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INTRODUCTION

ANATOMY and PHYSIOLOGY

VULVA

- Plays a role in stimulation and protects the body from foreign

materials.

Mons pubis/mons veneris

- a rounded pad of flesh located over the

symhpysis pubis; covered by hair

after puberty.

Labia Majora - two elongated folds of

hair covered-adipose tissue separated

by a cleft, and covered by loose

connective tissue and epithelium.
Labia Minora- two thin hairless
folds of

connective tissue between the
labia majora

and vaginal opening; they divide
and unite

to form the hood like prepuce of
the clitoris.

And contains the Bartholin’s gland
which

secretes mucus for lubrication
during sexual

intercourse.

Clitoris- an organ homologous
to penis, a small body of spongy
tissue that functions

solely for sexual pleasure.

OVARIES

- Also called as the female gonads; they produce, mature, and discharge ova.

- They also produce estrogen and progesterone which initiates and regulates the
menstrual cycle, influences the growth and enlargement of the breasts and uterus and
stimulate endometrial growth.

- Secured to the lateral walls of the pelvic wall by the suspensory ligament. They flank
the uterus laterally and anchor to it medially by the ovarian ligaments.

- Ovarian follicles are can be seen inside which are saclike structures. And consist of
immature eggs called the oocyte, it is surrounded by one or more germ layers called
ovarian follicles.
Two almond-sized glands which consists

of three surface germinal

epitheliums:

 tunica albugniea- dense connective tissue; outer layer

 stroma

 cortex- dense outer layer

 medulla- loose inner layer

FALLOPIAN TUBES

Thin-walled tubes with serosal covering, with a muscular layer and ciliated mucus
lining, transport the ova after fertilization.

It is approximately 10cm or 4 inches long.

FIMBRIAE

It is the distal end of the fallopian tube, which has finger like projections and catches
the ova when it is ejected by the ovaries.

UTERUS

Uterine growth is the formation of a few new muscle fibers and the stretching of
existing muscle fibers in the uterine myometrium which is influenced by estrogen and
progesterone.

A pear-shaped, hollow muscular organ in the pelvic cavity ( 2-5 cm thick, 5 cm long, 5
cm at widest point, 2 cm at narrowest point). Provides as an environment for
implantation, development, and delivery of fetus.

It is suspended in the pelvis by the broad and uterosacral ligament. the It is
composed of three layers namely:

Endometrium- inner mucosal layer, which is the site of implantation
Myometrium- the bulky middle layer, made of bundles of inert lacing smooth muscles.
Plays a role in delivering the baby.

Perimetrium- the outer most serous layer.

It receives an ovum from the ovaries, and provides a place for implantation and
nourishment during fetal growth

CERVIX

Lower, narrow portion of the uterus cylindrical or conical in shape and protrudes through
the upper anterior vaginal wall. It allows the passage of sperm from the vaginal canal
during intercourse.

VAGINA

The canal between inferior to the uterus and cervix, provides as a route of entry for
sexual intercourse; exit for menstrual blood and serves as a birth canal.

PATHOPHYSIOLOGY

Precipitating factor Precipitating factors
•Age: 30-50 ·Hormone
SIGNS AND SYMPTOMS
·Gender ETIOLOGY: replacement therapy
·Lifestyle Unknown ·Anovulation
·SWELLING OF
·Early menarche
·Nulliparity BREAST
·High-fat diet
·Obesity ·DEPRESSION
·Faimily history
·Anxiety ·DYSMENORRHEA
· Race: African- 50%,
·LOSS OF SEXUAL
American 25%
• lifestyle DRIVE
Stimulation of increase
estrogen production

IF NOT TREATED

PROLIFERATION OF CELLS IN THE
UTERUS

OVERGROWTH OF THE ENDOMETRIAL LINING

DIAGNOSTIC

·PELVIC EXAM DEVELOPS INTO UTERINE
FIBROID
·ULTRASOUN
D

INTERFERENCE IN THE VASCULAR SUPPLY

SIGNS AND SYMPTOMS

DETERIORATION IN THE INTERIOR HYPERAMENORRHEA
PART OF THE FIBROID
(If untreated with
radiation)

1. Vital signs monitoring – to continuously monitor client’s health status

2. Nutritional Needs – on Diet As Tolerated and was placed on Nothing Per Orem
subsequently for surgical purposes.

3. Fluid Intake and Output – to monitor hydration pattern of the client whether it is too
high or too low than normal amount of hydration and to check the function of the kidney
through urine output.
IVF Therapy– implemented to maintain the fluid and electrolyte balance of the body
which sustains bodily functions on the optimum level.

