INTRODUCTION
A wise man should consider that health is the greatest of human blessings, and learn
how by his own thought to derive benefit from his illnesses.
- Hippocrates
Every individual aspires to be as healthy as they currently can, but as it turns out
life isn’t that simple. It’s 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.
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
cystsoccur as a result of the follicle not rupturing, the follicle not changing into its
smaller size, or doing the rupturing itself.
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 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 cases
per 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 cystadenocarcinomas. 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.
Benign cysts can cause pain and discomfort related to pressure on adjacent
structures, torsion, rupture, hemorrhage (both within and outside of the cyst), and
abnormal uterine bleeding. They rarely cause death. Mucinous cystadenomas may
cause a relentless collection of mucinous fluid within the abdomen, known as
pseudomyxoma peritonei, which may be fatal without extensive treatment.
Women from northern and western Europe and North America are affected most
frequently, whereas women from Asia, Africa, and Latin America are affected least
frequently.Within the United States, age-adjusted incidence rates in surveillance areas
are highest among American Indian women, followed by white, Vietnamese, Hispanic,
and Hawaiian women. Incidence is lowest among Korean and Chinese women.
Functional ovarian cysts occur at any age (including in utero), but are much more
common in reproductive-aged women. They are rare after menopause. Luteal cysts
occur after ovulation in reproductive-aged women. Most benign neoplastic cysts occur
during the reproductive years, but the age range is wide and they may occur in persons
of any age.
Ovarian cancer tumors sometimes include ovarian cysts, but the average ovarian
cyst is benign. Chances of developing an ovarian cyst are higher during a woman's
reproductive years, as both follicular and corpus luteum cysts are tied to the ovulation
cycle. An ovarian cyst is much less common after menopause. However, if
postmenopausal women develop an ovarian cyst, there is a higher risk of the cyst
developing into ovarian cancer. To be safe, any ovarian cyst symptoms should be
reported to a health professional, such as ovarian cyst pain. Watchful waiting is the
most common treatment, as an ovarian cyst will usually disappear within a few months.
GENERAL OBJECTIVES
The purpose of the presentation is to know related information and knowledge
about the aforementioned disease condition. This presentation will serve as a guideline
for student nurses in assessing and providing proper nursing care to patients with the
same problem or disease.
SPECIFIC OBJECTIVES
To understand condition of disease and associate it with patients having similar
manifestations.
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 disease condition and correlate lab
results.
To provide the client a set of nursing care plans to assure for clients total
wellness during her hospitalization up to the time of discharge.
ANATOMY AND PHYSIOLOGY
FEMALE REPRODUCTIVE ORGANS
Front View Side View
Ovaries
The ovaries are the main reproductive organs of a woman. The two ovaries,
which are about the size and shape of almonds, produce female hormones (estrogens
and progesterone) and eggs (ova). All the other female reproductive organs are there to
transport, nurture and otherwise meet the needs of the egg or developing fetus.
The ovaries are held in place by various ligaments which anchor them to the
uterus and the pelvis. The ovary contains ovarian follicles, in which eggs develop. Once
a follicle is mature, it ruptures and the developing egg is ejected from the ovary into the
fallopian tubes. This is called ovulation. Ovulation occurs in the middle of the menstrual
cycle and usually takes place every 28 days or so in a mature female. It takes place
from either the right or left ovary at random.
Fallopian tubes
The fallopian tubes are about 10 cm long and begin as funnel-shaped passages
next to the ovary. They have a number of finger-like projections known as fimbriae on
the end near the ovary. When an egg is released by the ovary it is ‘caught’ by one of the
fimbriae and transported along the fallopian tube to the uterus. The egg is moved along
the fallopian tube by the wafting action of cilia — hairy projections on the surfaces of
cells at the entrance of the fallopian tube — and the contractions made by the tube. It
takes the egg about 5 days to reach the uterus and it is on this journey down the
fallopian tube that fertilisation may occur if a sperm penetrates and fuses with the egg.
The egg, however, is only usually viable for 24 hours after ovulation, so fertilisation
usually occurs in the top one-third of the fallopian tube.
Uterus
The uterus is a hollow cavity about the size of a pear (in women who have never
been pregnant) that exists to house a developing fertilised egg. The main part of the
uterus (which sits in the pelvic cavity) is called the body of the uterus, while the rounded
region above the entrance of the fallopian tubes is the fundus and its narrow outlet,
which protrudes into the vagina, is the cervix.
The thick wall of the uterus is composed of 3 layers. The inner layer is known as
the endometrium. If an egg has been fertilised it will burrow into the endometrium,
where it will stay for the rest of its growth. The uterus will expand during a pregnancy to
make room for the growing fetus. A part of the wall of the fertilised egg, which has
burrowed into the endometrium, develops into the placenta. If an egg has not been
fertilised, the endometrial lining is shed at the end of each menstrual cycle.
The myometrium is the large middle layer of the uterus, which is made up of
interlocking groups of muscle. It plays an important role during the birth of a baby,
contracting rhythmically to move the baby out of the body via the birth canal (vagina).
Vagina
The vagina is a fibromuscular tube that extends from the cervix to the vestibule of
the vulva. The vagina is a passage connecting the uterus with the external genitals,
receives the penis and the sperm ejaculated from it during sexual intercourse. It also
serves as an exit passageway for menstrual blood and for the baby during birth. The
external genitals, or vulva, include the clitoris, erectile tissue that responds to sexual
stimulation, and the labia, which are composed of elongated folds of skin.
