1

Chapter I
IN1kCDUC1ICN
LndomeLrlal olyp ls a condlLlon by whlch a mass ls formed ln Lhe llnlng of Lhe uLerlne
endomeLrlum slmulLaneous Lo Lhe growLh of uLerlne llnlng lnfluenced by Lhe hormone esLrogen lL
ls consldered a compllcaLlon ln pregnancy because lL may cause a severe harm due Lo bleedlng Lo
Lhe moLher and Lo her feLus and can even lnlLlaLe mlscarrlage
A kA1ICNALL
ur group declded Lo choose Lhe case endomeLrlal polyps as a compllcaLlon durlng pregnancy
because we know LhaL Lhere ls [usL a rare number of lLs occurrences ln our counLry even ln rlenLal
Mlndoro rovlnclal PosplLal whlch ls our Lralnlng ground We also wanLed Lo be famlllarlzed and
orlenLed wlLh Lhe rare dlseases/compllcaLlons LhaL wlll cause a Lerrlfylng and compllcaLed effecLs Lo
moLher especlally Lo her feLus ur goal ls also Lo enhance our knowledge skllls and aLLlLude
Loward Lhe managemenL of Lhls sald compllcaLlon
LLAkNING CLC1IVLS
1 Cogn|t|ve
@o have furLher learnlng and comprehenslon abouL endomeLrlal polyp
@o deflne lLs meanlng
@o ldenLlfy Lhe rlsk facLors LhaL have been llnked Lo Lhls healLh problem Lhe slgns and
sympLoms and lLs cllnlcal manlfesLaLlons
@o learn Lhe LreaLmenL and oLher relaLed managemenL regardlng Lhe case

sychomotor
@o become pracLlced ln handllng Lhe sald condlLlon
@o use our skllls ln performlng Lhe nurslng process
@o develop skllls ln carlng endomeLrlal polyp paLlenL
@o pracLlced Lhe appllcaLlon of nurslng care plan
ehav|ora|
@o develop undersLandlng and appreclaLlon wlLh Lhe cllenL's condlLlon
@o provlde rapporL and lnLeracL cllenL uLlllzlng LherapeuLlc communlcaLlon






Chapter II
CLINICAL SUMMAk


A GLNLkAL DA1A
Name !L@
Un|t ass|gnment Labor room
Age 41yrs old
|rthdate Aprll 3 1970
|rth p|ace vlcLorla rlenLal Mlndoro
Gender lemale
ke||g|on 8orn Agaln ChrlsLlan
Address vlcLorla rlenLal Mlndoro
C|v|| status Marrled
Cccupat|on @eacher
Lducat|ona| ackground @erLlary
Date of Adm|ss|on AugusL 1 011
1|me of Adm|ss|on 1039am
Adm|tt|ng hys|c|an ura @abudlo
Adm|tt|ng D|agnos|s AborLlon lncompleLe 11 weeks A lnduced nS
1
3%001)
revlous CS
1
@ransverse
CnILI CCMLAIN1
vaglnal 8leedlng + passage of aborLlon 7 days ago
CnIS1Ck CI kLSLN1 ILLNLSS
A 43 year old moLher was admlLLed ln rlenLal Mlndoro PosplLal on AugusL 16010 aL 400 am
ambulaLory accompanled by her relaLlves wlLh chlef complalnL of vaglnal bleedlng 3 days prlor Lo
admlsslon
nurse l have sudden hypogasLrlc paln LhaL sLarL lnLermlLLenLly ln 3 hours sharp characLer profuse
causlng 4 pads/days aggravaLed wlLh acLlvlLy relleve by resL and puLLlng Lampons Lo sLop or mlnlmlze
Lhe bleedlng as verballzed by Lhe cllenL
D AS1 MLDICAL nIS1Ck
CllenL sLaLes LhaL she has chlcken fox and mumps durlng her chlldhood years @wo years ago she
was hosplLallzed durlng her prevlous pregnancy ln her 7
Lh
monLh She aLLendlng prenaLal check up ln
rlenLal Mlndoro rovlnclal PosplLal done dlagnosLlc examlnaLlons especlally compleLe blood counL
reveals LhaL Lhe paLlenL sufferlng from anemla @he uocLor's order was blood Lransfuslon She was
conflned for 4 hours for observaLlon She doesn'L Lake any medlcaLlon durlng her slcknesses
3

LLCLNl.
!|c

lc:|c



C IAMILIAL nIS1Ck
@he faLher and eldesL broLher of Lhe cllenL have boLh a hlsLory of asLhma and paLlenL and her
flfLh slbllng have urlnary LracL lnfecLlon buL her moLher husband and oLher slbllngs do noL have any
dlsease



60 y/o 39y/o































LNDCML1kIAL CLS
AS1nMA
AS1nMA
4

A nSICAL ASSLSSMLN1
VI1AL SIGNS August 16 1
890/70mmPg
8 108 bpm
88 19 cpm
@LM373 C



n8MAL llnulnS SlnlllCAn@
llnulnS
ln@L88L@A@ln
ln@LDMLn@A8?
S?S@LM

PAl8


SkDLL Anu lACL



L?LS Anu vlSln




LA8S Anu PLA8ln





Lvenly dlsLrlbuLed sllky
reslllenL halr no lnfecLlon

8ounded normocephallc
absence of nodules or masses
symmeLrlc nasolablal folds
symmeLrlc faclal movemenLs

