1

Chapter I
IN1kCDUC1ICN
LndomeLrlal Þolyp 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 esLrogenŦ 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 mlscarrlageŦ
AŦ kA1ICNALL
ur group declded Lo choose Lhe caseţ 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 Þrovlnclal PosplLal whlch ls our Lralnlng groundŦ 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 feLusŦ ur goal ls also Lo enhance our knowledgeţ skllls and aLLlLude
Loward Lhe managemenL of Lhls sald compllcaLlonŦ
Ŧ LLAkNING CLC1IVLS
1Ŧ Cogn|t|ve
@o have furLher learnlng and comprehenslon abouL endomeLrlal polypŦ
@o deflne lLs meanlngŦ
@o ldenLlfy Lhe rlsk facLors LhaL have been llnked Lo Lhls healLh problemţ Lhe slgns and
sympLomsţ and lLs cllnlcal manlfesLaLlons
@o learn Lhe LreaLmenL and oLher relaLed managemenL regardlng Lhe caseŦ

Ŧ Þsychomotor
@o become pracLlced ln handllng Lhe sald condlLlonŦ
@o use our skllls ln performlng Lhe nurslng process
@o develop skllls ln carlng endomeLrlal polyp paLlenLŦ
@o pracLlced Lhe appllcaLlon of nurslng care planŦ
Ŧ ehav|ora|
@o develop undersLandlng and appreclaLlon wlLh Lhe cllenL's condlLlonŦ
@o provlde rapporL and lnLeracL cllenL uLlllzlng LherapeuLlc communlcaLlonŦ






Chapter II
CLINICAL SUMMAk¥


AŦ GLNLkAL DA1A
Nameť !ŦLŦ@Ŧ
Un|t ass|gnmentť Labor room
Ageť 41yrs old
|rthdateť Aprll 3ţ 1970
|rth p|aceť vlcLorlaţ rlenLal Mlndoro
Genderť lemale
ke||g|onť 8orn Agaln ChrlsLlan
Addressť vlcLorlaţ rlenLal Mlndoro
C|v|| statusť Marrled
Cccupat|onť @eacher
Lducat|ona| ackgroundť @erLlary
Date of Adm|ss|onť AugusL 1ţ 011
1|me of Adm|ss|onť 10ť39am
Adm|tt|ng Þhys|c|anť uraŦ @abudlo
Adm|tt|ng D|agnos|sť AborLlonţ lncompleLe 11 weeks A lnduced nS
1
3Þ%001)
Þrevlous CS
1
@ransverse
Ŧ CnILI CCMÞLAIN1
vaglnal 8leedlng + passage of aborLlon 7 days agoŦ
CŦnIS1Ck¥ CI ÞkLSLN1 ILLNLSS
A 43 year old moLher was admlLLed ln rlenLal Mlndoro PosplLal on AugusL 16ţ010 aL 4ť00 am
ambulaLoryţ accompanled by her relaLlves wlLh chlef complalnL of vaglnal bleedlng 3 days prlor Lo
admlsslonŦ
ºnurse 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 º as verballzed by Lhe cllenLŦ
DŦ ÞAS1 MLDICAL nIS1Ck¥
CllenL sLaLes LhaL she has chlcken fox and mumps durlng her chlldhood yearsŦ @wo years agoţ she
was hosplLallzed durlng her prevlous pregnancyţ ln her 7
Lh
monLhŦ She aLLendlng preŴnaLal check up ln
rlenLal Mlndoro Þrovlnclal PosplLal ţ done dlagnosLlc examlnaLlons especlally compleLe blood counL
reveals LhaL Lhe paLlenL sufferlng from anemlaŦ @he uocLor's order was blood LransfuslonŦ She was
conflned for 4 hours for observaLlonŦ She doesn'L Lake any medlcaLlon durlng her slcknessesŦ
3

LLCLNl.
!|¦c

lc:|¦c



CŦ 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 lnfecLlonţ buL her moLherţ husband and oLher slbllngs do noL have any
dlseaseŦŦ



60 y/o 39y/o































LNDCML1kIAL ÞCL¥ÞS
AS1nMA
AS1nMA
4

AŦ Þn¥SICAL ASSLSSMLN1
VI1AL SIGNSť August 16ţ 1
8Þť90/70mmPg
Þ8ť 108 bpm
88ť 19 cpm
@LMÞť37Ŧ3 C



n8MAL llnulnS SlnlllCAn@
llnulnS
ln@L8Þ8L@A@ln
ln@LDMLn@A8?
S?S@LM

PAl8


SkDLL Anu lACL



L?LS Anu vlSln




LA8S Anu PLA8ln





Lvenly dlsLrlbuLedţ sllkyţ
reslllenL halrţ no lnfecLlon

8oundedţ normocephallcţ
absence of nodules or massesţ
symmeLrlc nasolablal foldsţ
symmeLrlc faclal movemenLs

Lyebrows' skln conLacLţ halr
evenly dlsLrlbuLedţ eyebrows
symmeLrlcally allgnedţ equal
movemenLţ skln lnLacLţ no
dlschargeţ whlLe scleraţ
plnklsh con[uncLlvaţ no orblLal
edemaţ ÞL88LA
Color same as faclal sklnţ
symmeLrlcalţ aurlcle allgned
wlLh ouLer canLhus of eyeţ
plnna recolls afLer foldedţ
mlnlmal amounL of dry
cerumenţ able Lo hear on boLh
ears clearlyŦ