Breasts (Mammary Glands)
After birth the infant is fed with milk from the breasts, or mammary glands, which
are also sometimes considered part of the reproductive system.
Fallopian tube
One of two ducts in female leading from the ovaries to the upper part of the
uterus. They are also known as oviducts. In the human female the fallopian tubes are
about 2 cm (about 0.75 in) thick and 10 to 13 cm (4 to 5 in) long. As the ovum leaves
the ovary it passes into the mouth of the adjoining fallopian tube and is propelled toward
the uterus by hair-like projections called cilia on the inner surface of the tube. If the
ovum is fertilized inside the tube, where most fertilization takes place, it usually implants
in the uterus.
DIAGNOSTICS AND LABORATORY PROCEDURES
Diagnostic/
Laboratory
Procedures
Indications or PurposesNormal Value (Units
used in the hospital)
1. Complete Blood
Count
a. Hemoglobin
CBC is a screening test, used to diagnose and manage
numerous diseases. The results can reflect problems with fluid or
loss of blood.
Hemoglobin determines the RBC that carries oxygen and carbon
dioxide throughout the body
Hemoglobin is a protein in red blood cells that carries oxygen.
Hgb: 120-140g/L
Hct: 0.37-0.47
b. Hematocrit
c. Leukocytes
d. Neutrophils
e. Lympocytes
Hematocrit determines the concentration of RBC within the
blood volume
Leukocytes are used to measure the no. of WBC in the blood.
They are the major infection-fighting cells in the body.
Neutrophils is the first WBC component that phagocytize
invading microorganism
It determines if there are enough cells that produce antibodies
and other chemicals responsible for destroying microorganisms.
WBC count:
5-10x 109/L
Neutrophils:
0.45-0.65
Lymphocytes:
0.20-0.35
Nursing Responsibilities for Complete Blood Count
Before
Check the doctor’s order.
Check the right client.
Explain the procedure to the patient or to the SO.
Tell the patient or SO that no fasting is required.
Assure the patient or SO that collecting the blood sample take less than 3 minutes.
Inform the patient or SO that the patient will be experiencing mild pain on the site where the needle will be prick.
During
Use distal vein of the arm
Use pt.’s non dominant arm whenever possible
Select a vein that is easily palpated, feels soft and full, naturally splinted by bone, large enough to allow adequate
circulation around the catheter.
Maintain sterile/aseptic technique
After
Apply pressure or a pressure dressing to the venipuncture site.
Check the venipuncture site for bleeding.
Fill-up the laboratory form properly and send it to the laboratory technician during the collection of the sample or
specimen.
Record all procedures done.
Diagnostic/Laboratory Procedures Indication/s or Purposes Normal
Values(Units
used in hospital)
2. Urinalysis
It is a routine screening to determine urine
complications and possible abnormal
components (e.g. CHON, glucose, blood, pus) or
infection.
diagnostic tool because it can help detect
substances or cellular material in the urine
associated with different metabolic and kidney
disorders.
Color
Transparency
pH
Specific Gravity
Yellow-Clear
Clear
4.6-6.5
1.003-1.030
Albumin
Sugar
Pus Cells
Red Cells
Epithelial Cells
Negative
Negative
0-2/HPF
0-2/HPF
None
Nursing Responsibility for Urinalysis :
Explain to the client that the urine specimen is required, give the reason, and explain to be used to collect. Discuss
how the results will be used in planning further care or treatments.
Wash hands observe other appropriate infection control procedure.
Provide client privacy.
Routine urine examination is usually done on the first voided specimen in the morning because it tends to have a
higher, more uniform concentration and a more acidic pH than specimens later in the day.
At least 10 ml of urine is generally sufficient for a routine urinalysis.
The specimen must be free of fecal contamination, so urine must be kept separate from feces.
Female client should discard the toilet tissue in the toilet or in a waste bag rather than in the bedpan because
tissue in the specimen makes laboratory specimen makes laboratory analysis more difficult.
Put the lid tightly on the container to prevent spillage of the urine and contamination of other object
Make sure that the specimen label and laboratory requisition carry the correct information and attach them securely
to the specimen.
Imaging Studies
Ultrasonography
Ultrasonography is the most favored imaging modality to assess ovarian cysts.
Transabdominal ultrasonography allows for a better overall view of the abdomen and
pelvis in visualizing large ovarian masses and their subsequent complications, such
ashydronephrosis or free fluid. It is best performed with a full bladder to use as an
acoustic window in order to better visualize structures. Transvaginal ultrasonography
with a higher-frequency probe allows better resolution of the ovary than a
transabdominal lower-frequency probe.
A normal ovary is 2.5-5 cm long, 1.5-3 cm wide, and 0.6-1.5 cm thick. In the
follicular phase, several follicles are usually visible within the ovarian tissue.
On a sonogram, ovarian cysts have a thin rounded wall and a unilocular appearance
that is either hypoechoic or anechoic. They usually measure 2.5-15 cm in diameter, and
posterior acoustic enhancement (a hyperechoic area) may be visible deep to the fluid-
filled cyst.
The corpus luteum (especially in pregnancy) tends to be larger and more
symptomatic than the follicular cyst and is prone to hemorrhage and rupture. On a
sonogram, it has a varied appearance ranging from a simple cyst to a complex cystic
lesion with internal debris and thick walls.
