A CASE STUDY OF A PATIENT WITH UTERINE FIBROID

BY

POWOOLA GLORY OMOLABAKE

INDEX NO:

SET 44 BASIC NURSING

FCT SCHOOL OF NURSING, GWAGWALADA, ABUJA

NOVEMBER 2022.
 THIS CASE STUDY ENTITLED

UTERINE FIBROIDS

FROM

UNIVERSITY OF ABUJA TEACHING HOSPITAL, GWAGWALADA, ABUJA

BY

POWOOLA GLORY OMOLABAKE

IN PARTIAL FULFILMENT OF THE REQUIREMENT OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF REGISTERED NURSE

CERTIFICATE (RN)

______________________ ____________________

MR. CISHAK PAUL MR. LAKEREKS J.K

(PROJECT SUPERVISOR) (PRINCIPAL)

 APPROVAL PAGE

This case study has been read and approved by as meeting the requirements of Basic Nursing,

FCT School of Nursing, Gwagwalda, Abuja.

Signature: ____________________ _________________

Mr. Cishak Paul Bitrus Date

(RN, RM, RNE, BNSC, PGDE, MPH in view)

Signature: ______________________ __________________

Mr. Lakareks K. James Date

(PGD (Mgt), BSc (PHN), RPHN, RNT, RN)

School Principal
 DEDICATION

This project work is dedicated to God Almighty, the creator of all, for his infinite love,

mercy, guidance, provision and protection.

 ACKNOWLEDGEMENT

My gratitude goes to God Almighty, the one who was, who is, and who will forever be.

My unreserved gratitude also goes to my wonderful supervisor Mr. Cishak Paul Bitrus, for

his tireless correction and support; this work would not have been possible without you.

Thank you for making this a success.

My appreciation also goes to my great parents Mr. and Mrs. Powoola, most especially my

mum for her sacrifice, support and for her tireless support, emotionally, financially,

physically and spiritually, thank you so much ma, without you I think I would have not been

where I am today.

My sincere appreciation also goes to my principal Mr. Lakereks, tutors and Management of

FCT School of Nursing, for their guidance and coordination towards achieving this goal.

My appreciation also goes to my beloved siblings; Anointing, Prosper and Clinton,

roommates; Toyosi, Yegosi, Oyinkansola, Susan, Suzan, and Delight, and all members of Set

44, you are so wonderful and exceptionally supportive.

My appreciation also goes to Mrs. Rosemary, Omolola, Pst. Jide Olawoyin, Prophet Kunle

Olusoji, and Pastor Niyi Adetiloye, thank you so much, you are so wonderful, thank you for

nurturing me physically, spiritually and morally. God bless you all.

My appreciation also goes to Pastor and Mrs Felix-King Giwa, Faithful, Fruitful, and

Fullness for their love and support, sometimes I wonder what manner of love you’ve

bestowed upon me, you stood by me, nurtured me and also supported me physically,

spiritually, emotionally, financially and psychologically, thank you so much I can’t thank you

enough.
My appreciation also goes to Mr & Mrs. Emmanuel Aliu, Righteous, Pentecost, and True

riches for your love, thank you for lending out your laptop to me, without your support and

help I don’t think this project will be a success. Thank you very much sir and God bless you

all.

TABLE OF CONTENTS

Title page - - - - - - - - -

Approval page - - - - - - - -

Dedication - - - - - - - -

Acknowledgement - - - - - - -

Table of content - - - - - - -

CHAPTER ONE: INTRODUCTION

Brief History of Patient and illness - - - - -

Objectives of the Case Study - - - - -

Definition of Terms - - - - - - -

CHAPTER TWO: LITERATURE REVIEW

Anatomy and Physiology of the Uterus - - - -

Disease Theory - - - - - - -

Definition - - - - - - - -

Causes - - - - - - - - -

Pathophysiology of the Disease - - - - -

Clinical Manifestation - - - - - -

Management of the Disease condition - - - -

Medical Management - - - - - - -

Surgical Management - - - - - -

Nursing Management - - - - - - -
Pharmacology of drugs used - - - - - -

Complications - - - - - - - -

CHAPTER THREE: NURSING PROCESS

Assessment - - - - - - - -

Patient’s personal Data - - - - - -

History of Past and Present illness - - - - -

Investigations and Observations - - - - -

Nursing Process - - - - - - - -

Nursing Care Plan - - - - - - -

Summative Evaluation - - - - - -

CHAPTER FOUR - - - - - - -

Summary - - - - - - - -

Conclusion - - - - - - - -

Recommendations - - - - - - -

Advice on Discharge - - - - - - -

Bibliography - - - - - - - -

Appendices - - - - - - - -

Vital Signs Chat - - - - - - -

 CHAPTER ONE

INTRODUCTION

1.1. BRIEF HISTORY OF PATIENT’S ILLNESS

Mrs. A. G is 37 years old flight dispatcher; she is married with no kids yet. She is of

an average height and dark in complexion, she is Igbo by tribe and she is a Christian.

She resides at Abuja Municipal Area Council with her husband, she has a good set of

dentitions and all other sense organs are intact, she communicates well in English and

Igbo, she is not a known diabetes, asthmatic or hypertensive patient.

The above – mentioned client was admitted to UATH of the 13th April, 2022. She was

apparently normal until 4years ago when she first noticed a cherry sized mass at her

lower abdomen just below the navel, mass was described to be firm, movable and not

attached the overlaying skin or underlying organs and was described to have

progressively increased in size up to its current size. Mass was associated with lower

abdominal pain at the pelvic region, pain is dull aching, insidious in onset and occur

intermittently graded 5/10 on seventy scale, pain does not radiate to any other part of

the body. There are no known of gravity or relieving factors. No histories of weight

loss, chronic cough or drench night sweat, no history of bone pain, Jaundice. No

history of sweating on any other part of the body.