Lyebrows' skln conLacL halr
evenly dlsLrlbuLed eyebrows
symmeLrlcally allgned equal
movemenL skln lnLacL no
dlscharge whlLe sclera
plnklsh con[uncLlva no orblLal
edema L88LA
Color same as faclal skln
symmeLrlcal aurlcle allgned
wlLh ouLer canLhus of eye
plnna recolls afLer folded
mlnlmal amounL of dry
cerumen able Lo hear on boLh
ears clearly



Lxpresslonless face
lrequenLly yawnlng


Losls of eyelld








no devlaLlon


uue Lo sleeplness



uue Lo sleeplness





no devlaLlon


3



nSL Anu SlnDSLS





MD@P Anu
8PA8?nx

SymmeLrlc and sLralghL nose
no dlscharge no leslons nose
brldge lnLacL alr moves freely
as Lhe cllenL breaLhes Lhrough
Lhe nares maxlllary and
fronLal slnus noL Lender


WlLhouL denLures
@ongue freely moves gag
reflex presenL








Llps pallor
and dry



no devlaLlon




uue Lo blood loss


nLCk Pead cenLered no palpable
lymph nodes coordlnaLed
movemenL wlLhouL
dlscomforLs presence of
caroLld pulse Lrachea ln
mldllne
no devlaLlon

DL8 Lx@8LMl@lLS

Skln Anu nAlLS






MDSCLL Anu
S@8LnP@



8rown complexlon no edema
no leslons good skln Lurgor
smooLh nalls



Muscles equal slze on boLh
sldes no conLracLures
presence of brachlal and radlal
pulse


enerallzed pallor

allor nall beds
4 seconds caplllary
reflll


llaccldlLy or
weakness


uue Lo blood loss

lndlcaLlon of poor
clrculaLory lmpalrmenL
due Lo excesslve blood
loss


uue Lo excesslve blood
loss
6

CPLS@ Anu 8ACk
SlnAL CLDMn



LDnS


88LAS@ Anu
AxlLLAL





PLA8@


ChesL symmeLrlc splnal
column sLralghL skln lnLacL
no masses

LfforLless resplraLlons
no rales

SymmeLrlc no masses no
leslons rounded skln unlform
ln color nlpple round equal ln
slze slmllar ln color no
dlscharge axllla no
Lenderness masses or
nodules













WlLh palplLaLlons

no devlaLlon


no devlaLlon


no devlaLlon



8ecause of excesslve
bleedlng Lhe body
compensaLes resulLlng Lo
lncrease conLracLlon of
Lhe hearL Lo supply Lhe
whole body
A8uMLn

Skln














8rown complexlon
flaL symmeLrlc
movemenLs caused by
resplraLlon no
Lenderness relaxed
sofL abdomen


no devlaLlon



7











Lnl@ALS
ublc skln lnLacL no
leslons presence of
publc halr
darkercomplexlon of
vulva

lL %+)
bleedlng
%40 mL per
day)

uue Lo lrrlLaLlon
of polyp
AnDS Anu
8LC@DM

8rown color no devlaLlon



LWL8
Lx@8LMl@lLS

Skln Anu @LnAlLS

MDSCLL



DLSL
8rown complexlon wlLh
cuLlcle

Lqual ln slze and lengLh
symmeLrlcal no leslons no
masses
resence of popllLeal and
pedal pulse
no devlaLlon


no devlaLlon

no devlaLlon

8

kLVILW CI SS1LMS
LLVLL IINDINGS
IN1LGUMLN1Ak SS1LM

@PL CLlLn@ vL88ALlZLu l lLLLln CLu
kLSIkA1Ck SS1LM n ullllCDL@? ln 88LA@Pln

CAkDICVASCULAk SS1LM

n lLLLln l ALl@A@lnS n PLA8@ 8D8n n
CPLS@ Aln

GAS1kCIN1LS1INAL]DIGLS1IVL]ML1ACLIC
LSS l AL@l@L uLlLCA@LS Anu D8lnA@LS
8LDLA8L?
GLNI1CkLkCDUC1IVL SS1LM n Aln ln @PL Lnl@AL A8LA
MUSCULCSkLLL1AL SS1LM @PL A@lLn@ PAS n lLLLln l MDSCLL WLAknLSS
NLUkCLCGIC SS1LM 8lLn@Lu Wl@P @lML Anu LACL AnxlL@?



