or

carcinoma in situ (CIS) Formation of non seminatous tumor

Diffuse peritoneal implantation of

the serosal surface

AB

Malignant tumor of the ovaries

Embryonal carcinoma

A B

40 | C S : O . N . G . | G r p . 1 0

Uterine contractility

TAHBSO(Aug.2, 2012)

Sloughing of the endometrial lining

Excessive amount if bleeding

ANEMIAAug. 3. 2012

Hct: 0.30; Hgb: 105

Weakness

Pallor

Cold clammy skin

2. Synthesis of the Disease (Client – centered)

2.1. Definition of the disease

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.

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.

2.3. Non-modifiable Factors

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.

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.

3. Sex/Gender-Certain cancer occurs in only one sex due to

different anatomy, e.g. ovarian cancer occurs only in female.

41 | C S : O . N . G . | G r p . 1 0


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.

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 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.

42 | C S : O . N . G . | G r p . 1 0

V. THE PATIENT AND HIS CARE

1. MEDICAL MANAGEMENT

a. IVFs, BT, NGT feeding, Nebulization, TPN, Oxygen Therapy, etc.

MEDICAL

MANAGEMENT/TREATME

NT

DATE ORDERED

DATE

PERFORMED

DATE CHANGED/

D/C

GEBERAL

DESCRIPTION

INDICATON(S) CLIENT’S

RESPONSE TO

THE TREATMENT

1. Intravenous Fluid

D5LRS

#1

#2

#4

DO: 8-2-12

DP: 8-2-12

DC: 8-2-12

5% Dextrose in

Lactated Ringer’s

Solution (D5LRS)

LRS contains

sodium, chloride,

potassium, calcium

and lactate. Lactate

is metabolized in

the liver to form

bicarbonate saline

and balanced

electrolyte solution

commonly are used

To prevent

electrolyte

imbalance and

serves as fluid and

caloric supply for

the patient. It also

serves as a route

for administration

for intravenous

medication

especially if the

patient is for

preoperative.

The patient

responded well to

the treatment and

did not manifest

any signs of

dehydration of

electrolyte

imbalances. The

patient had an

effective fluid

balance during the

entire therapy.

43 | C S : O . N . G . | G r p . 1 0

to restore vascular

volume, particularly

after trauma or

surgery.

PNSS/ 0.9 NaCl

#1

#2

#3

DO: 8-2-12

DP: 8-2-12

DC: 8-2-12

Normal Saline is a

sterile,

nonpyrogenic

solution for fluid

and electrolyte

replenishment. It

contains no

antimicrobial

agents.

It is indicated as a

source of water and

electrolytes. It is

also for fluid and

electrolyte

replenishment as

well as for

medication

administration.

The patient

responded well to

the treatment and

did not manifest

any signs of

dehydration of

electrolyte

imbalances. The

patient had an

effective fluid

balance during the

entire therapy.

Voluven

#2

#3

DO: 8-2-12

DP: 8-2-12

DC: 8-2-12

Voluven contains a

synthetic starch

that does not

dissolve in water. It

Indicated for the

treatment of

hypovolemia when

plasma volume

The patient

responded well to

the treatment and

did not manifest

44 | C S : O . N . G . | G r p . 1 0

is made by linking

individual starch

molecules together

and combining

them with a salt

solution, similar to

the salt

concentration

typically found in

blood. Voluven

expands the volume

of blood plasma –

the liquid portion of

the blood – and thus

draws fluid into

small blood vessels

known as

capillaries.

It is not a substitute

for red blood cells

or coagulation

expansion is

required.

any signs of

dehydration of

electrolyte

imbalances. The

patient had an

effective fluid

balance during the

entire therapy.

45 | C S : O . N . G . | G r p . 1 0

factors in plasma.

D5NM

#5

#6

#7

DO: 8-2-12

DP: 8-2-12

DC: 8-3-12

5% Dextrose in

Normosol-M (D5NM)

D5NM is a sterile,

nonpyrogenic,

hypertonic solution

of balance

maintenance

electrolytes and 5%

dextrose injection in

water for injection.

For parenteral

maintenance of

routine daily fluid

and electrolyte

requirement with

minimal

carbohydrate

calories.

The patient

responded well to

the treatment and

did not manifest

any signs of

dehydration of

electrolyte

imbalances. The

patient had an

effective fluid

balance during the

entire therapy.

46 | C S : O . N . G . | G r p . 1 0


Prior:

Explain the procedure to the client to ensure her cooperation and to reduce anxiety.

Check the information on the label of the IV infusion container, including the patient’s name and room

number, type of solutions, time and date of each preparation, preparer’s name and order infusion rate.

Compare the doctor’s 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 patient’s identity by comparing the information on the solution container with patient’s

wristband or any identification item.

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.

47 | C S : O . N . G . | G r p . 1 0

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.

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.

48 | C S : O . N . G . | G r p . 1 0

MEDICAL

MANAGEMENT/TREAT

MENT

DATE ORDERED

DATE PERFORMED

DATE CHANGED/

D/C

GEBERAL

DESCRIPTION


RESPONSE TO THE

TREATMENT

2. Foley Catheter DO: 8-2-12

DP: 8-2-12

DC: ø

Foley catheter is a

double-lumen

catheter. The larger

lumen drains urine

from the bladder. A

second, smaller

lumen is used to

inflate a balloon

near the tip of the

catheter in place

within the bladder.

The balloon of

retention catheter is

sized by the volume

of fluid used to

inflate them.