Inability to conceive was noticed about 2years after onset of abdominal swelling when

she got married to her husband with whom she lives with and had regular unprotected

coitus. She has had a regular menstrual cycle pattern of 3days in a 25day cycle but

there’s a significant increase in the volume of bleeding from her previous normal

menstrual cycle, evidenced by her need to change pads frequently and sometimes
 support her pads with tissue paper, no history of contraceptive use, no history of

trauma to the pelvic organ.

She’s married in a monogamous setting to her husband who hasn’t fathered a child

before. He doesn’t wear tight underwear, no history of chronic genital infection, no

history of blurry vision and nipple discharge.

1.2. OBJECTIVES OF STUDY

1. To learn more about uterine fibroid, the cause and how to prevent it.

2. To acquire skills and knowledge on how to manage patients with this disease

condition.

3. To give health education to individuals on how to prevent the disease condition.

4. To give a comprehensive nursing care to the patients and prevent possible

complications.

1.3. DEFINITION OF TERMS

 UTERUS: The hollow, pear-shaped organ in a woman's pelvis. It’s also called

womb.

 FIBROID: Non-cancerous growths in the uterus that can develop during a woman's

childbearing years.

 CERVIX: neck of the uterus

 MYOMECTOMY: surgical removal of myomas

 UTERINE TUMOUR: abnormal growth of cells in the uterus.

 INFERTILITY: this is the inability to conceive

 CHAPTER TWO

LITERATURE REVIEW

2.1. ANATOMY AND PHYSIOLOGY OF THE UTERUS

2.1.1 THE UTERUS

The Uterus, also called womb, an inverted pear-shaped muscular organ of the

female reproductive system, located between the bladder and the rectum. It functions

to nourish and house a fertilized egg until the foetus, or offspring, is ready to be

delivered.

2.1.2 STRUCTURE OF THE UTERUS

The uterus has four major regions: the fundus is the broad curved upper area in which

the fallopian tubes connect to the uterus; the body, the main part of the uterus, starts

directly below the level of the fallopian tubes and continues downward until the

uterine walls and cavity begin to narrow; the isthmus is the lower, narrow neck

region; and the lowest section, the cervix, extends downward from the isthmus until it

opens into the vagina. The uterus is 6 to 8 cm (2.4 to 3.1 inches) long; its wall

thickness is approximately 2 to 3 cm (0.8 to 1.2 inches). The width of the organ

varies; it is generally about 6 cm wide at the fundus and only half this distance at the
isthmus. The uterine cavity opens into the vaginal cavity, and the two make up what is

commonly known as the birth canal.

The uterus is divided into the cervix, isthmus and corpus. The cervix (neck) lies

subperitoneally and consists of a part projecting into the vagina (vaginal portion or

portio) and a part fixed in the parametrium (supravaginal portion). The cervical canal

has two orifices: the internal orifice to the isthmus and the external orifice to the

vagina. The isthmus is an about 1 cm long narrow passage connecting the cervix and

corpus. The corpus (body) lies intraperitoneally and has a “triangle” lumen through its

connection to the isthmus and both fallopian tubes. The base of the uterus is called

fundus.

In most women the corpus is bent forward against the cervix at the isthmus

(anteflexion) and the long axis of the uterus is inclined towards the vagina

(anteversion). The shape and size however may vary depending on age, number of

pregnancies and hormonal status.

The uterus is surrounded by the circumjacent connective tissue (parametrium).

The peritoneum covers the uterus almost completely (except the ventral part of the

cervix) forming two recesses: ventrally the vesicouterine pouch and dorsally

the rectouterine pouch (pouch of Douglas).

NEUROVASCULATURE

It is supplied by branches of the uterine arteries (branch of the internal iliac artery).

One branch travels within the broad ligament of the uterus until the region close to the

ovarian hilum, where it forms an anastomosis with the uterine branches of the ovarian

artery (branch of the abdominal aorta). The second branch supplies the cervix and
 anastomoses with several branches of the vaginal artery. The uterine artery also gives

several perforating branches within the uterine wall that form two surrounding

systems around the uterus called the posterior and anterior arcuate arteries. The

venous blood drains through the uterine venous plexus into the internal iliac vein.

The nerves derive from the inferior hypogastric plexus. Sympathetic innervation

originates from the T12 and L1 spinal segments, while the parasympathetic nervous

supply is provided by the S2 to S4 spinal segments. All vessels and nerves run

through the lateral ligaments (ligamentum latum uteri), a broad duplication of the

peritoneum connecting the lateral wall of the uterus with the pelvic wall.

LYMPHATICS

Lymphatic vessels drain lymph from the body and cervix of the uterus to the iliac

lymph nodes (external and internal), as well as the obturator lymph nodes. In turn, the

fundus is drained to the para-aortic lymph nodes.

2.1.3. HISTOLOGY OF THE UTERUS

The uterus has three layers: mucosa (endometrium), muscularis (myometrium) and

serosa/adventitia (perimetrium).

 The endometrium (uterine mucous membrane) is lined with simple columnar

epithelium (lamina epithelialis) and contains numerous tubular glands. It is followed by

a cell-rich connective tissue layer (lamina propria). There is a transition to squamous

non-keratinized epithelium at the portio (squamocolumnar junction). Physiologically

the endometrium is divided into the functional layer (stratum functionale) and basal

layer (stratum basale).
  The myometrium (uterine musculature) comprises a complex of three smooth

muscle layers which are microscopically difficult to separate (from the inside to the

outside):

 The subvascular layer is rather thin and mainly participates in the sealing of

the tubes and the separation of the endometrium during the menstrual cycle.

 The vascular layer is quite strong and well-perfused running around the

uterus like a net. It plays a major role during labor.

 The supravascular layer is again a thin sheet of crossing muscle fibers

stabilizing the uterine wall.

 The perimetrium equals the peritoneum and is surrounded by a thin connective tissue

layer (Tela subserosa). In peritoneal free areas there is no serosa but adventitia.

2.1.4. FUNCTIONS

The uterus plays an important role in human reproduction. It is the organ where

the implantation and nourishment of the fertilized ovum takes place. Furthermore it

helps pushing out the baby during birth through muscle contraction.

