General Objectives

The purpose of the presentation is to know related information and knowledge

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

Specific Objectives

• To understand condition of disease and associate it with the patient through the
introduction of the case

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

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

organ.

• To discuss and determine manifestation and complications

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

Overview of the disease

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

Signs and Symptoms

Ovarian Cysts Causes

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

The following are possible risk factors for developing ovarian cysts:

• History of previous ovarian cysts

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

Ovarian Cysts Symptoms

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

However, the following symptoms may be present:

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

Functional anatomy of the ovary

Female Reproductive System

The female reproductive anatomy includes internal and external structures. The female
reproductive system contains two main parts: the vagina and uterus, which act as the
receptacle for the male's sperm, and the ovaries, which produce the female's ova. All of
these parts are always internal; the vagina meets the outside at the vulva, which also
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 certain
intervals, the ovaries release an ovum, which passes through the fallopian tube into the
uterus. If, in this transit, it meets with sperm, the sperm penetrate and merge with the egg,
fertilizing it. The fertilization usually occurs in the oviducts, but can happen in the uterus
itself. The zygote then implants itself in the wall of the uterus, where it begins the
processes of embryogenesis and morphogenesis. When developed enough to survive
outside the womb, the cervix dilates and contractions of the uterus propel the fetus
through the birth canal, which is the vagina. The ova are larger than sperm and are
generally all created by birth. Approximately every month, a process of oogenesis
matures one ovum to be sent down the Fallopian
tube attached to its ovary in anticipation of fertilization. If not fertilized, this egg is
flushed out of the system through menstruation. The function of the external female
reproductive structures (the genital) is twofold: To enable sperm to enter the body and to
protect the internal genital organs from infectious organisms. The main external
structures of the female reproductive system include:

Labia majora:
The labia majora enclose and protect the other external reproductive organs. Literally
translated as "large lips," the labia majora are relatively large and fleshy, and are
comparable to the scrotum in males. The labia majora contain sweat and
oil-secreting glands. After puberty, the labia majora are covered with hair.

Labia minora:
Literally translated as "small lips," the labia minora can be very small or
up to 2 inches wide. They lie just inside the labia majora, and surround the openings to
the vagina (the canal that joins the lower part of the uterus to the outside of the body) and
urethra (the tube that carries urine from the bladder to the outside of the body).

Bartholin's glands:
These glands are located next to the vaginal opening and produce a fluid (mucus)
secretion.
Clitoris:
The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable
to the penis in males. The clitoris is covered by a fold of skin, called the prepuce, which
is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very
sensitive to stimulation and can become erect.

Vagina:

The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the
body. It also is known as the birth canal. The vagina is the tubular tract leading from the
uterus to the exterior of the body in female mammals, or to the cloaca in female birds and
some reptiles. Female insects and other invertebrates also have a vagina, which is the
terminal part of the oviduct. The vagina is the place where semen from the male is
deposited into the female's body at the climax of sexual intercourse, commonly known as
ejaculation.

Uterus (womb):

The uterus is a hollow, pear-shaped organ that is the home to a developing fetus. The
uterus is divided into two parts: the cervix, which is the lower part that opens into the
vagina, and the main body of the uterus, called the corpus. The corpus can easily expand
to hold a developing baby. A channel through the cervix allows sperm to enter and
menstrual blood to exit. The uterus or womb is the major female reproductive organ of
humans. One end, the cervix, opens into the vagina; the other is connected
on both sides to the fallopian tubes.
The uterus mostly consists of muscle, known as myometrium. Its major function is to
accept a fertilized ovum which becomes implanted into the endometrium, and derives
nourishment from blood vessels which develop exclusively for this purpose. The
fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. If
the egg does not embed in the wall
of the uterus a woman gets her period and the egg is flushed away.

Ovaries:

The ovaries are small, oval-shaped glands that are located on either side of the uterus.
The ovaries produce eggs and hormones. The ovaries are the place inside the female
body where ova or eggs are produced. The process by which the ovum is released is
called ovulation. The speed of ovulation is periodic and impacts directly to the length of a
menstrual cycle.
After ovulation, the ovum is captured by the oviduct, where it travelled down the oviduct
to the uterus, occasionally being fertilized on its way by an incoming sperm, leading to
pregnancy and the eventual birth of a new human being.
The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help
the egg cell travel.