It is indicated to

provide bladder

drainage for a

patient who is

unable to void

spontaneously after

the patient had

given an anesthesia.

It is also used to

monitor output

precisely and to

know the

characteristics of the

patient urine. And to

facilitate proper

hygiene of the

patient.

The patient was able

to tolerate the foley

catheter and she

experienced relief

from bladder

distention though

she was activity

intolerance.

49 | C S : O . N . G . | G r p . 1 0


Prior:

Read Doctors order.

Maintain sterile technique with insertion.

During:

Check for patency of tubing.

Place the urinary bag lower than the patient.

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.

50 | C S : O . N . G . | G r p . 1 0

MEDICAL

MANAGEMENT/TREAT

MENT

DATE ORDERED

DATE PERFORMED

DATE CHANGED/

D/C

GEBERAL

DESCRIPTION


RESPONSE TO THE

TREATMENT

3. Blood Transfusion

Fresh Whole

Blood (FWB)

#1

#3

#4

#5

DO: 8-2-12

DP: 8-2-12

DC: 8-3-12

A blood transfusion

is a safe, common

procedure in which

you receive blood

through an

intravenous (IV) line

inserted into one of

your blood vessels.

Blood transfusions

are used to replace

blood lost during

surgery or a serious

injury. A transfusion

also might be done if

your body can't

make blood properly

because of an

illness.

The patient

responded well to

the treatment and

did not manifest any

signs of blood

transfusion

reactions.

51 | C S : O . N . G . | G r p . 1 0


Prior:

Assess laboratory values.

Verify the medical prescription.

Assess the client’s 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 client’s name and number check blood compatibility, and note

expiration time.

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.

After:

When the transfusion is completed, discontinue infusion and dispose the bag and the tubing properly.

Document.

52 | C S : O . N . G . | G r p . 1 0

b. Drugs

NAME OF

DRUGS;

GENERIC

NAME AND

BRAND NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE CHANGED/

D/C

ROUTE OF

ADMINISTRATIO

N, DOSAGE AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATION

MECHANISM OF

ACTION

INDICATION(S

)

CLIENT’S

RESPONSE TO

THE

MEDICATION W/

ACTUAL SIDE

EFFECT.

GENERIC

NAME:

Nalbuphine

BRAND NAME:

Nubaine

DO: 8-2-12

DT/DG: 8-2-12

DC: ø

10mg SIVP PRN for

severe pain

Narcotic agonist-antagonist 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

Relief of moderate to severe pain

Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery.

The patient was relieved of pain.

53 | C S : O . N . G . | G r p . 1 0

receptors.Nursing Responsibilities:

Prior:

Read carefully the doctor’s order.

Review methods of administration/storage. Consume fluids; ensure adequate hydration.

Take for prescribed number of days even if symptoms subside.

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.

During:

Observe patient’s reaction to drug while administering.

After:

Reassess patient’s 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 drug’s CNS effects are known.

Teach patient how to manage troublesome adverse effects such as constipation.

Document.

54 | C S : O . N . G . | G r p . 1 0

NAME OF

DRUGS;

GENERIC

NAME AND

BRAND NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATIO

N, DOSAGE AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATION

MECHANISM OF

ACTION

INDICATION(S) CLIENT’S

RESPONSE TO

THE

MEDICATION

W/ ACTUAL

SIDE EFFECT.

GENERIC

NAME:

Cefoxitin

BRAND

NAME:

Mefoxin

DO: 8-2-12

DT/DG: 8-2-12

DC: ø

500mg q8 Antibiotic Cephalosporin

(2nd

generation)

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Lower respiratory infections

Skin and skin structure infections

UTI Uncomplicated

gonorrhea Intra-

abdominal infections

Gynecologic infections

Septicemia Perioperative

prophylaxis

The patient did not anymore manifest any signs and symptoms of infection.


55 | C S : O . N . G . | G r p . 1 0

Prior:


Obtain ANST before administering.




During

Observe patient’s reaction to drug.

Monitor for nephrotoxicity.

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.

NAME OF

DRUGS;

DATE ORDERED

DATE

ROUTE OF

ADMINISTRATIO

GEN. ACTION

FUNCTIONAL

INDICATION(

S)

CLIENT’S

RESPONSE TO

56 | C S : O . N . G . | G r p . 1 0

GENERIC

NAME AND

BRAND NAME

TAKEN/GIVEN

DATE CHANGED/

D/C

N, DOSAGE AND

FREQUENCY

CLASSIFICATION

MECHANISM OF

ACTION

THE

MEDICATION W/

ACTUAL SIDE

EFFECT.

GENERIC

NAME:

Ketorolac

BRAND NAME:

Acular LS,

Acular PF

DO: 8-2-12

DT/DG: 8-2-12

DC: ø

30 mg IV q6 (-)

ANST

Antipyretic Nonopioid

analgesic NSAID

Anti-inflammatory and analgesic activity; inhibits prostaglandins and leukotriene synthesis.

Short-term management of pain (up to 5 days)

Ophthalmic: Relief of ocular itching due to seasonal conjunctivitis and relief of postoperative inflammation after cataract surgery.

The patient did not manifest any signs and symptoms of inflammation.


Prior:

57 | C S : O . N . G . | G r p . 1 0






During



After




occur.


Document.

58 | C S : O . N . G . | G r p . 1 0

STAT MEDICATIONS

NAME OF

DRUGS;

GENERIC

NAME AND

BRAND NAME

DATE

ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATIO

N

MECHANISM

OF ACTION


RESPONSE TO

THE

MEDICATION

W/ ACTUAL

SIDE EFFECT.

