Ovarian New Growth

Ovarian New GrowthRight Salphingo Oopherectomy

PATIENT’S PROFILE

Name: Maria Consuelo Oropesa Age: 32 y/o Civil Satus: Single Address: Bagumbayan, Daraga, Albay Religion: Roman Catholic Birthday: 09-25-73 Occupation: none (housewife) Date of Admission: 11-25-09

Admitting Diagnosis: PU 37 1/7 wks. AOG NIL G1P0: ONG probably benign

ANATOMY AND PHYSIOLOGY

MENSTRUAL CYCLEPURPOSE:

prepare the uterus for pregnancy

PRIMARY ORGANS:

hypothalamuspituitary glandovaryuterus

CYCLES:Hypothalamic-pituitary cycleOvarian cycleEndometrial cycle

Ovarian Cycle:Follicular phase

-time before ovulation(the start of menstruation until the day of ovulation)-development of primordial follicle to Graafian follicle.

-secretion of estrogen ( in serum estrogen, peak: 24-48 hours

Luteal phase:-the period following ovulation-the empty follicle is transformed into

yellowish body called corpus luteum.-secretion of progesterone-life span of corpus luteum is 7-8 days.

OVARIAN FOLLICLE:Primordial follicle

Primary follicle

Secondary follicle

Mature follicle

Ovulation

Corpus luteum

Corpus albicans

PATHOPHYSIOLOGY

Menstrual cycle↓

Surge of luteinizing hormone↓

After ovulation, follicular remnants form a corpus luteum

↓Hormonal stimulation causes cyst to continue

to grow↓

Ovarian new growth

DIAGNOSTIC EXAM

Ultrasound Computed tomography (CT), magnetic

resonance imaging(MRI), Hormone levels. (LH), (FSH), and testosterone. Laparoscopy.

Other exam done:

Blood test = her WBC is slightly elevated

MEDICAL MANAGEMENT

Cefazolin 2mg TIVT First-generation cephalosporin that inhibit cell-wall

synthesis, promoting osmotic instability; usually bactericidal

Promethazine 25mg on call Phenothiazine derivative that competes with

histamine for H1-receptor sites on effector cells Prevents, but doesn’t reverse, histamine mediated

responses. At high doses, drug also has local anesthetic effects.

Ranitidine 50mg IV Completely inhibits action of histamine on

the H2 at receptor sites of pariental cells, decreasing gastric acid secretion

Tramadol 50mgA centrally acting synthetic analgesic

compound not chemically related to opiods. Thought to bind to opiod receptors and inhibit reuptake of norepinephrine and serotonin

Ketorolac 30mg May inhibit prostaglandin synthesis, to produce

anti-inflammatory, analgesic and anti-pyretic effects.

Cefalexin 500mg Treatment of upper and lower respiratory tract

infections, abcsess, wound infections, UTI, joint infections

Adverse Reaction: nausea, vomiting, diarrhea, abdominal discomfort, skin rash, pruritus,

Mefenamic acid 500mg TID Relief of pain, including muscular,

rheumatic, traumatic, dental, post-op postpartum pain, headache

Adverse reaction: GI & visual disturbances, drowsiness, dizziness & nervousness

Ferrous Sulfate 1tab OD Prevention & treatment of Fe deficiency . Provides elemental iron, an essential component in the

formation of hemoglobin.

SURGICAL MANAGEMENT

Unilateral salpingo-oophorectomy is the surgical removal of a fallopian tube and an ovary. If both sets of fallopian tubes and ovaries are removed, the procedure is called a bilateral salpingo-oophorectomy.

This surgery is performed to treat ovarian or other gynecological cancers, or infections caused by pelvic inflammatory disease.

Occasionally, removal of one or both ovaries may be done to treat endometriosis, a condition in which the lining of the uterus (the endometrium) grows outside of the uterus (usually on and around the pelvic organs).

General or regional anesthesia will be given.