C A11LkNS CI IUNC1ICNING

luncLlonal
PealLh
aLLerns
rlor Lo
PosplLallzaLlon
uurlng PosplLallzaLlon Analysls
lnLerpreLaLlon

uay 1 uay uay 3

*PealLh
ercepLlon
PealLh
ManagemenL
aLLern







*@he cllenL
does noL rely
on docLors
when her
feellngs of
slckness are
noL Loo
serlous





*@he cllenL
relles on Lhe
care glven by
Lhe healLh
care
personnel or
docLor





*@he cllenL
sLlll seeks Lhe
medlcal
asslsLance of
Lhe docLors







*@he cllenL LrusL
docLors and
nurses
regardlng her
healLh care







*rlor Lo
hosplLallzaLlon
Lhe cllenL do noL
manage her
healLh serlously
and does noL
seek docLor`s
asslsLance buL
when
hosplLallzed Lhe
cllenL really seek
on docLors and
relled her healLh
unLo Lhem
9


*nuLrlLlonal
MeLabollc
aLLern



*LllmlnaLlon




*AcLlvlLy
Lxerclse
aLLern




*Sleep 8esL
aLLern


*CognlLlve
ercepLual
aLLern



*@he cllenL
eaLs a loL as
long as she
wanLed and
her favorlLe
dlsh was
vegeLables

*@he cllenL
defecaLe and
vold every day


*@he cllenL
was dolng her
regular work
llke washlng of
cloLhes
cooklng and
vegeLable
farmlng and
copra`s"

*@he cllenL has
a regular sleep
aL 9pm Lo 4 am
and aL noon

*@he cllenL
responds
clearly


*@he cllenL
can`L eaL
because she
was under
n


*@he cllenL
dld noL
defecaLe Lhls
day


*@he cllenL
can`L do her
work




*@he cllenL
can`L sleep
good


*@he cllenL
was
moderaLely
anxlous

*@he cllenL
was ln Lhe
yneWard
so she can
eaL whaL she
wanLs

*@he cllenL
defecaLe
once



*@he cllenL
can`L sLlll do
her work
because
she`s far aL
home


*@he cllenL
can`L sleep
good


*@he cllenL
feels beLLer



*@he cllenL can
freely eaL whaL
she wanLs



*@he cllenL
defecaLes
regularly



*@he cllenL was
ready Lo do
work buL she`s
sLlll aL Lhe
hosplLal



*@he cllenL had
ad[usLed Lo her
envlronmenL
buL sLlll can`L
sleep good
* @he cllenL
feels a loL
beLLer


*When Lhe
cllenL was aL
home she can
eaL whaL she
wanLs w/ouL
llmlLaLlons
unllke when
hosplLallzed
*When Lhe cllenL
was aL home she
defecaLes and
volds regularly
because of Lhe
regular work of
Lhe body and so
promoLlng
perlsLalsls
*@he cllenL has
a loL of work
when aL home
buL all of Lhem
dlsappears
when she was
hosplLallzed
*@he cllenL has
a regular sleep
paLLern aL home
buL dlsLurbed
when
hosplLallzed
*@he cllenL has
no problem aL
home buL a llLLle
blL anxlous when
broughL aL Lhe
hosplLal buL Lhen
easlly adapLed
10

*Self
ercepLlon
Self ConcepL




*8ole
8elaLlonshlp
aLLern





*SexuallLy
8eproducLlve




*CoplngSLress
@olerance
aLLern





*@he cllenL
was noL
senslLlve of
oLhers
slLuaLlon
when Lhey are
slck ``8asLa
gumaleng"
*@he cllenL
was a moLher
and wlLh her
husband
sLrlved hard
for Lhelr
chlldren


*@he cllenL
says LhaL Lhelr
relaLlonshlp
was good and
Lhey en[oyed
sexual
relaLlonshlp

*Whenever
Lhe cllenL has
problem and
sLressed she
was noL alone
because her
husband has
been wlLh her
so she feels
okay

*@he cllenL
was confldenL
LhaL she wlll
recover
lmmedlaLely


*@he cllenL
has no ablllLy
Lo do her
obllgaLlons as
a moLher
because she
was slck and
conflned


*@he cllenL
says LhaL Lhey
can`L make
sexual
relaLlonshlp
because she
was conflned
*now Lhe
cllenL was
confldenL LhaL
she can
overcome Lhls
problem
because her
husband has
been wlLh
her

*@he cllenL
feels beLLer




*@he cllenL
feels LhaL she
can do her
obllgaLlons
buL she was
conflned



*@he cllenL
sLlll can`L
make love




*@he cllenL
was relaxed




*@he cllenL feels
a loL beLLer




*@he cllenL
wanLed Lo go
home and do
her
responslblllLles
as a good
provlder wlLh
her husband
and she was
Lhlnklng of her
chlldren
*@he cllenL
can`L make love
buL her
husband has
been so
supporLlve and
sweeL Lo her

*@he cllenL was
exclLed Lo go
home Lo do her
responslblllLles
Per husband has
been always
comforLlng her
so she feels a
good

* @he cllenL was
noL aware of
havlng an lllness
unLll she
became on LhaL
poslLlon

*@he cllenL was
dolng her very
besL Lo be a
good moLher
and a provlder
Lo her chlldren
buL slnce her
husband was
wlLh her Lhey
can`L do Lhelr
responslblllLles

*@he cllenL and
her husband has
been so sweeL
and supporLlve
wlLh each
oLher @hey
en[oyed belng
wlLh each oLher