The uteruses of women in childbearing age underlie an about 28-day hormone-

controlled rhythm (menstrual cycle) which goes through three phases:

 During the menstrual phase (day 1 to 4) the spiral arteries in the endometrium

contract leading to an ischemia and sloughing of the functional layer (desquamation).

At the same time coagulation factors in the menstrual blood are decomposed in order

to avoid blood clotting. This phase is predominately controlled by oestrogen causing

painful contractions of the uterine musculature. A total blood loss during this phase is

about 80ml; more than that is considered abnormal (menorrhagia). 

  During the proliferative phase (day 5 to 14) the cells of the basal layer divide

rapidly leading to a fast regeneration of the epithelium, functional layer and spiral

arteries.

 The secretory phase (day 15 to 28) begins with the ovulation stopping the

proliferation and preparing an implantation of the ovum. It comes to an intracellular

accumulation of glycogen and a dilatation of the uterine lumen. The glands have a

saw-tooth-like shape and increasingly secrete nutrients. The endometrial stromal cells

resemble the decidua of the placenta (predecidual cells). The spiral arteries are

triggered to supply a possible placenta. If no fertilization occurs during the secretory

phase the spiral arteries contract and the cycle begins again.

2.2. DISEASE THEORY

2.2.1. UTERINE FIBROID

According to Mayoclinic (2022), uterine fibroids are a common type of noncancerous

tumour that can grow in and on your uterus. Not all fibroids cause symptoms, but

when they do, symptoms can include heavy menstrual bleeding, back pain, frequent

urination and pain during sex. Small fibroids often don’t need treatment, but larger

fibroids can be treated with medications or surgery.

Uterine fibroids (also called leiomyomas) are growths made up of the muscle and

connective tissue from the wall of the uterus. These growths are usually not cancerous

(benign). Your uterus is an upside down pear-shaped organ in your pelvis. The normal

size of your uterus is similar to a lemon. It’s also called the womb and it’s the place

where a baby grows and develops during pregnancy.

Fibroids can grow as a single nodule (one growth) or in a cluster. Fibroid clusters can

range in size from 1 mm to more than 20 cm (8 inches) in diameter or even larger. For
 comparison, they can get as large as the size of a watermelon. These growths can

develop within the wall of the uterus, inside the main cavity of the organ or even on

the outer surface. Fibroids can vary in size, number and location within and on your

uterus.

You may experience a variety of symptoms with uterine fibroids and these may not be

the same symptoms that another woman with fibroids will experience. Because of

how unique fibroids can be, your treatment plan will depend on your individual case.

2.2.2. TYPES OF FIBROIDS

According to Cleveland (2020), the type of fibroid a woman develops depends on its

location in or on the uterus.

 INTRAMURAL FIBROIDS

Intramural fibroids are the most common type of fibroid. These types appear within

the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch

your womb. These fibroids are embedded into the wall of the uterus itself.

 SUBSEROSAL FIBROIDS

Subserosal fibroids form on the outside of your uterus, which is called the serosa.

They may grow large enough to make your womb appear bigger on one side.

 PEDUNCULATED FIBROIDS

Subserosal tumors can develop a stem, a slender base that supports the tumour. When

they do, they’re known as pedunculated fibroids. The least common type, these

fibroids are also located on the outside of the uterus. However, pedunculated fibroids

are connected to the uterus with a thin stem. They’re often described as mushroom-

like because they have a stalk and then a much wider top.

 SUBMUCOSAL FIBROIDS
 These types of tumors develop in the middle muscle layer, or myometrium, of your

uterus. Submucosal tumors aren’t as common as the other types.

2.2.3. CAUSES OF UTERINE FIBROID

It’s unclear why fibroids develop, but several factors may influence their formation.

 HORMONES

Oestrogen and progesterone are the hormones produced by the ovaries. They cause

the uterine lining to regenerate during each menstrual cycle and may stimulate the

growth of fibroids.

 FAMILY HISTORY

Fibroids may run in the family. If your mother, sister, or grandmother has a history of

this condition, you may develop it as well.

 PREGNANCY

Pregnancy increases the production of oestrogen and progesterone in your body.

Fibroids may develop and grow rapidly while you’re pregnant.

2.2.4. RISK FACTORS

 Women are at greater risk for developing fibroids if they have one or more of the

following risk factors:

 Pregnancy

 a family history of fibroids

 age of 30 or older

 African-American

 a high body weight

2.2.5. PATHOPHYSIOLOGY OF UTERINE FIBROID

Uterine fibroids are a common type of noncancerous tumour that can grow in and on

your uterus. The causes of fibroids are not known. Most fibroids happen in women of

reproductive age. They typically aren’t seen in young women who haven’t had their

first period yet. Most fibroids do not cause any symptoms and don’t require treatment

other than regular observation and these are typically called small fibroids. When

you don’t experience symptoms, it’s called an asymptomatic fibroid. Larger fibroids

can cause you to experience a variety of symptoms, including: Excessive or painful

bleeding during your period (menstruation), Bleeding between your periods, A feeling

of fullness in your lower abdomen/bloating, frequent urination (this can happen when

a fibroid puts pressure on your bladder), Pain during sex, low back pain, constipation

and chronic vaginal discharge which could lead to

2.2.6. CLINICAL MANIFESTATION OF UTERINE FIBROID

Your symptoms will depend on the number of tumours you have as well as their

location and size. For instance, submucosal fibroids may cause heavy menstrual

bleeding and trouble conceiving.
 If your tumour is very small or you’re going through menopause, you may not have

any symptoms. Fibroids may shrink during and after menopause. This is because

women undergoing menopause are experiencing a drop in their levels of oestrogen

and progesterone, hormones that stimulate fibroid growth.

Symptoms of fibroids may include:

 heavy bleeding between or during your periods that includes blood clots

 pain in the pelvis or lower back

 increased menstrual cramping

 pain during intercourse

 menstruation that lasts longer than usual

 swelling or enlargement of the abdomen

 A feeling of fullness in your lower abdomen/bloating.