Fallopian tubes:

These are narrow tubes that are attached to the upper part of the
uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the
uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the
fallopian tubes. The fertilized egg then moves to the uterus, where it implants to the
uterine wall.

Cervix:
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the
vagina. It is cylindrical or conical in shape and protrudes through the upper anterior
vaginal wall.
Approximately half its length is visible; the remainder lies above the vagina beyond view.
Oviducts:

The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of
female mammals into the uterus. On maturity of an ovum, the follicle and the ovary's
wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it travels
toward the uterus, pushed along by movements of cilia on the inner lining of the tubes.
This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it
normally implants in the endometrium when it reaches the uterus, which signals the
beginning of pregnancy

Total Abdominal Hysterectomy

With and Without Bilateral
Salpingo-oophorectomy

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

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

Physiologic Changes. The predominant physiologic change from removal of

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

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

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

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

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

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

Laboratory/Diagnostic Examination

Complete Blood Count Results Normal Values

Hemoglobin 13.7 14-18gm/gl

Hematocrit 41 40-50vol

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

Differential Count
Neutrophils 78 40-60

Lymphocyte 32 35-40

Eosinophils 3 2-4
 Drug Study

Name of Action Indication Dosage Adverse Nursing

the Drug &Preparation Reaction Responsibility
Mefenamic Produces anti-Mild to500mg q6 CNS: >Observe 10 rights in
Acid inflammatory, moderate pain, drowsiness, giving medication
analgesic &dysmenorrhea dizziness, > Administered with
antipyretic nervousness food to minimize GI
effects possibly CV: edema adverse reactions.
through GI: nausea,>Contraindicated in
inhibition of vomiting, GI ulceration r
prostaglandin diarrhea, pepticinflammation.
synthesis. ulceration, >Teach patient sign
hemorrhage and symptoms of GI
GU:dysuria, bleeding, and tell
hematuria, patient to report these
nephrotoxicity to the doctor
Hepatic: immediately.
hepatotoxicity >Severe hemolytic
Skin:rash, anemia may occur
urticaria with prolonged use.
Monitor CBC
periodically.
>Stop drug if rash,
visual disturbances,
diarrhea develops.
Name of Action Indication Dosage Adverse Nursing
the Drug and Reaction Responsibi
Preparati lity
on
Metronidazole >Direct –actingThe indication1g / rectum 1hrCNS: headache,>Always observe
(Flagyl) trichomonacide are based on theprior to OR seizures, fever, vertigo,the 10 Rights
ANTI- and amebicideanti-parasitic and ataxia, dizziness,when giving
INEFECTIVES that works insideantibacterial confussion,depression, medication.
(amebicides& and outside inactivity. irritability >Give oral form
antiprotozoals) the intestines.>Amebic liver Vision disorder:with meals to
It’s thought toabscess, transient visionminimize GI upset
enter the cells ofIntestinal disorders such as>Tell pt. he may
microorganisms amebiasis, diplopia, myopia experience a
that containTrichomoniasis GI: epigastric pain,metallic taste and
nitroreductase, >Bacterial pain, nausea, vomiting,have dark or red-
forming unstableinfections caused diarrhea, metallic taste,brown urine.
compounds thatby aerobic dry mouth >Instruct pt in
binds DNA andmicroorganisms Hypersensitivity proper hygiene
inhibits >To prevent Reactions: rash,>Tell pt to avoid
synthesis, postoperative pruritus, flushing,alcohol during
causing cellinfection in urticaria, anaphylacticmetronidazole
death. contaminated shocks therapy and for
colorectal GU: darkened urine,atleast one day
surgery polyuria, dryness ofafterwards beause
>Bacterial vagina,dysuria of possibility of
Vaginosis dislfiram-like
>Clostridium (Antabuse effect)
difficle- reaction.
associated >May cause
diarrhea and transient visual
colitis disorder,
>Pelvic dizziness&
Inflammatory confusion avoid
disease activities
requiring alertness
like driving a
vehicle.
Name of Action Indication Dosage Adverse Reaction Nursing
the &Preparation Responsibility
Drug
Bisacodyl Stimulant Chronic 2 tablets (hoursCNS: dizziness, faintness,>Give drugs at
