Edited Ng Masa Final

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Arellano University

Pag-Asa St. Caniogan Pasig City

College of Nursing

In Partial Fulfilment of the

Requirements

In

NCM 103 (RLE)

CASE STUDY

(Ovarian New Growth Malignant)

Submitted by:

Dela Rosa, Jesusa

Estacio, Frederick

Eleazar, Jonathan

Espinosa, Maybeth Lara

Francicsco, Genevieve

Galang, Emma Angela

Gallardo, Leny

Garcia, Hanna Mae

Gigante, Maricris

Ligon, Anne Nichole

Lozano, Mario



Table of Contents

Introduction

Acknowledgement O bjectives

y General

y S pecific Patients Profile

y Initial Database

y Patients Data Nursing History

y Chief Complaint

y History of Present Illness

y History of Family Illness Patterns of Health Care

Patients Physical Assessment

Anatomy and Physiology Pathophysiology Drug Study

Nursing Care Plan Evaluation

y Discharge Plan



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¶tthat 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 unfavourable 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 satisfiedwith 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, someovarian 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 isreleased, the follicle changes into a smaller sac called the corpus luteum. Ovarian cysts occur as

a result of the follicle not rupturing, the follicle not changing into its smaller size, or doing therupturing 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 eachmenstrual 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 resultin abdominal pain, infertility and other health problems.



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 cyst adenomas may cause a relentless collection of mucinous fluid within the abdomen, known as pseudomyxoma peritonei, which may be fatal

without extensive treatment.

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. Watchfulwaiting is the most common treatment, as an ovarian cyst will usually disappear within a few

months.



GENERAL OBJECTIVES

y To develop mastery towards the patient¶s condition.

y To develop and maintain a good clinical practice to the patient.

y To create a study that will serve as a guideline to our co-nursing students in providing a better and proper care in the near future for patients with same condition as our patient.

SPECIFIC OBJECTIVES

Knowledge

y To know the causes as well as manifestations of the client¶s condition.

y To explain the anatomy and pathophysiology about the case of the patient.

Skills

y To practice good history-taking and physical assessment.

y To enhance the effective interventions needed in taking care of the post-operative client.

y To formulate a drug study about the patient on what medications that was administeredto the client.

y To create a Nursing Care Plan to provide interventions that is applicable to the clientduring hospitalization.

y To formulate a discharge plan for the continuity of care after hospitalization.

Attitude

y Promoting a good nurse-patient interaction to the patient.

y Developing and helping a trust and establish therapeutic relationship to the patient.



Biographic Data

Patient¶s Name: Mrs. T

Address: San Andres, Cainta

Age: 48 yrs. old

Gender: Female

Citizenship: Filipino

Civil Status: Married

Occupation: none

Religious Affiliation: Roman Catholic

Source of Health Care Finance: family

Chief Complaint /Concern or Reason for Visit/ Seeking Healthcare:

Abdominal Enlargement

Health History

A. History of Present Illness

On October 2010, the patient felt pain on her abdomen and sought consultation to a

³manghihilot´. The ³manghihilot´ told her that she was pregnant. The patient felt presumptive signs of pregnancy such as nausea and vomiting yet she claims to have her

menstrual period irregularly. The client also experienced painful defecation. On June2011, the client went to De Luna Clinic in Masbate for an ultrasound, it was then she

discovered that she was not pregnant and it was a huge cystic mass inside her abdomen.The client was also positive in uterine enlargement. She was referred at Philippine

General Hospital. The client along with her husband decided to flew to Manila to seek for further health care. Instead of following the referral, the client chose Rizal Medical

Center for further health care.



B. Past History

The Client said that she could not recall if she had chickenpox, mumps, measles, rubella

and rheumatic fever as a child. She also said that she has no allergy to anythingwhatsoever. She doesn¶t remember if she had complete immunization, her last shot wasgiven when she was still in second year High School. The client was hospitalized once on

1983 because of experiencing menstrual flow with fever.

C. Family History of Illness

Both parents of the patient are already dead. The client could not recall what caused thedeath of her mother, her father died because of kidney cancer.

D. OB History

The client¶s menarche started when she was 13 yrs. old. Since she was hospitalized(1983), the client¶s menstrual period became irregular. The patient is nullipara because of

her husband¶s infertility.

