Disaster Nursing

University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV
Endometrial Polyps: A Case Presentation
Submitted by:
Cristobal, Stacey Valerie Eve
Roldan, Zyrin Elleid
Saribay, Crismae
Alcabedos, Hydie Mae
Dancel, Angelica Kaye
Mallo, Colin Joy
Eleydo, Alisoldy Ceasar Reno
Submitted to:
Mrs. Taytana Tulauan, RN, MSN
Mrs. Demee Alyemma Iquin, RN
Mr. Michael Goze, RN, MSN
Mr. Christian Joy Tiu, RN
March 2023
Uterine Polyps I 1
Table of Contents
Title Page
Title Page ------------------------------------- 1
Table of Contents ------------------------------------- 2
Objectives ------------------------------------- 3
INTRODUCTION
Disease Description ------------------------------------ 4

Disease Statistics ------------------------------------ 5
Predisposing and Precipitating Factors ------------------------------------- 7

Complications ------------------------------------- 10
Diagnostics ------------------------------------- 11
Signs and Symptoms ------------------------------------- 9
Treatment and Management ------------------------------------- 15
PATIENT’S PROFILE
Patient Information ------------------------------------- 17
NURSING HISTORY ------------------------------------- 18
GORDON’S 11 FUNCTIONAL PATTERNS ------------------------------------- 21
PHYSICAL ASSESSMENT ------------------------------------- 27
ANATOMY AND PHYSIOLOGY ------------------------------------- 40
PATHOPHYSIOLOGY ------------------------------------- 44
COURSE IN THE WARD ------------------------------------- 47
LABORATORY AND DIAGNOSTICS ------------------------------------- 57
NURSING CARE PLAN ------------------------------------- 60
DRUG STUDY ------------------------------------- 74
DISCHARGE PLAN -------------------------------------- 86
REFERENCES ------------------------------------- 87
Uterine Polyps I 2
OBJECTIVES
This case presentation aims to provide a thorough understanding of
Endometrial Polyps, learn more about the condition, and better understand the
patient's situation.
Furthermore, this paper also aims to:
• Provide a comprehensive knowledge and understanding of Endometrial Polyps.

• Understand the pathophysiology and recognize the contributing risk factors
leading to Endometrial Polyps.
• Provide statistics on the prevalence of the disease.
• Identify, define, and elaborate on the holistic functioning of the patient
using Gordon's 11 Functional Health Patterns to understand better the
patient's current condition about his illness.
• Present the anatomy and physiology of the female reproductive sytem.
• Trace and explain the pathophysiology of Endometrial Polyps based on
the sign and symptoms manifested by the patient.
• Formulate and present specific, measurable, attainable, realistic, and time-
bound nursing care plan for the patient.
• Determine and discuss the objective of the drugs prescribed to the patient,
as well as their action, side effects, and nursing obligations.
Uterine Polyps I 3
INTRODUCTION
Disease Description
Polyps are tissue growths that resemble small, flat bumps or tiny mushroom-like stalks.
Most polyps are small and less than half an inch wide. In addition, some polyps are benign, but
some can be malignant because of abnormal cell growth growing through rapidly dividing cells.
Polyps can develop in the ear canal, cervix, stomach, nose, and throat. However, the most
common is in the colon, and in this paper’s case, in the uterine.
Focusing on this paper’s case, Uterine or Endometrial Polyps are abnormal growth-
containing glands, stroma, and blood vessels projecting from the lining of the uterus
(endometrium) that occupies spaces small or large enough to fill the uterine cavity. Unlike other
etiologies, most endometrial polyps are neither malignant nor premalignant. However, an
increased risk of malignancy occurs in selected patients (e.g., bleeding, postmenopausal,
hereditary cancer syndrome, tamoxifen use).
Dwelling more on the size, endometrial polyps that are 5 millimeters to less than 10
millimeters are considered benign while polyps that measure more than 10 millimeters are
associated with an increased incidence of malignancy. Lastly, polyps more than 15 millimeters
are incorporated with endometrial hyperplasia, or the condition in which the lining of the uterus
grows too thick. Moreover, larger polyps are also associated with abnormal vaginal bleeding.
As stated above, uterine polyps can arise everywhere in the uterine cavity. Still, the most
common is in the posterior wall of the uterine cavity, followed by the anterior, lateral, and
uterotubal junction. In addition, there was a reported incidence of endometrial polyps embedded
in the fetal membrane. Withal, single, or multiple polyps may occur and range in diameter from a
few millimeters to several centimeters, strengthening the statement that polyps can develop
anywhere in the endometrial cavity.
Moreover, if an endometrial polyp is attached to the uterine surface by a narrow, elongated
pedicle, it is known as pedunculated. However, they are known as sessile if it has a large flat base
and the absence of a stalk. Its gross morphological appearance is smooth, spherical, or cylindrical
in structure and is tan to yellow.
Many endometrial polyps are asymptomatic. Most often, a symptomatic uterine polyp can
cause stopping or bleeding at irregular intervals-either intermenstrual bleeding (in between
periods), or metrorrhagia (irregularity of the periods). Bleeding can also ensue following sexual
intercourse, called postcoital bleeding. Also, endometrial polyps are one of the most common
etiologies of abnormal genital tract bleeding in premenopausal and postmenopausal patients.
In addition, as most endometrial polyps are considered benign, they are believed to still
contribute to infertility because they make it more difficult for the fertilized egg to attach to the
uterine walls. They block the sperm from entering the uterus. Thus, they stop the sperm from
joining with an egg.
Furthermore, to avoid confusion, endometrial polyps are linked to uterine fibroids; although
they grow into the uterus, and it is possible to have both of them simultaneously, their structure
differs. Uterine fibroids are made of thick, smooth muscle tissues originating from the uterine
wall's muscular middle layer called the myometrium. Therefore, it can protrude outwards towards
the outer serosal layer on inwards towards the inner endometrial layer. While uterine polyps, as
stated above, are made from endometrial tissue and are always located within the uterine cavity,
with the fundus of the uterus as its common site. Furthermore, polyps are more dangerous than
uterine fibroids as they lead to serious health issues, including vaginal bleeding, bladder issues,
abnormal menstruation, and even cancer.
Uterine Polyps I 4
Disease Statistics
International Statistics
The peak incidence of endometrial polyps occurs between the age of 40 to 49 years old
and rarely affects people under 20 years old. Although uterine polyps are considered benign,
there is a small risk of malignant transformation. The odds of a uterine polyp becoming cancerous
are low. In premenopausal women, the risk of the polyp becoming cancerous is 1-2%, with less
than six percent of abnormal uterine bleeding than in postmenopausal, and in women who have
gone through menopause, the risk of uterine polyp becoming cancerous is 5-6% with an increased
risk for abnormal uterine bleeding.
Source: National Library of Medicine, (2019).