Lxpresslonless face
lrequenLly yawnlng


ÞLosls of eyelld








no devlaLlon


uue Lo sleeplness



uue Lo sleeplness





no devlaLlon


3



nSL Anu SlnDSLS





MD@P Anu
8ÞPA8?nx

SymmeLrlc and sLralghL noseţ
no dlschargeţ no leslonsţ nose
brldge lnLacLţ alr moves freely
as Lhe cllenL breaLhes Lhrough
Lhe naresţ maxlllary and
fronLal slnus noL LenderŦ


WlLhouL denLures
@ongue freely movesţ gag
reflex presenL








Llps pallor
and dry



no devlaLlon




uue Lo blood loss


nLCk Pead cenLeredţ no palpable
lymph nodesţ coordlnaLed
movemenL wlLhouL
dlscomforLsţ presence of
caroLld pulseţ Lrachea ln
mldllne
no devlaLlon

DÞÞL8 Lx@8LMl@lLS

Skln Anu nAlLS






MDSCLL Anu
S@8LnP@



8rown complexlonţ no edemaţ
no leslonsţ good skln Lurgorţ
smooLh nalls



Muscles equal slze on boLh
sldesţ no conLracLuresţ
presence of brachlal and radlal
pulse


enerallzed pallor

Þallor nall beds
4 seconds caplllary
reflll


llaccldlLy or
weakness


uue Lo blood loss

lndlcaLlon of poor
clrculaLory lmpalrmenL
due Lo excesslve blood
lossŦ


uue Lo excesslve blood
loss
6

CPLS@ Anu 8ACk
SÞlnAL CLDMn



LDnS


88LAS@ Anu
AxlLLAL





PLA8@


ChesL symmeLrlcţ splnal
column sLralghLţ skln lnLacLţ
no masses

LfforLless resplraLlons
no rales

SymmeLrlc ţ no massesţ no
leslonsţ roundedţ skln unlform
ln colorţ nlpple roundţ equal ln
slzeţ slmllar ln colorţ no
dlschargeţ axllla no
Lendernessţ masses or
nodulesŦ













WlLh palplLaLlons

no devlaLlon


no devlaLlon


no devlaLlon



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

Skln














8rown complexlonţ
flaLţ symmeLrlc
movemenLs caused by
resplraLlonţ no
Lendernessţ relaxedţ
sofL abdomenŦ


no devlaLlon



7











Lnl@ALS
Þublc skln lnLacLţ no
leslonsţ presence of
publc halrţ
darkercomplexlon of
vulvaŦ

lLť %+)
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



ÞDLSL
8rown complexlonţ wlLh
cuLlcleŦ

Lqual ln slze and lengLhţ
symmeLrlcalţ no leslonsţ no
massesŦ
Þresence of popllLeal and
pedal pulseŦ
no devlaLlon


no devlaLlon

no devlaLlon

8

Ŧ kLVILW CI S¥S1LMS
LLVLL IINDINGS
IN1LGUMLN1Ak¥ S¥S1LM

@PL CLlLn@ vL88ALlZLu l lLLLln CLu
kLSÞIkA1Ck¥ S¥S1LM n ullllCDL@? ln 88LA@Pln

CAkDICVASCULAk S¥S1LM

n lLLLln l ÞALÞl@A@lnSţ n PLA8@ 8D8nţ n
CPLS@ ÞAlnŦ

GAS1kCIN1LS1INAL]DIGLS1IVL]ML1ACLIC
LSS l AÞÞL@l@Lţ uLlLCA@LS Anu D8lnA@LS
8LDLA8L?
GLNI1CkLÞkCDUC1IVL S¥S1LM n ÞAln ln @PL Lnl@AL A8LA
MUSCULCSkLLL1AL S¥S1LM @PL ÞA@lLn@ PAS n lLLLln l MDSCLL WLAknLSSŦ
NLUkCLCGIC S¥S1LM 8lLn@Lu Wl@P @lML Anu ÞLACLţ AnxlL@?



CŦ ÞA11LkNS CI IUNC1ICNING

luncLlonal
PealLh
ÞaLLerns
Þrlor Lo
PosplLallzaLlon
uurlng PosplLallzaLlon AnalyslsƎ
lnLerpreLaLlon

uay 1 uay uay 3

*PealLh
ÞercepLlonŴ
PealLh
ManagemenL
ÞaLLern







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





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





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







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







*Þrlor Lo
hosplLallzaLlonţ
Lhe cllenL do noL
manage her
healLh serlously
and does noL
seek docLor`s
asslsLance buL
when
hosplLallzedţ Lhe
cllenL really seek
on docLors and
relled her healLh
unLo LhemŦ
9


*nuLrlLlonal Ŷ
MeLabollc
ÞaLLern



*LllmlnaLlon




*AcLlvlLyŴ
Lxerclse
ÞaLLern




*Sleep 8esL
ÞaLLern


*CognlLlve
ÞercepLual
ÞaLLern



*@he cllenL
eaLs a loLţ as
long as she
wanLed and
her favorlLe
dlsh was
vegeLablesŦ