A corpus luteal cyst is typically surrounded by a circumferential rim of color on
Doppler flow referred to as "the ring of fire." Compared with a follicular cyst, a corpus
luteal cyst has thicker, more echogenic, and more vascular walls. A hemorrhagic corpus
luteal cyst has a variable echogenic pattern on ultrasonography, depending on clot
formation and lysis in the cyst. Fresh blood appears acutely anechoic. There is mixed
echogenicity subacutely; chronically, the blood appears anechoic again, which is
consistent with clot formation, retraction, and lysis.
Hemorrhage into the cyst appears diffuse with a reticular pattern described as a
"fishnet pattern" or "spider web" appearance. Color Doppler shows no vascularity within
the clot, whereas a solid nodule may show vascularity.
The ultrasonographic appearance of ovarian torsion varies, but, most commonly,
the ovary is enlarged. Massive ovarian edema may be seen with torsion, as the twisting
of the pedicle impedes lymphatic drainage and venous outflow, leading to ovarian
enlargement. Torsion may be intermittent and recurrent with spontaneous detorsion,
allowing both arterial and venous flow to the ovary to be observed on ultrasonography.
Occasionally, a twisted vascular pedicle (referred to as the "whirlpool sign") may be
visible during active torsion. However this is not a sensitive finding.
If the ultrasonographic features are not typical of an ovarian cyst, follow-up
ultrasonography can be performed to exclude ovarian neoplasm. Follow-up
ultrasonography can show resolution of cyst.
CT scanning
CT scanning is more sensitive but less specific than ultrasonography in detecting
ovarian cysts. The addition of CT scanning in the workup of ovarian cysts offers very
little additional information and usually does not alter treatment plans.
CT scanning is best in imaging hemorrhagic ovarian cysts or hemoperitoneum
due to cyst rupture. It can also be used to distinguish other intra-abdominal causes of
acute hemorrhage from cyst rupture. However, CT scanning should be avoided in
pregnancy, if possible, to prevent radiation exposure to the fetus. MRI is a better option
in these patients when ultrasonography cannot clearly elucidate the adnexal mass.
MRI
MRI in conjunction with ultrasonography may provide marginal improvements in
specificity, but, in most cases, the additional cost in not justified.
MRI is reserved for cases in which ultrasonography and CT scanning findings are
indeterminate in identifying the mass as an ovarian cyst safely in a pregnant patient.
Simple ovarian cysts show a low signal intensity with T1-weighted images and a high
signal intensity with T2-weighted images owing to the intracystic fluid.
Hemorrhagic cysts result in a high signal on T1-weighted images and intermediate to
high signal on T2-weighted images. Hemoperitoneum after cyst rupture appears bright
on T2-weighted images and slightly hyperintense on T1-weighted images.
SYNTHESIS OF DISEASE
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- Cysts don't always have to be large to cause pain.
Several small cysts can occur within an ovary and cause pain by stretching the
ovary slightly. If scar tissue is on the ovary, a cyst can expand and pull on the
scar tissue and cause pain. A medium-sized cyst can twist on its pedicle, and this
can cause pain. Other types of abnormal cysts include endometriotic and
dermoid cysts. Some patients can have very large cysts and no pain at all.
When they cause pain, ovarian cysts usually cause pain off on one side or the
other, and the pain can radiate slightly around the flank. A cyst which is bleeding
or leaking some irritative fluid can cause generalized pelvic and lower abdominal
pain which may seem to spread from the affected side. Some women can have
recurrent ovarian cysts after spontaneous resolution of, or surgical removal of a
cyst, since each of some 200,000 oocytes (eggs) in each ovary at birth is
surrounded by a small follicle or potential cyst.
• Irregular menstrual periods- In women with PCOS, the ovary doesn't make all
of the hormones it needs for an egg to fully mature. The follicles may start to
grow and build up fluid but ovulation does not occur. Instead, some follicles may
remain as cysts. For these reasons, ovulation does not occur and the hormone
progesterone is not made. Without progesterone, a woman's menstrual cycle is
irregular or absent. Plus, the ovaries make male hormones, which also prevent
ovulation.
• Feeling of lower abdominal or pelvic pressure or fullness- Direct pressure
from the cysts on the ovaries and surrounding structures. This causes chronic
pelvic fullness or a dull ache.
• Long-term pelvic pain during menstrual period that may also be felt in the
lower back
• Pelvic pain after strenuous exercise or sexual intercourse - may be a sign
of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with
internal bleeding
• Pain or pressure with urination or bowel movements- Urination may hurt if
your bladder is inflamed. This may occur even if you don't have an infection.
Something pressing against the bladder like in ovarian cyst
• Nausea and vomiting- may be a sign of torsion or twisting of the ovary on its
blood supply, or rupture of a cyst with internal bleeding
• Vaginal pain or spots of blood from vagina - Some functional ovarian cysts
can twist or break open (rupture) and bleed.
• Infertility
Medical Management
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Name of the
DrugAction Indication
Dosage
&Preparation
Adverse
Reaction
Nursing
Responsibilities
Mefenamic Acid Produces anti-
inflammatory,
analgesic &
antipyretic effects
possibly through
inhibition of
prostaglandin
synthesis.
