Ovarian New Growth

Right Salphingo Oopherectomy

PATIENT’S PROFILE
Nam e: Maria Consuelo Oropesa
Age: 32 y/o
Civil Sat us: Single
Address: Bagum bayan, Daraga, Albay
Religion: Rom an Cat holic
Birt hday: 09-25-73
Occupat ion: none (housewife)
Dat e of Adm ission: 11-25-09

Adm it t ing
Diagnosis: PU 37 1/7 wks. AOG
NIL G1P0: ONG probably benign
ANATOMY AND
PHYSIOLOGY
  MENSTRUAL CYCLE
 PURPOSE:
 prepare the uterus for pregnancy


 PRIMARY ORGANS:


 hypothalamus
 pituitary gland
 ovary
 uterus

 CYCLES:
 Hypothalamic-pituitary cycle
 Ovarian cycle
 Endometrial 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
ØFirst-generation cephalosporin that inhibit
cell-wall synthesis, promoting osmotic
instability; usually bactericidal


§ Promethazine 25mg on call

ØPhenothiazine derivative that competes with
histamine for H1-receptor sites on effector
cells
ØPrevents, but doesn’t reverse, histamine
mediated responses.
ØAt high doses, drug also has local anesthetic
effects.


§ Ranitidine 50mg IV
ØCompletely inhibits action of histamine
on the H2 at receptor sites of pariental
cells, decreasing gastric acid secretion


§ Tramadol 50mg
ØA centrally acting synthetic analgesic
compound not chemically related to
opiods. Thought to bind to opiod
receptors and inhibit reuptake of
norepinephrine and serotonin
Ø

§
§ Ketorolac 30mg
ØMay inhibit prostaglandin synthesis, to
produce anti-inflammatory, analgesic and
anti-pyretic effects.
Ø


§ Cefalexin 500mg
ØTreatment of upper and lower respiratory
tract infections, abcsess, wound infections,
UTI, joint infections
ØAdverse Reaction: nausea, vomiting,
diarrhea, abdominal discomfort, skin rash,
pruritus,
 § Mefenamic acid 500mg TID
ØRelief of pain, including muscular,
rheumatic, traumatic, dental, post-op
postpartum pain, headache
ØAdverse reaction: GI & visual
disturbances, drowsiness, dizziness &
nervousness


§ Ferrous Sulfate 1tab OD

ØPrevention & treatment of Fe deficiency .
ØPro vid e s e le m e n ta liro n , a n e sse n tia l
co m p o n e n t in th e fo rm a tio n o f
h e m o g lo b in .
Ø
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
Øcomplications:
§ Changes in sex life
§ Hot flushes
§ And other symptoms of menopause
 ID EAL
N URSIN G CARE PLAN
 Cues: With wound obtained from surgical procedure
Nursing Diagnosis: Risk for infection related to site for microorganism invasion
secondary to cesarean section.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Because the The patient Wash hands before
 Interventions help Patient


operation requires will not and after caring for prevent the remains free
cutting the flesh, experience patient, using gloves spread of from
an incision is signs of when indicated; no pathogens symptoms of
made. The incision infection by sharing of equipment between staff and infection.
impairs the first discharge. with other units. patients.
line of defense
which is the skin,
thus enabling
microorganism to
enter the body.
 Cues: With wound obtained from surgical procedure
Nursing Diagnosis: Risk for infection related to site for microorganism invasion
secondary to cesarean section.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Assess lower Assessment Patient
abdominal incision provides remains free
noting if area is clean, information about from
dry and intact, if developing symptoms of
incisions exhibit infection: Local infection.
redness, edema, inflammatory
ecchymosis, drainage, effects cause
and approximation. redness and
edema. This may
be followed by
purulent drainage
and would
dehiscence.
 Cues: With wound obtained from surgical procedure
Nursing Diagnosis: Risk for infection related to site for microorganism invasion
secondary to cesarean section.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
 Assess temperature. Fever may be the Patient
first sign of remains free
infection in the from
obstetrics patient, symptoms of
and temperature infection.
values can have
important
consequences for
treatment
decisions.
 Cues: With wound obtained from surgical procedure
Nursing Diagnosis: Risk for infection related to site for microorganism invasion
secondary to cesarean section.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Maintain a clean A clean
 Patient
environment. Ensure environment may remains free
the client’s room and discourage the from
bathroom is cleaned growth of symptoms of
frequently and microorganisms. infection.
appropriately.
 Cues: Pain on incision site
Nursing Diagnosis: Alteration in comfort; pain related to traumatized nerve ending
secondary to surgical incision.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Because of the After an hour Encourage the use of Refocuses Patient
surgical incision the patient stress management attention, verbalized a
made, it causes will verbalize techniques e.g. promotes relief of pain.
trauma to the a relief of progressive relaxation, relaxation, and
nerve endings that pain. deep breathing, guided enhances sense
causes pain. imagery and of control which
visualization. may reduce
pharmacological
dependency.
 Cues: Pain on incision site
Nursing Diagnosis: Alteration in comfort; pain related to traumatized nerve ending
secondary to surgical incision.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
 Encourage expression Verbalization Patient
of feelings about pain. allows outlet for verbalized a
 emotions and may relief of pain.
 enhance coping
 mechanisms.
 