*@he cllenL
defecaLe and
vold every dayŦ


*@he cllenL
was dolng her
regular work
llke washlng of
cloLhesţ
cooklngţ and
vegeLable
farmlng and
ºcopra`s"Ŧ

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

*@he cllenL
responds
clearlyŦ


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


*@he cllenL
dld noL
defecaLe Lhls
dayŦ


*@he cllenL
can`L do her
workŦ




*@he cllenL
can`L sleep
good


*@he cllenL
was
moderaLely
anxlousŦ

*@he cllenL
was ln Lhe
yneŴWard
so she can
eaL whaL she
wanLsŦ

*@he cllenL
defecaLe
onceŦ



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


*@he cllenL
can`L sleep
good


*@he cllenL
feels beLLerŦ



*@he cllenL can
freely eaL whaL
she wanLsŦ



*@he cllenL
defecaLes
regularlyŦ



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



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


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

*Self
ÞercepLlonŴ
Self ConcepL




*8ole
8elaLlonshlp
ÞaLLern





*SexuallLy
8eproducLlve




*CoplngŴSLress
@olerance
ÞaLLern





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


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

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

*@he cllenL
was confldenL
LhaL she wlll
recover
lmmedlaLelyŦ


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


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

*@he cllenL
feels beLLerŦ




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



*@he cllenL
sLlll can`L
make loveŦ




*@he cllenL
was relaxedŦ




*@he cllenL feels
a loL beLLerŦ




*@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 herŦ

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

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

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

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

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

11

*value 8ellef
ÞaLLern



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

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

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

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

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


DŦ AC1IVI1ILS CI DAIL¥ LIVING

LŦ ÞA1ILN1'S CCNCLÞ1 CI nLAL1nţ ILLNLSS AND nCSÞI1ALI2A1ICN
ºkapag nagkakasaklL ako o kaya yung mga anak ko aL asawa ko sa albularyo muna ako
pumupunLaŦ Mahal kasl pag osplLal agad Lsaka baka nanununo lang o kaya nadawdawŦ nagpapaLapal
muna kaml o kaya nagpapaLawasţ mlnsan pag may mga ball nagpapahlloL kaml sa mga hlloLŦ kapag
walang nangyarl sa glnawa ng albularyo Lsaka lang kaml pumupunLa sa cenLerŦ kapag walang gamoL sa
cenLer Lsaka pa sa osplLalţ" as verballzed by Lhe paLlenLŦ
ur paLlenL sLlll belleves LhaL Lhe cause of Lhe lllness of Lhelr famlly ls some
exLraordlnary creaLures or supersLlLlous acLlonsŦ @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
soŦ @hey belleve LhaL Lhelr lllnesses can be cured by Lhe quack docLorsŦ @hey used Lo uLlllze Lhe Lhlngs
LhaL a quack docLor uses when LreaLlng Lhem llke Laklng ln herbal planLsţ uslng ºLawas" or ºLapal"Ŧ lf Lhe
ºalbularyo" dldn'L LreaL Lhelr dlseaseţ Lhls ls Lhe Llme LhaL Lhey wlll go Lo Lhe hosplLal and seek Lhe
docLor's helpŦ

Þ8l8 @ PSÞl@ALlZA@ln uD8ln PSÞl@ALlZA@ln AnAL?SlS
ºMaaga akong naglglslng
kasl ako lahaL gumagawa ng
gawalngŴbahayţ naglalabaţ
nagluluLoţ nagllllnls Lapos
naggagamas paŦ 8uong araw
nga may glnagawa akoŦ abl
lang aL pagkakaln pahlnga
koţ" as verballzed by Lhe
paLlenLŦ
ºnakakapanlbago pala kapag nasa
osplLalŦ nakakalnlp! Lagl na lang
nakahlgaţ paupoŴupoţ paLayuŴLayoŦ
Þarang ngang napakabagal ng orasŦ
Mlnsan lang ako nakakalabas dlLoŦ
Plndl ko na nagagawa mga glnagawa
ko daLlŦ Plndl rln ako makaLulog kasl
mallngay slla mlnsanţ"as verballzed by
Lhe paLlenLŦ
PosplLallzaLlon affecLs Lhe dally
acLlvlLles of Lhe paLlenLŦ lL glves a
blg change ln her llvlngŦ She cannoL
perform her usual acLlvlLlesŦ @here
was also a sleep paLLern
dlsLurbanceŦ She also felL boredom
because of Lhe long sLay ln Lhe
hosplLalŦ
1

IŦ LACkA1Ck¥ AND DIAGNCS1IC LkAM
AugusL 16ţ 010
Comp|ete |ood Count
ulagnosLlc Lxam normal value SlgnlflcanL llndlngs Analysls
Pemoglobln 10Ŵ160 g/l 10 normal
PemaLocrlL 0Ŧ36Ŵ0Ŧ48 0Ŧ33
SllghLly decreaseŦ
Þosslble Lo anemlaŦ
LeukocyLe CLŦ 4Ŧ0Ŵ11Ŧ0x10L 11Ŧ7 8enal %kldney) fallure
neuLrophlls 0Ŧ40Ŵ0Ŧ60 0Ŧ79 Þosslble Lo lnfecLlon
LymphocyLes 0Ŧ0Ŵ0Ŧ40 0Ŧ0 normal
Loslnophlls 0Ŧ01Ŵ0Ŧ03 0Ŧ01 normal