The exact prevalence of endometrial polyps is unknown. It is reported that 82% of the
women who had histopathology-verified polyps were asymptomatic.
Nevertheless, endometrial polyps have been implicated in about 50% of cases of
abnormal uterine bleeding and 35% of infertility.
Source: National Library of Medicine

Endometrial polyps have been associated with infertility; the incidence of this disease in
primary infertility is 3.8%–38.5% and 1.8%–17% in secondary infertility. It has a combined
infertility incidence of 1.9%–24%.
Uterine Polyps I 5
Local Statistics
Source: Department of Obstetrics and Gynecology, Dr. Jose Fabella Memorial Hospital ,(2017)
According to the study from the Department of Obstetrics and Gynecology, findings
showed that in the total of seventy-three patients with an intrauterine disease with endometrial
pathology in Dr. Jose Fabella Memorial Hospital, the top three histopathologic diagnoses are
endometrial polyp 41 cases (46.2%), proliferative endometrium 9 cases (12.3%), and simple
hyperplasia without atypia 8 cases (11.0%). The age of the subjects was significantly associated
with the histopathologic findings of benignancy or malignancy. At 40-49 years old, a substantially
higher proportion of subjects with benign lesions and 60 years and above had a predominance of
malignancy.
No data was available from the Department of Health Region II.
Uterine Polyps I 6
Risk Factors
(The patient manifests words that are italicized)
Predisposing Factors
Being Perimenopausal. The most common contributing factor to uterine polyps growth
is hormonal imbalance and significantly elevated estrogen levels. During perimenopause, women
can skip ovulating, which prevents progesterone from being produced, and without it, the woman
may have unopposed estrogen. Estrogen is a growth hormone, and without progesterone being
available to put on the breaks, it can produce problematic growths such as polyps.
Perimenopause can begin in some women in their thirties but most often starts in women
ages 40-44.
Hypertension. Hypertension was found as a significant risk factor for the development of
endometrial polyps. Despite the unknown etiology of this relationship, it’s remarkable that
hypertension prevalence is higher in patients with endometrial polyps.
Diabetes. Multiple resources state diabetes is an independent risk for endometrial polyps.
Yet, some clinical journals state that diabetes was not an independent risk factor in developing
endometrial polyps; however, larger polyps were seen in diabetic patients compared to non-
diabetics.
Family History. Patients may be at increased risk if they have a family history of polyps
or an inherited genetic syndrome or mutation. This is because genetic factors may also play a
role in developing excess estrogen as well. Estrogen plays a role in causing the endometrium to
thicken each month during your menstrual cycle. This thickening likely contributes to uterine polyp
growth.
Precipitating Factors
Obesity. As fat mass increases in obesity, aromatase expression also increases, and
estrogen levels are elevated. On the other hand, females who are obese have been shown to
have luteal progesterone levels approximately 75%-80% lower than those of normal-weight
women. Subsequently, having high estrogen and low progesterone leads to a higher risk of
developing endometrial polyps.
Use of Tamoxifen. Tamoxifen is primarily used to lower the risk of early breast cancer
from recurring after surgery or the development of the other breast. It can control advanced breast
cancer for some time. Unfortunately, Tamoxifen has pro-estrogenic effects on the endometrium,
causing an increased prevalence of endometrial changes, including hyperplasia, carcinoma, and
polyps.
Use of Hormone Replacement Therapy (HRT) for Postmenopausal Symptoms. Post

Menopause is the time after a woman has gone through menopause for longer than 12
consecutive months. At this stage, the female reproductive years are behind and no longer
ovulating. Thus, the hormone levels will remain low, resulting in the permanent loss of the monthly
period. Due to the ovaries no longer producing high levels of estrogen and progesterone, changes
in these hormone levels can cause uncomfortable symptoms. These changes in the hormones
lead to the development of uncomfortable symptoms that may become intense, which leads to
interference in the activities of daily living. Thus, HRT is used to treat the symptoms of
menopause. Two types of HRT are Estrogen Therapy and Estrogen Progesterone/Progesterone
Hormone Therapy (EPT). Unfortunately, postmenopausal women on HRT have been found to
have a higher incidence of endometrial polyps, especially for postmenopausal women taking
Estrogen Therapy. This is further strengthened by a clinical study that states that endometrial
polyp formation may be dependent on the type of dosage of estrogen and progesterone.
Especially progesterone with antiestrogenic activity may plan an important preventive role in
developing endometrial polyps. As estrogen is responsible for the continuous stimulation of the
endometrium, that leads to its thickening and may cause the growth of polyps.
Uterine Polyps I 7
Follicle Stimulating Hormone (FSH) Therapy. Fertility drugs generally work like natural
hormones like the follicle-stimulating hormone (FSH). Used to trigger ovulation. It is also used in
women who ovulate to stimulate a better or extra egg. Unfortunately, FSH causes estrogen, the
primary female hormone, to rise. Estrogen plays a role in causing the endometrium to thicken
each month during your menstrual cycle. This thickening likely contributes to uterine polyp growth.
Uterine Polyps I 8
Signs and Symptoms

(The words that are italicized are patient-centered)
Uterine Bleeding. Endometrial polyps continuously stimulate the endometrium due to

constant estrogen exposure and lack of progesterone. With insufficient progesterone to provide
structural support, portions of the endometrial lining slough at irregular intervals. The usual
progesterone-guided vasoconstriction and platelet plugging do not occur, often resulting in
profuse or excessive bleeding.
Moreover, uterine bleeding is also due to stromal congestion, wherein the blood vessels
in the endometrium become blocked or clogged, which causes slow blood flow in the uterine
veins. As a result, necrosis damages the drainage of deoxygenated blood. This could lead to
tissue engorgement, thus, vasculature ruptures causing uterine bleeding. This occurs in women
who are in their menopausal stage.
Furthermore, endometrial polyps are fragile, and if they have blood vessels within them,
they are prone to bleeding. The polyps dangle from their stalks and irritate the surrounding tissue,
which causes the tissue to rub off, exposing tiny blood vessels. These blood vessels bleed,
causing spots. This usually occurs after exercise or excessive movement, where the pressure in
the abdomen increases.
Menstrual-type cramps. Endometrial polyps arise from the endometrium, the inner lining
of the uterus that is shed monthly during menstruation. Occasionally, large endometrial polyps
can cause menstrual-type cramps since the uterus is naturally designed to expel anything inside
of it.
Uterine Polyps I 9
Complications
Pre-cancerous Polyps. Although most polyps are benign, some can be malignant or
develop into cancer (precancerous polyps). This is because polyps are caused by abnormal cell
growth and, like cancer, grow through rapidly dividing cells. They can become malignant.
Miscarriage. The likelihood of miscarriage may increase with polyps in the uterine lining.
Polyps are abnormal and cause the body, especially the uterus, to become inflamed. Since polyps
sometimes have irregular periods and unusual bleeding, the lining may start to shed or bleed just
as the embryo is about to implant. Moreover, the inflammation makes the embryo's surroundings
unfavorable and results in miscarriage. Uterine polyps can also act as a contraceptive, like an
intrauterine device (IUD), by preventing an embryo from implanting or attaching to the uterine
walls.
Infertility. Uterine polyps can cause infertility in two ways: mechanical obstruction and
inflammatory response.
Mechanical obstruction may result in several consequences, such as hindering sperm

transport by blocking the cervical canal or entrance into the fallopian tube.
Uterine polyps are also associated with infertility because of inflammatory reactions. In the
normal process, the egg and sperm meet in the fallopian tubes, where fertilization happens. Then,
the embryo grows and develops until it reaches the uterine cavity. Once the embryo is in the
uterine cavity, it implants and finds a spot on the endometrium. This process is followed by the
release of protease, which eats away at the uterus wall so that the placenta can lock the embryo
to grow in.
Unfortunately, polyps cause inflammation due to the high inflammatory marker or plasma
cells inside the uterus.
This irritates the uterus lining, interfering with an embryo's implantation. Thus, causing
infertility.
Uterine Polyps I 10
Diagnostics
Transvaginal Ultrasonography (TVUS). Endovaginal Ultrasound or Transvaginal