GENERIC

NAME:

Omeprazole

BRAND NAME:

Omepron

DO: 8-1-12

DT/DG: 8-1-12

DC: 8-2-12

40mg/cap HS

8pm

Antisecretory

drug

Proton pump

inhibitor

Gastric acid-

pump

inhibitor:

Suppresses

gastric acid

secretion by

specific

inhibition of

the

hydrogen-

Short-term

treatment of

active

duodenal

ulcer

Treatment of

heartburn or

symptoms of

GERD

Long-term

therapy:

Treatment of

pathologic

hypersecreto

ry conditions

The patient

responded well

with the

medication. No

symptoms of

medication

reactions were

noted.

59 | C S : O . N . G . | G r p . 1 0

potassium

ATPase

enzyme

system at

the secretory

surface of

the gastric

parietal cells;

blocks the

final step of

acid

production.

Zegerid oral

suspension:

Reduction of

risk of upper

GI bleeding

in critically ill

patients;

includes

sodium

bicarbonate.

Nursing Responsibilities

60 | C S : O . N . G . | G r p . 1 0

Prior:


Administer before meals.

Assess other medications patient maybe taking for effectiveness and interaction.

Administer with antacids, if needed.




During


Monitor therapeutic effectiveness and adverse reaction at the beginning of therapy and periodically

throughout the therapy.

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.

NAME OF

DRUGS;

DATE ORDERED

DATE

ROUTE OF

ADMINISTRATI

GEN. ACTION

FUNCTIONAL


RESPONSE TO

61 | C S : O . N . G . | G r p . 1 0

GENERIC NAME

AND BRAND

NAME

TAKEN/GIVEN

DATE

CHANGED/ D/C

ON, DOSAGE

AND

FREQUENCY

CLASSIFICATIO

N

MECHANISM OF

ACTION

THE

MEDICATION W/

ACTUAL SIDE

EFFECT.

GENERIC NAME:

Bisacodyl

BRAND NAME:

Dulcolax

DO: 8-1-12

DT/DG: 8-1-12

DC: 8-2-12

1 rectal

suppository @

10pm

Stimulant

Laxatives

It acts directly

on the bowels,

stimulating

the bowel

muscles to

cause a bowel

movement.

Short term

release of

constipation,

either chronic

or of recent

onset,

whenever a

stimulant

laxative is

required.

Bowel

clearance

before

surgery or

radiological

investigation.

Replacement

of the

The patient

responded well

with the

medication. No

symptoms of

medication

reactions were

noted.

62 | C S : O . N . G . | G r p . 1 0

evacuant

enema in all

its indications.


Prior:

63 | C S : O . N . G . | G r p . 1 0


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.


During




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 patient’s 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.

NAME OF

DRUGS;

DATE ORDERED

DATE

ROUTE OF

ADMINISTRATI

GEN. ACTION

FUNCTIONAL


RESPONSE TO

64 | C S : O . N . G . | G r p . 1 0

GENERIC NAME

AND BRAND

NAME

TAKEN/GIVEN

DATE

CHANGED/ D/C

ON, DOSAGE

AND

FREQUENCY

CLASSIFICATIO

N

MECHANISM OF

ACTION

THE

MEDICATION W/

ACTUAL SIDE

EFFECT.

GENERIC NAME:

Metronidazole

BRAND NAME:

Flagyl

DO: 8-2-12

DT/DG: 8-2-12

DC: 8-3-12

500mg/tab @

12am

Amebicide

Antibacterial

Antibiotic

Antiprotozoal

Bactericidal:

Inhibits DNA

synthesis in

specific

(obligate)

anaerobes,

causing cell

death;

antiprotozoal-

trichomonacid

al, amebicidal:

Bio-chemical

mechanism of

Acute infection with susceptible anaerobic bacteria

Acute intestinal amebiasis

Amebic liver abscess

Trichomoniasis (acute and partners of patients with acute infection)

Bacterial vaginosis

Preoperative, intraoperative, postoperative prophylaxis for patients

The patient

responded well

with the

medication. No

symptoms of

infection and

medication

reactions were

noted.

65 | C S : O . N . G . | G r p . 1 0

action is not

known.

undergoing colorectal surgery

Unalabeled use: Prophylaxis for patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn’s disease


Prior:


Obtain C&S before beginning drug therapy to identify if correct treatment has been initiated.

66 | C S : O . N . G . | G r p . 1 0

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.


During




Obtain baseline information on patient’s infection: fever, wound characteristics, vaginal secretions, WBC

count (>100,000/mm3) and regular assess during treatment.

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.

NAME OF

DRUGS;

GENERIC NAME

AND BRAND

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

GEN. ACTION

FUNCTIONAL

CLASSIFICATIO

N


RESPONSE TO

THE

MEDICATION W/

67 | C S : O . N . G . | G r p . 1 0

NAME CHANGED/ D/C FREQUENCY MECHANISM OF

ACTION

ACTUAL SIDE

EFFECT.

GENERIC NAME:

Sodium

Biphosphate and

Sodium

Phosphate

BRAND NAME:

Fleet Enema

DO: 8-2-12

DT/DG: 8-2-12

DC: 8-3-12

--- Laxatives For relief of

occasional

constipation or

bowel cleansing

before rectal

examinations.

The patient

responded well

with the

medication. No

symptoms of

medication

reactions were

noted.


Prior:

Verify the doctor’s order.

Prepare the necessary equipments.

Wash hands and put on gloves.