8lood Lype ƹ 8+
P8sA Ŷ nonŴreacLlve

AugusL 16ţ 010
Ur|na|ys|s
LxamlnaLlon normal values llndlngs Analysls
Color
Þale yellow Lo
amber
?ellow
Lxcess sweaLlng could resulL
ln Lhe urlne becomlng a
deeper yellowŦ Alsoţ lL ls a slgn
LhaL you have noL been
drlnklng enough llqulds
CharacLer clear Clear normal
Speclflc gravlLy 1Ŧ010Ŵ1Ŧ03 1Ŧ010
Þosslble Lo renal fallure
pP 4Ŧ3Ŵ8Ŧ0 6Ŧ3 normal
88C negaLlve or rare 10Ŵ13
@he paLlenL has vaglnal
bleedlng
W8C negaLlve or rare 6Ŵ8 Drlnary @racL lnfecLlon
Albumln negaLlve @race
Þosslble Lo glomerular
damage
Sugar negaLlve negaLlve normal
CrysLals amorphous negaLlve lew uevlaLlon
Þ8LnAnC? @LS@ť ÞoslLlve
AugusL 16ţ 010
U|trasound kesu|t
normal anLeverLed wlLh 7Ŧ9 x 4Ŧ8 x 4Ŧ4 cm wlLh Lhlck endomeLrlum 1Ŧ66 Lo conslder
hyperplasla

AugusL 17ţ 010
ulagnosLlc exam normal value SlgnlflcanL flndlng Analysls
Pemoglobln 10Ŵ160g/l 93 uecreasedŦ Anemla
PemaLocrlL 0Ŧ36Ŵ0Ŧ48 0Ŧ8 uecreasedŦ Anemla

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

IIIŦ CLINICAL DISCUSSICN CI 1nL DISLASL

AŦ ANA1CM¥ AND Þn¥SICLCG¥

GLNLkAL
@he organs of Lhe reproducLlve sysLems are concerned wlLh Lhe general process of
reproducLlonţ and each ls adapLed for speclallzed LasksŦ @hese organs are unlque ln LhaL Lhelr
funcLlons are noL necessary for Lhe survlval of each lndlvldualŦ lnsLeadţ Lhelr funcLlons are vlLal Lo
Lhe conLlnuaLlon of Lhe human speclesŦ ln provldlng maLernlLy gynecologlc healLh care Lo womenţ
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
usualŦ @he female reproducLlve sysLem conslsLs of lnLernal organs and exLernal organsŦ @he lnLernal
organs are locaLed ln Lhe pelvlc cavlLy and are supporLed by Lhe pelvlc floorŦ @he exLernal organs
are locaLed from Lhe lower margln of Lhe publs Lo Lhe perlneumŦ @he appearance of Lhe exLernal
genlLals varles greaLly from woman Lo womanţ slnce ageţ heredlLyţ raceţ and Lhe number of
chlldren a woman has borne deLermlnes Lhe slzeţ shapeţ and colorŦ See flgure 1Ŵ1 for Lhe female
reproducLlve organsŦ
1LkMS AND DLIINI1ICNS
1Ŧ Corpus LuteumŦ @he yellow mass found ln Lhe graaflan folllcle afLer Lhe ovum has been
expelledŦ
14

Ŧ LstrogenŦ @he generlc Lerm for Lhe female sex hormonesŦ lL ls a sLerold hormone produced
prlmarlly by Lhe ovarles buL also by Lhe adrenal corLexŦ
3Ŧ I|mbr|aeŦ lrlngesŤ especlally Lhe flngerŴllke ends of Lhe falloplan LubeŦ
4Ŧ Io|||c|eŦ A pouch llke depresslon or cavlLyŦ
3Ŧ Io|||c|e St|mu|at|ng normoneŦ @he folllcle sLlmulaLlng hormone %lSP) ls a hormone
produced by Lhe anLerlor plLulLary durlng Lhe flrsL half of Lhe mensLrual cycleŦ lL sLlmulaLes
developmenL of Lhe graaflan folllcleŦ
6Ŧ Graaf|an Io|||c|eŦ A maLureţ fully developed ovarlan cysL conLalnlng Lhe rlpe ovumŦ
7Ŧ normoneŦ A chemlcal subsLance produced ln an organţ whlchţ belng carrled Lo an
assoclaLed organ by Lhe bloodsLream exclLes ln Lhe laLLer organţ a funcLlonal acLlvlLyŦ
8Ŧ Lactat|onŦ @he producLlon of mllk by Lhe mammary glandsŦ
9Ŧ Lute|n|z|ng normoneŦ A hormone produced by Lhe anLerlor plLulLary LhaL sLlmulaLes
ovulaLlon and Lhe developmenL of Lhe corpus luLeumŦ
10ŦCvumŦ @he female reproducLlve cellŦ
11ŦÞrogesteroneŦ @he pure hormone conLalned ln Lhe corpora luLea whose funcLlon ls Lo
prepare Lhe endomeLrlum for Lhe recepLlon and developmenL of Lhe ferLlllzed ovumŦ
1Ŧkeproduct|onŦ @he process by whlch an offsprlng ls formedŦ
IN1LkNAL ILMALL CkGANS
@he lnLernal organs of Lhe female conslsL of Lhe uLerusţ vaglnaţ falloplan Lubesţ and Lhe ovarlesŦ
aŦ UterusŦ @he uLerus ls a hollow organ abouL Lhe slze and shape of a pearŦ lL serves Lwo
lmporLanL funcLlonsť
lL ls Lhe organ of mensLruaLlon and durlng pregnancy lL recelves Lhe ferLlllzed ovum
reLalns and nourlshes lL unLll lL expels Lhe feLus durlng laborŦ