Ultrasonography is the primary tool for the initial diagnosis of endometrial polyps. In this
procedure, a handheld device called an ultrasound transducer is inserted into the vagina which
will allow the visualization of the pelvic cavity and the organs inside the pelvis. The inserted
transducer releases sound waves that bounce off the various structures inside the pelvic cavity;
these organs include the cervix, uterus, fallopian tubes, and ovaries. The sound waves return to
the transducer, where they’re converted into electrical signals. These signals project a real-time
visual image of the pelvic organs onto a screen that the health care provider/technician performing
the procedure can view.
Nursing Responsibilities:
Before
● Verify the patient’s identity.
● Explain the purpose to the patient, including that it is a painless imaging diagnostic
and that she might feel a device (transducer) being inserted into her vagina.
Explain that the insertion is similar when inserting a tampon. Yet, the transducer is
larger than the tampon but smaller than the speculum.
● Notify the patient that during the exam, she will feel a fair amount of pressure
during the exam. When felt, instruct her to remain to lie still. Although, inform her
that she might also be asked to change positions.
● Assess if the patient is allergic to latex.
● Instruct the patient to wear clothes that can slip off easily as she will be asked to
remove the pants and underwear, and she may have to wear a gown.
● If the patient is wearing her tampon, inform her that the tampon will be removed to
insert the transducer.
● Instruct the patient to drink at least 1 liter of water an hour before the examination.
Also, remind the patient not to urinate before the exam.
● Instructor assist the patient with perineal care. The perineal care is done by using
a clean wipes or swab then, cleaning it in a midline outward order: vulva, labia,
inside of the labia, and outside of the labia.
During:
● Ensure that the examination room is clean.
● Provide privacy.
● Assist the patient in changing into her hospital gown.
● Assist the patient in positioning herself on her back on the exam table with her legs
raised by placing her legs on the stirrups.
● Assist the patient in changing positions if required.
After:
● Wipe any remains of lubricating gel in the patient’s vagina.
● Assist in removing the patient’s leg on the stirrups and assisting her from sitting to
standing up from the exam table.
● Assist the patient in changing back to her original clothes.
Hysterosonography/ Sonohysterography/ Saline Infusion Sonography (SIS). It is a

procedure that uses sound waves to produce pictures of the inside of the uterus and aids in
diagnosis. Yet, this is a special kind of ultrasound that uses fluid put into the uterus through the
cervix.
To elaborate, a speculum is inserted into the vagina, and a catheter is inserted into the
uterus cavity. Then, using a small tube inserted into the vagina, the healthcare provider will inject
a small amount of sterile saline into the uterus cavity and study its lining using the ultrasound
transducer. Ultrasound transducers transmit high-frequency sound waves that are converted into
electrical impulses that produce a moving image of the inside of the body on a screen.
Moreover, it is best to perform hysterosonography immediately after the menstrual period

and within ten days after the first day of the period to minimize the risk of infection and unintended
loss of very early pregnancy.
Uterine Polyps I 11
Before
● Verify the patient’s last menstrual period.
● Explain the procedure to the patient. Inform the patient that the entire procedure
usually takes approximately 30 minutes. Inform the patient that she might feel a
slight discomfort while the vaginal speculum, catheter, and transducer are
inserted. Furthermore, explain that the insertion of the transducer is similar when
inserting a tampon. Yet, the transducer is larger than the tampon but smaller than
the speculum.
● Assess if the patient is allergic to latex.
● Inform the patient to empty her bladder before the test.
● Instructor assist the patient with perineal care. The perineal care is done by using
a clean wipes or swab then, cleaning it in a midline outward order: vulva, labia,
inside of the labia, and outside of the labia.
During:
After:
● Wipe any remains of lubricating gel in the patient’s vagina.
● Assist in removing the patient’s leg on the stirrups as well as assisting her from
sitting to standing up from the exam table.
Endometrial Biopsy. This is a procedure done by physicians to assess what is the cause
of problems leading to heavy or irregular bleeding and investigate fertility problems. This is a
preventive measure to check if the tissue sample of the removed polyp is analyzed for signs of
cancer. This is done because some precancerous changes in the uterus, called endometrial
hyperplasia or uterine cancers, appear as uterine polyps.
Before
● Witness the signing of consent for the procedure.
● Explain the procedure to the patient. Inform her that the procedure is short and
lasts only 10 minutes. Explain as well that she might feel discomfort when the
speculum is inserted. Further, explain that the insertion of a tenaculum can also
cause discomfort.
● Inform the patient that she may experience light bleeding, so she may wear a
sanitary pad for 7 to 10 days or until the bleeding is gone.
● Inform the patient that her period may be expected after an endometrial biopsy
after 30 to 35 days.
● Inform the patient not to engage in sexual intercourse, use tampons, or douche for
one week after the procedure.
● Assess or ask if the patient is pregnant.
● Assess if the patient is taking any medications like blood thinner such as warfarin,
clopidogrel, and aspirin.
● Assess if the patient is allergic to latex or iodine.
● Inform the patient not to douche.
● Administer pain medication like ibuprofen 30 minutes before the procedure if the
physician orders.
Uterine Polyps I 12
During:
After:
● Assist the patient with any signs of dizziness.
● Assist in removing the patient’s leg on the stirrups and assisting her from sitting to
standing up from the exam table.
● Remind the patient regarding the pre-procedure teachings.
Complete Blood Count (CBC) with Platelet Count. In most surgical procedures like
Hysterectomy Polypectomy, the CBC count provides the surgeon with information regarding the
patient's baseline status. A blood count also ensures adequate oxygenation to all vital and healing
tissues and an adequate immune response. On the other hand, platelets, also called
thrombocytes, are blood cell fragments that are crucial for blood clotting. So they are an essential
assessment to prevent excessive bleeding during surgery.
Before
● Explain to the patient the procedure's purpose and how it can help the patient.
Explain that this is also part of the preparation for a possible Hysterectomy
Polypectomy.
● Explain that a blood sample is needed for the test.
● Advise the patient that she may experience slight discomfort from the tourniquet
and needle punctures.
During:
● Inform the patient to remain still throughout the procedure.
After:
● Apply direct pressure to the venipuncture site until the bleeding stops.
● Assess the venipuncture site for hematoma formation; if one develops, apply direct
pressure.
Urinalysis with Pregnancy Test (PT). Also called the urine test, a urinalysis is a simple
test that looks at a small urine sample. It can detect any underlying procedure like infection. It can
also be used to determine if a patient is pregnant. A positive urine test indicates possible
pregnancy due to high human chorionic gonadotropin hormone levels.
Furthermore, urinalysis with PT is also used before a Hysterectomy Polypectomy because

a positive pregnancy test means the procedure could not push through. This is because viable
intrauterine pregnancy is a contraindication for hysteroscopy. The procedure may cause
infections or lead to abortion.
Before
● Explain the to the patient the procedure. Explain that, before the test, and the
patient should drink enough water to make her urinate but not to the extent of an
excessive amount.
● Instruct the patient that before urinating, she should adequately clean her vagina
by sitting on the toilet with her legs apart and then wiping her labia in a front-to-
back motion. Instruct her not to use the same wipe with the second wipe again.
Uterine Polyps I 13
For the second wipe, instruct the patient to wipe the opening where her urine
comes out, which is only above her vagina.
● Provide the patient with instructions on how to collect a clean-catch urine sample.
Instruct her to void first in the toilet. Then, only collect the urine during the
midstream. Instruct the mother not to touch the inside or tip of the cup with her
hands or any part of the body.
During:
● Ensure that the container is sterile and dry.
● Instruct the patient to do the pre-procedure teaching regarding proper perineal care
and catching urine.
● Assist the patient with collecting the urine sample if she is unable or having
difficulties.
After:
● Label the urine sample container with the patient's name, collection date and time,
and any other relevant information per the hospital policy.
● Transport the urine sample to the laboratory promptly and appropriately.
● Monitor the patient for any signs of discomfort or difficulty during the collection
process, such as pain, dizziness, or nausea.
● Document the collection process and any relevant patient information, including
vital signs, medications, and other laboratory values.
Uterine Polyps I 14
Treatment and Management