68 | C S : O . N . G . | G r p . 1 0

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 client’s stomach may encourage further cleansing.

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.

NAME OF

DRUGS;

GENERIC NAME

AND BRAND

NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATIO

N

MECHANISM OF


RESPONSE TO

THE

MEDICATION

W/ ACTUAL

69 | C S : O . N . G . | G r p . 1 0

ACTION SIDE EFFECT

GENERIC

NAME: Cefoxitin

BRAND NAME:

Mefoxin

DO: 8-2-12

DT/DG: 8-2-12

DC: 8-3-12

16/IV (+) ANST/1

hr prior to OR

Antibiotic Cephalosporin

(2nd

generation)

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Lower respiratory infections

Skin and skin structure infections

UTI Uncomplicated

gonorrhea Intra-

abdominal infections

Gynecologic infections

SepticemiaPerioperative prophylaxis

The patient did not anymore manifest any signs and symptoms of infection.


Prior:




70 | C S : O . N . G . | G r p . 1 0



During



After




occur.


Document.

NAME OF

DRUGS;

GENERIC NAME

AND BRAND

NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATION

MECHANISM OF

ACTION


RESPONSE TO

THE

MEDICATION

W/ ACTUAL

SIDE EFFECT

71 | C S : O . N . G . | G r p . 1 0

GENERIC

NAME:

Hydrocorstisone

BRAND NAME:

Cortef

DO: 8-2-12

DT/DG: 8-2-12

DC: 8-3-12

100ml/IV 1hr

prior to OR

Adrenocortical

steroid

Corticosteroid

(short-acting)

Glucocorticoid

Hormone

Enters target

cells and binds

to cytoplasmic

receptors;

initiates many

complex

reactions that

are responsible

for its anti-

inflammatory,

immunosuppre

ssive

glucocorticoid),

and salt-

retaining

Replacement

therapy in

adrenal

cortical

insufficiency

Allergic states-

severe or

incapacitating

allergic

conditions

Hypercalcemia

associated

with cancer

Short-term

inflammatory

and allergic

disorders,

such as

rheumatoid

arthritis,

collagen

disease (SLE),

The patient

responded well

with the

medication. No

symptoms of

medication

reactions were

noted.

72 | C S : O . N . G . | G r p . 1 0

(mineralocortic

oid) actions.

Some actions

may be

undesirable,

depending on

drug use.

dermatologic

diseases

(pemphigus),

status

asthmaticus,

and

autoimmune

disorders.

Hematologic

disorders –

thrombocytop

enic purpura,

erythroblastop

enia

Anorectal

cream,

suppositories:

To relieve

discomfort of

hemorrhoids

and perianal

itching or

73 | C S : O . N . G . | G r p . 1 0

irritation.


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.

74 | C S : O . N . G . | G r p . 1 0

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.

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.

NAME OF

DRUGS;

GENERIC NAME

AND BRAND

NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATIO

N

MECHANISM OF

ACTION


RESPONSE TO

THE

MEDICATION W/

ACTUAL SIDE

EFFECT

GENERIC NAME:

Famotidine

DO: 8-2-12

DT/DG: 8-2-12

20mg/IV Histamine-2

(H2) receptor

Relief of

symptoms of

The patient

responded well

75 | C S : O . N . G . | G r p . 1 0

BRAND NAME:

Pepcid

DC: 8-3-12 antagonist

Competitively

blocks the

action of

histamine at

the H2

receptors of

the parietal

cells of the

stomach;

inhibits basal

gastric acid

secretion and

chemically

induced

gastric acid

secretion.

heartburn,

acid

indigestion,

sour stomach

Unlabeled

uses: Part of

combination

therapy of

Helicobacter

pylori,

perioperative

suppression of

gastric acid

secretion,

prevention of

stress ulcers,

prevention of

aspiration

pneumonitis,

treatment of

some urticaria

with the

medication. No

symptoms of

medication

reactions were

noted.

76 | C S : O . N . G . | G r p . 1 0


Prior:


If using one dose a day, administer drug HS.

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.

77 | C S : O . N . G . | G r p . 1 0

Therapy may continue for 4–6 wk or longer. Place rapidly disintegrating tablet on tongue and swallow with or

without water.

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.

NAME OF

DRUGS;

GENERIC NAME

AND BRAND

NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATIO

N

MECHANISM OF

ACTION


RESPONSE TO

THE

MEDICATION W/

ACTUAL SIDE

EFFECT

GENERIC NAME:

Furosemide

DO: 8-2-12

DT/DG: 8-2-12

---- Loop Diuretic

Pregnancy

Treatment of

edema

The patient

responded well

78 | C S : O . N . G . | G r p . 1 0

BRAND NAME:

Lasix

DC: 8-3-12 Category C

Rapid-acting

potent

sulfonamide

“loop” diuretic

and

antihypertensi

ve with

pharmacologi

c effects and

uses almost

identical to

those of

ethacrynic

acid. Exact

mode of

action not

clearly

defined;

decreases

renal vascular

associated

with CHF,

cirrhosis of

liver, and

kidney

disease,

including

nephrotic

syndrome.

May be used

for

management

of hypertensio

n alone or in

combination

with other

antihypertensi

ve agents.

Treatment of

hypercalcemia

.

Has been

with the

medication. No

symptoms of

medication

reactions were

noted.