D5LR – a physiological solution used for infusion into the circulation. In addition to
essential ions it also contains glucose.

PNSS – a way to replace water at correct electrolyte deficits. It provides medium for
IV drug administration.

5. Foley Catheter insertion - allow drainage of urine in certain disoreder and to empty
the bladder before abdominal operation.

6. O2 Therapy – inhalation (2L/min)

7. Medications:

 Ceftriaxone 1g IVTT q8h x3daysantibiotic; pre-operative prophylaxis

 Celecoxib – 200mg/cap, 1 cap BID x 5 days (8am – 6pm)

 for acute pain

 anti-inflammatory

 Tramadol 50mg IVTT q6h PRN for severe pain (6am-12nn-6pm-12mn)

Ketorlac 30mg IVTT q8h ANST (-)

analgesic, anti-inflammatory; short term pain management

Multivitamins 1cap OD 8am

Vitamin supplement; additional vitamin for post-op patient

Co-amoxiclav 625mg 1tab BID

antibiotic

Diagnostic Exams

 Urinalysis – analysis of the volume, physical, chemical and microscopic properties of
urine.

 Complete Blood Count – examines the component of blood including RBC, WBC and
platelets as a preoperative test to ensure adequate O2 carrying capacity of
homeostatsis.
Blood Chemistry – used to detect electrolyte level to supplement physical exam.

Protothrombin Time – blood test that measure how long it takes blood to clot; can be
used to check for bleeding problems; also used to check whether anticoagulant is
effective.

 Ultrasound – is a noninvasive diagnostic test that uses sound waves to create a
visual image of the uterus as well as other pelvic organs.

 Chest X-ray Posterior Anterior View- NORMAL

 ECG – used to measure the rate and regularity or heartbeats as well as the size and
position of chambers, the presence of any damage to the heart and the effects of drugs
or devices used to regulate the heart.

Surgical Interventions

TAHBSO (Total Abdominal Hysterectomy Bilateral Salpingo- Oopherectomy) –
removal of the uterus including the cervix as well as the fallopian tubes and ovaries
using an incision in the abdomen. Intended for obstetrical conditions of which the

normal functions of these organs involve are compromised and necessitate.

Indication: Removal as the last recourse of management; in this case, Myoma.

Treatment:

Blood Typing – determines blood compatibility.

Blood Transfusion –indicated to make-up for blood loss during the onset of
intraoperative phase.

Subarachnoid Block– a type of regional anesthesia, that averts pain sensation from
the lower extremity to the nipple line making it the anesthesia of choice for obstetric
surgery.

Operative Technique - TAHBSO

Induction of Anesthesia Asepsis/antiseptics/draping

Midline intra-umbilical incision done on the skin and deepened down to the peritoneum
abdominal pack and retractors applied. Round ligament doubly clamped cut and suture
ligated with chromic 1 suture.
Anterior left of the broad ligament lifted and incised done to the vesicouterine
peritoneum in collinear manner bladder strap separated bluntly.

A window was made on the peritoneum of the posterior left of the broad ligament under
the infundibulopelvic ligament. The infundobulopelvic ligament was triply clamped, cut
and suture ligated with chromic 1 suture. The same procedure was carried out on the
opposite side.

Posterior left of the broad ligament at medically from the pelvic opening to the posterior
uterine wall toward the cardinal ligament. Ascending to the uterus vessels on both
sides, identified and clamped near the origin adjacent and the uterus and the divided
peclide suture ligated using chromic suture.

Series of clamping cutting and suture ligation done on the cardinal and uterosacral
ligaments on both sides using chromic suture.

Amputation of the cervix at the level of the cervical os baseline applied over the rest up.

The angle on both sides of the vaginal string anchored to the cardinal ligaments using
chromic suture for homeostasis.

Bleeding inspected and ligated as encountered.

Reperitonealization done with simple continuous strikes using chromic sutures.

Retractor and abdominal removed abdominal cavity covered os.

Peritoneum closed with simple continuous suture using chromic 2-0 suture.

Fascia closed with continuous interlocking stitches using vicryl 4-0 suture.

Subcutaneous tissue closed with simple interrupted suture.

Skin closed subticullarly with vicryl 4-0 suture.

Betadine and abdominal dressing applied; kept dry and intact.

NURSING CARE PLAN