Preventive Measures. Small polyps without symptoms might resolve on their own.
Treatment of small polyps is unnecessary for those who aren't at risk of uterine cancer. If the
polyps are small and not causing symptoms, they may be left alone and can resolve
independently. Yet, it is still best to prevent the polyps from growing as it may impose more risk.
One great way to avoid such overgrowing is to maintain a moderate weight. This is a preventive
measure to prevent obesity. As fat mass increases in obesity, aromatase expression also
increases, resulting in an increased estrogen, a growth hormone that may contribute to the polyps
multiplying and growing in size.
Medication. Progestins and gonadotropin-releasing hormone agonists such as leuprolide,

goserelin, triptorelin, and histrelin may lessen polyp symptoms. It can help control hormone levels.
It may shrink polyps and ease symptoms like heavy bleeding; however, the symptoms typically
recur once the medication is stopped.
Hysteroscopic Polypectomy. Hysteroscopic Polypectomy is a surgical procedure in

which the polyps are removed. These are the non-cancerous overgrowth of cells in the lining or
the inner wall of the uterus. It is a routine procedure used to eliminate polyps and their symptoms
and is also a test for cancer. A hysteroscopy removes uterine polyps using surgical instruments
inserted through the cervix and into the womb (uterus). If polyps cause severe symptoms and
have children, the doctor might suggest a hysterectomy or removal of the entire uterus.
Hysterectomy is the preferred treatment if polyps are cancerous.
According to the National Library of Medicine, seventy-three out of 168 (43%) women had
polyp recurrence after hysteroscopic Polypectomy. A higher number of endometrial polyps and
longer follow-up duration are associated with a more significant potential of polyp recurrence after
hysteroscopic polypectomy.
Hysterectomy. This is a surgical process that removes the entire uterus. The following
are its types:
● An abdominal hysterectomy is an operation that removes the uterus through a cut in the
lower belly, also called the abdomen. This is known as an open procedure. The uterus
also called the womb, is where a baby grows when someone is pregnant. A partial
hysterectomy removes the uterus, leaving the neck of the womb in place. The neck of the
womb is the cervix. A total hysterectomy removes the uterus and the cervix.
● Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina.
During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian
tubes, and upper vagina, as well as from the blood vessels and connective tissue that
support it, before removing the uterus.
Progesterone Hormone Therapy. Post-hysteroscopic progesterone hormone therapy

has favorable clinical effects in treating endometrial polyps. It can effectively prevent the
recurrence of endometrial polyps, relieve the hemoglobin level and reduce endometrial thickness.
Intrauterine Device (IUD). In most cases, endometrial polyps do not recur after they
have been removed by polypectomy. If they do recur, a repeat polypectomy procedure may be
recommended. However, if a person is concerned, an intrauterine device (IUD) can be inserted
into the uterus to help prevent a recurrence of endometrial polyps. This contraceptive may be a
good choice for those hoping to maintain fertility.
Levonorgestrel IUD releases progesterone that inhibits the synthesis of estrogen

receptors and induces atrophy of the endometrial glands. A decrease in the proliferation of
endometrial polyps has been reported to be associated with an increase in apoptosis, which
could, in some cases, lead to the spontaneous regression of endometrial polyps.
Uterine Polyps I 15
Endometrial Ablation. Endometrial ablation is a surgical procedure that destroys

(ablates) the inner lining of the uterus, known as the endometrium. It is performed in women who
no longer desire pregnancy to treat abnormal uterine bleeding due to benign conditions. Before
an ablation is performed, a sample of the uterine lining, known as an endometrial biopsy, is taken
to ensure no cancer is present. Endometrial Ablation is a safe and effective treatment for irregular
and/or heavy periods. It is an option when the cause of the bleeding is from a benign or non-
cancerous condition such as hormonal abnormalities, uterine polyps, or fibroids.
Birth Control Pills. Birth control pills may help regulate the hormone fluctuations that
cause endometrial tissue to grow in excess and may reduce the risk of polyps. The use of oral
contraceptive pills in treating endometrial polyps is low-cost and non-invasive compared with such
surgical procedures.
Uterine Polyps I 16
PATIENT’S PROFILE
Name: G.F.T.
Sex: Female
Age: 30 years old
Birthdate: July 12, 1992
Birthplace: Tuguegarao City
Address: Lapu-Lapu Street, San Gabriel, Tuguegarao City,

Cagayan
Nationality: Filipino
Dialect: Tagalog
Religion: Roman Catholic
Educational attainment: College Graduate
Occupation: Government Employee
Civil Status: Single
Date of Admission: February 20, 2023 at 8:10 am
Chief Complaint: Scheduled Polypectomy
Admitting Diagnosis: Endometrial Polyp
Preoperative Diagnosis: Endometrial mass to consider Endometrial Polyp
Post-Operative Diagnosis: Endometrial mass to consider Endometrial Polyp
Final Diagnosis: —
Admitting Physician: Dr. J.B.P.
Attending Physician: Dr. J.B.P.
Date Handled: February 21, 2023 at 9:00 am
ADMITTING VITAL SIGNS CURRENT VITAL SIGNS