79 | C S : O . N . G . | G r p . 1 0

http://nursingcrib.com/case-study/hypertension/

http://nursingcrib.com/case-study/hypertension/

http://nursingcrib.com/nursing-notes-reviewer/medical-surgical-nursing/nephrotic-syndrome/

http://nursingcrib.com/nursing-notes-reviewer/medical-surgical-nursing/nephrotic-syndrome/

resistance and

may increase

renal blood

flow.

used

concomitantly

with mannitol

for treatment

of severe

cerebral

edema,

particularly in

meningitis.


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.

During:

Observe patients receiving drug carefully; close monitor BP and vital signs.

80 | C S : O . N . G . | G r p . 1 0

Monitor for signs and symptoms of hypokalemia.

Administer with food or milk to prevent GI upset.

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.

NAME OF

DRUGS;

GENERIC NAME

AND BRAND

NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATIO

N

MECHANISM OF

ACTION


RESPONSE TO

THE

MEDICATION W/

ACTUAL SIDE

EFFECT

GENERIC NAME:

Ca Gluconate

DO: 8-2-12

DT/DG: 8-2-12

--- Antacid

Electrolyte

Dietary

supplement

The patient

responded well

81 | C S : O . N . G . | G r p . 1 0

BRAND NAME:

Cal-G

DC: 8-3-12

Essential

element of

the body;

helps

maintain the

functional

integrity of

the nervous

and muscular

systems;

helps

maintain

cardiac

function,

blood

coagulation; is

an enzyme

cofactor and

affects the

secretory

activity of the

when calcium

intake is

inadequate.

Prevention of

hypocalcemia

during

exchange of

transfusions.

with the

medication. No

symptoms of

medication

reactions were

noted.

82 | C S : O . N . G . | G r p . 1 0

endocrine and

exocrine

glands;

neutralizes or

reduces

gastric acidity

(oral use).


Prior:


Take drug in between meals and at bedtime.

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.

83 | C S : O . N . G . | G r p . 1 0

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.

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.

NAME OF

DRUGS;

GENERIC NAME

AND BRAND

NAME

DATE ORDERED

DATE

TAKEN/GIVEN

DATE

CHANGED/ D/C

ROUTE OF

ADMINISTRATI

ON, DOSAGE

AND

FREQUENCY

GEN. ACTION

FUNCTIONAL

CLASSIFICATIO

N

MECHANISM OF

ACTION


RESPONSE TO

THE

MEDICATION

W/ ACTUAL

SIDE EFFECT

GENERIC

NAME:

Magnesium

DO: 8-3-12

DT/DG: 8-3-12

DC: ø

SIVP---4PM Antiepileptic

Electrolyte

Laxative

IV:

Hypomagnese

mia,

The patient

responded well

with the

84 | C S : O . N . G . | G r p . 1 0

Sulfate

BRAND NAME:

Epsom Salt

Cofactor of

many enzyme

systems

involved in

neurochemica

l transmission

and muscular

excitability;

prevents or

controls

seizures by

blocking

neuromuscula

r

transmission;

attracts and

retains water

in the

intestinal

lumen and

distends the

replacement

therapy

IV or IM:

Preeclampsia

or eclampsia

PO: Short-term

treatment for

constipation

PO: Evacuation

of the colon

for rectal and

bowel

examinations

To correct or

prevent

hypomagnese

mia in patients

on parenteral

nutrition.

Unlabeled use:

Inhibition of

premature

medication. No

symptoms of

medication

reactions were

noted.

85 | C S : O . N . G . | G r p . 1 0

bowel to

promote mass

movement

and relieve

constipation.

labor

(parenteral)


Prior:

Assess for contraindicated conditions:

Monitor knee-jerk reflex before repeated parenteral administration.

Give laxative as temporary measure.

Reserve IV use in eclampsia for life-threatening situations.

Observe the 15 rights in drug administration.

During:

Give IM route by deep IM injection.

86 | C S : O . N . G . | G r p . 1 0

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.

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.

87 | C S : O . N . G . | G r p . 1 0

B. SURGICAL MANAGEMENT (Client-centered)

A. Description

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:

A hysterectomy is the surgical removal of the uterus. It may be

total, as removing the body and cervix of the uterus or partial.

Salphingo refers specifically to the fallopian tubes which connect

the ovaries to the uterus.

Oophorectomy is the surgical removal of an ovary or ovaries.

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.

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.

Up–to–date Pap smear.

Pelvic ultrasound may be appropriate, depending on what the

physician finds on the above.

88 | C S : O . N . G . | G r p . 1 0

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

B. Nursing Responsibilities prior to, during, and after the operation.

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 patient’s vital signs to assess the

patient’s condition before the surgery.

The nurse should explain the invasive procedure within the patient’s

understanding and let the client sign consent.

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.

After

At the end of the procedure, the operative field is inspected and

any clots are removed with a suction-irrigator or grasping

89 | C S : O . N . G . | G r p . 1 0

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 patient’s 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

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C. NURSING MANAGEMENT

1. Nursing Care Plans

Problem No. 1: Infection related to Presence of Incision Site Secondary to Surgical Procedure

ASSESSMENT

NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

OBJECTIVES INTERVENTIONS

RATIONALE EXPECTED OUTCOMES

S > O > The patient manifested: Increase

WBC count : Neutrophils of 0.77; Monocytes of 0.05

Redness Pain on the

incision site

Irritation

The patient may manifest: Swelling of

the incision site

Risk for infection r/t presence of incision site secondary to surgical procedure

TAHBSO is a surgical invasive procedure, which means it requires an incision site to end the procedure,Breakage in the skin integrity decrease the first line of defense of the body which make the body more susceptible in acquiring infection brought about by invading

SHORT TERM: After 2 hours of nursing intervention, patient will be able to identify interventions to prevent infection from occurring.