%1)Locat|onť
8eLween Lhe urlnary bladder and Lhe recLumŦ
lL ls suspended ln Lhe pelvls by broad llgamenLsŦ
%)D|v|s|ons of the uterusŦ
@he uLerus conslsLs of Lhe body or corpusţ fundusţ cervlxţ and Lhe lsLhmusŦ @he ma[or
porLlon of Lhe uLerus ls called Lhe body or corpusŦ @he fundus ls Lhe superlorţ rounded
reglon above Lhe enLrance of Lhe falloplan LubesŦ @he cervlx ls Lhe narrowţ lnferlor ouLleL
LhaL proLrudes lnLo Lhe vaglnaŦ @he lsLhmus ls Lhe sllghLly consLrlcLed porLlon LhaL [olns Lhe
corpus Lo Lhe cervlxŦ
%)Wa||s of the uterusŦ
@he walls are Lhlck and are composed of Lhree layersť
1Ŧ Lhe endomeLrlumţ
Ŧ Lhe myomeLrlumţ
3Ŧ Lhe perlmeLrlumŦ
@he endomeLrlum ls Lhe lnner layer or mucosaŦ A ferLlllzed egg burrows lnLo Lhe
endomeLrlum %lmplanLaLlon) and resldes Lhere for Lhe resL of lLs developmenLŦ
When Lhe female ls noL pregnanLţ Lhe endomeLrlal llnlng sloughs off abouL every 8 days ln
response Lo changes ln levels of hormones ln Lhe bloodŦ @hls process ls called mensesŦ @he
myomeLrlum ls Lhe smooLh muscle componenL of Lhe wallŦ @hese smooLh muscle flbers are
arrangedŦ
13

ln longlLudlnalţ clrcularţ and splral paLLernsţ and are lnLerlaced wlLh connecLlve LlssuesŦ
uurlng Lhe monLhly female cycles and durlng pregnancyţ Lhese layers undergo exLenslve
changesŦ @he perlmeLrlum ls a sLrongţ serous membrane LhaL coaLs Lhe enLlre uLerlne
corpus excepL Lhe lower one fourLh and anLerlor surface where Lhe bladder ls aLLachedŦ
bŦ Vag|naŦ
%1) Locat|onŦ @he vaglna ls Lhe Lhln ln walled muscular Lube abouL 6 lnches long leadlng from Lhe
uLerus Lo Lhe exLernal genlLallaŦ lL ls locaLed beLween Lhe bladder and Lhe recLumŦ
%) Iunct|onŦ @he vaglna provldes Lhe passageway for chlldblrLh and mensLrual flowŤ lL recelves Lhe
penls and semen durlng sexual lnLercourseŦ
cŦ Ia||op|an 1ubes %1wo)Ŧ
%1) Locat|onŦ Lach Lube ls abouL 4 lnches long and exLends medlally from each ovary Lo empLy lnLo
Lhe superlor reglon of Lhe uLerusŦ
%) Iunct|onŦ @he falloplan Lubes LransporL ovum from Lhe ovarles Lo Lhe uLerusŦ @here ls no
conLacL of falloplan Lubes wlLh Lhe ovarlesŦ
%) Descr|pt|onŦ @he dlsLal end of each falloplan Lube ls expanded and has flngerŴllke pro[ecLlons
called flmbrlaeţ whlch parLlally surround each ovaryŦ When an oocyLe ls expelled from Lhe ovaryţ
flmbrlae creaLe fluld currenLs LhaL acL Lo carry Lhe oocyLe lnLo Lhe falloplan LubeŦ ocyLe ls carrled
Loward Lhe uLerus by comblnaLlon of Lube perlsLalsls and clllaţ whlch propel Lhe oocyLe forwardŦ
@he mosL deslrable place for ferLlllzaLlon ls Lhe falloplan LubeŦ
dŦ Cvar|es
%1) Iunct|onsŦ @he ovarles are for oogeneslsŴLhe producLlon of eggs %female sex cells) and for
hormone producLlon %esLrogen and progesLerone)Ŧ
%) Locat|on and gross anatomyŦ
@he ovarles are abouL Lhe slze and shape of almondsŦ
@hey lle agalnsL Lhe laLeral walls of Lhe pelvlsţ one on each sldeŦ
@hey are enclosed and held ln place by Lhe broad llgamenLŦ
@here are compacL llke Llssues on Lhe ovarlesţ whlch are called ovarlan folllclesŦ
@he folllcles are Llny sacŴllke sLrucLures LhaL conslsL of an lmmaLure egg surrounded by one or more
layers of folllcle cellsŦ As Lhe developlng egg beglns Lo rlpen or maLureţ folllcle enlarges and
develops a fluld fllled cenLral reglonŦ When Lhe egg ls maLuredţ lL ls called a graaflan folllcleţ and ls
ready Lo be e[ecLed from Lhe ovaryŦ
%) Þrocess of hormone product|on by the ovar|esŦ
%a) LsLrogen ls produced by Lhe folllcle cellsţ whlch are responslble secondary sex characLerlsLlcs
and for Lhe malnLenance of Lhese LralLsŦ @hese secondary sex characLerlsLlcs lnclude Lhe
enlargemenL of falloplan Lubesţ uLerusţ vaglnaţ and exLernal genlLalsŤ breasL developmenLŤ
lncreased deposlLs of faL ln hlps and breasLsŤ wldenlng of Lhe pelvlsŤ and onseL of menses or
mensLrual cycleŦ
%b) ÞrogesLerone ls produced by Lhe corpus luLeum ln presence of ln Lhe bloodŦ lL works wlLh
esLrogen Lo produce a normal mensLrual cycleŦ ÞrogesLerone ls lmporLanL durlng pregnancy and ln
preparlng Lhe breasLs for mllk producLlonŦ