Pain Assessment

Presence of discomfort or pain was noticed during the interview due to the back pain the

client is experiencing.



ANATOMY AND PHYSIOLOGY

FEMALE REPR ODUCTIVE ORGANS

Front View Side View

Ovaries

The ovaries are the main reproductive organs of a woman. The two ovaries, which areabout 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 otherwisemeet the needs of the egg or developing fetus.

The ovaries are held in place by various ligaments which anchor them to the uterus andthe 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.O

vulation occurs in the middle of the menstrual cycle and usually takes placeevery 28 days or so in a mature female. It takes place from either the right or left ovary atrandom.

Fallopian tubes

The fallopian tubes are about 10 cm long and begin as funnel-shaped passages next to theovary. 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 transportedalong 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 fertilization may occur if a sperm penetrates andfuses with the egg. The egg, however, is only usually viable for 24 hours after ovulation, so

fertilization 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 fertilized 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 thecervix.

The thick wall of the uterus is composed of 3 layers. The inner layer is known as theendometrium. If an egg has been fertilized 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 thegrowing fetus. A part of the wall of the fertilized egg, which has burrowed into the endometrium,

develops into the placenta. If an egg has not been fertilized, the endometrial lining is shed at theend 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 rhythmicallyto move the baby out of the body via the birth canal (vagina).

Vagina

The vagina is a fibro muscular 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 penisand 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 theclitoris, 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 arealso 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. Theyare 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 calledcilia on the inner surface of the tube. If the ovum is fertilized inside the tube, where mostfertilization takes place, it usually implants in the uterus.



PATHOPHYSIOLOGY

Menorrhagia

Increased human

chorionic GonadotropinHormonal Imbalance

Suppression of FSH and LH

(helps organ to mature

Ovarian follicles)

Altered maturation of ovarian

follicle

Failure of the follicle ovulates

and continues to grow

Cyst may grow in size up to

15cm in diameter

Irregular menstruation

Dull, Unilateral lower

quadrant pain

Increased abdominal girth

Increased pelvic pressure

Rupture of the cyst

Sepsis

Death

Hemorrhage and Acute

pain

Fatigue & sense

of heaviness in

the pelvis

Urinary

frequency,

constipation &

LEGEND:

SIGNS & SYMPTOMS

DISEASE PROCESS

FACTOR

Abdominal bloating

TAH&BSO

ETIOLOGY

PRECIPITATING FACTORS

y Lifestyle

y Stress IDIOPATHIC

PREDISPOSING FACTORS

y Hormonal imbalance

y Irregular menstruation

Nausea and Vomiting

SURGICAL PROCEDURE



Physical Assessment:

General Heath: Patient is a 48 female nulligravida, standing 5¶4. Conscious and coherent uponinteraction, but answer only the question she is comfortable with. Vital sign was taken. She is

lightly nervous.

Skin: Her skin tone is brown intact and there are no reddened areas. Skin surface vary from

moist to dry. Her skin is smooth and soft to touch without lesions, stretch mark, freckles or birthmarks. Skin pinches easily and immediately returns to its original position.

Hair: Her hair color is black evenly distributed with some sparse dandruff. Hair is short, dry and

she doesn¶t wear wig.

Nails: Nail beds are pink in color without clubbing. Cuticles are smooth no detachment of nailed. Nails are slightly long and dirty.

Head: Head is symmetrically round in shape hard and smooth without lesion. No report of severe headache, fainting and dizziness or head trauma. No history of head operation over the

past years.

Eyes: Eyes are symmetrical and almond in shape. Eyeballs are symmetrically aligned in socketswithout protruding or sinking. Eyelashes are equally distributed and skin around the eyes is

intact. Client denies recent changes in vision, denies excessive tearing, redness swelling or painof eyes. No history of eye operation over the past years. Doesn¶t wear eyes glasses. No eye

examination and check-up ever since.

Ears: Ears are equal in size bilaterally. The skin is smooth without lesion, lumps or nodules.Client denies recent changes in hearing, no drainage, no pain or ringing over the ears. Has had no

surgery and doesn¶t wear hearing aid device.

Nose: No swelling of the mucus membrane and presence of nasal hair were seen. Client noted

occasional common colds but relieved with over the counter oral decongestant. No reports of nosebleeds, allergies pain and tenderness.