Mild to moderate
pain,
dysmenorrhea
500mg q6 CNS: drowsiness,
dizziness,
nervousness
CV: edema
GI: nausea,
vomiting, diarrhea,
peptic ulceration,
hemorrhage
GU:dysuria,
hematuria,
nephrotoxicity
Hepatic:
hepatotoxicity
Skin:rash,
urticaria
>Observe 10
rights in giving
medication
> Administered
with food to
minimize GI
adverse reactions.
>Contraindicated
in GI ulceration r
inflammation.
>Teach patient
sign and
symptoms of GI
bleeding, and tell
patient to report
these to the
doctor
immediately.
>Severe
hemolytic anemia
may occur with
prolonged use.
Monitor CBC
periodically.
>Stop drug if rash,
visual
disturbances,
diarrhea develops.
Name of the
DrugAction Indication
Dosage
&PreparationAdverse Reaction
Nursing
Responsibilities
Metronidazole
(Flagyl)
ANTI-
INEFECTIVES
(amebicides&
antiprotozoals)
>Direct –acting
trichomonacide
and amebicide
that works inside
and outside in
the intestines. It’s
thought to enter
the cells of
microorganisms
that contain
nitroreductase,
forming unstable
compounds that
binds DNA and
inhibits
synthesis,
causing cell
death.
The indications
are based on the
anti-parasitic and
antibacterial
activity.
>Amebic liver
abscess,
Intestinal
amebiasis,
Trichomoniasis
>Bacterial
infections caused
by aerobic
microorganisms
>To prevent
postoperative
infection in
contaminated
colorectal
surgery
1g / rectum 1hr
prior to OR
CNS: headache,
seizures, fever,
vertigo, ataxia,
dizziness,
confussion,depression,
irritability
Vision disorder:
transient vision
disorders such as
diplopia, myopia
GI: epigastric pain,
pain, nausea,
vomiting, diarrhea,
metallic taste, dry
mouth
Hypersensitivity
Reactions: rash,
pruritus, flushing,
urticaria, anaphylactic
shocks
>Always observe
the 10 Rights
when giving
medication.
>Give oral form
with meals to
minimize GI upset
>Tell pt. he may
experience a
metallic taste and
have dark or red-
brown urine.
>Instruct pt in
proper hygiene
>Tell pt to avoid
alcohol during
metronidazole
therapy and for
atleast one day
afterwards
>Bacterial
Vaginosis
>Clostridium
difficle-
associated
diarrhea and
colitis
>Pelvic
Inflammatory
disease
GU: darkened urine,
polyuria, dryness of
vagina,dysuria
beause of
possibility of
dislfiram-like
(Antabuse effect)
reaction.
>May cause
transient visual
disorder,
dizziness&
confusion avoid
activities requiring
alertness like
driving a vehicle.
Name of the
DrugAction Indication
Dosage
&PreparationAdverse Reaction
Nursing
Responsibilities
Bisacodyl Stimulant
laxative that
increases
peristalsis,
probably by
direct effect on
smooth muscle
of the intestine,
by irritating the
muscle or
stimulating the
colonic
intramural
plexus.
Drug also
promotes fluid
accumulation in
colon and small
intestine.
Chronic
constipation;
preparation for
child birth,
surgery, or rectal
or bowel
examination.
2 tablets (hours
of sleep)
CNS: dizziness,
faintness, muscle
weakness with
excessive use
GI: abdominal cramps,
burning sensation in
rectum with
suppositories, nausea
and vomiting
METABOLIC:
alkalosis, fluid and
electrolyte imbalance,
hypokalemia.
MUSCULOSKELETAL:
tetany
>Give drugs at
times that don’t
interfere with
scheduled
activities or sleep.
>Before giving for
constipation,
determine
whether patient
has adequate
fluid intake
exercise and diet.
>Tablets and
suppositories are
use together to
clean the colon
before and after
surgery and
before barium
enema.
>Insert
suppository as
high as possible
in to the rectum,
and try to position
suppository
against the rectal
wall. Avoid
embedding within
fecal material
because doing so
may delay onset
of action.
>Bisco-Lax may
contain tartazine.
Name of the
DrugAction Indication
Dosage
&Preparation
Adverse
Reaction
Nursing
Responsibilities
Morphine Sulfate Binds with opiate
receptor in the
CNS, altering
perception of and
emotional
response to pain.
>Severe pain
>Moderate to
severe pain
requiring
continuous,
around the clock
opioid
>Single dose,
epidural extended
pain relief after
major surgery.
3mg through
Epidural catheter
q12 x 3
CNS: dizziness,
euphoria, light-
headedness,
nightmares,
sedation,
somnolence,
seizures,
depression,
hallucinations,
nervousness,
physical
dependence.
CV:
bradycardia,
cardiac arrest,
shock,
hypertension,
tachycardia
GI: constipation,
>Reassess
patient’s level of
pain at least 15 to
30 minutes.
>Keep opioid
anatagonist
(naloxone) and
resuscitation
equipment
available.
>Monitor
circulatory,
respiratory,
bladder and bowel
function carefully.
>Oral solutions of
various
concentrations
and an intensified
nausea and
vomiting,
anorexia, biliary
tract spasm, dry
mouth, ileus
GU: urine
retention,
HEMATOLOGIC:
thrombocytopenia
RESPIRATORY:
apnea, respiratory
arrest, respiratory
depression
SKIN:
diaphoresis,
edema, pruritus
and skin flushing
OTHER:
decreased libido
oral solution are
available.
>Oral capsules
may be carefully
opened and the
entire contents
poured into cool
soft foods such as
water, orange
juice, apple sauce
or pudding.