*@he cllenL
could always
cope wlLh her
problems by Lhe
supporL of her
husband

11

*value 8ellef
aLLern



*@he cllenL
belleves on
u She can`L
afford Lo go
every Sunday
Lo Church
because Lhey
are Loo far
from Lhe
Church

*@he cllenL
belleves LhaL
u ls Lhe
mosL
powerful of
all

*@he cllenL
LrusL on u
and
verballzes
LhaL she
prays

*@he cllenL Lold
LhaL u ls
merclful and
when she goL
home she wlll
vlslL Lhe church

*@he cllenL
seldom go Lo
church because
Lhey are Loo far
from Lhe Church
buL she says
LhaL she knows
u and LrusL
ln Plm


D AC1IVI1ILS CI DAIL LIVING

L A1ILN1'S CCNCL1 CI nLAL1n ILLNLSS AND nCSI1ALI2A1ICN
kapag nagkakasaklL ako o kaya yung mga anak ko aL asawa ko sa albularyo muna ako
pumupunLa Mahal kasl pag osplLal agad Lsaka baka nanununo lang o kaya nadawdaw nagpapaLapal
muna kaml o kaya nagpapaLawas mlnsan pag may mga ball nagpapahlloL kaml sa mga hlloL kapag
walang nangyarl sa glnawa ng albularyo Lsaka lang kaml pumupunLa sa cenLer kapag walang gamoL sa
cenLer Lsaka pa sa osplLal" as verballzed by Lhe paLlenL
ur paLlenL sLlll belleves LhaL Lhe cause of Lhe lllness of Lhelr famlly ls some
exLraordlnary creaLures or supersLlLlous acLlons @hey always Lend Lo go flrsL Lo quack docLors lnsLead
of golng sLralghL Lo hosplLals or rural healLh cenLers because accordlng Lo Lhem Lhey can'L afford dolng
so @hey belleve LhaL Lhelr lllnesses can be cured by Lhe quack docLors @hey used Lo uLlllze Lhe Lhlngs
LhaL a quack docLor uses when LreaLlng Lhem llke Laklng ln herbal planLs uslng Lawas" or Lapal" lf Lhe
albularyo" dldn'L LreaL Lhelr dlsease Lhls ls Lhe Llme LhaL Lhey wlll go Lo Lhe hosplLal and seek Lhe
docLor's help

8l8 @ PSl@ALlZA@ln uD8ln PSl@ALlZA@ln AnAL?SlS
Maaga akong naglglslng
kasl ako lahaL gumagawa ng
gawalngbahay naglalaba
nagluluLo nagllllnls Lapos
naggagamas pa 8uong araw
nga may glnagawa ako abl
lang aL pagkakaln pahlnga
ko" as verballzed by Lhe
paLlenL
nakakapanlbago pala kapag nasa
osplLal nakakalnlp! Lagl na lang
nakahlga paupoupo paLayuLayo
arang ngang napakabagal ng oras
Mlnsan lang ako nakakalabas dlLo
Plndl ko na nagagawa mga glnagawa
ko daLl Plndl rln ako makaLulog kasl
mallngay slla mlnsan"as verballzed by
Lhe paLlenL
PosplLallzaLlon affecLs Lhe dally
acLlvlLles of Lhe paLlenL lL glves a
blg change ln her llvlng She cannoL
perform her usual acLlvlLles @here
was also a sleep paLLern
dlsLurbance She also felL boredom
because of Lhe long sLay ln Lhe
hosplLal
1

I LACkA1Ck AND DIAGNCS1IC LkAM
AugusL 16 010
Comp|ete |ood Count
ulagnosLlc Lxam normal value SlgnlflcanL llndlngs Analysls
Pemoglobln 10160 g/l 10 normal
PemaLocrlL 036048 033
SllghLly decrease
osslble Lo anemla
LeukocyLe CL 40110x10L 117 8enal %kldney) fallure
neuLrophlls 040060 079 osslble Lo lnfecLlon
LymphocyLes 00040 00 normal
Loslnophlls 001003 001 normal

8lood Lype 8+
P8sA nonreacLlve

AugusL 16 010
Ur|na|ys|s
LxamlnaLlon normal values llndlngs Analysls
Color
ale yellow Lo
amber
?ellow
Lxcess sweaLlng could resulL
ln Lhe urlne becomlng a
deeper yellow Also lL ls a slgn
LhaL you have noL been
drlnklng enough llqulds
CharacLer clear Clear normal
Speclflc gravlLy 1010103 1010
osslble Lo renal fallure
pP 4380 63 normal
88C negaLlve or rare 1013
@he paLlenL has vaglnal
bleedlng
W8C negaLlve or rare 68 Drlnary @racL lnfecLlon
Albumln negaLlve @race
osslble Lo glomerular
damage
Sugar negaLlve negaLlve normal
CrysLals amorphous negaLlve lew uevlaLlon
8LnAnC? @LS@ oslLlve
AugusL 16 010
U|trasound kesu|t
normal anLeverLed wlLh 79 x 48 x 44 cm wlLh Lhlck endomeLrlum 166 Lo conslder
hyperplasla

