c

c 

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.

·  
 
c


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.


 c c
 
c


O To understand condition of disease and associate it with patients having similar

manifestations.
O To know the nursing history, personal data, health history and physical
assessment of the patient.
O To illustrate the anatomy and physiology and pathophysiolgy of the affected
organ.
O To discuss and determine manifestation and complications.
O To develop an effective skill on how to manage care in patient with the disease.
O To formulate a drug study with regards to the disease condition and correlate lab
results.
O 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.
 
 
c ·


FEMALE REPRODUCTIVE ORGANS



Front View Side View


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.


 

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 µcaught¶ 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 ² hairy projections on the surfaces of
cells at the entrance of the fallopian tube ² 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.



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).



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.


 ·!"

After birth the infant is fed with milk from the breasts, or mammary glands, which
are also sometimes considered part of the reproductive system.



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.
c· 

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#$

  c!#
!%%"
#!


&'
! 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



' Hgb: 120-140g/L

Hemoglobin is a protein in red blood cells that carries oxygen.



 Hct: 0.37-0.47
 '# Hematocrit determines the concentration of RBC within the
 blood volume

#' (#  WBC count:
 Leukocytes are used to measure the no. of WBC in the blood. 5-10x 109/L
 They are the major infection-fighting cells in the body.
!' % Neutrophils:
 Neutrophils is the first WBC component that phagocytize 0.45-0.65
 invading microorganism


' # 
 Lymphocytes:
It determines if there are enough cells that produce antibodies 0.20-0.35
and other chemicals responsible for destroying microorganisms.


‘ rsing Responsibilities for Complete Blood Co nt
Before
O Check the doctor¶s order.
O Check the right client.
O Explain the procedure to the patient or to the SO.
 O Tell the patient or SO that no fasting is required.
O Assure the patient or SO that collecting the blood sample take less than 3 minutes.
O Inform the patient or SO that the patient will be experiencing mild pain on the site where the needle will be prick.

During
O Use distal vein of the arm
O Use pt.¶s non dominant arm whenever possible
O Select a vein that is easily palpated, feels soft and full, naturally splinted by bone, large enough to allow adequate
circulation around the catheter.
O Maintain sterile/aseptic technique

After
O Apply pressure or a pressure dressing to the venipuncture site.

O Check the venipuncture site for bleeding.

O Fill-up the laboratory form properly and send it to the laboratory technician during the collection of the sample or
specimen.
O Record all procedures done.



 #$  #! c!#$ 

!%"

)' 

It is a routine screening to determine urine diagnostic tool because it can help detect
complications and possible abnormal components substances or cellular material in the urine
(e.g. CHON, glucose, blood, pus) or infection. associated with different metabolic and kidney
 disorders.

O Color Yellow-Clear

O Transparency Clear

O pH 4.6-6.5

O Specific Gravity 1.003-1.030

 O Albumin Negative

O Sugar Negative

O Pus Cells 0-2/HPF

O Red Cells
0-2/HPF

O Epithelial Cells
None

Nursing Responsibility for Urinalysis :


O 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.

O Wash hands observe other appropriate infection control procedure.

O Provide client privacy.

O 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.

O At least 10 ml of urine is generally sufficient for a routine urinalysis.

O The specimen must be free of fecal contamination, so urine must be kept separate from feces.

O 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.

O Put the lid tightly on the container to prevent spillage of the urine and contamination of other object

O Make sure that the specimen label and laboratory requisition carry the correct information and attach them securely
to the specimen.
c
!

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.
£RI

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.






















c
 c



 er iew 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


 arian Cysts Ca ses

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

 arian 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:

‡ *!#+*%#% !! 
+!!+!%, 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.

‡ c!, 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.

‡ -*!#-, Direct pressure

from the cysts on the ovaries and surrounding structures. This causes chronic
pelvic fullness or a dull ache.

‡ ,#!!% -%
*#(

‡ #-.#.#, may be a sign

of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with
internal bleeding
‡ *%*,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

‡ !, may be a sign of torsion or twisting of the ovary on its

blood supply, or rupture of a cyst with internal bleeding

‡ -!-, Some functional ovarian cysts

can twist or break open (rupture) and bleed.