 Frequent urination (this can happen when a fibroid puts pressure on your bladder).

 Constipation.

 Chronic vaginal discharge.

 Inability to urinate or completely empty your bladder.

 Increased abdominal distention (enlargement), causing your abdomen to look

pregnant.

2.2.7. DIAGNOSIS

There are several tests that can be done to confirm fibroids and determine their size

and location. These tests can include:

 Ultrasonography: This non-invasive imaging test creates a picture of your internal

organs with sound waves. Depending on the size of the uterus, the ultrasound may be

performed by the transvaginal or transabdominal route.

  Magnetic resonance imaging (MRI): This test creates detailed images of your

internal organs by using magnets and radio waves.

 Computed tomography (CT): A CT scan uses X-ray images to make a detailed

image of your internal organs from several angles.

 Hysteroscopy: During a hysteroscopy, your provider will use a device called a scope

(a thin, flexible tube with a camera on the end) to look at fibroids inside your uterus.

The scope is passed through your vagina and cervix and then moved into your uterus.

 Hysterosalpingography (HSG): This is a detailed X-ray where a contrast material is

injected first and then X-rays of the uterus are taken. This is more often used in

women who are also undergoing infertility evaluation.

 Sonohysterography: In this imaging test, a small catheter is placed transvaginally

and saline is injected via the catheter into the uterine cavity. This extra fluid helps to

create a clearer image of your uterus than you would see during a standard ultrasound.

 Laparoscopy: During this test, your provider will make a small cut (incision) in your

lower abdomen. A thin and flexible tube with a camera on the end will be inserted to

look closely at your internal organs.

2.3 MANAGEMENT OF THE DISEASE CONDITION

2.3.1. MEDICAL MANAGEMENT

Treatment for uterine fibroids can vary depending on the size, number and location of

the fibroids, as well as what symptoms they’re causing. If you aren’t experiencing any

symptoms from your fibroids, you may not need treatment. Small fibroids can often

be left alone. Some women never experience any symptoms nor have any problems

associated with fibroids. Your fibroids will be monitored closely over time, but

there’s no need to take immediate action. Periodic pelvic exams and ultrasound may
 be recommended by your healthcare provider depending on the size or symptoms of

your fibroid. If you are experiencing symptoms from your fibroids — including

anaemia from the excess bleeding, moderate to severe pain, infertility issues or

urinary tract and bowel problems — treatment is usually needed to help. Your

treatment plan will depend on a few factors, including:

 How many fibroids you have.

 The size of your fibroids.

 Where your fibroids are located.

 What symptoms you are experiencing related to the fibroids.

 Your desire for pregnancy.

 Your desire for uterine preservation.

The best treatment option for you will also depend on your future fertility goals. If

you want to have children in the future, some treatment options may not be an option

for you.

MEDICATIONS

 Over-the-counter (OTC) pain medications: These medications can be used to

manage discomforts and pain caused by the fibroids. OTC medications include

acetaminophen and ibuprofen.

 Iron supplements: If you have anaemia from the excess bleeding, your provider may

also suggest you take an iron supplement.

 Birth control: Birth control can also be used to help with symptoms of fibroids —

specifically heavy bleeding during and between periods and menstrual cramps. Birth

control can be used to help control heavy menstrual bleeding. There are a variety of

birth control options you can use, including oral contraceptive pills, intravaginal

contraception, injections and intrauterine devices (IUDs).

  Gonadotropin-releasing hormone (GnRH) agonists: These medications can be

taken via a nasal spray or injection and they work by shrinking your fibroids. They’re

sometimes used to shrink a fibroid before surgery, making it easier to remove the

fibroid. However, these medications are temporary and if you stop taking them, the

fibroids can grow back.

 Oral therapies: Elagolix is a new oral therapy indicated for the management of heavy

uterine bleeding in premenopausal women with symptomatic uterine fibroids. It can

be used up to 24 months. Talk to your doctor for pros and cons of this therapy.

Another oral therapy, Tranexamic acid, is an antifibrinolytic oral drug that’s indicated

for the treatment of cyclic heavy menstrual bleeding in women with uterine fibroids.

Your doctor will monitor you during this therapy.

2.3.2. SURGICAL MANAGEMENT

There are several factors to consider when talking about the different types of surgery

for fibroid removal. Not only can the size, location and number of fibroids influence

the type of surgery, but your wishes for future pregnancies can also be an important

factor when developing a treatment plan. Some surgical options preserve the uterus

and allow you to become pregnant in the future, while other options can either

damage or remove the uterus.

 Myomectomy: is a procedure that allows your provider to remove the fibroids

without damaging the uterus. There are several types of myomectomy. The type of

procedure that may work best for you will depend on where your fibroids are located,

how big they are and the number of fibroids. The types of myomectomy procedure to

remove fibroids can include:

  Hysteroscopy: This procedure is done by inserting a scope (a thin, flexible

tube-like tool) through the vagina and cervix and into the uterus. No incisions

are made during this procedure. During the procedure, you provider will use

the scope to cut away the fibroids. Your provider will then remove the

fibroids.

 Laparoscopy: In this procedure, your provider will use a scope to remove the

fibroids. Unlike the hysteroscopy, this procedure involves placing a few small

incisions in your abdomen. This is how the scope will enter and exit your

body. This procedure can also be accomplished with the assistance of a robot.

 Laparotomy: During this procedure, an incision is made in your abdomen and

the fibroids are removed through this one larger cut.

If you aren’t planning future pregnancies, there are additional surgical options your

healthcare provider may recommend. These options are not recommended if

pregnancy is desired and there are surgical approaches that remove the uterus. These

surgeries can be very effective, but they typically prevent future pregnancies.