Mouth and Throat: She has an incomplete set of teeth. Oral mucosa and gingival are pinkish in

color, but her lips are pale and dry. Tongue is pinkish and free of swelling and lesion. She brushes three times a day. No report of difficulty of swallowing, voice changes or hoarseness.

The client doesn¶t wear dentures. Her last dental appointment when she was in high school.

Neck: The patient is able to freely move her neck. No reports of pain, swelling and stiffness.

Breast: B

ilateral breast moderate in size. No history of breast disease, biopsies or surgery.Reports no breast lesion, lumps, swelling pain rashes or discharge. Her last mammogram and breast examination before and after her surgery.

Respiratory System: No reports of pain during inhalation and exhalation. No history of past

respiratory disease. No adventitious sounds heard such as crackles or wheezes when auscultated.The client last chest x-ray is before her operation for her cardio pulmonary clearance.



Cardiovascular System: Clients reports no chest pain, dyspnea, dizziness or palpitation. Her current blood pressure is 120/80 mmHg. She had an ECG done last July 8, 2011 the

interpretation was Non S pecific ST-T wave Changes Apico Septal Wall Correlate Clinically.

Gastrointestinal System: There is incision in the lower abdominal area due to her operation.

One week after her operation she is suffering from mild pain in the incision site up to her back.She told us that she has had no changes in her usual bowel habits. Client report she never had

ulcer, GERD, inflammatory and obstructive bowel disease, pancreatitis, inflammation of gallbladder, liver disease, diverticulosis or appendicitis. She is currently having Jackson-Pratt

drainage since after she got operated.

Genitourinary System: Client states regular menstruation cycle last August 18, 2011. Novaginal discharge, pain itching, genital lumps, swelling or masses. No difficulty urinating or

controlling urine. No problems with fertility. Client denies smoking and drinking alcohol. She isstill in catheterization.

Musculoskeletal System: The client is able to move but preferred with companion. Client report

back pain due to long stayed at bed. No weakness or joint swelling. She walks around everymorning 3-5 minutes every morning for her daily exercise. She is currently working as a

caretaker in her in-laws house.

Neurologic System: The client is oriented and coherent while lying in her bed. No history of

head trauma or injury. No dizziness, Tinnitus, severe and chronic headache. No difficultyswallowing or communicating problem. She has an open communication with her husband and

sibling. She can directly look into our eyes while talking and she talked in soft voice. She cancommunicate well to the people around her.

Endocrine System: The client denies history of goiter, no heat or cold intolerance, diabetes

mellitus, excessive thirst or excessive eating.



DIAGNOSTICS AND LABORATORY PROCEDURES

Ultrasound result

Date: June 21, 2011

Examination: Pelvis

Findings: uterus is not enlarged and displaced to the right homogenous parenchymal echo pattern. It measures about 7.5 cm x 5.5 cm x 5.1 cm (lxwxh).endometrial stripe is thin measuring

about 0.3 cm. no focal mass noted.

There is a huge cystic mass with evidence of septa noted in the pelvic-abdominal area.

Impression: huge cystic mass, as described consider ovarian neoplasm unremarkable uterus.

X-ray results

Date: July 27, 2011

Examination: Chest

There are no active pulmonary infiltrate

The heart is not enlarged

Pulmonary vascular markings within normal limits

Diaphragm and sulki are intact

Impression: normal chest

Clinical chemistry section blood chemistry

Blood chemistry was done on July 20, 2011 however all result showed normal.

Electrocardiographic report

Date Examined: July 18, 2011

Rhythm: Sinus QR S

Axis: Normal

Auricular: 97/min

Ventricular: 97/min

QT Interval: 0.36/min

QR S: 0.08 sec.