‡c- 

£edical £anagement
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
-%  ! 
# c!#
 / # 
-##! Produces anti- Mild to moderate 500mg q6 CNS: drowsiness, >Observe 10
inflammatory, pain, dizziness, rights in giving
analgesic & dysmenorrhea nervousness medication
antipyretic effects CV: edema > Administered
possibly through GI: nausea, with food to
inhibition of vomiting, diarrhea, minimize GI
prostaglandin peptic ulceration, adverse reactions.
synthesis. hemorrhage >Contraindicated
GU:dysuria, in GI ulceration r
hematuria, inflammation.
nephrotoxicity >Teach patient
Hepatic: sign and
hepatotoxicity symptoms of GI
Skin:rash, bleeding, and tell
urticaria 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.
 -%  
# c!# !#
 / 
Metronidazole >Direct ±acting The indications 1g / rectum 1hr CNS: headache, >Always observe
(Flagyl) trichomonacide are based on the prior to OR seizures, fever, the 10 Rights
ANTI- and amebicide anti-parasitic and vertigo, ataxia, when giving
INEFECTIVES that works inside antibacterial dizziness, medication.
(amebicides& and outside in activity. confussion,depression, >Give oral form
antiprotozoals) the intestines. It¶s >Amebic liver irritability with meals to
thought to enter abscess, Vision disorder: minimize GI upset
the cells of Intestinal transient vision >Tell pt. he may
microorganisms amebiasis, disorders such as experience a
that contain Trichomoniasis diplopia, myopia metallic taste and
nitroreductase, >Bacterial GI: epigastric pain, have dark or red-
forming unstable infections caused pain, nausea, brown urine.
compounds that by aerobic vomiting, diarrhea, >Instruct pt in
binds DNA and microorganisms metallic taste, dry proper hygiene
inhibits >To prevent mouth >Tell pt to avoid
synthesis, postoperative Hypersensitivity alcohol during
causing cell infection in Reactions: rash, metronidazole
death. contaminated pruritus, flushing, therapy and for
colorectal urticaria, anaphylactic atleast one day
surgery shocks afterwards
>Bacterial GU: darkened urine, beause of
Vaginosis polyuria, dryness of possibility of
>Clostridium vagina,dysuria dislfiram-like
difficle- (Antabuse effect)
associated reaction.
diarrhea and >May cause
colitis transient visual
>Pelvic disorder,
Inflammatory dizziness&
disease confusion avoid
activities requiring
alertness like
driving a vehicle.
 -%  
# c!# !#
 / 
Bisacodyl Stimulant Chronic 2 tablets (hours CNS: dizziness, >Give drugs at
laxative that constipation; of sleep) faintness, muscle times that don¶t
increases preparation for weakness with interfere with
peristalsis, child birth, excessive use scheduled
probably by surgery, or rectal GI: abdominal cramps, activities or sleep.
direct effect on or bowel burning sensation in >Before giving for
smooth muscle examination. rectum with constipation,
of the intestine, suppositories, nausea determine
by irritating the and vomiting whether patient
muscle or METABOLIC: has adequate
stimulating the alkalosis, fluid and fluid intake
colonic electrolyte imbalance, exercise and diet.
intramural hypokalemia. >Tablets and
plexus. MUSCULOSKELETAL: suppositories are
Drug also tetany use together to
promotes fluid clean the colon
accumulation in before and after
colon and small surgery and
intestine. before barium
enema.
>Insert
suppository as
high as possible
in to the rectum,
and try to position
suppository
against the rectal
wall. Avoid
embedding within
fecal material
because doing so
may delay onset
of action.
>Bisco-Lax may
contain tartazine.
 -%  ! 
# c!#
 / # 
Morphine Sulfate Binds with opiate >Severe pain 3mg through CNS: dizziness, >Reassess
receptor in the >Moderate to Epidural catheter euphoria, light- patient¶s level of
CNS, altering severe pain q12 x 3 headedness, pain at least 15 to
perception of and requiring nightmares, 30 minutes.
emotional continuous, sedation, >Keep opioid
response to pain. around the clock somnolence, anatagonist
opioid seizures, (naloxone) and
>Single dose, depression, resuscitation
epidural extended hallucinations, equipment
pain relief after nervousness, available.
major surgery. physical >Monitor
dependence. circulatory,
CV: respiratory,
bradycardia, bladder and bowel
cardiac arrest, function carefully.
shock, >Oral solutions of
hypertension, various
tachycardia concentrations
GI: constipation, and an intensified
nausea and oral solution are
vomiting, available.
anorexia, biliary >Oral capsules
tract spasm, dry may be carefully
mouth, ileus opened and the
GU: urine entire contents
retention, poured into cool
HEMATOLOGIC: soft foods such as
thrombocytopenia water, orange
RESPIRATORY: juice, apple sauce
apnea, respiratory or pudding.
arrest, respiratory >Morphine is
depression drug of choice in
SKIN: relieving MI pain;
diaphoresis, may cause
edema, pruritus transient decrease
and skin flushing in blood pressure.
OTHER:
decreased libido
 -%  ! 
# c!#
 / # 
Cefuroxime Second >Serious lower 1.5 qm IVP after CV: phlebitis, > Before giving
generation respiratory tract negative skin thrombophlebitis drug ask patient if
cephalosporin that infection, UTI, skin testing GI: diarrhea, she is allergic to
inhibits cell wall or skin structure pseudo- penicillin or
synthesis infections, bone or membranous cephalosporin.
promoting osmotic joint infections, colitis, nausea, >Obtain specimen
instability; usually septicemia, anorexia and for culture and
bactericidal meningitis and vomiting sensitivity test
gonorrhea GU: urine before giving first
>Pre-operative retention, dose.
prevention HEMATOLOGIC: >Absorption of
>Bactericidal thrombocytopenia, oral drug is
exarbations of hemolytic anemia, enhanced
chronic bronchitis transient >Tablets may be
or secondary neutropenia, crushed, if
bacterial infection eosiniphilia. absolutely
of acute bronchitis RESPIRATORY: necessary for
>Acute bacterial apnea, respiratory patient who can¶t
maxillary sinusitis arrest, respiratory swallow tablets.
>Pharyngitis and depression
tonsillitis SKIN:
>Otitis media maculopapular
and erythematous
rashes, urticaria,
pain, induration,
sterile abscesses,
temperature
elevation, tissue
sloughing at IM
injection site
OTHER:
anaphylaxis,
hypersensitivity
reactions, serum
sickness
 S rgical £anagement