>Morphine is
drug of choice in
relieving MI pain;
may cause
transient decrease
in blood pressure.
Name of the
DrugAction Indication
Dosage
&Preparation
Adverse
Reaction
Nursing
Responsibilities
Cefuroxime Second
generation
cephalosporin that
inhibits cell wall
synthesis
promoting osmotic
instability; usually
bactericidal
>Serious lower
respiratory tract
infection, UTI, skin
or skin structure
infections, bone or
joint infections,
septicemia,
meningitis and
gonorrhea
>Pre-operative
prevention
>Bactericidal
exarbations of
chronic bronchitis
or secondary
bacterial infection
of acute bronchitis
>Acute bacterial
maxillary sinusitis
>Pharyngitis and
1.5 qm IVP after
negative skin
testing
CV: phlebitis,
thrombophlebitis
GI: diarrhea,
pseudo-
membranous
colitis, nausea,
anorexia and
vomiting
GU: urine
retention,
HEMATOLOGIC:
thrombocytopenia,
hemolytic anemia,
transient
neutropenia,
eosiniphilia.
RESPIRATORY:
apnea, respiratory
arrest, respiratory
depression
> Before giving
drug ask patient if
she is allergic to
penicillin or
cephalosporin.
>Obtain specimen
for culture and
sensitivity test
before giving first
dose.
>Absorption of
oral drug is
enhanced
>Tablets may be
crushed, if
absolutely
necessary for
patient who can’t
swallow tablets.
tonsillitis
>Otitis media
SKIN:
maculopapular
and erythematous
rashes, urticaria,
pain, induration,
sterile abscesses,
temperature
elevation, tissue
sloughing at IM
injection site
OTHER:
anaphylaxis,
hypersensitivity
reactions, serum
sickness
Surgical Management
Most ovarian cysts will go away on their own. If you don’t have any bothersome
symptoms, especially if you haven’t yet gone through menopause, your doctor may
advocate “watchful waiting.” The doctor won’t treat you. But the doctor will check you
every one to three months to see if there has been any change in the cyst.
Birth control pills may relieve the pain from ovarian cysts. They prevent ovulation,
which reduces the odds that new cysts will form.
Surgery is an option if the cyst doesn’t go away, grows, or causes you pain.
There are two types of surgery:
Laparoscopy uses a very small incision and a tiny, lighted telescope-like instrument.
The instrument is inserted into the abdomen to remove the cyst. This technique works
for smaller cysts.
Laparotomy involves a bigger incision in the stomach. Doctors prefer this technique for
larger cysts and ovarian tumors. If the growth is cancerous, the surgeon will remove as
much of the tumor as possible. This is called debulking. Depending on how far the
cancer has spread, the surgeon may also remove the ovaries, uterus, fallopian tubes,
omentum -- fatty tissue covering the intestines -- and nearby lymph nodes.
Other treatments for cancerous ovarian tumors include:
Chemotherapy -- drugs given through a vein (IV), by mouth, or directly into the
abdomen to kill cancer cells. Because they kill normal cells as well as cancerous ones,
chemotherapy medications can have side effects, includingnausea and vomiting, hair
loss, kidney damage, and increased risk of infection. These side effects should go away
after the treatment is done.
Radiation -- high-energy X-rays that kill or shrink cancer cells. Radiation is either
delivered from outside the body, or placed inside the body near the site of the tumor.
This treatment also can cause side effects, including red skin, nausea,diarrhea,
and fatigue. Radiation is not often used for ovarian cancer.
Surgery, chemotherapy, and radiation may be given individually or together. It is
possible for cancerous ovarian tumors to return. If that happens, you will need to have
more surgery, sometimes combined with chemotherapy or radiation.
Complications
A large ovarian cyst can cause abdominal discomfort. If a large cyst presses on
your bladder, you may need to urinate more frequently because its capacity is reduced.
Some women develop less common types of cysts that may not produce
symptoms, but that your doctor may find during a pelvic examination. Cystic ovarian
masses that develop after menopause may be cancerous (malignant). These factors
make regular pelvic examinations important.
The following types of cysts are much less common than functional cysts:
Dermoid cysts. These cysts may contain tissue such as hair, skin or teeth because
they form from cells that produce human eggs. They are rarely cancerous, but they
can become large and cause painful twisting of your ovary.
Endometriomas. These cysts develop as a result of endometriosis, a condition in
which uterine cells grow outside your uterus. Some of that tissue may attach to
your ovary and form a growth.
Cystadenomas. These cysts develop from ovarian tissue and may be filled with a
watery liquid or a mucous material. They can become large — 12 inches or more in
diameter — and cause twisting of your ovary.
NURSING CARE PLANS
PROBLEM #1: Chronic pain related to increase pressure to ovary secondary to ovarian cyst
ASSESSMENT DIAGNOSIS
SCIENTIFIC
EXPLANATIO
N
PLANNINGINTERVENTION
SRATIONALE
EXPECTED
OUTCOME
Subjective:
Ф
Objective:
-Facial
grimaces noted
-pain scale
Chronic pain
related to
increase
pressure to
ovary
secondary to
ovarian cyst
ovarian cyst
symptoms may
include
persistent
bloating,
swelling, or
pain in the
abdomen,
difficulty eating
or feeling full
quickly, urgent
or frequent
urination, and
vaginal
bleeding not
associated with
menstruation
After 4-5 hrs
of nursing
interventions
patient
verbalizes
reduction of
pain.