 Sleep deprivation


Promote uninterrupted can increase

sleep periods. perception of

 pain/reduce
 coping abilities.
 

 

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

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Collaborative: Tramadol Patient
Administer analgesics possesses agonist verbalized a
as ordered. (Tramadol) actions at the μ- relief of pain.
 opioid receptor
and affects
reuptake at the
noradrenergic and
serotonergic
systems.

 Cues: Depression
Nursing Diagnosis: Situational low self-esteem related to concerns about femininity,
effect on sexual relationships and inability to have children.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Because of the The patient will Provide time to listen to Research supports the idea Patient
 

that removal of any

loss of the ovaries verbalize concerns and fears of reproductive part of a woman verbalized her
a woman feels that concerns and client/SO. Discuss is physically and
psychologically stressful for a feelings and
indicate healthy
her femininity is ways of dealing
client’s perceptions of woman, even when she concern.
desires the procedure.
incomplete and willwith them. self related to Although preoperative
be unable to bear Verbalize anticipated changes instruction and interaction
are often performed at the
a child. Her sexual acceptance of and her specific community level, the post
libido also self in situation lifestyle. operative care providers can
convey interest and concern
decreases that and adaptation and make opportunities for
leads to marital to change in support, teaching and
correction of misconception,
body/self-
conflicts. e.g. loss of femininity and
image. sexuality, weight gain, and
menopausal body changes.
 Cues: Depression
Nursing Diagnosis: Situational low self-esteem related to concerns about femininity,
effect on sexual relationships and inability to have children.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
 Ascertain individual Helpful to build on Patient

strengths and identify strengths already verbalized her

previous positive copingavailable for client feelings and
behaviors. to use in coping concern.
 with current
 situation.
 Promote sharing of

beliefs/values abut
sensitive subject, and
Provide open identifies
environment for client misconceptions/myths
to discuss concerns that may interfere with
adjustment to the
about sexuality. situation.
 Cues: Depression
Nursing Diagnosis: Situational low self-esteem related to concerns about femininity,
effect on sexual relationships and inability to have children.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Provide open Promote sharing Patient
environment for client of beliefs/values verbalized her
to discuss concerns abut sensitive feelings and
about sexuality. subject, and concern.
identifies
misconceptions/m
yths that may
interfere with
adjustment to the
situation.
 Cues: Depression
Nursing Diagnosis: Situational low self-esteem related to concerns about femininity,
effect on sexual relationships and inability to have children.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Collaborative: May need
 Patient
Refer to pastoral staff, additional help to verbalized her
psychiatric clinical resolve feelings feelings and
nurse specialist, and about loss. concern.
other professionals for
counseling as
necessary.
 ACTUAL
NURSING CARE PLAN
 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

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Sleep is after the health maintain a quiet a quiet environment patient was

a naturally teaching and environment. increases the able to rest

recurring state of nursing possibility to fall well.
relatively interventions, asleep.
suspended the pt. will be to maximize

sensory and motor able to do as much care as sleeping process.

activity, rest/sleep well possible when the
to enhance ability
characterized by patient is still awake.
total or partial encourage wearing of to fall asleep.
unconsciousness eye cover, drinking
and the inactivity warm milk and sleeping
of nearly all at the same time every
voluntary muscles. night.
 Cues: patient verbalized “sumasakit parin tahi ko kapag naglalakad ako…”; pain
level=2
Nursing Diagnosis: acute pain r/t post-op surgical wound.

Background Nursing Goals Nursing Intervention Rationale Evaluation

Knowledge
Pain is the initial at the end of Encourage patient to
 Promotes healing patient did not
response/reaction the shift, the do deep breathing of surgical wounds comply with
of the body to patient’s pain exercises by and decreases the medication
injury. It is will decrease demonstrating how to pain felt. regimen but
considered as the from 2 to 0 do it (every 4 hours  was relieved
5th vital sign. The daily with 5-10 breaths from pain.
harmful effects of during exercise).
unrelieved acute To distract


pain can affect the Instruct the patient to attention and

pulmonary, use relaxation reduce tension.
cardiovascular, techniques and 

GIT, Endocrine encourage diversional

system and can activity

Background Nursing Goals Nursing Intervention Rationale Evaluation
Knowledge

cause severe pain such as listening to

and it may increase music, and socialization
the risk of with others.
developing instruct to comply with

physiologic the medication regimen. analgesics

disorders. decreases the pain
felt by the patient.

Cues: bipedal edema noted

Nursing Diagnosis: fluid volume excess r/t pregnancy and excess sodium intake.
Background Nursing Goals Nursing Intervention Rationale Evaluation
Knowledge
edema is the excessive after 2 days,  encourage to limit/restrict to promote  pt.’s edema
accumulation of fluid the patient’s sodium and fluid intake. mobilization/elimin decreased in size.
in the body tissues. edema will ation of excess
decrease in Elevate edematous fluid.
size. extremities.
 to reduce tissue

 pressure and risk of

 skin breakdown.


Stress need for mobility to prevent stasis



and/or frequent position and reduce risk of

changes. tissue injury.
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

 Instructto 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.