Performed through a laparoscope or incision 4-6 inches

Before diagnosis the doctor will order blood and urine test, ultrasound or x-ray. NPO before the operation.

After the operation, the patient should avoid sharply flexing the thighs or the knees.

Risk : Infection Reactions to the anesthesia Hemorrhage Scar

complications: Changes in sex life Hot flushes And other symptoms of menopause

IDEALNURSING CARE PLAN

Background Knowledge

Nursing Goals

Nursing Intervention

Rationale Evaluation

• Because the operation requires cutting the flesh, an incision is made. The incision impairs the first line of defense which is the skin, thus enabling microorganism to enter the body.

• The patient will not experience signs of infection by discharge.

• Wash hands before and after caring for patient, using gloves when indicated; no sharing of equipment with other units.

• Interventions help prevent the spread of pathogens between staff and patients.

•Patient remains free from symptoms of infection.

Cues: With wound obtained from surgical procedureNursing Diagnosis: Risk for infection related to site for microorganism invasion secondary to cesarean section.


Nursing Goals



• • • Assess lower abdominal incision noting if area is clean, dry and intact, if incisions exhibit redness, edema, ecchymosis, drainage, and approximation.

• Assessment provides information about developing infection: Local inflammatory effects cause redness and edema. This may be followed by purulent drainage and would dehiscence.




Nursing Goals



• • • Assess temperature.

• Fever may be the first sign of infection in the obstetrics patient, and temperature values can have important consequences for treatment decisions.




Nursing Goals



• • • Maintain a clean environment. Ensure the client’s room and bathroom is cleaned frequently and appropriately.

• A clean environment may discourage the growth of microorganisms.




Nursing Goals



•Because of the surgical incision made, it causes trauma to the nerve endings that causes pain.

•After an hour the patient will verbalize a relief of pain.

•Encourage the use of stress management techniques e.g. progressive relaxation, deep breathing, guided imagery and visualization.

Refocuses attention, promotes relaxation, and enhances sense of control which may reduce pharmacological dependency.

Patient verbalized a relief of pain.

Cues: Pain on incision siteNursing Diagnosis: Alteration in comfort; pain related to traumatized nerve ending secondary to surgical incision.


Nursing Goals



•Encourage expression of feelings about pain.

•Promote uninterrupted sleep periods.

• Verbalization allows outlet for emotions and may enhance coping mechanisms.

•Sleep deprivation can increase perception of pain/reduce coping abilities.




Nursing Goals



Collaborative:•Administer analgesics as ordered. (Tramadol)

•Tramadol possesses agonist actions at the μ-opioid receptor and affects reuptake at the noradrenergic and serotonergic systems.




Nursing Goals



•Because of the loss of the ovaries a woman feels that her femininity is incomplete and will be unable to bear a child. Her sexual libido also decreases that leads to marital conflicts.

•The patient will verbalize concerns and indicate healthy ways of dealing with them. Verbalize acceptance of self in situation and adaptation to change in body/self-image.

•Provide time to listen to concerns and fears of client/SO. Discuss client’s perceptions of self related to anticipated changes and her specific lifestyle.

•Research supports the idea that removal of any reproductive part of a woman is physically and psychologically stressful for a woman, even when she desires the procedure. Although preoperative instruction and interaction are often performed at the community level, the post operative care providers can convey interest and concern and make opportunities for support, teaching and correction of misconception, e.g. loss of femininity and sexuality, weight gain, and menopausal body changes.

Patient verbalized her feelings and concern.

Cues: DepressionNursing Diagnosis: Situational low self-esteem related to concerns about femininity, effect on sexual relationships and inability to have children.


Nursing Goals



•Ascertain individual strengths and identify previous positive coping behaviors.

•Provide open environment for client to discuss concerns about sexuality.

•Helpful to build on strengths already available for client to use in coping with current situation.•Promote sharing of beliefs/values abut sensitive subject, and identifies misconceptions/myths that may interfere with adjustment to the situation.