LONG TERM:After 2-4 days of nursing intervention, the patient will remain free of infection.

1. Instruct the patient to give time to rest on bed

2. Encourage the patient to eat foods rich in Vitamin C, protein and carbohydrates

3. Encourage

1. This will help the patient to prevent injury

2. These foods will help for the regeneration and repair of tissues, energy production for unassisted movement and infection prevention

SHORT TERM:

After NI and health teachings, the patient shall have been able to identify interventions to prevent infection from occurring.

LONG TERM:

After nursing interventions, the patient shall have been free from

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microorganism which is transmitted through direct or indirect contact that could proliferate in a traumatize tissue breakage in the skin

the patient to increase fluid intake

4. Instruct the SO to give patient a good personal hygiene

5. Instruct the patient to give importance for wound care

6. Changed dressings as needed

3. To prevent dehydration

4. This will help the patient to prevent infection related to poor personal hygiene because of microorganism spread

5. This will help the patient to have faster healing of the wound

6. To prevent the dressing

infection.

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from soaking with secretions.

Problem No. 2: Acute Pain

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ASSESSMENT NURSING

DIAGNOSIS

SCIENTIFIC

EXPLANATION

OBJECTIVES NURSING

INTERVENTION

S

RATIONALE EXPECTED

OUTCOME

S: “ali ken,

me-opera ku

kasi, masakit”

O: patient

manifested:

facial

grimace

a pain

scale of

8/10

weakness

Acute Pain When the

abdomen is

incisioned

cells called

nociceptors

sense damage

and send an

impulse via a

sensory nerve

to the dorsal

horn region of

the spinal

cord. This

processes the

signal and

sends another

signal down

the abdomen

via amotor

Short Term:

After 4hrs. of

Nursing

interventions

the patient will

verbalized

understanding

of health

teachings.

Long Term:

After 2-3 days

of Nursing

Interventions,

patient will

1. Established

Rapport

2. Monitored

and

Recorded

VS.

3. Assess pain

characteristi

cs such as

quality,seve

rity

location,ons

et, duration

and used

pain scale

0/10.

1. To gain

trust.

2. To obtain

baseline data.

3. To obtain

baseline data.

Short Term:

After 4hrs. of

Nursing

interventions

the patient

shall have

verbalized

understanding

of health

teachings.

Long Term:

After 2-3 days

of Nursing

interventions,

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nerve causing

abdominal

muscles to

pun away from

the source of

injury.

demonstrate/

report that

pain is

controlled.

AEB decrease

in pain scale

from 8/10 to

2/10.

4. Encourage

adequate

rest periods

5. Encourage

to eat

nutritious

foods and

rich in

protein.

6. Provided

clients

safety.

7. Provided

quiet

environment

4. To prevent

fatigue.

5. For tissue

regeneration

of wound.

6. To protect

client from

injuries

7. To have

calm

activities.

the patient

shall have

demonstrated/

reported that

pain is

controlled.

AEB decrease

in pain scale

from 8/10 to

2/10.

Problem No.3: Impaired Physical Mobility related to pain.

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ASSESSMEN

T

NURSING

DIAGNOSIS

SCIENTIFIC

EXPLANATIO

N

OBJECTIVES NURSING

INTERVENTI

ONS

RATIONALE EXPECTED

OUTCOME

S>Ø

O> the

patient may

manifest:

Weakness

and fatigue

Discomfort

on

movement

Limited

range of

motion

Restless

Irritable

The patient

may manifest:

Impaired

physical

mobility R/T

pain

Due to the

surgical

procedure

performed,

the patient

lost the

energy

reserved and

increases the

need to adapt

the pain thus

limiting

client’s

movement.

SHORT TERM:

After 2 hours

of nursing

interventions

and health

teachings, the

patient will be

able to use

identified

technique to

enhance

activity

intolerance.

LONG TERM:

After 3 days of

nursing

1. Monitor

and record

vital signs

2. Teach

method to

increase

activity

level.

3. Plan care

with rest

periods

between

activities

4. Provide

positive

atmospher

1. For

baseline

data

2. To

conserve

energy

3. To reduce

fatigue

SHORT TERM:

The patient

shall have

used the

identified

technique to

enhance

activity

intolerance.

LONG TERM:

The pt. shall

will maintain

or increase

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Decreased

walking

speed

Difficulty

turning

interventions,

the pt. will

maintain or

increase

strength and

function of

affected body

part.

e

5. Assist with

activities

6. Promote

comfort

measures

7. Encourage

participatio

n and

diversion

of activities

4. To

minimize

frustrations

5. To protect

from injury

6. To reduce

pain

7. To

minimize

pain

strength and

function of

affected body

part.

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Problem No. 4: Impaired Skin Integrity relatd to Skin Trauma Secondary to TAHBSO

ASSESSMENT NURSING

DIAGNOSIS

SCIENTIFIC

EXPLANATIO

N

OBJECTIVES INTERVENTI

ONS

RATIONALE EXPECTED

OUTCOME

S >

O > The patient

manifested:

Destruction of

skin layers

surrounding

the abdominal

incision

Disruption of

skin surface

Pain on the

incision site

The patient may

manifest:

Invasion of

Pathogen

Impaired skin

integrity r/t

skin trauma

secondary to

TAHBSO

Like any other

surgical

procedures,

TAHBSO

includes

invasion of the

inside body,

requiring a

surgical

incision to

perform the

specified

surgical

procedure

(TAHBSO).