(February 20, 2023) (February 21, 2023 )
Blood Pressure: 120/80 mmHg Blood Pressure: 120/80 mmHg
Pulse Rate 62 bpm Pulse Rate 94 bpm
Respiratory Rate 20 cpm Respiratory Rate 20 cpm
Temperature 36.3°C Temperature 36.8°C
Oxygen Saturation: 95% Oxygen Saturation: 99%
BODY MASS INDEX 19.85 kg/m² BODY MASS INDEX 19.85 kg/m²
(BMI) (BMI)
Uterine Polyps I 17
NURSING HISTORY
History of Past Illness
Patient G.F.T. reported that she didn’t experience any severe illnesses during her
childhood. She added that she only had the common coughs, colds, and influenza, which her
parents managed with over-the-counter drugs such as paracetamol and herbal medicines like
Lagundi.
As an adult, she only experiences common illnesses like colds, coughs, and flu, just like
in her childhood. She manages them with Biogesic (Paracetamol) and water therapy as she
doesn’t want her body to depend on drugs. Through these interventions, she stated that her
illnesses were treated. Moreover, the patient has no known allergies to foods and medications.
Although, during her college years in Manila, she fell into a maintenance hole and got
wounded on her right leg, which she managed by cleansing and dressing her injury. According to
the patient, the wound was 1 cm long and healed immediately with no infection. No history of
surgeries and no previous hospitalizations were reported before this admission.
Regarding her vaccinations during her newborn and childhood years, the patient is unaware
of all the vaccines she received and didn’t receive. She added that she only remembers two
vaccines: her Polio and Hepatitis. Unfortunately, she cannot remember the dates when she
received the said vaccines. Furthermore, for vaccines she received as an adult, the patient
received her COVID-19 vaccines with two doses of Sinovac: the first in April 2021, the second in
May 2021, and a booster shot of Pfizer last December 2021. The patient also preferred not to
receive the second booster shot as she verbalized, “hindi naman na ganun kalala ang COVID
ngayon”.
History of Present Illness
The patient mentioned that she and her partner have been trying to conceive for two years
since 2020. Unfortunately, the patient was not able to get pregnant. Hence, they decided in 2022
to consult an infertility doctor regarding their concern. The patient failed to remember what specific
month in 2022 she went for a consult. The patient's decision for a consult was made firm due to
her mother's difficulty conceiving, making the patient believe that she might inherit her mother's
difficulty in getting pregnant.
Due to the said circumstances, the patient proceeded to have a consultation with an
obstetrician who is also an infertility doctor, Dr. J.B.P. According to the patient, Dr. J.B.P.
prescribed monthly Follicle-stimulating hormone (FSH) injections during the third day of
menstruation. In addition, the patient has also been prescribed Letrozole, two tablets, taken
before sleeping every third day of her menstruation period.
She was also advised to take Glutathione, Myra-E, Folic Acid, and Co-Enzyme once a day
to support her overall health and fertility. When asked if the patient follows her therapeutic
regimen, she stated, "Opo pero one week bago ako ma-ospital, tinigil ko na." When asked if Dr.
J.B.P. ordered her to stop taking the prescribed medicines, she stated, "Ay hindi po, ako lang
po."
In November 2022, the patient stated her menstrual flow had changed. She
verbalized, "nag-start na mens ko tapos ang lakas bigla ng flow, dati tatlong beses lang ako mag
palit sa isang araw tapos biglang nakaka limang palit ako dahil sa lakas". When asked if it was
the only time it had happened, the patient indicated that it was the same for her menstrual cycle
from December 2022 to February 9-14, 2023, which was her last menstrual period before the
interview. The patient was also asked if it bothered her that her menstrual flow changed, to which
she replied, “hindi naman po, nanibago lang”. Furthermore, the patient also stated that her heavy
menstrual flow was also accompanied by dysmenorrhea on the first day of her menstrual period
which was normal for her. When asked how she manages the pain, the patient states that she
applies a hot compress and takes Ibuprofen when the pain is not tolerable, which she finds
compelling.
Uterine Polyps I 18
In December 2022, the patient had her check-up, and her obstetrician performed an
ultrasound revealing endometrial polyps. When asked regarding the result of the procedure, the
patient verbalized, “sinabi ni doc na kaya hirap akong mag-buntis kasi daw may polyps ako.
Sayang ma’am hindi ko dala yung result”. On the same day, her obstetrician scheduled her for a
polypectomy procedure in the same month to address this issue. However, the patient couldn't
proceed with the operation due to financial constraints.
Despite the financial constraints stated above, the patient and her partner were able to
save up money for the previously scheduled procedure. Thus, patient G.F.T., a 30-year-old
female, was admitted to Divine Mercy Wellness Center at 8:10 in the morning on February 20,
2023, for her scheduled Hysteroscopy Polypectomy. The physician's admitting diagnosis was
endometrial polyps.
Obstetric History,
The patient stated that she was in her first year of high school when she had her
menarche. She mentioned having regular menstruation lasting 3 to 5 days and changing her pads
3 to 4 times daily. She uses one in the morning and one during lunch, sometimes changing it
during the afternoon and again at night. Yet, according to the patient, she never experienced
having a full menstrual pad. She added, “para lang hygienic, ma’am.” She usually experienced
dysmenorrhea on her first day and managed it by applying a hot compress to the affected area.
Yet, if the pain is intolerable, she takes a tab of Ibuprofen which is effective for her.
Moreover, the patient has had no pregnancies or deliveries (G0P0), as she has difficulty
conceiving. This led to her consultation with an obstetrician, which prescribed her medication,
Letrozole; two tablets are taken before sleeping during the third day of menstruation. As well as
glutathione, Myra-E, Folic Acid, and Co-Enzyme, one tablet daily. The patient is also under FSH
therapy every third day of her menstrual period. Due to the mandatory ultrasound procedure done
on the patient in December 2022, Endometrial Polyps were seen. Yet, due to financial constraints,
the patient postponed her Hysterectomy polypectomy.
Her latest menstrual cycle began on February 9, 2023, and ended on February 14, 2023.
Family History
The patient's parents are both hypertensive with a maintenance drug of Losartan, one
tablet per day. In addition, her maternal grandparents are still alive but are also diagnosed with
Uterine Polyps I 19
hypertension. Unfortunately, the patient is unaware that her grandparents have maintenance
drugs for their condition. On the other hand, her paternal grandparents passed away due to old
age.
The patient's sister, a college student, is diagnosed with asthma.
Similar to the patient's experiencing, she stated that her mother also had difficulty
conceiving, as it took eight years to conceive the patient's youngest and only sister.
Uterine Polyps I 20
GORDON’S 11 FUNCTIONAL PATTERN
FUNCTIONAL BEFORE HOSPITALIZATION DURING HOSPITALIZATION

HEALTH PATTERN
Health-Perception- The patient believes that health is Her perspective on her health
Health Management wealth. She keeps her body didn’t change while she was in
Pattern strong by eating meals consisting the hospital. She still believes
of vegetables accompanied by that health is wealth. She further
meat. Besides that, she typically describes this as "Kayamanan
performs household chores. The ang pagiging malusog, kasi eto
patient only engages in brisk yung pundasyon natin sa lahat
walking for around 30 minutes in ng ating ginagawa. Kung sakitin
the morning; she typically doesn't ang isang tao, syempre hindi siya
follow a routine exercise regimen. makakatrabaho tapos gagasto
In regards to her sleep, she pa sa mga gamot," as verbalized
doesn’t have difficulty falling by the patient. She also added in
asleep and thus doesn't take any having the possibility of receiving
sleeping pills. She rarely her 2nd booster of COVID
experienced unpleasant dreams, vaccines, she stated , "Ang hirap
and she thought it might be from pala maospital, para lang
being too exhausted from work, sigurado na 'di na ako maadmit,
thus she managed it by getting mag papa bakuna na lang ulit
more sufficient rest after her work. ako. " medical professionals
Moreover, when experiencing gave her.
various illnesses, including
coughs, colds, and influenza, she
used over-the-counter drugs such
as paracetamol and water
therapy, which is effective for her.
Although, when it comes to her
COVID vaccine, the patient failed
to receive her 2nd Booster; she
mentioned, “hindi naman na
ganun kalala ang COVID ngayon”.
The patient received her COVID-
19 vaccines with two doses of
Sinovac: the first in April 2021, the
second in May 2021, and a
booster shot of Pfizer last
December 2021.
Moreover, the patient said she

takes Ibuprofen for her
dysmenorrhea during the first day
of her dysmenorrhea. She added
that she only takes Ibuprofen
when the pain is no longer
tolerable, and the hot compress
does not alleviate the pain. She
also mentioned that she never
had a full menstrual pad, but she
changes 3-4 times a day. She
stated, “para lang hygienic,
ma’am.”
The patient stated that she and

her partner had been trying to
conceive since 2020.
Unfortunately, they were never
successful. Thus, they decided to
consult an obstetrician who is also
an infertility doctor in 2022. The
Uterine Polyps I 21
patient was then prescribed to