Surgeries to remove fibroids can include:

 Hysterectomy: During this surgery, your uterus is removed. A hysterectomy

is the only way to cure fibroids. By removing your uterus completely, the

fibroids can’t come back and your symptoms should go away. If your uterus

alone is removed — the ovaries are left in place — you will not go into

menopause after a hysterectomy. This procedure might be recommended if

you’re experiencing very heavy bleeding from your fibroids or if you have

large fibroids. When recommended, the most minimally invasive procedure to

perform hysteroscopy is advisable. Minimally invasive procedures include

vaginal, laparoscopic or robotic approaches.

  Uterine fibroid embolization: This procedure is performed by an

interventional radiologist who works with your gynaecologist. A small

catheter is placed in the uterine artery or radial artery and small particles are

used to block the flow of blood from the uterine artery to the fibroids. Loss of

blood flow shrinks the fibroids — improving your symptoms.

 Radiofrequency ablation (RFA): This is a safe and effective treatment for

women with symptomatic uterine fibroids and can be delivered by

laparoscopic, transvaginal or transcervical approaches.

There’s also a newer procedure called magnetic resonance imaging (MRI)-guided

focused ultrasound that can be used to treat fibroids. This technique is actually done

while you’re inside a MRI machine. You are placed inside the machine — which

allows your provider to have a clear view of the fibroids — and then an ultrasound is

used to send targeted sound waves at the fibroids. This damages the fibroids.

2.3.3. NURSING MANAGEMENT

The objectives of my nursing management are as follows

 To allay any form of anxiety and make the patient comfortable as she gets use to his

new environment.

 To teach patient how to care for himself and avoid over-dependence.

 To prevent complication.

 To aid quick recovery.

Nursing Management processes involved;

 Admission: patient was highly welcomed into the ward and shown the neatly dressed

bed.

 History taking- history of past and present illness.

  Physical examination- to detect if there is oedema, skin discoloration.

Pre-operative Phase

 Psychological Preparation: patient is likely to develop fear and anxiety because of

the surgery she is to undergo due to knowledge deficit. The client should be reassured

and essential facts of the operation should be explained to the patient and she should

also be given time to ask questions and appropriate answers should be given.

 Physical preparation which involves nutrition, fluid and electrolytes to ensure that

the client is not dehydrated.

 Patient should be properly shaved and clean: the thighs perineum and pubic

regions was shaved.

 Respiration exercise: the patient should be taught deep breathing exercise before the

operation. This is done to prevent development of post-operative pneumonia.

 Patient should be instructed to commence (NPO) nil per oral the evening or night

before the surgery.

 Mouth and oral care.

 Patient should be properly dressed with the operating hospital gown.

 Patient vital signs were monitored and charted.

 Patient was instructed to remove any jewellery, (rings and dentures of any).

 Informed consent should be properly signed.

 Laboratory and diagnostic findings should also be available.

Post-operative Nursing Management

 Preparations to receive the patient on a neatly dressed post-operative bed with all

necessary accessories such as drip stand, suction machine and oxygen ready by the

side of the bed.

  While receiving the patient from the theatre, observe patient’s pulse and respiration.

 On reaching the ward, place patient in a supine position with head turn to one side to

drain secretions.

 Check if the airway is patent.

 Observation: immediately the patient is received, checks patient’s vital signs and

record responds to stimuli, surgery site is observed for bleeding.

 Check for immediate post-operative orders and carry out immediately.

 Oral care, bed bath and care of pressure areas.

 Prescribed post-operative drugs were served.

 All necessary tubing and catheters should be fixed.

 Patient closely monitored.

 Monitor patient input and output chart.

 Encourage deep breathing exercise.

2.4. PHARMACOLOGY OF DRUGS USED

The following drugs were used;

 Augumentin

 Metronidazole (Flagyl)

 Nifedipine

 Aldomet

 Pentazocin

1. AUGUMENTIN

Group: It is a broad-spectrum Antibiotic

Mode of Action: It is a semi-synthetic penicillin which inhibits the synthesis of

bacterial cell wall.

 Indications: Upper respiratory tract infections (e.g. tonsillitis, sinusitis), Lower

respiratory tract infections (e.g. Bronchopneumonia), Genitourinary tract infections,

skin and soft tissue infections, bone and joint infections (e.g. Osteomyelitis). Others

include Septic abortions, puerperal sepsis, Otitis media.

Dosage:

 Adult and children over 12years = a tablet of 375mg thrice daily or a tablet of 625mg

twice daily

 Children (2 – 6years) = 5ml Augumentin syrup (i.e. 228mg/5ml twice dly), (7 -12

years = 10mls Augumentin syrup (i.e. 228mg/5ml twice dly).

Route of administration: Orally

Side effects: Mucocutaneous candidiasis, Anaphylaxis, Leucopenia,

thrombocytopenia, prolonged bleeding and clotting time, Angioneurotic oedema,

Hypersensitivity, Diarrhoea, Nausea and Vomitting.

Contraindications: History of Hypersensitivity, history of Augumentin – associated

jaundice or hepatic dysfunction, pregnancy.

Nursing Responsibilities:

 Before administration of Augumentin, enquire about previous hypersensitivity

reactions to penicillin, cephalosporins or other allergens.

 Patient on contraceptives should be warned, since Augumentin reduces the efficacy of

oral contraceptives.

2. Metronidazole (Flagyl)

Group: It is an Anti-amoebic or Anti-microbial or Anti-protozoal or anti-trichomonal

drug.
 Mode of Action: It is a synthetic derivative of Imidazole group helping to alter the

biosynthesis of cell wall of the protozoon or microbe thereby altering cell

permeability with loss of intracellular constituents.

Indications: Amoebic dysentery, Liver abscess, Vaginal and urethral Trichomoniasis,

Ulcerative gingivitis, Giardiasis, Appendicitis, Septic Abortion, Diverticulitis, Dento-

alveolar abscesses, Non-specific vaginitis, pre and post operatively.