AugusL 17 010
ulagnosLlc exam normal value SlgnlflcanL flndlng Analysls
Pemoglobln 10160g/l 93 uecreased Anemla
PemaLocrlL 036048 08 uecreased Anemla

@he paLlenL was glven packed blood Lype 8 on AugusL 17 010 3 am
13

III CLINICAL DISCUSSICN CI 1nL DISLASL

A ANA1CM AND nSICLCG

GLNLkAL
@he organs of Lhe reproducLlve sysLems are concerned wlLh Lhe general process of
reproducLlon and each ls adapLed for speclallzed Lasks @hese organs are unlque ln LhaL Lhelr
funcLlons are noL necessary for Lhe survlval of each lndlvldual lnsLead Lhelr funcLlons are vlLal Lo
Lhe conLlnuaLlon of Lhe human specles ln provldlng maLernlLy gynecologlc healLh care Lo women
you wlll flnd LhaL lL ls vlLal Lo your career as a pracLlcal nurse and Lo Lhe paLlenL LhaL you wlll
requlre a greaLer depLh and breadLh of knowledge of Lhe female anaLomy and physlology Lhan
usual @he female reproducLlve sysLem conslsLs of lnLernal organs and exLernal organs @he lnLernal
organs are locaLed ln Lhe pelvlc cavlLy and are supporLed by Lhe pelvlc floor @he exLernal organs
are locaLed from Lhe lower margln of Lhe publs Lo Lhe perlneum @he appearance of Lhe exLernal
genlLals varles greaLly from woman Lo woman slnce age heredlLy race and Lhe number of
chlldren a woman has borne deLermlnes Lhe slze shape and color See flgure 11 for Lhe female
reproducLlve organs
1LkMS AND DLIINI1ICNS
1 Corpus Luteum @he yellow mass found ln Lhe graaflan folllcle afLer Lhe ovum has been
expelled
14

Lstrogen @he generlc Lerm for Lhe female sex hormones lL ls a sLerold hormone produced
prlmarlly by Lhe ovarles buL also by Lhe adrenal corLex
3 I|mbr|ae lrlnges especlally Lhe flngerllke ends of Lhe falloplan Lube
4 Io|||c|e A pouch llke depresslon or cavlLy
3 Io|||c|e St|mu|at|ng normone @he folllcle sLlmulaLlng hormone %lSP) ls a hormone
produced by Lhe anLerlor plLulLary durlng Lhe flrsL half of Lhe mensLrual cycle lL sLlmulaLes
developmenL of Lhe graaflan folllcle
6 Graaf|an Io|||c|e A maLure fully developed ovarlan cysL conLalnlng Lhe rlpe ovum
7 normone A chemlcal subsLance produced ln an organ whlch belng carrled Lo an
assoclaLed organ by Lhe bloodsLream exclLes ln Lhe laLLer organ a funcLlonal acLlvlLy
8 Lactat|on @he producLlon of mllk by Lhe mammary glands
9 Lute|n|z|ng normone A hormone produced by Lhe anLerlor plLulLary LhaL sLlmulaLes
ovulaLlon and Lhe developmenL of Lhe corpus luLeum
10Cvum @he female reproducLlve cell
11rogesterone @he pure hormone conLalned ln Lhe corpora luLea whose funcLlon ls Lo
prepare Lhe endomeLrlum for Lhe recepLlon and developmenL of Lhe ferLlllzed ovum
1keproduct|on @he process by whlch an offsprlng ls formed
IN1LkNAL ILMALL CkGANS
@he lnLernal organs of Lhe female conslsL of Lhe uLerus vaglna falloplan Lubes and Lhe ovarles
a Uterus @he uLerus ls a hollow organ abouL Lhe slze and shape of a pear lL serves Lwo
lmporLanL funcLlons
lL ls Lhe organ of mensLruaLlon and durlng pregnancy lL recelves Lhe ferLlllzed ovum
reLalns and nourlshes lL unLll lL expels Lhe feLus durlng labor

%1)Locat|on
8eLween Lhe urlnary bladder and Lhe recLum
lL ls suspended ln Lhe pelvls by broad llgamenLs
%)D|v|s|ons of the uterus
@he uLerus conslsLs of Lhe body or corpus fundus cervlx and Lhe lsLhmus @he ma[or
porLlon of Lhe uLerus ls called Lhe body or corpus @he fundus ls Lhe superlor rounded
reglon above Lhe enLrance of Lhe falloplan Lubes @he cervlx ls Lhe narrow lnferlor ouLleL
LhaL proLrudes lnLo Lhe vaglna @he lsLhmus ls Lhe sllghLly consLrlcLed porLlon LhaL [olns Lhe
corpus Lo Lhe cervlx
%)Wa||s of the uterus
@he walls are Lhlck and are composed of Lhree layers
1 Lhe endomeLrlum
Lhe myomeLrlum
3 Lhe perlmeLrlum
@he endomeLrlum ls Lhe lnner layer or mucosa A ferLlllzed egg burrows lnLo Lhe
endomeLrlum %lmplanLaLlon) and resldes Lhere for Lhe resL of lLs developmenL
When Lhe female ls noL pregnanL Lhe endomeLrlal llnlng sloughs off abouL every 8 days ln
response Lo changes ln levels of hormones ln Lhe blood @hls process ls called menses @he
myomeLrlum ls Lhe smooLh muscle componenL of Lhe wall @hese smooLh muscle flbers are
arranged
13