receive an FSH therapy injection
every third day of her
menstruation. In addition she was
also prescribed o take Letrozole,
two tablets, before sleeping every
third day of her menstruation
period. She was also advised to
take Glutathione, Myra-E, Folic
Acid, and Co-Enzyme once a day.
When asked if the patient follows
her therapeutic regimen, she
stated, "Opo pero one week bago
ako ma-ospital, tinigil ko na."
When asked if her physician
ordered her to stop taking the
prescribed medicines, she stated,
"Ay hindi po, ako lang po."
Nutritional-Metabolic According to the patient, she is not The patient stated that she could
Pattern a heavy eater. She usually has eat all the foods that were served
three meals daily with two snacks to her during the hospitalization.
(one in the morning and one in the Unlike before, she does not eat
afternoon). Her meals generally snacks because she prefers to
include 1 cup of rice and a meat or rest. Her water intake is about
vegetable dish, depending on the 500 mL since after her surgery
food served. Her snacks usually was done, as the patient
include juice or carbonated drinks verbalized, "Pakonti-konti lang
like Coke with a biscuit. Her water ako uminom ngayon pero nakaka
intake is about 1 liter a day. In 1 liter po talaga ako.”
addition, she also drinks about 2
cups a day.
Moreover, the patient added that

she is an occasional drinker and
moderately drinks about five
bottles of beer. She also said that
she had no food allergies. She
had no swallowing, indigestion,
skin, or dental problems.
Elimination Pattern The patient stated that she usually The patient was lying comfortably
urinates about 3–5 times daily. on the bed. She said she doesn't
Her usual color of urine is clear to get up in bed to use the bathroom
light yellow. She said she because she is on a catheter.
regularly defecated, usually once She is usually seated, mainly
in the morning, and consistently when she eats her meals. She
has semi-formed to formed brown also said that she hasn't been
stools. She had no trouble able to defecate nor do walking
urinating or defecating. Thus, she because of the inserted catheter,
doesn’t use laxatives or other she verbalized "Naka catheter po
medications to aid her elimination. kasi ako ma'am, baka mahirapan
The patient has no genital po ako". She added, "Pag-naalis
problems besides the difficulty of na siguro ma'am makakapag
conceiving and the development lakad-lakad akko ng mabuti kahit
of endometrial polyps. dito lang sa kwarto."
Activity-Exercise Before leaving for work, the The patient was lying comfortably
Pattern patient typically performs on the bed. She said she doesn’t
household chores like light get up in bed to use the bathroom
sweeping and washing the because she is on a catheter.
morning dishes. She also takes a She wishes to sit up sometimes,
30-minute walk around their mainly when she eats her meals.
neighborhood when her time
permits.
Uterine Polyps I 22
Regarding her work, she only

does paperwork and works on the
computer; according to the
patient, little movement or energy
is required. She converses with
her coworkers during break time
or uses the opportunity to scroll on
her phone.
Sleep-Rest Pattern Before admission, the patient According to the patient, she
typically goes to bed at 10 p.m. slept approximately one hour in
and wakes up at 6:30 a.m. After the post-anesthesia care unit
her sleep, she generally felt rested before being transferred to the
and had the energy she needed Obstetrics and Gynecologic ward
for the day. She explained that at 10 PM. Moreover, that night,
she had to get up early to do she fell asleep around midnight
household chores and arrive at and woke up at 8 AM; she said
work on time. She takes a 30- she felt well-rested.
minute walk around their
neighborhood when she has The patient stated that during her
additional time. She doesn't have stay in the hospital didn't
difficulty falling asleep and thus experience distractions and felt
takes no sleeping pills. She rarely rested most of the time.
experienced unpleasant dreams
and thought it might be from being
too exhausted from work. Thus
she managed it by getting
sufficient rest after her work.
She eats, watches videos online,

and does TikTok dancing in her
free time. Additionally, when she
has a day off from work, she thinks
about relaxing by staying home
and spending time with her family
or hanging out with her partner.
Cognitive-Perceptual When the patient usually During her stay in the hospital,
Pattern encounters problems, she usually the patient did not encounter
consults her partner and her problems with decision-making.
parents for advice. Though she However, she overthinks
can decide on her own, she regarding her surgery. When
verbalized, "Pag may problema asked if she felt better that her
kaya ko namang solusyonan, pero surgery was successful, she
gusto ko lang hingin yung opinyon stated, "Syempre po pero ang
ng partner or parents ko para ikinaka-worry ko po ay 'yung
malaman ko kung tama ba yung baka may tumubo ulit saka kung
mga desisyon ko sa buhay." mabubuntis ba ako after nitong
surgery. Iniisip ko kung mag-
She has difficulty concentrating in kakababy pa kami. Bilang isang
a noisy environment; and prefers babae nakakahiya sa partner
to work in a quiet environment. ko.”
She doesn’t wear eyeglasses and
has no problems with hearing, She doesn’t experience difficulty
taste, sense of touch, or smell. processing her thoughts and
feelings. The patient’s language
was also clear and
understandable. The patient was
able to answer the questions
asked of her with interest. She
stated that she had no problems
with her hearing, taste, sense of
touch, or smell.
Uterine Polyps I 23
Role-Relationship According to the patient, she is During the patient’s stay in the
Pattern close with her family. She lives hospital, her partner is the one
with her partner, parents, and who takes care of her. She stated
younger sister. When asked what that their relationship becomes
is her role in the family she more robust as they try to
stated, "Father ko parin po ang conceive. Her family, relatives,
breadwinner sa pamilya namin and friends constantly monitored
pero nasusuportahan ko naman her condition online. Her family
po financially 'yung ibang and friends were there for her
pangangailangan nila lalo na po throughout her hospital stay and
sa tuition ng kapatid ko." When sent their best wishes for a quick
asked regarding her role in her recovery.
relationship with her partner, the
patient verbalized, "Pag-dating sa
mga desisyons regarding sa'min,
pinag uusapan talaga namin, para
dalawa kaming magdedecide.
Tulad 'yung consultation ko kay
Doc J.B.P., pinag usapan namin
'yun pati na rin itong operation
ko."
She mentioned that she has no

problems with her colleagues at
work, and she usually shares
meals and conversations. She
also considered them as her
friends. She also added that she
has a good relationship with her
neighbors due to engaging in her
30-minute walk, where she has
conversations with them.
Self-Perception-Self- After almost two years of trying to While in the hospital, she is
Concept Pattern get pregnant, she feared that her anxious about whether she can
fertility problems would ruin her conceive after the polyps are
relationship with her partner. She gone. When asked what her
believed that she was perception was of her current
disappointing her partner and that situation, she verbalized, "Iniisip
her condition made her feel less ko kung mag-kakababy pa kami.
confident as a woman. "Bilang Bilang isang babae nakakahiya
isang babae, parang may kulang sa partner ko. Nakakawala ng
sa akin at nakakahiya kung hindi confidence, iniisip ko rin na kung
ko man lang mabigyan ng baby paano kung babalik 'yung mga
ang partner ko", as the patient polyps."
verbalized.
Sexuality- The patient has her menarche She was admitted to Divine
Reproduction Pattern during her first year of high school. Mercy Wellness Center because
Her menstrual cycle lasts five it was scheduled as her
days on average. According to the Hysteroscopic Polypectomy
patient, she changes at least 3-4 under Dr. J.B.P. She claimed she
times even though her menstrual wasn't in pain during the
flow is not heavy; she procedure, but once the
stated, "para lang hygienic anesthesia wore off, she
ma'am." Moreso, having experienced a 3/10 pain score,
dysmenorrhea during the first day where ten is the highest and one
of the menstrual period is normal is the lowest.
for the patient. When asked how
she manages the pain, the patient
claims that hot packs and taking
Ibuprofen to relieve her
discomfort. Therefore she uses
them to do so.
Uterine Polyps I 24
Yet, on November 2022. She