-Assess pain
characteristics:
*Severity( to 10,
with 10 being the
most severe)
-Asses for
probable cause
of pain.
-Assess the Pt’s
willingness or
ability to explore
a range of
techniques aimed
at controlling
pain.
-Eliminate
additional
-Assessment
of the pain
experience is
the first step in
planning pain
management
strategies
-Different
etiologic
factors
respond better
to different
therapies.
-Some pt. will
feel
uncomfortable
exploring
After 4-5
hours of
nursing
interventions
patient
verbalized
reduction of
pain.
stressors or
sources of
discomforts
whenever
possible.
-Provide rest
periods to
facilitate comfort,
sleep, and
relaxation
-Administer
analgesics as
indicated
(morphine). Give
doses to provide
analgesia around
the clock.
Convert from
short-acting to
long-acting
analgesics when
indicated
alternative
methods of
pain relief
-Pt’s may
experience
exaggeration
in pain.
-The pt’s
experiences of
pain may
become
exaggerated
as the result of
fatigue.
-Pain is
frequent
complication
of cancer,
although
individual
responses
differ
-Determine some
pain relief
method like
relaxation and
breathing
exercises
-Techniques
are used to
bring about a
state of
physical and
mental
awareness
w/c reduces
pain.
PROBLEM #2: Disturbed sleep pattern related to fear for the out coming surgical procedure
ASSESSMEN
T
DIAGNOSI
S
SCIENTIFIC
EXPLANATIONPLANNING
INTERVENTION
SRATIONALE
EXPECTED
OUTCOME
Subjective
Data:
Ф
Objective
Data:
-Fatigue
-weak
-anxious
Disturbed
sleep
pattern
related to
fear for the
out coming
surgical
procedure
The physical symptom
s of anxiety and fear
reflect a chronic
“readiness” to deal
with some future
threat. These
symptoms may include
fidgeting, muscle
tension, sleeping
problems, and
headaches.
After 3-4 hrs
of nursing
intervention
s patient will
verbalizes
improvemen
t sleeping
pattern
-Assess past
patterns of sleep
in environment.
-Recommend an
environment
conducive to
sleep or rest
-Provide nursing
aids( backrub,
comfortable
position,
relaxation
techniques.
-Post a “ Do not
disturb’ sign on
the door.
-Provide soft
-Sleep
patterns are
unique to
each
individual.
-Many people
sleep better
in cool, dark,
quite
environments
-These aids
promote rest.
-This will alert
people to
avoid
entering the
room and
After 3-4 hrs
of nursing
intervention
s patient
verbalized
improvemen
t sleeping
pattern
music or white
noise
-Organize
nursing care:
Eliminate
nonessential
nursing activities
-Teach about the
possible causes
o sleep difficulties
and optimal ways
to treat them
-Teach on non-
pharmacological
sleep
enhancement
techniques
interrupting
sleep
-Reduces
sensory
stimulation by
blocking out
other
environmenta
l sounds that
could
interfere with
restful sleep
-This
promotes
minimal
interruption in
sleep or rest
-This allows
patients to
participate in
their care.
-This
techniques
can be used
throughout a
lifetime. Phar.
Should be
used for a
limited time
PROBLEM #3: Fatigue related to sleep deprivation
ASSESSMENT DIAGNOSIS
SCIENTIFIC
EXPLANATIO
N
PLANNINGINTERVENTION
SRATIONALE
EXPECTED
OUTCOME
Subjective:
Ф
Objective:
-always
yawning
-weak
-tiresome
-easily irritated
Fatigue
related to
sleep
deprivation
One of area
causes fatigue
is Lifestyle
problems.
Feelings of
fatigue often
have an
obvious cause,
such as sleep
deprivation,
overwork or
unhealthy
habits.
After 3-4
hours of
nursing
interventions
Patient will
have
sufficient
energy to
complete
desired
activities
-Assess patient
emotional
response to
fatigue
-Encourage
patient to have
rest
-Provide
recommendations
for nutritional
intake for
adequate energy
sources and
metabolic
requirements
-Minimize
-These
emotional
state can add
to the person’s
fatigue level
and create a
vicious cycle
-Periods of
rest will help
prevent
adding to
levels of
fatigue
-The patient
needs
adequate
After 3-4
hours of
nursing
interventions
Patient have
sufficient
energy to
complete
desired
activities.
environmental
stimuli, especially
during planned
times of sleep
and rest
-Teach the
patient and family
task organization
techniques and
time
management
strategies
-Help the patient
develop habits to
promote effective
rest/sleep
patterns
-Encourage the
pt. and SO to
verbalize feelings
about the impact
of fatigue
balanced
intake to
provide
energy
sources like
carbohydrates
, fats, protein,
vitamins and
minerals.
-Bright
lighting, noise,
visitors,
frequent
distractions in
the patient’s
environment
can inhibit
relaxation,
interrupt
rest/sleep.
And contribute
to fatigue
-Organization
and time
management
can help the
patient
conserve
energy and
prevent
fatigue.
-Promoting
relaxation
before sleep
and providing
for several
hours of
uninterrupted
sleep can
contribute to
energy
restoration.
-Fatigue can
have a
profound
negative
influence on
family and
social
interaction.