Dosage:

 Adult and children over 10years = 400 – 800mg 3times dly for 5days for invasive

intestinal Amoebiasis or 200mg 3times dly for 7days for Giardiasis or 200mg 3times

dly for 7days for Trichomoniasis and to be taken by both partners (husband and wife)

 Children (2 – 12months) = ½ teaspoonful 4times dly for 2-5 days. (1 – 5 years) = one

teaspoonful 4times daily for 2 – 5days. (5 – 12 years) = 2 teaspoonfuls 4 times for 2 –

5 days.

Route of administration: Orally, suppositorily, intravenously

Side effects: Gastrointestinal disturbances, unpleasant taste, Hypersensitivity

reactions, Urticaria, drowsiness, dizziness, headache, rashes, darkening of urine,

peripheral neuropathy, epileptiform seizures, reversible leucopenia.

Contraindications: CNS diseases, blood dyscrasias, pregnancy, known

hypersensitivity reaction, Hepatic encephalopathy

Nursing Responsibilities:

 Not to be administered to pregnant, Lactating mothers

 Patients with known hypersensitivity reactions, Hepatic encephalopathy and Central

Nervous System disease

 Intake of Alcohol is to be avoided within 24hrs of Flagyl intake because it may

produce Disulfiram – like reaction

3. Nifedipine (Nifecard, Adalat Retard, Procardia)

Group: It is a vasodialator, Antihypertensive and Calcium ion antagonist.

Mode of Action:

 It dilates the arteries causing a reduction in peripheral vascular resistance and

therefore decreasing arterial blood pressure.

 It dilates the main coronary arteries and arterioles both in the normal and ischaemic

myocardial regions, thereby inhibiting coronary artery spasm

 It is a potent inhibitor of coronary artery spasm.

Indications: Arterial hypertension, coronary diseases, stable angina pectoris, vaso-

spastic Angia pectoris

Dosage:

 Initial 30mg or 60mg once daily to each patient’s need.

Route of administration: Orally

Side effects: Peripheral oedema, Headache, flushing, heat sensation, dizziness,

fatigue, constipation, nausea, retrosternal pain, lethargy, hypotension, syncope,

palpitation, diarrhoea, cramps in upper and lower extremities.

Contraindications: Arterial hypotension, severe aortic valve stenosis, obstructive

cardiomyopathy, porphyria, hypersensitivity reaction.

Nursing Responsibilities:

 Should not be used in cardiogenic shock, angina pectoris at rest because it may

precipitate myocardial infection.

 It should be used with caution in patients with congestive heart failure, liver

insufficiency, and diabetes

  Since patients who have severe obstructive coronary disease may develop (though

rarely) increased frequency, severity and duration of angina pectoris attack after

ingestion of Nifedipine, treatment should then be stopped

 Nifedipine tablet should be swallowed whole and should not be divided, crushed or

bitten

 It should be decreased gradually, if discontinuation is necessary.

 Avoid grapefruit juice which may affect metabolism

4. METHYLDOPA (Aldomet)

Group: It is a centrally acting Antihypertensive and Vasodilator drug.

Mode of Action:

 It blocks Renin release, and interferes with synthesis and release of Norepinephrine

(Noradrenaline) thereby helping to reduce the peripheral vascular resistance and

lowering the blood pressure.

Indications: Moderate to severe Hypertension

Dosage: Initial 250mg 2-3 times daily, increase gradually at intervals of at least 2

days. Maximum dose is 3gm daily. Elderly initial dose is 125mg twice daily,

increased gradually to a maximum of 2gm daily

Route of administration: Orally

Side effects: Orthostatic hypotension, dizziness, malaise, impotence, Dry mouth,

diarrhoea, Bradycardia, Haemolytic anaemia, decreased libido, possible transient

sedation, nightmare, stomatitis, bradycardia, oedema, headache, asthenia, myalgia,

arthralgia, mild psychosis, depression, paraesthenia, hypersensitivity reaction,

Hepatitis, Jaundice, Nasal congestion, impotence, failure of ejaculation.

Contraindications: Acute hepatic disease, porphyria, hypersensitivity reaction,

phaeochromocytoma, Depression
 Nursing Responsibilities:

 Monitor the patient’s vital signs especially pulse and blood pressure

 Watch for any of the side effects of Methyldopa

 Do not administer to groups of people mentioned under contraindications’ above

5. Pentazocin

Group: It is a Non-Narcotic Analgesics

Mode of Action:

 It has an anaesthetic or depressive effect on the sensory nerve cells and sensory centre

in the brain causing a sedative or drowsy effect with reduced pain and discomfort

 It is a partial agonist of opioid receptors.

Indications: for relief of all types and degrees of pain in acute and chronic disorders

either associated with Surgery, Trauma, Burns, Colic, Cancer, in acute labour and as

Pre-anaesthetic medications

Dosage: Adult = 30 – 60mg intramuscularly or 30mg intravenously may be repeated

3 – 4hours later or 50 – 100mg (2 – 4 tablets) every 3 – 4hrs. Doses in excess of 30mg

intravenously or 60mg intramuscularly or subcutaneously are not recommended.

Maximum daily dose is 360mg. Dosage should not exceed 600mg. patient in labour is

30mg intramuscularly when contractions become regular and may be given once to

3times at 2 – 3 hours intervals or 20mg intravenously in maximum of 2 – 3 doses.

Tablet = 25 – 100mg repeated when necessary reaching a maximum of 600mg daily.

Route of administration: Orally, Intramuscularly, Intravenously, subcutaneously.

Side effects: Dizziness, Nervousness, Nausea, Euphoria, vomiting, hallucination,

respiratory and circulatory depression, rarely diarrhoea, facial oedema, vomiting,

headache, hypertension.
 Contraindications: hypersensitivity reaction, children under 12yrs, Head injury,

pregnancy, High alcohol intake, concurrent Narcotic use, impaired renal and hepatic

function, hypertension, myocardial infarction.

Nursing Responsibilities:

 Ambulatory patients should be warned not to operate machinery or drive car or

unnecessary exposure to hazards.

 To be used with caution in patients with head injury, raised increase intracranial

pressure, depressed respiration.