verbalized, "nag-start na mens ko
tapos ang lakas bigla ng flow, dati
tatlong beses lang ako mag palit
sa isang araw tapos biglang
nakaka limang palit ako dahil sa
lakas". When asked if it was the
only time it had happened, the
patient indicated that it was the
same for her menstrual cycle from
December 2022 to February 9-14,
2023, her latest menstrual period
before the interview. Alongside
with the heavy menstraul flow was
dysmenorrhe but only in the first
day of the menstual period, which
was considered normal by the
patient.
The patient has had difficulty

conceiving since 2022. She then
decided to consult with a
specialist regarding her concern.
She was then prescribed to take
Letrozole, two tablets, before
sleeping every third day of her
menstruation period. She was
also advised to take Glutathione,
Myra-E, Folic Acid, and Co-
Enzyme once a day. She also
receives an FSH therapy injection
every third day of her
menstruation. In December 2022,
she had a check-up in the clinic of
Dr. J.B.P. and was seen to have
endometrial polyps. On the same
day, her obstetrician scheduled
her for a polypectomy procedure
in the same month to address this
issue. However, the patient
couldn't proceed with the
operation due to financial
constraints.
She also had no issues with her

reproduction aside from having
difficulty conceiving.
She and her partner are sexually

active because they have been
trying to become pregnant for
about two years.
Uterine Polyps I 25
Coping-Stress When the patient gets stressed The patient stated that she was
Tolerance Pattern out because of her work, she not under any stress during the
usually talks about it with her interview. Even though she was
colleagues. When she feels tense, anxious before having a
she plays relaxing music and Hysteroscopic Polypectomy, she
wants a quiet environment. She prayed and hoped for a
does not take any drugs to help successful procedure. Although,
her stay calm. she expressed her concern
regarding her difficulty in
Her difficulty conceiving was also conceiving and the recurrence of
the biggest challenge of their lives polyps, as she stated, "ikinaka-
together as partners. For almost 2 worry ko po ay 'yung baka may
years of trying, she and her tumubo ulit saka kung
partner lifted each other’s spirit, as mabubuntis ba ako after nitong
the patient surgery. Iniisip ko kung mag-
verbalized, "Naniniwala na lang kakababy pa kami. Bilang isang
kami na hindi pa siguro ito yung babae nakakahiya sa partner
time para magka-baby kami. Pero ko.”
patuloy lang kami gumagawa ng
paraan at sa When asked about her coping
panalangin.” Although, she strategy while in the hospital, she
added, "Bilang isang babae, said she watches entertaining
parang may kulang sa akin at videos online and converses with
nakakahiya kung hindi ko man her partner.
lang mabigyan ng baby ang
partner ko."
Value-Belief Pattern The patient is a Roman Catholic. When asked what changes in her
She considers herself very spiritual belief occurred during
religious, as she attends mass hospitalization, she
every Sunday. Her religion is verbalized, "Sa pagsubok na
essential to her, and when asked pinag-dadaanan ko ngayon,
what her views were, “Magkaka- kailangan ko lang i-sustain yung
iba naman tayo ng paniniwala, so faith ko kasi naniniwala ako na
kailangan lang mag-adjust.” as pagsubok lang ni Lord sa amin
verbalized by the client. ito". She sustains it by praying
after waking up and at night
before bed. She believed that
God was a true healer. His
religious beliefs and the
treatment she was receiving did
not conflict.
Uterine Polyps I 26
PHYSICAL ASSESSMENT
Date of Assessment: February 21, 2022 at 9:00 in the morning (2nd day of admission Status
Post hysteroscopy polypectomy)
Patient G.F.T.'s physical assessment was done a day after her hysteroscopy polypectomy
surgery. Patient G.F.T. was awake, conscious, and coherent during the physical assessment, and
her general appearance was clean.
Patient G.F.T.'s vital signs were checked. The patient has a warm temperature of 36.8 °C.
The patient has a pulse rate of 94 beats per minute which is considered normal. Capillary refill is
within 1-2 seconds. Respirations are regular, rapid, and symmetrical, with clear breath sounds.
Her respiratory rate is 20 cycles per minute, and her oxygen saturation is 99%.
The patient's appearance was appropriate for her age. During the interview, the patient
was cooperative. She appeared to be calm and maintained good eye contact when answering
questions. Interviewers noted no apparent deformities or distinguishing characteristics.
Patient G.F.T. also has an ongoing intravenous infusion of 1000 ml of D5LRS with an
ordered K.V.O. rate infused into her right metacarpal vein.
Body Mass Index (B.M.I.)
Height: 47.7kg
Weight 5 feet
BMI: 19.85 kg/m² (Normal)
AREA TECHNIQUE NORMAL ACTUAL REMARKS

ASSESSED USED FINDINGS FINDINGS
SKIN
Color Inspection Skin color based Normal

on the genetic, Patient has a fair
race, and skin color.
environmental
effects.
Texture Inspection Smooth, soft and Smooth, soft, and Possible

and Palpation even skin. even skin except due to high
on her forehead, estrogen
where acne is levels.
present.
Uterine Polyps I 27
Mobility and Palpation Resilience. When pinched, Normal

Turgor the skin goes
Returns to a
back to its original
normal state within
state in 1-2
1-2 seconds when
seconds.
pinched.
Lesions Inspection Freckles No freckles or Possible

nevi are noted, no due to high
Nevi
birthmarks or estrogen
Birthmarks not abrasions. But levels.
changed since acne
childhood (polymorphic
lesions) are
No abrasions or present on her
lesions forehead.
Uniformity Inspection Skin color varies Due to the

from body areas Patient has fair presence of
and from exposed skin, but is not inflammatio
and non-exposed fully uniformed in n of the skin
to sun areas. the facial area acne.
because the
Knees and elbows patient has
darker skin. redness of the
skin acne on her
forehead.
Moisture Palpation Minimal presence Moisture in the Normal

of perspiration or axilla and skin
oiliness. folds is slightly
present. This
Increased
varies because of
perspiration on
the
palms, scalp,
environmental
forehead, axillae.
temperature and
activity of the
patient.
HEAD
Size and Inspection Normocephalic, Normocephalic Normal

Circumference appropriate with
age and gender
Uterine Polyps I 28
Facial Features Inspection No dysmorphic No deformity, Normal

features. lesions, edema,
and inflammation
No presence of
were noted.
lesions, edema,
and inflammation.
Shape Inspection Rounded Rounded Normal
HAIR
Color Inspection Color varies Hair changes with Normal due

depending on the dye. Hair color is to usage of
genetics and race. black with brown hair coloring
highlights. products.
Changes with
rinses, dyes, and
permanents.
Distribution Inspection Evenly distributed. Normal