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 ³watchful 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:

O 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.
O 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:

O 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.
O 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:

O |ermoid 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.
O Jndometriomas. 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.
O Cystadenomas. These cysts develop from ovarian tissue and may be filled with a
watery liquid or a mucous material. They can become large ² 12 inches or more in
diameter ² and cause twisting of your ovary.








 
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Subjective: Chronic pain ovarian cyst After 4-5 hrs -Assess pain -Assessment After 4-5
Ɏ related to symptoms may of nursing characteristics: of the pain hours of
Objective: increase include interventions *Severity( to 10, experience is nursing
-Facial pressure to persistent patient with 10 being the the first step in interventions
grimaces noted ovary bloating, verbalizes most severe) planning pain patient
-pain scale secondary to swelling, or reduction of -Asses for management verbalized
ovarian cyst pain in the pain. probable cause of strategies reduction of
abdomen, pain. -Different pain.
difficulty eating -Assess the Pt¶s etiologic
or feeling full willingness or factors
quickly, urgent ability to explore a respond better
or frequent range of to different
urination, and techniques aimed therapies.
vaginal at controlling -Some pt. will
bleeding not pain. feel
associated with -Eliminate uncomfortable
menstruation additional exploring
stressors or alternative
sources of methods of
discomforts pain relief
whenever -Pt¶s may
possible. experience
-Provide rest exaggeration
periods to in pain.
facilitate comfort, -The pt¶s
sleep, and experiences of
relaxation pain may
-Administer become
analgesics as exaggerated
indicated as the result of
(morphine). Give fatigue.
doses to provide -Pain is
analgesia around frequent
the clock. Convert complication of
from short-acting cancer,
to long-acting although
analgesics when individual
indicated responses
-Determine some differ
pain relief method -Techniques
 like relaxation and are used to
breathing bring about a
exercises state of
physical and
mental
awareness w/c
reduces pain.
















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Subjective Disturbed The physical symptom After 3-4 hrs -Assess past -Sleep After 3-4 hrs
Data: sleep s of anxiety and fear of nursing patterns of sleep patterns are of nursing
Ɏ pattern reflect a chronic interventions in environment. unique to interventions
Objective Data: related to ³readiness´ to deal with patient will -Recommend an each patient
-Fatigue fear for the some future threat. verbalizes environment individual. verbalized
-weak out coming These symptoms may improvemen conducive to -Many people improvemen
-anxious surgical include fidgeting, t sleeping sleep or rest sleep better t sleeping
procedure muscle tension, pattern -Provide nursing in cool, dark, pattern
sleeping problems, and aids( backrub, quite
headaches. comfortable environments
position, -These aids
relaxation promote rest.
techniques. -This will alert
-Post a ³ Do not people to
disturb¶ sign on avoid
the door. entering the
-Provide soft room and
music or white interrupting
noise sleep
-Organize nursing -Reduces
care: sensory
Eliminate stimulation by
nonessential blocking out
nursing activities other
-Teach about the environmenta
possible causes o l sounds that
sleep difficulties could
and optimal ways interfere with
to treat them restful sleep
-Teach on non- -This
pharmacological promotes
sleep minimal
enhancement interruption in
techniques 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


