ASSESSMENT DIAGNOSIS SCIENTIFIC
EXPLANATIO
N
PLANNING INTERVENTION
S
RATIONALE EXPECTED
OUTCOME
Subjective:
Ф
Objective:
-anxiety
-non verbal
expression of
fear
-worriness
Fear related
to threat of
fetal death for
the out
coming
surgical
procedure
The factors that
precipitate fear
are, to some
extent,
universal; fear
of death, pain,
and bodily
injury are
common to
most people.
After 3-4
hours of
nursing
interventions
patient
breathing
pattern will
verbalizes
reduction of
fear
-Acknowledge
awareness of
patient’s fear
-Advise SO to
stay with the
patient to
promote safety,
especially during
the procedure
-Maintain a calm
and tolerant
manner in
interacting with
-This validates
the feelings
the patient is
having and
communicates
an acceptance
of those
feelings.
-The presence
o a trusted
people
increases the
patient’s
After 3-4
hours of
nursing
interventions
patient
verbalized
reduction of
fear
PROBLEM #4: Fear related to threat of fetal death for the out coming surgical procedure
the patient
-Assist the patient
in identifying
strategies used in
the past to deal
with fearful
situations
-As the patient’s
fear subsides,
encourage him or
her to explore
specific events
preceding the
onset of the fear
-Encourage rest
periods
-Give positive
information about
the incoming
surgical
procedure
sense of
security and
safety during a
period of fear
-The patient’s
feeling of
stability
increases in a
calm and
nonthreatenin
g atmosphere
-This helps the
patient focus
on fear as a
real and
natural part in
life that has
been and can
continue to be
dealt with
successfully
-Recognition
and
explanation of
actors leading
to ear are
significant in
developing
alternative
responses
-Rest
improves
ability to cope
-This
information
will help
minimize fear
PROBLEM #5: Self-care deficit related to abdominal pain
ASSESSMEN
TDIAGNOSIS
SCIENTIFIC
EXPLANATIO
N
PLANNING INTERVENTIONS RATIONALEEXPECTED
OUTCOME
Subjective
Data:
Ф
Objective
Data:
- weak
-facial
grimaces
-limited ROM
Self-care
deficit related
to abdominal
pain
Patient may be
immobilized by
pain, muscle
weakness or
they may be
immobilized for
therapeutic
reasons when
mobility is
impaired the
After 5-6
hours of
nursing
interventions
patient will
performs/sel
f care
activities.
-Asses ability to carry
out activities of daily
living, such as
feeding, dressing, and
ambulating on a
regular basis.
-Assist the patient in
accepting necessary
amount of
dependence
-The patient
may only
require
assistance
with some
self-care
measures.
-Self-care
deficit is
recent, the
After 5-6
hours of
nursing
intervention
s patient
performed
self care
activities.
well known
consequences
may include
activity
intolerance,
loss of muscle
mass, strength
and self care
deficit
-Set short-range goals
with the patient
-Use consistent
routines and allow
adequate time for the
patient to complete
task
-Provide positive
reinforcement for all
activities attempted ;
note partial
achievements
-Provide assistance
when patient in
feeding, dressing,
hygiene,
transferring/ambulatio
n and toileting.
patient may
need to
grieve before
accepting
that
dependence
is necessary.
-Assisting
the patient to
set realistic
goals will
decrease
frustration
-This help
the patient
organize and
carry out
self-care
skills
-This
provides the
patient with
an external
source of
positive
reinforcemen
t and
promoter
ongoing
efforts
-Assistance
can reduce
energy
expenditure
and
frustration
SUMMARY
Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary.
The ovaries are two organs — each about the size and shape of an almond — located
on each side of your uterus. Eggs (ova) develop and mature in the ovaries and are
released in monthly cycles during your childbearing years.
Many women have ovarian cysts at some time during their lives. Most ovarian
cysts present little or no discomfort and are harmless. The majority of ovarian cysts
disappear without treatment within a few months.
However, ovarian cysts — especially those that have ruptured — sometimes
produce serious symptoms. The best way to protect your health is to know the
symptoms and types of ovarian cysts that may signal a more significant problem, and to
schedule regular pelvic examinations.
You can’t depend on symptoms alone to tell you if you have an ovarian cyst. In
fact, you’ll likely have no symptoms at all. Or if you do, the symptoms may be similar to
those of other conditions, such as endometriosis, pelvic inflammatory disease, ectopic
pregnancy or ovarian cancer. Even appendicitis and diverticulitis can produce signs and
symptoms that mimic a ruptured ovarian cyst.
Still, it’s important to be watchful of any symptoms or changes in your body and
to know which symptoms are serious. If you have an ovarian cyst, you may experience
the following signs and symptoms:
Menstrual irregularities
Pelvic pain — a constant or intermittent dull ache that may radiate to your lower
back and thighs
Pelvic pain shortly before your period begins or just before it ends
Pelvic pain during intercourse (dyspareunia)
Pain during bowel movements or pressure on your bowels
Nausea, vomiting or breast tenderness similar to that experienced during
pregnancy
Fullness or heaviness in your abdomen
Pressure on your rectum or bladder — difficulty emptying your bladder completely
The signs and symptoms that signal the need for immediate medical attention include:
Sudden, severe abdominal or pelvic pain
Pain accompanied by fever or vomiting
Your ovaries normally grow cyst-like structures called follicles each month.
Follicles produce the hormones estrogen and progesterone and release an egg when
you ovulate.