PR Interval: 0.16 sec



Interpreting findings

Non- specific ST wave changes apico septal wall

Correlate clinically

Clinical Chemistry Section

Date: September 08, 2011

Reference Test Result

135.00 ± 148.00 Na+ Sodium 142.8 mmo/l N

3.50 ± 4.50 K+ Potassium 3.92 mmo/L N

98.00 ± 107.00 Cl+ Chloride 106.20 mmo/L N

1,120 ± 1,320 Ica++ Ionized calcium 1,110 mmo/L v

Hematology result

Date: July 20, 2011

TEST NAME RESULT UNIT REFERENCE

VALUE

INTERPRETATIO N

Hemoglobin 122 g/L 120.00 ± 180.00

Hematocrit 0.373 L g/L 0.380 ± 0.470

Erythrocyte 4.62 X10^g/L 4.20 ± 5.40

Mean Corpuscular

Volume

80.7 fL 80.00 ± 96.00

Mean Corpuscular

Hemoglobin

26.40 L Pg 27.00 ± 31.00

Mean Corpuscular

HemoglobinConcentration

32.70 L g/dL 33.00 ± 37.00

Red Cell DistributionWidth

14.90 H fL % 11.70 ± 14.40

Leukocytes 7.07 X10^g/L 5.00 ± 15.00

LEUK OCYTE

DIFFERENTIALCOUNT

Neutrophils 0.54 % 0.35 ± 0.65Eosinophils 0.13 H % 0.00 ± 0.05

Basophils

Monocytes 0.08 % 0.00 ± 0.08

Lymphocytes 0.25 % 0.20 ± 0.40

Platelet Count 380 X10^g/L 150 ± 450

Mean Platelet Volume 9.70 fL 9.00 ± 13.00





VALUE

INTERPRETATIO N

Hemoglobin 97 L g/L 120.00 ± 180.00 Normal

Hematocrit 0.314 L g/L 0.380 ± 0.470 Normal

Erythrocyte 3.73 L X10^g/L 4.20 ± 5.40 Normal

Mean Corpuscular

Volume

84 fL 80.00 ± 96.00 Normal

Mean Corpuscular

Hemoglobin

26.0 L Pg 27.00 ± 31.00 Normal

Mean Corpuscular

HemoglobinConcentration

30.9 L g/dL 33.00 ± 37.00 Normal


12.4 fL % 11.70 ± 14.40 Normal

Leukocytes 16.4 H X10^g/L 5.00 ± 15.00 Normal Normal

LEUK OCYTEDIFFERENTIAL

COUNT

Normal

Neutrophils 0.86 H % 0.35 ± 0.65 Normal

Eosinophils 0.01 % 0.00 ± 0.05 Normal

Basophils Normal

Monocytes 0.06 % 0.00 ± 0.08 Normal

Lymphocytes 0.07 % 0.20 ± 0.40 Normal

Platelet Count 238 X10^g/L 150 ± 450 Normal

Mean Platelet Volume 7.94 fL 9.00 ± 13.00 Normal



VALUE

INTERPRETATIO N

Hemoglobin 84 L g/L 120.00 ± 180.00

Hematocrit 0.247 L g/L 0.380 ± 0.470

Erythrocyte 3.00 L X10^g/L 4.20 ± 5.40

Mean Corpuscular Volume

82 fL 80.00 ± 96.00

Mean Corpuscular Hemoglobin

28.0 Pg 27.00 ± 31.00

Mean Corpuscular Hemoglobin

Concentration

34.1 g/dL 33.00 ± 37.00


12.6 fL % 11.70 ± 14.40



Leukocytes 8.9 H X10^g/L 5.00 ± 15.00

LEUK OCYTE

DIFFERENTIALCOUNT

Neutrophils 0.74 H % 0.35 ± 0.65Eosinophils 0.06 H % 0.00 ± 0.05

Basophils

Monocytes 0.04 % 0.00 ± 0.08

Lymphocytes 0.16 % 0.20 ± 0.40





VALUE

INTERPRETATIO N

Hemoglobin 120 g/L 120.00 ± 180.00

Hematocrit 0.357 L g/L 0.380 ± 0.470

Erythrocyte 4.43 X10^g/L 4.20 ± 5.40

Mean Corpuscular

Volume

80.6 fL 80.00 ± 96.00

Mean Corpuscular

Hemoglobin

27.10 Pg 27.00 ± 31.00

Mean Corpuscular

HemoglobinC

oncentration

33.60 g/dL 33.00 ± 37.00


15.40 fL % 11.70 ± 14.40

Leukocytes 10.60 X10^g/L 5.00 ± 15.00

LEUK OCYTE

DIFFERENTIALCOUNT

Neutrophils 0.89 H % 0.35 ± 0.65

Eosinophils 0.06 H % 0.00 ± 0.05

Basophils

Monocytes 0.01 % 0.00 ± 0.08Lymphocytes 0.10 L % 0.20 ± 0.40



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Edited Ng Masa Final