5

Ht 5ft. wt 95kg., NKDA, Abdominal pain,

worsening abdominal distention, SOB,
Nausea and vomiting, weakness,
difficulty eating. Dry skin, Edema to
extremities. V/S 140/85, R20, P.100,
T.98, O2 sat 92%.
DIAGNOSTIC TEST WBC,13.0 H. RBC3.40 H HGB9.2,L HCT29.7 L,
LYMP 12.13 L(CBC is low b/c of diuretics )Glucose, 122H
increase cortisole, stress and increased anxiety. BUN42 H, Due
to laxis, creatinine 2.4, chest xray- infiltration. K.3.4 L, Calcium
7.5 L (electrolyte embalance

Clinical Concept Map sample format RNSG 2263

Ovarian Malignancy is a cancerous growth arising from the
ovary. Symptoms are frequently very subtle early on and may
include: bloating, pelvic pain, difficulty eating and frequent
urination, and are easily confused with other illnesses.

PAST MEDICAL HISTORY

G 1162

HTN, Abdominal Bloating, Abdominal pain,

Ovarian Malignancy.

In the United States, 5 of 100 women with a first-degree relative with ovarian
[19]
cancer will eventually get ovarian cancer themselves. This corresponds to a
risk increased by a bit more than twice that of ovarian cancer in the general
[20]
population. 7 out of 100 women with two or more relatives with ovarian
cancer will eventually get ovarian .

PATIENT DATA age, 80 sex F, MS S medical

diagnosis, Ovarian Malignancy. Date of admission
04/11/14 and (HPI) Abdominal bloating, large mass
in pelvic floor, malaise, Nausea and vomiting.
Abdominal pain, unexplained weight loss

A long-standing hypothesis that has considerable support via animal model studies is the
incessant ovulation hypothesis. According to this, "repeated cycles of ovulation-induced
trauma and repair of the OSE [ovarian surface epithelium] at the site of ovulation, without
pregnancy-induced rest periods, contributes to ovarian cancer development." [32] Analysis of
316 high-grade serous ovarian adenocarcinomas found that the TP53 gene was mutated in
96% of cases.[33] Other genes commonly mutated were NF1, BRCA1, BRCA2, RB1 and cyclindependent kinase 12 (CDK12).

MEDICAL-SURGICAL MANAGEMENT. Left pleural effusion drained .

CT Scan reveals large mass in pelvis by oncology dr. CBC , basic
metabolic panel, chest xray to rule out infiltration. Repeat labs,
Foley cath.Monitor blood sugar. DVT prophylasis, monitor I&O.
check lower extremity wt venous dropple to rule out DVT. O2 , 2 L
via nasal canula v/s every 4 hours. Increase activity as
tolerated.Focus assessment. ECG etc.

Imbalance nutrition less than body requirement Rt

abdominal pain AEB unexplained weight loss, difficulty
eating.

MEDICATIONS famotidine 20mg IV daily,

difluca 200mg IV daily, NACL 0.9% 100ml,
furosemide 20mg po daily. Hydralazine HCL
Q4H. PRN. Heparin Sodium 5000units SQ
q8HR IV. Piperacillin 25ml/hr
IVPG.potassium cl 50ml/hr iv

Fluid volume Deficit r/t ovarian

malignancy AEB difficulty eating,
vomiting.

Patient will take in 80 % of diet at

breakfast.
Monitor I & O.R. Body weight may decrease as a result of fluid loss..2. Obtain
and record pt. weight at same time. R to obtain accurate reading. 3.Monitor
electrolyte level and report abnormal values(K=3.4) low.R poor nutrition status
may cause electrolyte imbalance.4 Provide diet as prescribed for pt. specific
condition(clear liquid diet) R To improve pt. nutritional status. 5 determine
food preference within the limitation of prescribed diet R to enhance
compliance.

Activity intolerance RT abdominal

pain AEB patient states pain of 8
in a scale of 10 (10 being worst
pain).

Patient will drink 240ml of fluid within 2hrs

1Administer and encourage adequate fluid. R TO REPLACE FLUIDS LOSS 2..Measure I

&0 every 1-4 hours report significant changes like decreased urine R LOW URINE
OUTPUT AND HIGH SPECIFIC GRAVITY INDICATES HYPOVOLEMIA. 3. Asses skin turgor and
oral mucous membrane every 8hrs R TO CHECK FOR DEHYDRATION. 4 Monitor Vital
signs every 4 hours, R.HYPOTENSION MAY INDICATE FLUID VOLUME DEFICIT. 5.Teach
patient not to sit or stand up quickly .R due to orthosthatic hpotension

Dietician
Rdesum08

Goal Met. Patient consumed more than 80% of

diet.

Met :patient drank 240ml

within 2hrs.

Attending Physician