laxative thatconstipation; of sleep) muscle weakness withtimes that don’t
increases preparation excessive use interfere with
peristalsis, for child birth, GI: abdominal cramps,scheduled
probably bysurgery, or burning sensation inactivities or
direct effectrectal or rectum with suppositories,sleep.
on smoothbowel nausea and vomiting >Before giving
muscle of theexamination. METABOLIC: for constipation,
intestine, by alkalosis, fluid anddetermine
irritating the electrolyte imbalance,whether patient
muscle or hypokalemia. has adequate
stimulating the MUSCULOSKELETAL: fluid intake
colonic tetany exercise and diet.
intramural >Tablets and
plexus. suppositories are
Drug also use together to
promotes fluid clean the colon
accumulation before and after
in colon and surgery and
small before barium
intestine. enema.
>Insert
suppository as
high as possible
in to the rectum,
and try to
position
suppository
against the rectal
wall. Avoid
embedding
within fecal
material because
doing so may
delay onset of
action.
>Bisco-Lax may
contain tartazine.
Name of Action Indication Dosage Adverse Nursing
the &Preparation Reaction Responsibility
Drug
Morphine Binds with>Severe pain 3mg throughCNS: dizziness,>Reassess patient’s
Sulfate opiate >Moderate toEpidural cathetereuphoria, light-level of pain at least
receptor insevere painq12 x 3 headedness, 15 to 30 minutes.
the CNS,requiring nightmares, >Keep opioid
altering continuous, sedation, anatagonist
perception around the somnolence, (naloxone) and
of andclock opioid seizures, resuscitation
emotional >Single dose, depression, equipment available.
response toepidural hallucinations, >Monitor
pain. extended pain nervousness, circulatory,
relief after physical respiratory, bladder
major surgery. dependence. and bowel function
CV: carefully.
bradycardia, >Oral solutions of
cardiac arrest,various
shock, concentrations and
hypertension, an intensified oral
tachycardia solution are
GI: constipation,available.
nausea and>Oral capsules may
vomiting, be carefully opened
anorexia, biliaryand the entire
tract spasm, drycontents poured into
mouth, ileus cool soft foods such
GU: urineas water, orange
retention, juice, apple sauce or
HEMATOLOGIC: pudding.
thrombocytopenia >Morphine is drug
RESPIRATORY: of choice in
apnea, respiratoryrelieving MI pain;
arrest, respiratorymay cause transient
depression decrease in blood
SKIN: pressure.
diaphoresis,
edema, pruritus
and skin flushing
OTHER:
decreased libido
Name of Action Indication Dosage Adverse Nursing
the Drug &Preparati Reaction Responsibility
on
Cefuroxime Second >Serious 1.5 qm IVPCV: phlebitis,> Before giving drug
generation lower after negativethrombophlebiti ask patient if she is
cephalosp respiratory skin testing s allergic to penicillin
orin thattract GI: diarrhea,or cephalosporin.
inhibits infection, pseudo- >Obtain specimen for
cell wallUTI, skin or membranous culture and sensitivity
synthesis skin colitis, nausea,test before giving first
promoting structure anorexia anddose.
osmotic infections, vomiting >Absorption of oral
instability; bone or joint GU: urinedrug is enhanced
usually infections, retention, >Tablets may be
bactericida septicemia, HEMATOLOGI crushed, if absolutely
l meningitis C: necessary for patient
and thrombocytopen who can’t swallow
gonorrhea ia, hemolytictablets.
>Pre- anemia,
operative transient
prevention neutropenia,
>Bactericida eosiniphilia.
l exarbations RESPIRATORY
of chronic : apnea,
bronchitis or respiratory
secondary arrest,
bacterial respiratory
infection of depression
acute SKIN:
bronchitis maculopapular
>Acute and
bacterial erythematous
maxillary rashes, urticaria,
sinusitis pain, induration,
>Pharyngitis sterile
and abscesses,
tonsillitis temperature
>Otitis elevation, tissue
media sloughing at IM
injection site
OTHER:
anaphylaxis,
hypersensitivity
reactions, serum
sickness
Discharge Plan

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

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

Treatment
Surgical treatments for Ovarian Cysts

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

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

Health Teachings:

 Proper hygiene.
 Proper diet such as eating nutritional foods that are rich in protein and Vit. C to
promote well-being.
 Increase physical activities.
 Avoid eating sweet foods.
 Adequate rest and sleep.
OPD (follow up)
7 days after the patient was discharge, patient should have his follow up
check up on the nearest health center or hospital
Diet
Increase oral fluid intake
Prevent eating of sweet foods
Have a high fiber diet