ln longlLudlnal clrcular and splral paLLerns and are lnLerlaced wlLh connecLlve Llssues
uurlng Lhe monLhly female cycles and durlng pregnancy Lhese layers undergo exLenslve
changes @he perlmeLrlum ls a sLrong serous membrane LhaL coaLs Lhe enLlre uLerlne
corpus excepL Lhe lower one fourLh and anLerlor surface where Lhe bladder ls aLLached
b Vag|na
%1) Locat|on @he vaglna ls Lhe Lhln ln walled muscular Lube abouL 6 lnches long leadlng from Lhe
uLerus Lo Lhe exLernal genlLalla lL ls locaLed beLween Lhe bladder and Lhe recLum
%) Iunct|on @he vaglna provldes Lhe passageway for chlldblrLh and mensLrual flow lL recelves Lhe
penls and semen durlng sexual lnLercourse
c Ia||op|an 1ubes %1wo)
%1) Locat|on Lach Lube ls abouL 4 lnches long and exLends medlally from each ovary Lo empLy lnLo
Lhe superlor reglon of Lhe uLerus
%) Iunct|on @he falloplan Lubes LransporL ovum from Lhe ovarles Lo Lhe uLerus @here ls no
conLacL of falloplan Lubes wlLh Lhe ovarles
%) Descr|pt|on @he dlsLal end of each falloplan Lube ls expanded and has flngerllke pro[ecLlons
called flmbrlae whlch parLlally surround each ovary When an oocyLe ls expelled from Lhe ovary
flmbrlae creaLe fluld currenLs LhaL acL Lo carry Lhe oocyLe lnLo Lhe falloplan Lube ocyLe ls carrled
Loward Lhe uLerus by comblnaLlon of Lube perlsLalsls and cllla whlch propel Lhe oocyLe forward
@he mosL deslrable place for ferLlllzaLlon ls Lhe falloplan Lube
d Cvar|es
%1) Iunct|ons @he ovarles are for oogeneslsLhe producLlon of eggs %female sex cells) and for
hormone producLlon %esLrogen and progesLerone)
%) Locat|on and gross anatomy
@he ovarles are abouL Lhe slze and shape of almonds
@hey lle agalnsL Lhe laLeral walls of Lhe pelvls one on each slde
@hey are enclosed and held ln place by Lhe broad llgamenL
@here are compacL llke Llssues on Lhe ovarles whlch are called ovarlan folllcles
@he folllcles are Llny sacllke sLrucLures LhaL conslsL of an lmmaLure egg surrounded by one or more
layers of folllcle cells As Lhe developlng egg beglns Lo rlpen or maLure folllcle enlarges and
develops a fluld fllled cenLral reglon When Lhe egg ls maLured lL ls called a graaflan folllcle and ls
ready Lo be e[ecLed from Lhe ovary
%) rocess of hormone product|on by the ovar|es
%a) LsLrogen ls produced by Lhe folllcle cells whlch are responslble secondary sex characLerlsLlcs
and for Lhe malnLenance of Lhese LralLs @hese secondary sex characLerlsLlcs lnclude Lhe
enlargemenL of falloplan Lubes uLerus vaglna and exLernal genlLals breasL developmenL
lncreased deposlLs of faL ln hlps and breasLs wldenlng of Lhe pelvls and onseL of menses or
mensLrual cycle
%b) rogesLerone ls produced by Lhe corpus luLeum ln presence of ln Lhe blood lL works wlLh
esLrogen Lo produce a normal mensLrual cycle rogesLerone ls lmporLanL durlng pregnancy and ln
preparlng Lhe breasLs for mllk producLlon




16

A1nCnSICLCG

























LnuML@8lDM
rowLh of uLerlne llnlng
afLer mensLruaLlon
L?S A8LAS
8ubblng off of
Llssues
Lxposure of caplllarles
Lxcesslve vaglnal
bleedlng or spoLLlng
lncrease chance
of mlscarrlage
8emalned and aLLached
Lo small sLalks
lnLerference Lo
egg and sperm
ulfflculL
pregnancy
*age 4030
*premenopausal
red|spos|ng factors
rec|p|tat|ng factors
* esLrogen
S]Sk
*pale llps
*generallzed pallor
*cold clammy skln