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Subjective: Fatigue One of area After 3-4 -Assess patient -These After 3-4
Ɏ related to causes fatigue hours of emotional emotional hours of
Objective: sleep is Lifestyle nursing response to state can add nursing
-always deprivation problems. interventions fatigue to the person¶s interventions
yawning Feelings of Patient will -Encourage fatigue level Patient have
-weak fatigue often have sufficient patient to have and create a sufficient
-tiresome have an energy to rest vicious cycle energy to
-easily irritated obvious cause, complete -Provide -Periods of complete
such as sleep desired recommendations rest will help desired
deprivation, activities for nutritional prevent adding activities.
overwork or intake for to levels of
unhealthy adequate energy fatigue
habits. sources and -The patient
metabolic needs
requirements adequate
-Minimize balanced
environmental intake to
stimuli, especially provide energy
during planned sources like
times of sleep carbohydrates,
and rest fats, protein,
-Teach the patient vitamins and
and family task minerals.
organization -Bright lighting,
techniques and noise, visitors,
time management frequent
strategies distractions in
-Help the patient the patient¶s
develop habits to environment
promote effective can inhibit
rest/sleep relaxation,
patterns interrupt
-Encourage the rest/sleep. And
pt. and SO to contribute to
verbalize feelings fatigue
about the impact -Organization
of fatigue 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.

031 !%--!%-%###!






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Subjective: Fear related to The factors that After 3-4 -Acknowledge -This validates After 3-4
Ɏ threat of fetal precipitate fear hours of awareness of the feelings hours of
Objective: death for the are, to some nursing patient¶s fear the patient is nursing
-anxiety out coming extent, interventions -Advise SO to having and interventions
-non verbal surgical universal; fear patient stay with the communicates patient
expression of procedure of death, pain, breathing patient to promote an acceptance verbalized
fear and bodily pattern will safety, especially of those reduction of
-worriness injury are verbalizes during the feelings. fear
common to reduction of procedure -The presence
most people. fear -Maintain a calm o a trusted
and tolerant people
manner in increases the
interacting with patient¶s sense
the patient of security and
-Assist the patient safety during a
in identifying period of fear
strategies used in -The patient¶s
the past to deal feeling of
with fearful stability
situations increases in a
-As the patient¶s calm and
fear subsides, nonthreatening
encourage him or atmosphere
her to explore -This helps the
specific events patient focus
preceding the on fear as a
onset of the fear real and
-Encourage rest natural part in
periods life that has
-Give positive been and can
information about continue to be
the incoming dealt with
surgical successfully
procedure -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







 








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Subjective Self-care Patient may be After 5-6 -Asses ability to carry -The patient After 5-6
Data: deficit related immobilized by hours of out activities of daily may only hours of
Ɏ to abdominal pain, muscle nursing living, such as feeding, require nursing
Objective Data: pain weakness or interventions dressing, and assistance interventions
- weak they may be patient will ambulating on a with some patient
-facial immobilized for performs/self regular basis. self-care performed
grimaces therapeutic care -Assist the patient in measures. self care
-limited ROM reasons when activities. accepting necessary -Self-care activities.
mobility is amount of deficit is
impaired the dependence recent, the
well known -Set short-range goals patient may
consequences with the patient need to
may include -Use consistent grieve before
activity routines and allow accepting
intolerance, adequate time for the that
loss of muscle patient to complete dependence
mass, strength task is necessary.
and self care -Provide positive -Assisting the
deficit reinforcement for all patient to set
activities attempted ; realistic goals
note partial will decrease
achievements frustration
-Provide assistance -This help the
when patient in patient
feeding, dressing, organize and
hygiene, carry out self-
transferring/ambulation care skills
and toileting. -This
provides the
patient with
an external
source of
positive
reinforcement
and promoter
ongoing
efforts
-Assistance
can reduce
energy
expenditure
 and
frustration


















Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary.
The ovaries are two organs ² each about the size and shape of an almond ² 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 ² especially those that have ruptured ² 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:

O Menstrual irregularities
O Pelvic pain ² a constant or intermittent dull ache that may radiate to your lower
back and thighs
O Pelvic pain shortly before your period begins or just before it ends
O Pelvic pain during intercourse (dyspareunia)
O Pain during bowel movements or pressure on your bowels
O Nausea, vomiting or breast tenderness similar to that experienced during
pregnancy
O Fullness or heaviness in your abdomen
O Pressure on your rectum or bladder ² difficulty emptying your bladder completely

The signs and symptoms that signal the need for immediate medical attention include:

O Sudden, severe abdominal or pelvic pain

O 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:

O #%- *' 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.

O
% # ' 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 ² the
risk decreases the longer you take birth control pills.
O
 ' 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.

 
  
c 

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.











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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/
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College of Nursing
Angeles City
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 *·*%
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