Upon incision,

there will be

SHORT TERM:

After 3 hours

of nursing

interventions

the patient

will

demonstrate

participation

and

understandin

g of the

preventive

measures

and

treatment

program on

1. Establish

rapport

with the

patient.

2. Monitor

and record

vital signs

3. Inspect the

incision

site every

shift using

REEDA

(redness,

edema,

ecchymosi

s,

1. To gain

patient’s

trust and

cooperatio

n

2. to get the

health

status of

the patient

3. Frequent

assessme

nt can

detect

sign and

symptoms

of possible

SHORT TERM

The patient

shall have

demonstrated

participation

and

understanding

of the

preventive

measures and

treatment

program on

taking care of

the surgical

incision.

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impairment of

the skin

integrity

causing

damage,

Causing

impairment of

the skin

integrity.

taking care of

the surgical

incision.

LONG TERM:

After 24

hours of

nursing

interventions

the patient

will manifest

an intact skin

integrity and

absence of

any signs and

symptoms of

infection.

discharge

and

approxima

tion

method)

4. Assist the

patient in

understan

ding and

following

medical

regimen

and

developing

program of

preventive

case and

daily

maintenan

ce

5. Performed

the

infection

4. To

promote

wellness

5. Cleaning

LONG TERM:

The pt. shall

have

manifested an

intact skin

integrity and

absence of any

signs and

symptoms of

infection.

99 | C S : O . N . G . | G r p . 1 0

prescribed

treatment

regimen

6. Monitor

the

progress

and report

for

favorable

and

adverse

response

the incised

part

decreases

bacterial

concentrat

ion thus

aiding in

the

healing

process

6. Monitoring

the

response

to

treatment

can help

identify a

possible

need for

alternative

interventio

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7. Instruct

and assist

the patient

with

general

hygiene

including

hand

washing

and

toileting

practices

8. Help the

patient

assume

ns

7. Proper

hand

washing is

the most

effective

way for

disease

prevention

. Bacteria

from the

hands can

easily

contamina

te the

incision

area.

8. To

decrease

incidence

101 | C S : O . N . G . | G r p . 1 0

comfortabl

e position

9. Inform the

patient of

the

purpose of

self care

practices

10.Instruct

the patient

and

significant

others on

the

possible

danger

signs and

symptoms

that

of pain

and

induce

immobility

9. To

increase

complianc

e

10.Prompt

reporting

of danger

signs and

symptoms

may help

prevent

major

complicati

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should be

reported to

the

physician

immediatel

y

ons

Problem No. 5: Constipation related to Decrease In Physical Movement

ASSESSMENT NURSING

DIAGNOSIS

SCIENTIFIC

EXPLANATIO

N

OBJECTIVES INTERVENTIO

NS

RATIONALE EXPECTED

OUTCOMES

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S > Ø

O > The pt

may manifest:

Abdomi

nal

tendern

ess or

pain

and

feeling

of rectal

fullness

Change

in bowel

patterns

Decreas

ed

frequen

cy and

stool

Constipation

r/t decrease

physical

activity

Constipation is

the decrease

in normal

frequency of

defecation. It

occurs when

the movement

of feces

through the

large intestine

is slow, thus

allowing time

for additional

re-absorption

of fluid from

the large

intestine

accompanied

by difficult or

incomplete

passage of

stool and/or

SHORT TERM:

After 4-6 hours

of nursing

interventions,

the patient will

verbalize

understanding

of risk factors

and

appropriate

interventions

r/t individual

situation

LONG TERM:

After 1-2 days

of nursing

interventions,

the patient will

establish

normal pattern

of bowel

1. Establish

rapport

2. Assess

patient’s

condition

3. Monitor

and record

vital signs

4. Instruct

patient to

increase

fluid intake

1. To gain

patient’s

trust and

confidence

2. To

determine

what

interventio

n will be

perform

3. To obtain

baseline

data

4. To facilitate

absorption

of sufficient

amount of

fluid in the

SHORT TERM:

After nursing

interventions,

the patient

shall have

verbalized

understanding

of risk factors

and

appropriate

interventions

r/t individual

situation.

LONG TERM:

After nursing

intervention

patient

establish

normal bowel

functioning

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volume

strainin

g and

possibly

pain

during

defecati

on

passage of

excessively

hard and dry

stool. Due to

decrease

physical

activity the

movement of

feces through

the large

intestine is

low, thus, the

may patient

manifest

difficulty or

decrease

frequency in

defecation.

elimination

5. Instruct

patient to

eat foods

rich in fiber

such as

bread,

whole

grains.

Fruits and

vegetables

6. Encourage

ambulation

within

individual’s

ability

7. Administer

medication

as ordered

intestines

5. To facilitate

expulsion

of soft

consistency

of stools.

Fiber

absorbs

water

which add

softness to

stools

6. To facilitate

feces

expulsion

7. To facilitate

expulsion

of soft

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stools

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2. Actual SOAPIERs

S Ø

O Received patient on supine position, conscious, with an

ongoing IVF #6 of D5NM 1Lx40-41 gtts/min @ 500 cc level

infusing well over the left metacarpal vein; with an intact

indwelling foley catheter connected to urine bag draining

reddish urine @ 550 cc level, with dry intact wound dressing

on the lower abdominal midline; with normal capillary refill of

<3sec; with VS taken and recorded as follows:

BP: 110/80 mmHg, T: 36.6 °c/axilla, PR: 78bpm; RR:24cpm

A Impaired skin integrity r/t break in the skin 2° to post-

operative incision

P After 4 hrs of nursing intervention, the patient will be able to

verbalize techniques on how to practice proper wound

cleaning technique and will demonstrate behaviors to achieve

timely wound healing.