Anemla
17

Lndometr|a| o|yps
@he uLerus ls mosLly composed of muscle Powever Lhe lnslde llnlng of Lhe uLerus ls made of
fluffy" endomeLrlal Llssue LhaL grows and shrlnks durlng Lhe mensLrual cycle lf a woman does noL
become pregnanL Lhls llnlng sheds causlng a mensLrual perlod AfLer a perlod Lhe llnlng grows rapldly
under Lhe lnfluence of hormones llke esLrogen olyps are areas LhaL grow a llLLle Loo much As Lhey
grow Lhey usually fan ouL buL remaln aLLached Lo a small sLalk klnd of slmllar Lo a bush or a Lree @he
sLalk ls llke Lhe Lrunk of a Lree whlle Lhe larger parL of Lhe polyp ls llke Lhe branches %see phoLo below)
@hey are usually abouL Lhe slze of a pencll eraser alLhough Lhey can be even smaller 8arely polyps can
grow Lo Lhe slze of an orange!
Slnce mosL polyps are small Lhey probably do noL ofLen cause sympLoms Powever when
sympLoms do occur Lhey usually lnclude excesslve bleedlng durlng a mensLrual perlod or bleedlng ln
beLween perlods or even spoLLlng afLer lnLercourse Some women reporL a few days of brown blood
afLer a normal mensLrual perlod olyps cause Lhese sympLoms because Lhey dangle from Lhelr
sLalksand lrrlLaLe Lhe surroundlng Llssue whlch causes Lhe Llssue Lo rub off exposlng Llny blood vessels
@hese blood vessels bleed leadlng Lo spoLLlng or vaglnal bleedlng lf Lhe polyp lnLerferes wlLh Lhe
egg and sperm lL may make lL hard Lo geL pregnanL nobody knows how common Lhls ls lL ls also
posslble LhaL Lhey may lead Lo a sllghLly hlgher chance of mlscarrlage buL Lhls ls also unknown MosL
gynecologlsLs wlll remove polyps as dlscussed below lf Lhey are found ln women wlLh a hlsLory of
mlscarrlage
lf a woman goes Lo her docLor complalnlng of spoLLlng beLween perlods or afLer lnLercourse or
very heavy bleedlng durlng a mensLrual perlod her docLor wlll usually Lhlnk of polyps as one of Lhe
many posslble causes ulagnoslng endomeLrlal polyps lnvolves looklng lnslde Lhe uLerlne cavlLy A
regular ulLrasound %also called a sonogram) usually does noL dlagnose polyps because Lhe pressure
lnslde Lhe uLerus flaLLens Lhe polyps maklng Lhem very hard Lo see llnally gynecologlsLs are
becomlng more skllled aL uslng Lhe hysLeroscope Lo look lnslde Lhe uLerus @hls ls a small llghLed Lube
LhaL goes lnLo Lhe vaglna Lhen Lhe uLerus Lo look around lnslde Lhe uLerus PysLeroscopy uslng small
Lubes can be performed ln Lhe offlce buL larger Lubes %used Lo remove large polyps or flbrolds) usually
requlre anesLhesla ln Lhe hosplLal
lf a polyp ls dlagnosed one of Lhe flrsL quesLlons ls could Lhls be cancer?" lorLunaLely polyps
only rarely Lurn cancerous @he rlsk does lncrease buL only sllghLly as a paLlenL passes age 30 @he nexL
quesLlon ls ofLen how do you remove Lhe polyp?" @he oldfashloned way was Lo perform a u C
%dllaLaLlon and cureLLage) @hls lnvolves a genLle scraplng of Lhe uLerlne llnlng DnforLunaLely Lhls may
mlss Lhe polyp compleLely slnce Lhls procedure ls done solely by feel lmaglne a polyp dangllng by a
llLLle sLalk As Lhe scraplng lnsLrumenL goes by lL wlll llkely [usL push Lhe polyp ouL of Lhe way wlLhouL
grabblng lL




18

C DkUG S1UD
enerlc 8rand AcLlon
ClasslflcaLlon

lndlcaLlon ConLralndlca
Llon
Slde LffecLs/ Adverse
LffecLs
nurslng
8esponslblllLles
AugmenLln Amoxlcll
lln
Clavulan
aLe acld
Amoxlclllln
prevenLs
crossllnklng
of bacLerlal
cell wall and
leadlng Lo
cell deaLh
AddlLlon of
clavulanaLe
%a beLa
lacLam)
lncreases
drugs
reslsLance Lo
beLa
lacLamase
%an enzyme
produced by
bacLerla LhaL
may
lnacLlvaLe
amoxlclllln)
a
penlclllln
Lype
anLlbloLlc
*Co
amoxlclav
ls used Lo
LreaL
lnfecLlons
caused by
bacLerla
Dpper
lower
resp LracL
skln
sofL
Llssue
D@
bone
[olnL
lnfecLlons
*PypersenslL
lvlLy Lo drug
or any
penlclllln
*
henylkeLon
urla %some
producLs)
*PlsLory of
cholesLaLlc
[aundlce or
hepaLlc
dysfuncLlon
assoclaLed
wlLh Lhls
drug
anxleLy confuslon
dlzzlness faLlgue
*MonlLor
paLlenL
carefully for
slgns and
sympLoms of
hypersenslLlvlL
y reacLlon
* MonlLor for
selzures when
glvlng hlgh
doses
-Check
paLlenLs
LemperaLure
and waLch for
oLher slgns
and
sympLoms of
superlnfecLlon