 Patient to avoid movement for 15mins after receiving the drug parentherally.

 Alcohol and Barbiturates anaesthetics should not be used with Pentazocine, since they

may increase the respiratory and CNS depressant effects of Pentazocine.

2.5. COMPLICATIONS

Although uterine fibroids usually aren't dangerous, they can cause discomfort and

may lead to complications such as a drop in red blood cells (anemia), which causes

fatigue, from heavy blood loss. Rarely, a transfusion is needed due to blood loss.

Complications can arise from the location of the fibroids. These complications range

from intermittent bleedings to continuous bleeding over weeks, from single pain

episodes to severe menorrhagia and chronic abdominal pain with intermittent spasms,

from dysuria and constipation to chronic bladder and bowel spasms and even to

peritonitis. Infertility may be the result of continuous metro and menorrhagia, leading

to chronic infection and uterine spasms up to nonimplantation. Possible complications

resulting from treatment of these disorders are haemorrhages, infection, adhesions,

and secondary pain resulting from the treatment efforts.

 CHAPTER THREE

NURSING PROCESS

3.0 ASSESSMENT

3.1. PATIENT’S INFORMATION

Name: Mrs. A. G.

Age: 37years

Date of Birth: 29-04-1985

Sex: Female

Nationality: Nationality

Home Address: No. 31, Gbessa ville, Airport Road, Abuja

Marital Status: Married

Religion: Christianity

Occupation: Flight dispatcher

Next of Kin: Mr. I. A

Diagnosis: Uterine Fibroid

Hospital Number: 102 – 65 – 89

Ward: Gynae Ward

Bed no: 6

Date of Admission: 13 – 4 – 2022

Date of Discharge: 30 – 04 – 2022

Consultant: Dr. Mustapha.

3.2. HISTORY OF PAST ILLNESS

Patient has not been admitted in the University of Abuja Teaching Hospital on

account of this illness or any other disease condition and there’s a family history of

similar illness (in her mother). Prior to this illness, patient goes about doing his daily

activities normally. No history of drinking or smoking. Surgical – no past history of

surgery

Vital signs on admission

b/p: 110/70mmHg

PR: 80bpm

RR: 18cpm

3.3. HISTORY OF PRESENT ILLNESS

A 36 year old nulliparous presented to University of Abuja Teaching Hospital on

account of abdominal swelling which started about four years ago and inability to

conceive for 2 years.

She was apparently normal until 4 years ago when she first noticed a cherry sized

mass at her lower abdomen just below the navel mass was described to be firm,

movable and not attached to the overlying skin or underlying organs and was

described to have progressively increased in size up to its current size. Mass was

associated with Lower Abdominal pain at the pelvic region, pain is dull aching,

insidious in onset and occur intermittently graded 5/10 on seventy scale, pain does not

radiate to any other part of the body. There are no histories of weight loss, chronic

cough or drench night sweat, no history of bone pain, jaundice. No history of swelling

on any other part of the body.

 There has been a notable increase in the frequency of her urination at night to as much

as 5 times at night. She also experiences highly sensation of the region of her thighs

and feets.

Inability to conceive was noticed about 2 years after onset of abdominal swelling

when she got married to her husband with whom she lives with and had regular

unprotected coitus with him. She has had a regular menstrual cycle pattern of 3 days

in a 25day cycle but there’s a significant increase in the volume of bleeding from her

previous normal evidenced by her need to change pads frequently and sometimes

support her pads with tissue paper.

No history of contraceptive use, no history of trauma or irradiation to pelvic organs.

She’s married in a monogamous setting to her husband who hasn’t fathered a child

before.

Since onset of symptoms, she has had an abdominopelvic scan done with findings of

uterine myomas, she experienced menarche at age 13 and had a normal blood flow of

3 days in a 25days interval.

She was eventually admitted to Gynaecological ward on the 13 th of April, 2022 and

was booked for surgery on the 21st of April, 2022 for myomectomy surgery.

3.4. SOCIAL HISTORY OF PATIENT

Mrs. A.G is an extrovert; she interacts well with people and has a lot of friends.

 Activity/Exercise: client does not engage in any form of exercise but when stressed

up, she moves round the house to ease off the stress.

 Nutrition: client eats well, eats three times a day, eats a well-balanced diet when she

can afford it and drinks lot of water.

  Sleep/Rest: client sleeps very well during the day and night, and rest by lying down

and listening to music and inspirational talk when tensed up and a bit moody, and

sleeps off sometimes but does not have any problem in continuing or initiating sleep.

 Communication: all his five senses are intact and she communicates well in English,

and Igbo.

 Family/Social relationship: client relates well with his family members and friends.

 Sexuality/Reproduction: sexually active.

 Self-image: she feels good about herself

 Elimination: she evacuates his bowel once daily and empties his bladder when

necessary.

 Belief: she believes in God

3.5. INVESTIGATION AND OBSERVATION

Observation

After the surgery, surgery site was observed and examined for swelling, bleeding etc;

the stitches were still intact and surgery site was neatly closed, urethral catheter in situ

draining a clear amber color of urine.

Investigation

The following investigations were carried out;

 PCV: packed cell volume -39%

 FBC: full blood count

 Hepatitis A and Hepatitis B negative

 HIV: negative

 Abdominopelvic Scan
3.5. NURSING DIAGNOSIS

Pre-operative phase

 Anxiety related to diagnosis and unknown outcome of treatment evidence by facial

expression and frequent questioning.

Objectives: to allay patient’s anxiety and allow patient to exhibit signs of relaxation

within 24hours of nursing intervention.

Action

a. Assess the patient’s level of anxiety.

b. Establish good rapport with the patient.

c. Explain the surgical/situation and surgical procedure to the patient.

d. Introduce patient to other similar conditions that have recovered well.

e. Engage patient in discussion and allow patient to feel free to verbalize his fear.

Post-operative phase

 Pain (Acute) related to open wounds evidenced by patient’s facial expression and

verbalization.

