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