Sometimes a normal monthly follicle just keeps growing. When that happens, it
becomes known as a functional cyst. This means it started during the normal function of
your menstrual cycle.
Treatment depends on your age, the type and size of your cyst, and your
symptoms. Your doctor may suggest:
Watchful waiting. You can wait and be re-examined in one to three months if
you’re in your reproductive years, you have no symptoms and an ultrasound shows
you have a simple, fluid-filled cyst. Your doctor will likely recommend that you get
follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in
size.
Watchful waiting, including regular monitoring with ultrasound, is also a common
treatment option recommended for postmenopausal women if a cyst is filled with
fluid and is less than 2 centimeters in diameter.
Birth control pills. Your doctor may recommend birth control pills to reduce the
chance of new cysts developing in future menstrual cycles. Oral contraceptives
offer the added benefit of significantly reducing your risk of ovarian cancer — the
risk decreases the longer you take birth control pills.
Surgery. Your doctor may suggest removal of a cyst if it is large, doesn’t look like a
functional cyst, is growing or persists through two or three menstrual cycles. Cysts
that cause pain or other symptoms may be removed.
Some cysts can be removed without removing the ovary in a procedure known as a
cystectomy. Your doctor may also suggest removing the affected ovary and leaving
the other intact in a procedure known as oophorectomy. Both procedures may
allow you to maintain your fertility if you’re still in your childbearing years. Leaving
at least one ovary intact also has the benefit of maintaining a source of estrogen
production.
If a cystic mass is cancerous, however, your doctor will advise a hysterectomy to
remove both ovaries and your uterus. After menopause, the risk of a newly found
cystic ovarian mass being cancerous increases. As a result, doctors more
commonly recommend surgery when a cystic mass develops on the ovaries after
menopause.
CONCLUSION
Ovarian cysts are actually quite common. Women usually don't realize they have
them because they grow undetected and go away undetected a month or so later.
Rarely, however, these growths become problematic. For this reason, women must
understand how to recognize ovarian cyst signs. Symptoms usually aren't pleasant, but
if they indicate a real health problem, early detection is important.
Ovarian cyst signs, symptoms, and clues often begin with pain. Pain sometimes
comes as sharp pelvic or abdominal pain. Sometimes women notice a dull ache in their
legs or upper thighs. Also, they might notice breast tenderness, more painful than
during a regular menstrual cycle.
Sometimes pain only occurs during certain times, or when performing certain
actions. For example, a woman may feel completely normal until her period when she
experiences abnormal pelvic pain. Also, women usually indicate pain during sex as
common ovarian cyst signs or symptoms.
When women feel something strange or abnormal around their pelvic region,
they might easily come to the conclusion that something is wrong with their reproductive
organs. Other symptoms of ovarian cysts, however, aren't as easy to diagnose. Some
women experience vomiting and nausea and have trouble urinating. Coupling these
signs with other common symptoms helps women and doctors indicate the real source
of the problem.
Again, while most ovarian cysts aren't anything to worry yourself about, some
represent a serious health problem. Some cyst symptoms indicate a medical
emergency and women should seek medical care immediately. These include dizziness
and sudden strong abdominal pain. Also, if a woman experiences all three signs of a
fever, vomiting, and pelvic pain, she should see a doctor.
Since most ovarian cysts go away on their own, doctors usually recommend
coming back for a reevaluation after about two months for a re-check. If the cyst hasn't
shrunk in size, or if it's grown, they will perform a laparoscopy to remove it. Then, some
doctors prescribe birth control pills to prevent the woman from ovulating and developing
more cysts in the future.
Although the pain associated with some ovarian cysts is extremely strong, in
most cases, it is nothing to worry about. As long as the woman keeps a close eye on
her body and pays attention to any changing symptoms, ovarian cysts usually lead to
nothing serious.
BIBLIOGRAPHY
Books
Doenges, Marilynn E. Nurse’s Pocket Guide: Diagnoses, Interventions and Rationales.
(9th Edition). F.A. Davis Co., 2004.
Elsevier, Saunders. Medical - Surgical Nursing Clinical Management for the Positive
Outcomes. (7th Edition). C&E Publishing Inc., 2005.
Kozier. Fundamentals of Nursing: Concepts, Process and Practice. (7th edition).
Pearson education Inc., 2004.
Seeley, Stephens & Tate. Essentials of Anatomy and Physiology. (5th edition). Mc. Graw
Hill Co. Inc., 2005.
Karch, Amy M. Lippincott’ Nursing Drug Guide. Lippincott Williams and Wilkins, 2010.
Internet
http://emedicine.medscape.com/article/795877-followup#showall
http://agedcareact.wordpress.com/2008/06/29/what-is-ovarian-cysts/
http://www.sid.ir/en/VEWSSID/J_pdf/110920100305.pdf
http://humrep.oxfordjournals.org/content/15/12/2567.full
http://www.emedicinehealth.com/ovarian_cysts/article_em.htm
http://www.mayoclinic.com/health/ovarian-cysts/DS00129/DSECTION=symptoms
http://fcs.tamu.edu/health/healthhints/
Angeles University Foundation
College of Nursing
Angeles City
Ovarian New Growth
A CASE REPORT
In partial fulfillment of the requirements in
Related Learning Experience - Delivery Room
Submitted by:
Castro, Clariza
Group 12
Submitted to:
Brenda Policarpio, RN, MN
Clinical Instructor
April 15, 2011
Top Related