Objectives- patient will verbalize less pain within 40mins to 45mins of nursing

intervention.

Action

 Reassure patient

 Assess the level of the patient

 Put the patient in a supine position

 Give diversion therapy

  Elevation of the operation site

 Serve prescribe analgesic e.g. pentazocine 30mg TDS×24hours

 Risk of infection related to open wound.

Objective- patient will not show any sign of infection e.g. redness, swelling, fever,

pain, throughout hospitalization.

Action

a. Maintain aseptic technique particularly during wound dressing.

b. Ensure bed lines and clothing are clean and dry.

c. Monitor vital signs closely.

d. Educate patients and relatives on the importance of personal hygiene.

e. Encourage patient on good diet e.g. food rich in protein.

f. Served prescribed antibiotics e.g. metronidazole.

Evaluation Phase

i. Anxiety- patient’s anxiety was allayed and hoped for a good prognosis of the

disease condition after 24hours of nursing intervention.

ii. Patient verbalizes less pain after 2hours of nursing intervention.

iii. Patient did not show any sign of infection throughout hospitalization.
 CARE PLAN FOR MRS. A.G WITH A DIAGNOSIS OF UTERINE FIBROID

S/N DIAGNOSI OBJECTIVE ACTION SCIENTIFIC EVALUATI

S RATIONALE
ON

1. Anxiety To allay i. Assess the level of i. It serves as self- Anxiety level

related to patient’s anxiety anxiety. confident to the was allayed
diagnosis and and allow the patient and brings within 13hrs
unknown patient to interaction of nursing
outcome of exhibit sign of between nurse and intervention
treatment relaxation patient.
evidenced by within 24hours
facial of nursing ii. It broadens
ii. Establish a good patient knowledge
expression intervention.
rapport. Explain the about the
and frequent
condition to the patient. condition and
questioning.
allow him to
clarify those
question.

2. Acute pain Patient will i. Reassure the a. To calm the Patient

related to verbalize less patient. patient, to help the verbalized less
surgical pain within ii. Assess the level of patient to relax pain after
operation 40minutes of pain. and take away his 35mins of
evidenced by nursing iii. Give diversion mind from the nursing
patient’s intervention. therapy. problem. intervention
facial iv. Elevate the b. Elevation and
expression operated area. position helps to
and frequent v. Served prescribed relieve pain from
questioning. analgesics. the affected part
and encourage
blood circulation,
to reduce pain and
sensation.
3. Risk of Patient will not i. Maintain aseptic a. Help to reduce Patient did
infection show any sign technique the occurrence of not show any
related surgical of infection e.g. ii. Monitor and report the infection. sign of
incision fever, pain, elevated white blood b. It helps to infection
redness, cell count and identify signs of throughout
swelling monitor vital signs. infection and her stay in
throughout the iii. Ensure bed illness permit early the hospital
period of and clothing are dry medical
hospitalization. intervention.
c. To avoid the
entrance of
micro-organisms
from the bed
linens to the
wound.
 CHAPTER FOUR

4.1. SUMMARY

Mrs. A.G. was admitted on the 13th day of April, 2022 with the diagnosis of Uterine

Fibroid which initially started with a cherry sized mass at her lower abdomen just

below her navel. Mass was described to be firm, movable and not attached to the

overlying skin or underlying organs and was described to have progressively

increased in size up to its current size.

Abdomiopelvic scan was done with findings of Uterine Myomas. The client was

taken in for surgery for myomectomy to remove myomas tumors. Client first reported

to the university of Abuja teaching hospital on the 10th day of April, 2022 where she

was seen by the gynaecologist and then referred to gynae ward where after been seen

was admitted on the 13th of April, 2022.

From the process of admission till the surgery and after the surgery, patient was

adequately cared for both by the nurses and medical doctors. Due medications were

served daily and wound dressing done and after some inspection of wound and

viewed by the doctor (Dr. Mustapha) patient was discharged on the 30th of April,

2022. Client went home feeling better and satisfied.

4.2. CONCLUSION

In studying this case much was learnt about the disease condition, its features, causes,

management and complications. Uterine fibroids are a common type of noncancerous

tumour that can grow in and on your uterus. They are three major types; Submucosal

fibroids, Intramural firoids, subserosal fibroid, pendunculated fibroids, the cause is

unknown but there are some predisposing factors such as, Obesity and a higher body
 weight (a person is considered obese if they’re more than 20% over the healthy body

weight), family history of fibroids, not having children, early onset of menstruation

(getting your period at a young age), late age for menopause.

Some sign of this disease condition includes; Excessive or painful bleeding during

your period (menstruation), bleeding between your periods, a feeling of fullness in

your lower abdomen/bloating, frequent urination (this can happen when a fibroid puts

pressure on your bladder), pain during sex, low back pain. The management is mainly

through surgery and through medications.

Some complications can arise if not detected early enough and treated properly. The

prognosis is excellent.

4.3. RECOMMENDATION

Having studied this case the following objectives which were stated in chapter one

were met, which are as follows:

 To learn and know more about uterine fibroid, the causes and methods of prevention.

 To acquire skills and knowledge on how to manage a patient with the disease

condition.

 To give health education to individual on how to prevent the disease condition.

 To give a comprehensive nursing care to the patient and prevent possible

complications.

4.4. ADVICE ON DISCHARGE

 Mrs. A. G. was advised on good nutritional diet with enough fluid and fruit

 She was advised to avoid lifting heavy weight objects

 Ensure personal and environmental hygiene

 She was encouraged to come for follow-up and check up.

 BIBLIOGRAPHY

Mustapha R. O 2012 pharmacology for all health professional 3 rd edition, Adewunmi printing

press Ilorin, Kwara State.

What Are Uterine Fibroids? Symptoms, Treatment, Pictures https://www.onhealth.com  ›

content › uterine_fibroids

Google images

Cleveland Clinic medical professional last reviewed on 24/08/2020.

Https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids

Uterine Fibroids care at Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/uterine-

fibroids/symptoms-causes/syc.