Nursing Goals



•Provide open environment for client to discuss concerns about sexuality.

•Promote sharing of beliefs/values abut sensitive subject, and identifies misconceptions/myths that may interfere with adjustment to the situation.




Nursing Goals



Collaborative:•Refer to pastoral staff, psychiatric clinical nurse specialist, and other professionals for counseling as necessary.

•May need additional help to resolve feelings about loss.



ACTUALNURSING CARE PLAN


Nursing Goals



• Sleep is a naturally recurring state of relatively suspended sensory and motor activity, characterized by total or partial unconsciousness and the inactivity of nearly all voluntary muscles.

• after the health teaching and nursing interventions, the pt. will be able to rest/sleep well

• maintain a quiet environment.

• do as much care as possible when the patient is still awake.• encourage wearing of eye cover, drinking warm milk and sleeping at the same time every night.

• a quiet environment increases the possibility to fall asleep.• to maximize sleeping process.

• to enhance ability to fall asleep.

• patient was able to rest well.

Cues: pt. looks tired; verbalized “antok ko, hindi ako pinatulog ng baby ko, ang arte kasi…”Nursing Diagnosis: sleep pattern disturbance r/t noise and other generated awakenings

Cues: patient verbalized “sumasakit parin tahi ko kapag naglalakad ako…”; pain level=2Nursing Diagnosis: acute pain r/t post-op surgical wound.


Nursing Goals



• Pain is the initial response/reaction of the body to injury. It is considered as the 5th vital sign. The harmful effects of unrelieved acute pain can affect the pulmonary, cardiovascular, GIT, Endocrine system and can

• at the end of the shift, the patient’s pain will decrease from 2 to 0

• Encourage patient to do deep breathing exercises by demonstrating how to do it (every 4 hours daily with 5-10 breaths during exercise).

• Instruct the patient to use relaxation techniques and encourage diversional activity

• Promotes healing of surgical wounds and decreases pain felt.

• To distract attention and reduce tension.

• patient did not comply with the medication regimen but was relieved from pain.


Nursing Goals



cause severe pain and it may increase the risk of developing physiologic disorders.

such as listening to music, and socialization with others.• instruct to comply with the medication regimen.

• analgesics decreases the pain felt by the patient.

Cues: bipedal edema notedNursing Diagnosis: fluid volume excess r/t pregnancy and excess sodium intake.


Nursing Goals



• edema is the excessive accumulation of fluid in the body tissues.

• after 2 days, the patient’s edema will decrease in size.

• encourage to limit/restrict sodium and fluid intake.

•Elevate edematous extremities.

•Stress need for mobility and/or frequent position changes.

• to promote mobilization/elimination of excess fluid.

• to reduce tissue pressure and risk of skin breakdown.

• to prevent stasis and reduce risk of tissue injury.

• pt.’s edema decreased in size.

DISCHARGE MANAGEMENT

Instruct to take home meds. Explain how to take the meds, its precise dose and time to be taken to ensure efficiency and to avoid overdose or under dose. Emphasize the importance of the drugs to prevent further complication.

Instruct to stay in calm, quiet environment. Home environment must be free from slipping or accident hazards

Inform to have a follow-up check up after 1-2 weeks

Inform to avoid lifting heavy objects for 1-2 weeks

Discourage to participate in strenuous activities that might precipitate stress and trauma to the wound

Stress the importance of perineal cleanliness

Maintain good abdominal support. Using a pillow against the abdomen will help with pain when sneezing or coughing. It is also a good idea to use it for support when breast-feeding.

Instruct to promote breastfeeding

Observe for signs of dehiscence and evisceration

Instruct to report any signs of infection

Instruct to report any case of hemorrhage or abnormal bleeding

Instruct to eat foods rich in protein and green leafy vegetables to promote faster recovery.

Encourage to increase fiber and fluid intake to avoid constipation

Encourage to derive strength from God and maintain a close relationship to the family and community.

Documents

Ovarian New Growth