*lnsLrucL
paLlenL Lo
lmmedlaLely
reporL slgns or
sympLoms of
hypersenslLlvlL
y reacLlon
such as rash
fever or chllls


19


enerlc 8rand AcLlon ClasslflcaLlon lndlcaLlon ConLralndlcaLlon
Slde LffecLs/
Adverse
LffecLs
nurslng
8esponslblllLles
MulLlvlLamlns vlLamlns
are Lhe
bulldlng
blocks of
Lhe body
@hey are
used Lo
prevenL or
LreaL a
vlLamln
deflclency
due Lo
poor
nuLrlLlon
cerLaln
lllnesses
or durlng
pregnancy









anLloxldanL
vlLamlns wlLh
mlnerals
boron
calclum
calclum
carbonaLe
copper
essenLlal faLLy
aclds follc
acld
magneslum
magneslum
oxlde
magneslum
sulfaLe
manganese
mulLlple
vlLamlns
mulLlple
vlLamlns wlLh
mlnerals
pyrldoxlne
hydrochlorlde
vlLamln 8
complex wlLh
C and zlnc
vlLamln C
vlLamln u
vlLamln u3
vlLamln L %as
Locopherol
aceLaLe)
vlLamln k1
zlnc
*mulLlvlLaml
n deflclencles
Avold Laklng
more Lhan one
mulLlvlLamln
producL aL Lhe
same Llme unless
your docLor Lells
you Lo @aklng
slmllar vlLamln
producLs
LogeLher can
resulL ln a
vlLamln overdose
or serlous slde
effecLs

* uo noL Lake
Lhls medlcaLlon
wlLh mllk oLher
dalry producLs
calclum
supplemenLsor
anLaclds LhaL
conLaln calclum
Calclum may
make lL harder
for your body Lo
absorb cerLaln
lngredlenLs of
Lhe mulLlvlLamln
upseL
sLomach
headache
or

unusual or
unpleasanL
LasLe ln your
mouLh

*waLch for
sympLoms of
overdosage
*assess for
proper dosage
0

enerlc
8rand
AcLlon ClasslflcaLlon lndlcaLlon ConLra
lndlcaLlon
Slde
LffecLs/
Adverse
LffecLs
nurslng
8esponslblllLles
lollc Acld lollc acld ls used Lo
LreaL or prevenL
cerLaln anemlas
caused by poor
dleL pregnancy
alcohollsm llver
dlsease cerLaln
sLomach/lnLesLlnal
problems kldney
dlalysls or oLher
condlLlons @hls
medlcaLlon helps
Lo relleve
sympLoms such as
unusual Llredness
and dlarrhea LhaL
can occur wlLh
Lhese Lypes of
anemlas Women
of chlldbearlng age
should malnLaln
adequaLe amounLs
of follc acld elLher
Lhrough dleL or
supplemenLs Lo
prevenL lnfanL
splnal cord blrLh
defecLs lollc acld
ls a 8complex
vlLamln needed Lo
form healLhy cells
especlally red
blood cells



8complex
vlLamln
lollc acld deflclency can
have many causes
lnadequaLe dleL some
malabsorpLlon
sympLoms can lead Lo
manlfesLaLlons of
megaloblasLlc anemlas
Several drugs cause
follc acld deflclency
parLlcularly phenyLoln
posslbly also oLher
anLlepllepLlc agenLs
and meLhoLrexaLe
uurlng pregnancy follc
acld deflclency ls
parLlcularly acuLe so
LhaL regular follc acld
supplemenLs are
recommendedln
general lL ls deslrable
LhaL women who wlsh
Lo have chlldren sLarL
Laklng a dally dose of aL
leasL 400 g of follc acld
even before pregnancy
lL has now been safely
esLabllshed LhaL Lhls
precauLlon slgnlflcanLly
reduces Lhe lncldence
of neural Lube defecLs
%clefL splne
myelomenlngocele
anencephaly) Women
whohave glven blrLh Lo
a chlld wlLh one of Lhe
abovemenLloned
anomalles should
consLanLly Lake
relaLlvely hlgh doses of
follc acld ln vlew of
fuLure pregnancles

Pypersens
lLlvlLy Lo
Lhe drug
or
compone
nLs
dlzzlness *assess for
rash or lLchlng
*assess for
Lrouble
breaLhlng
*assess for Lhe
proper dosage
1


IV NUkSING kCCLSS


A kCLLM LIS1S

uaLe of onseL nurslng problem uaLe ldenLlfled uaLe resolve uaLe lnacLlve

Aug 16010




lneffecLlve Llssue
perfuslon relaLed Lo
blood loss

Selfcare deflclL relaLed
Lo weakness and
envlronmenLal barrlers

ulsLurbed sleep
paLLern relaLed Lo
envlronmenLal facLors

ueflclenL knowledge
relaLed Lo lnformaLlon
mlslnLerpreLaLlon
%lnaccuraLe/lncompleLe
lnformaLlon presenLed)

Aug 16 010



Aug 16 010



Aug 17 010




Aug17 010





Aug 17010


Aug 17010



Aug 18010


Aug 18010