16

Ŧ ÞA1nCÞn¥SICLCG¥

























LnuML@8lDM
rowLh of uLerlne llnlng
afLer mensLruaLlon
ÞL?ÞS 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 40Ŵ30
*premenopausal
Þred|spos|ng factors
Þrec|p|tat|ng factors
* esLrogen
S]Sk
*pale llps
*generallzed pallor
*coldţ clammy skln

Anemla
17

Lndometr|a| Þo|yps
@he uLerus ls mosLly composed of muscleŦ Poweverţ Lhe lnslde llnlng of Lhe uLerus ls made of
ºfluffy" endomeLrlal Llssue LhaL grows and shrlnks durlng Lhe mensLrual cycleŦ lf a woman does noL
become pregnanLţ Lhls llnlng shedsţ causlng a mensLrual perlodŦ AfLer a perlodţ Lhe llnlng grows rapldly
under Lhe lnfluence of hormones llke esLrogenŦ Þolyps are areas LhaL grow a llLLle Loo muchŦ As Lhey
growţ Lhey usually fan ouL buL remaln aLLached Lo a small sLalkţ klnd of slmllar Lo a bush or a LreeŦ @he
sLalk ls llke Lhe Lrunk of a Lreeţ whlle Lhe larger parL of Lhe polyp ls llke Lhe branches %see phoLo below)Ŧ
@hey are usually abouL Lhe slze of a pencll eraserţ alLhough Lhey can be even smallerŦ 8arelyţ polyps can
grow Lo Lhe slze of an orange!
Slnce mosL polyps are smallţ Lhey probably do noL ofLen cause sympLomsŦ Poweverţ when
sympLoms do occurţ Lhey usually lnclude excesslve bleedlng durlng a mensLrual perlodţ or bleedlng ln
beLween perlodsţ or even spoLLlng afLer lnLercourseŦ Some women reporL a few days of brown blood
afLer a normal mensLrual perlodŦ Þolyps cause Lhese sympLoms because Lhey dangle from Lhelr
sLalksand lrrlLaLe Lhe surroundlng Llssueţ whlch causes Lhe Llssue Lo rub offţ exposlng Llny blood vessels
@hese blood vessels bleedţ leadlng Lo spoLLlng or vaglnal bleedlngŦ lf Lhe polyp lnLerferes wlLh Lhe
egg and spermţ lL may make lL hard Lo geL pregnanLŦ nobody knows how common Lhls lsŦ lL ls also
posslble LhaL Lhey may lead Lo a sllghLly hlgher chance of mlscarrlageţ buL Lhls ls also unknownŦ MosL
gynecologlsLs wlll remove polypsţ as dlscussed belowţ lf Lhey are found ln women wlLh a hlsLory of
mlscarrlageŦ
lf a woman goes Lo her docLor complalnlng of spoLLlng beLween perlods or afLer lnLercourseţ or
very heavy bleedlng durlng a mensLrual perlodţ her docLor wlll usually Lhlnk of polyps as one of Lhe
many posslble causesŦ ulagnoslng endomeLrlal polyps lnvolves looklng lnslde Lhe uLerlne cavlLyŦ A
regular ulLrasound %also called a sonogram) usually does noL dlagnose polypsţ because Lhe pressure
lnslde Lhe uLerus flaLLens Lhe polypsţ maklng Lhem very hard Lo seeŦ llnallyţ gynecologlsLs are
becomlng more skllled aL uslng Lhe hysLeroscope Lo look lnslde Lhe uLerusŦ @hls ls a smallţ llghLed Lube
LhaL goes lnLo Lhe vaglna Lhen Lhe uLerusţ Lo look around lnslde Lhe uLerusŦ PysLeroscopy uslng small
Lubes can be performed ln Lhe offlceţ buL larger Lubes %used Lo remove large polyps or flbrolds) usually
requlre anesLhesla ln Lhe hosplLalŦ
lf a polyp ls dlagnosed one of Lhe flrsL quesLlons ls ºcould Lhls be cancer?" lorLunaLelyţ polyps
only rarely Lurn cancerousŦ @he rlsk does lncreaseţ buL only sllghLlyţ as a paLlenL passes age 30Ŧ @he nexL
quesLlon ls ofLen ºhow do you remove Lhe polyp?" @he oldŴfashloned way was Lo perform a u Ǝ C
%dllaLaLlon and cureLLage)Ŧ @hls lnvolves a genLle scraplng of Lhe uLerlne llnlngŦ DnforLunaLelyţ Lhls may
mlss Lhe polyp compleLelyţ slnce Lhls procedure ls done solely by feelŦ lmaglne a polyp dangllng by a
llLLle sLalkŦ As Lhe scraplng lnsLrumenL goes byţ lL wlll llkely [usL push Lhe polyp ouL of Lhe way wlLhouL
grabblng lLŦ