I Established rapport

Monitored and recorded vital signs

Assessed general condition

Assessed post-operative site, noting for color and

presence of discharge

Encouraged adequate rest periods

Emphasized proper hygiene

Encouraged frequent hand washing before and after

wound cleaning

Promoted safety measures such as placing pillows in

pt’s side

Encouraged early ambulation w/in client’s level of

tolerance

Instructed to eat foods high in Proteins such as fish,

meat and foods high in Vitamin C. such as citrus fruits

once on DAT

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Instructed and encouraged proper wound care, 2x a

day.

Encouraged deep breathing and coughing exercises w/

proper splinting

Regulated IVF accordingly

E Goal met. The patient was able to verbalize techniques on

how to practice proper wound cleaning technique and will

demonstrate behaviors to achieve timely wound healing.

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VI. PATIENT’S DAILY PROGRESS IN THE HOSPITAL

1. Client’s Daily Progress Chart

DAYS ADMISSION

(8-1-12)

2ND DAY

(8-2-12)

3RD DAY

(8-3-12)

Nursing Problems

1. Anxiety

2. Risk for fluid

volume deficit

3. Risk for injury

4. Impaired skin

integrity

Vital Signs PR: 81 bpm

RR: 21 cpm

BP: 120/80 mmHg

T: 36°c/axilla

PR: 80 bpm

RR: 22 cpm

BP: 100/70 mmHg

T: 36.3°c/axilla

PR: 78 bpm

RR: 24 cpm

BP: 110/80 mmHg

T: 36.6°c/axilla

OX’C/Lab. Procedures

9. Clinical Chemistry

(Fluid and

Electrolytes)

10. Complete

Blood Count

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Medical Management

11. IVFs

D5LRS

PNSS

Voluven

D5NM

12. BT

Fresh Whole Blood

(FWB)

DRUGS

Nalbuphine

Cefoxitin

Ketoroloac

Stat Meds

Omeprol

Dulcolax

Metronidazole

Fleet Enema

Cefoxitin

Hydrocorstisone

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Famotidine

Lasix

Ca Gluconate

MgSO4

Diet NPO NPO Foods rich in Protein and

Vitamin C once on DAT

Activity/Exercise ---- Deep breathing and

coughing exercise with

proper splinting

Deep breathing and

coughing exercise with

proper splinting

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VII. DISCHARGE PLANNING

A. General Condition of the Client upon Discharge

* Did not observed

B. Method

M- Instructed to take the ffg medications:

Nalbuphine 10mg whenever necessary for severe pain

Cefoxitin 500mg every 8 hours

Ketoroloac 30 mg every 6 hours

E- Encourage to do Ambulation

T- Encouraged to continue home medication/treatment regimen

H- Advised to eat foods rich in protein such as fish, soft meat, and Vitamin C

rich foods such as citrus fruits.

O-

D- Explained Soft Diet

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VIII. CONCLUSION

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.

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.

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.

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.

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.

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.

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

113 | C S : O . N . G . | G r p . 1 0

current trends if the disease since of its growing popularity with this

information it would help us to reflect upon our daily habits.

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IX. BIBLIOGRAPHY

Published Sources

Black, J.M,. et.al. Medical Surgical Nursing: Clinical Management for

Positive Outcomes.7th ed.

Doenges, M. E.2004.Nurse’s Pocket Guide: Diagnoses, Interventions

and Rationales.9th ed. F.A. Davis Co.

Handbook of diseases. 3rd ed.

Karch, A.M. (2011), 2011 Lippincott’s: Nursing Drug Guide. New York:

Lippincott Williams & Wilkins

Pilliteri, A. Maternal and Child Health Nursing Care of the Childbearing

and Child Rearing Family. 5th ed.

Smeltzer, S.C. et. Al. Brunner and Suddarth’s Textbook of Medical

Surgical Nursing.11th ed.

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http://web.squ.edu.om/med- lib/med_cd/e_cds/Nursing%20Drug

%20Guide/mg/famotidine.htm

http://www.emedicinehealth.com/ovarian_cysts/article_em.htm

http://www.medicinenet.com/famotidine/article.htm

http://www.medpill.info/bisacodyl-1108.htm

http://www.scribd.com/doc/13095017/Calcium-Gluconate-Drug-Summ

http://www.scribd.com/doc/17100240/Bisacodyl

http://www.scribd.com/doc/22828269/Hydrocortisone

http://www.scribd.com/doc/22828270/Magnesium-Sulfate

http://www.scribd.com/doc/25880841/What-is-TAH-BSO-Total-

Abdominal- Hysterectomy-And

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http://www.scribd.com/doc/25880841/What-is-TAH-BSO-Total-Abdominal-%09Hysterectomy-And

http://www.scribd.com/doc/25880841/What-is-TAH-BSO-Total-Abdominal-%09Hysterectomy-And

http://www.scribd.com/doc/22828270/Magnesium-Sulfate

http://www.scribd.com/doc/22828269/Hydrocortisone

http://www.scribd.com/doc/13095017/Calcium-Gluconate-Drug-Summ

http://www.medpill.info/bisacodyl-1108.htm

http://nurseslabs.com/tahbso-surgical-procedure-and-perioperative-

case study - ovarian new growth final.docx

Documents

left metacarpal

enhance activity

normal capillary

lower abdominal

skin trauma

intact skin

obtain baseline

date ordered