18

CŦ DkUG S1UD¥
enerlc 8rand AcLlon
ClasslflcaLlon

lndlcaLlon ConLralndlca
Llon
Slde LffecLs/ Adverse
LffecLs
nurslng
8esponslblllLles
AugmenLln Amoxlcll
lln
Clavulan
aLe acld
Amoxlclllln
prevenLs
crossŴllnklng
of bacLerlal
cell wall and
leadlng Lo
cell deaLhŦ
AddlLlon of
clavulanaLe
%a beLaŴ
lacLam)
lncreases
drugƌs
reslsLance Lo
beLaŴ
lacLamase
%an enzyme
produced by
bacLerla LhaL
may
lnacLlvaLe
amoxlclllln)Ŧ
a
penlcllllnŴ
Lype
anLlbloLlc
*CoŴ
amoxlclav
ls used Lo
LreaL
lnfecLlons
caused by
bacLerlaŦ
Dpper Ǝ
lower
resp LracLţ
skln Ǝ
sofL
Llssueţ
D@ţ
bone Ǝ
[olnL
lnfecLlons
*PypersenslL
lvlLy Lo drug
or any
penlclllln
*
ÞhenylkeLon
urla %some
producLs)
*PlsLory of
cholesLaLlc
[aundlce or
hepaLlc
dysfuncLlon
assoclaLed
wlLh Lhls
drug
anxleLyţ confuslonţ ţ
dlzzlnessţ faLlgueţ
*MonlLor
paLlenL
carefully for
slgns and
sympLoms of
hypersenslLlvlL
y reacLlonŦ
* MonlLor for
selzures when
glvlng hlgh
dosesŦ
-Check
paLlenLƌs
LemperaLure
and waLch for
oLher slgns
and
sympLoms of
superlnfecLlon
ţ
*lnsLrucL
paLlenL Lo
lmmedlaLely
reporL slgns or
sympLoms of
hypersenslLlvlL
y reacLlonţ
such as rashţ
feverţ or chlllsŦ


19


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








anLloxldanL
vlLamlns wlLh
mlneralsŤ
boronŤ
calclumŤ
calclum
carbonaLeŤ
copperŤ
essenLlal faLLy
acldsŤ follc
acldŤ
magneslumŤ
magneslum
oxldeŤ
magneslum
sulfaLeŤ
manganeseŤ
mulLlple
vlLamlnsŤ
mulLlple
vlLamlns wlLh
mlneralsŤ
pyrldoxlne
hydrochlorlde
Ť vlLamln 8
complex wlLh
C and zlncŤ
vlLamln CŤ
vlLamln uŤ
vlLamln u3Ť
vlLamln L %as
Locopherol
aceLaLe)Ť
vlLamln k1Ť
zlnc
*mulLlvlLaml
n deflclencles
Avold Laklng
more Lhan one
mulLlvlLamln
producL aL Lhe
same Llme unless
your docLor Lells
you LoŦ @aklng
slmllar vlLamln
producLs
LogeLher can
resulL ln a
vlLamln overdose
or serlous slde
effecLs

* uo noL Lake
Lhls medlcaLlon
wlLh mllkţ oLher
dalry producLsţ
calclum
supplemenLsţor
anLaclds LhaL
conLaln calclumŦ
Calclum may
make lL harder
for your body Lo
absorb cerLaln
lngredlenLs of
Lhe mulLlvlLamlnŦ
ŴupseL
sLomachŤ
ŴheadacheŤ
or

Ŵunusual or
unpleasanL
LasLe ln your
mouLhŦ

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

enerlc
8rand
AcLlon ClasslflcaLlon lndlcaLlon ConLraŴ
lndlcaLlon
Slde
LffecLs/
Adverse
LffecLs
nurslng
8esponslblllLles
lollc Acld lollc acld ls used Lo
LreaL or prevenL
cerLaln anemlas
caused by poor
dleLţ pregnancyţ
alcohollsmţ llver
dlseaseţ cerLaln
sLomach/lnLesLlnal
problemsţ kldney
dlalyslsţ or oLher
condlLlonsŦ @hls
medlcaLlon helps
Lo relleve
sympLoms such as
unusual Llredness
and dlarrhea LhaL
can occur wlLh
Lhese Lypes of
anemlasŦ Women
of chlldbearlng age
should malnLaln
adequaLe amounLs
of follc acld elLher
Lhrough dleL or
supplemenLs Lo
prevenL lnfanL
splnal cord blrLh
defecLsŦ lollc acld
ls a 8Ŵcomplex
vlLamln needed Lo
form healLhy cellsţ
especlally red
blood cellsŦ



8Ŵcomplex
vlLamln
lollc acld deflclency can
have many causesŦ
lnadequaLe dleLţ some
malabsorpLlon
sympLoms can lead Lo
manlfesLaLlons of
megaloblasLlc anemlasŦ
Several drugs cause
follc acld deflclencyţ
parLlcularly phenyLolnţ
posslbly also oLher
anLlepllepLlc agenLsţ
and meLhoLrexaLeŦ
uurlng pregnancy follc
acld deflclency ls
parLlcularly acuLeţ so
LhaL regular follc acld
supplemenLs are
recommendedŦln
general lL ls deslrable
LhaL women who wlsh
Lo have chlldren sLarL
Laklng a dally dose of aL
leasL 400 DŽg of follc acld
even before pregnancyŦ
lL has now been safely
esLabllshed LhaL Lhls
precauLlon slgnlflcanLly
reduces Lhe lncldence
of neural Lube defecLs
%clefL splneţ
myelomenlngoceleţ
anencephaly) Women
whohave glven blrLh Lo
a chlld wlLh one of Lhe
aboveŴmenLloned
anomalles should
consLanLly Lake
relaLlvely hlgh doses of
follc acld ln vlew of
fuLure pregnancles

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


IVŦ NUkSING ÞkCCLSS


AŦ ÞkCLLM LIS1S

uaLe of onseL nurslng problem uaLe ldenLlfled uaLe resolve uaLe lnacLlve

AugŦ 16ţ010




lneffecLlve Llssue
perfuslon relaLed Lo
blood loss

SelfŴcare deflclL relaLed
Lo weakness and
envlronmenLal barrlers

ulsLurbed sleep
paLLern relaLed Lo
envlronmenLal facLors

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

AugŦ 16ţ 010



AugŦ 16ţ 010



Aug 17ţ 010




AugŦ17ţ 010





AugŦ 17ţ010


AugŦ 17ţ010



AugŦ 18ţ010


AugŦ 18ţ010














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 f°  °n  f¯° .

 f¯°  f¯°   f¯°  %f¾ n½  fn f %  f¯°   °n   f°– ¯  f° °  ¯f¯° ½ n f   ¾f¯ ¯ ° ¾¾  n  ¾    @f°– ¾¯f f¯° ½ n¾ –   nf°  ¾ ° f f¯°  ¾   ¾ ¾ ¾  €€ n¾  &  ° f  ¾ ¯ nf°  ¯    f ½ n¾  nfn¯ ¾½½ ¯ °¾  f°fn ¾ f n°f° nfn¯  .

fn¯ ¯f ¯f   f  €     f ¾  n f° °–  °¾ €  ¯f¯°    .

 ° n f°  n° .

f¾¾€nf° ° nf° .

°f ° nf°   €€ n¾$   ¾  €€ n¾ -¾°–  ¾½°¾  ¾ nn  nfn ¾¾  n¯½   f  ½  ° f¯° n f° f° ¯f¾ nf¾   ½    ½ –°f°n  fn¾¯    ¾ f¾  n f° ¾¯fn$° ¾°f ½  ¯¾   °  f¾¾     n° °¾  @¾ ¯ nf°  ½¾      ¾¯½¯¾ ¾n f¾ °¾f  ° ¾¾ f°  f f f nf° nn   ¾  ½ ¾ € f° ¯f¾  J¯ ° € n f°– f–  ¾  ¯f°f° f f  f¯°¾ € €n fn    –    ¾½½ ¯ °¾  ½  ° °€f° ¾½°f n   € n¾  n fn  ¾ f n¯½  f¯° °   €¯  f n ¾  ¾½ nf    n ¾     nfn  €n °nnf° f  ¯f° nf¾ ¾  °f f     ¾¯  ¯ff ¾½° ¾¯½¯¾ nf°  f   ¯f°€ ¾f°¾ € ¯ –f f¾n f° ¯f¾    f –¾ nf¾  €n fn  €n °n  ½fnf ½ °°  ½¾¾  f¾   f° ½ ½n f– °¾  f°  ¯  f  °– ½ –°f°n €n fn  €n °n ¾ ½fnf fn  ¾ f  –f €n fn  ¾½½ ¯ °¾ f   n¯¯ ° ° – ° f  ¾ ¾f   f ¯ °  ¾  f  n  ° ¾f f°–f f ¾ €f  f¾ –€€nfn   ° €  ½ –°f°n   f¾ ° ° ¾f€  ¾f ¾  f ¾ ½ nf° ¾–°€nf°  n ¾   °n °n  € ° f   € n¾ %n € ¾½°  ¯ ¯ °°–n   f° °n ½f% J¯ ° f  – °   f n   °  €   f  ¯ °°  f°¯f ¾ ¾  n°¾f° f   f  – ¾ ¾ € €n fn  °   € € ½ –°f°n ¾ ½ ¾ °¾ ° ¾¾      –  n¯½° °¾ &f¾¾ ¾¾ € f¾n°– &f¾¾ ¾¾     f°– € &f¾¾ ¾¾ €   ½½  ¾f–     .

 I -D-9.

@  -¾°–½  ¯  ° €€ n ¾¾  ½ €¾° f   ¾¾   € nf  €n f   f° ¾¾f°  °°¯ °f f ¾  ¾ ¾ ½ ½f ° f  °°¯ °f€fn¾   €n °° –   f °€¯f° ¯¾° ½ f° %°fnnf $°n¯½   °€¯f°½ ¾ ° % f  °€   –      –      –      –       f  ¾   –     –     f °fn   –     –    f €°¾   –                 .      9 .

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