No generalized
Present on the and localized hair
scalp, nares, ears, loss was noted.
arms, and legs. No hirsutism
noted.
Texture Palpation Texture varies No brittleness Normal

depends on the noted
genetics, race,
Fine thick hair
location, and
noted
alteration.
Straight hair
Coarse or fine.
noted
Curly or straight
Smooth, shiny
Smooth, shiny and and resilient hair
resilient hair
Uterine Polyps I 29
Presence of Inspection No presence of No infestation, Normal

parasites infestation, inflammation, and
inflammation, and infection were
infection. noted
SCALP
Symmetry Inspection Symmetrical Symmetrical Normal

aligned with the
age, gender, and
body structure
Appearance Inspection Absence of Absence of Normal

seborrheic seborrheic
dermatitis, lesions, dermatitis,
and inflammations lesions, and
inflammations
NAILS
Color (nail bed) Inspection Variation of pink in Pinkish nail color. Normal
color.
Shape Inspection Convex, Convex curve Normal

curvature, 160
degrees angle.
Texture Palpation Smooth and firm Smooth and firm Normal

upon palpation
Tissue Palpation Intact epidermis Intact epidermis Normal

Surrounding
Nails
Capillary refill test Palpation Color should Returned to its Normal

return to normal normal state
state within 1 to 2 within 1 to 2
seconds seconds.
EYEBROWS
Distribution Inspection Evenly distributed Evenly distributed Normal

hair hair
Uterine Polyps I 30
Direction of Curl Inspection Equal in Equal in Normal

movement movement
Alignment Inspection Aligned Was aligned Normal

Symmetrically symmetrically
EYELASHES
Evenness Inspection Equally distributed Equally Normal

distributed
Direction of Curl Inspection Slightly curved Slightly curved Normal

outwards outwards
Appearance Inspection Moisturized, Moisturized, Normal

combined, and combined, and
nourished. nourished.
EYES
Color Inspection White sclera No pallor, Normal

redness and
yellowish of
sclera were
noted.
Conjunctiva Inspection Pink palpebral Pink palpebral Normal

conjunctiva. conjunctiva
Transparent
Eyelids Inspection Intact skin Intact skins were Normal

noted
No presence of
discharged and Absence of
discoloration discharged and
discoloration
Can close
symmetrically Can close
symmetrically
Uterine Polyps I 31
Iris Inspection Depends on the Black color is Normal.

genetic or race noted.
Black or dark Flat and round.

brown
Flat and round.
PUPILS
Color Inspection Depending on Black in color Normal.

race and genetics.
Shape Inspection Has a smooth and Smooth and Normal.

round border. round border
were noted.
Symmetry and Inspection Equal in size Equal in size Normal

Size
PERRLA
Accommodation Inspection Pupils can Both pupils can Normal

constrict while constrict and
looking at near dilate
object. Meanwhile, accordingly.
pupils can dilate
while looking at far
object.
Reaction to light Inspection When illuminated Both pupils Normal

pupils constricts constrict and
as a result of direct dilate
response accordingly.
When not
illuminated pupils Presence of
constricts as a response
result of
consensual Equal response
response were noted
Brisk response
Uterine Polyps I 32
Visual Fields Inspection Can be able to see Can be able to Normal

objects within see objects within
peripheral view peripheral view
when looking when looking
straightforward straightforward.
Extra Ocular Inspection Coordinated and Coordinated eye Normal

Movement has a unison movement.
movement of both
Can be able to
eyes having been
follow the finger
parallelly aligned.
of the hands in a
specific direction.
EARS
Color Inspection Consistent and Normal

aligned within the Uniformed and
color of the facial aligned with the
skin color of the facial
skin.
Size Inspection Bilaterally Bilaterally Normal

symmetrical in symmetrical in
size size
Position Inspection Laterally aligned Laterally aligned Normal

with the eyebrows with the
and auricles and to eyebrows and
the outer canthus auricles and to
of each eye the outer canthus
of each eye
Discharge Inspection No discharge No discharge was Normal

noted
Texture and Inspection Return to the Return to the Normal

elasticity of pinna and Palpation normal state within normal state
1 to 2 seconds within 1 to 2
seconds
NOSE
Uterine Polyps I 33
Tenderness and Inspection Absence of No tenderness Normal

masses tenderness during and masses were
palpation noted
Absence of
masses
Patency Inspection Air can move Both nares do not Normal

and palpation freely from nares accommodate
air moves during inhaling with restrictions.
freely and exhaling
sensation
Flaring Inspection Absence of nasal No nasal flaring Normal

flaring was noted
Discharge Inspection Absence of Absence of Normal

discharge discharge
Position Inspection Centered Symmetrically Normal

symmetrically centered
Absence of No deformities
deformities were noted.
MOUTH
Presence of Inspection Absence of No lesions were Normal

Lesions lesions noted.
Lips Inspection Depends on the Normal

age and genetics. Patient lip color is
uniformed pink.
Uniform pink color Moistened, soft
Moistened, soft and smooth in
and smooth in texture.
texture.
Ability to pursue Inspection Can be able to Can be able to Normal

lips purse lips purse lips
Uterine Polyps I 34
Buccal Mucosa Inspection Smooth, Moistened and Normal

moistened, and soft. Pink in color.
glistering with a
soft color of pink.
Teeth Inspection 32 adult teeth 32 adult teeth Normal
Smooth, white Smooth, slight

depending on the yellowish, shiny
genetics, shiny tooth enamel
tooth enamel
Gums Inspection Pink in color Pink in color. Normal

Moistened and
Moistened and
firm with no
firm in texture
tenderness and
bleeding were
noted.
Tongue Inspection Centrally Centrally Normal

positioned positioned
Pink in color Red color is

noted
Moist, slightly
rough, thin whitish Moist, slightly
coating. rough, thin
whitish coating.
Moves freely.
Moves freely.
Absence
tenderness and No tenderness
lesions. and lesions were
noted
Uvula Inspection Positioned midline Midline Normal

positioned
Inspection Pink, smooth Not inflamed and Normal

and Palpation posterior wall. swollen
Tonsils
Absence of No discharge was
discharge noted
NECK
Uterine Polyps I 35
Mobility Inspection Coordinated, Wide range of Normal

smooth in motion
movements with
no association of
discomfort No pain during
movement.
Position and Inspection Muscles are equal Muscles are Normal.

characteristics in size. equal in size
Head-centered Head-centered
THORAX AND LUNGS
Breathing Pattern Inspection Quiet, rhythmic, Quiet, rhythmic, Normal

and effortless and effortless
respirations. respirations.
Symmetry Inspection Chest expands Chest expands Normal

symmetrically symmetrically
during respiration; during
effortless respiration;
respiration effortless
respiration
Chest wall Inspection Intact Intact with no Normal

and palpation lumps, bulges,
Absence of
movable
tenderness
structures, and
Absence of without
masses tenderness.
Chest Expansion Palpation Full and Full and Normal

symmetric thorax symmetric thorax
expansion. expansion were
noted
Percussion Percussion Able to note Noted resonance. Normal

sound resonance.
Symmetry in
Symmetry in percussion notes.
percussion notes.
No areas of
No areas of dullness or
dullness or flatness over lung
flatness over lung tissue
tissue
Uterine Polyps I 36
Breath Sounds Auscultation With vesicular and No adventitious Normal

bronchovesicular breath sounds
breath sounds. are noted
ABDOMEN
Integrity Inspection Unblemished skin Unblemished Normal

with with no rash skin. No rash and
and lesions. lesions noted.
Umbilicus Inspection Positioned midline Positioned Normal

midline
Absence of
discoloration and No discoloration
inflammation and inflammation
were noted.
Abdominal Inspection Flat, convex, or The contour is Normal

Contour concave. symmetrically
flat. No distention
No notable
noted—no
enlargement of
notable
liver or spleen.
enlargement of
Contour is the liver or spleen
symmetric and uterus.
Bowel Sound Auscultation Audible bowel Gurgles can be Normal

sounds heard.
Tenderness Palpation Absence of Normal

tenderness Absence of
tenderness.
Relax, with Smooth when
smooth and palpated.
consistent tension
HEART
Heart Rate Auscultation 60-100 bpm 94 bpm was Normal

normal HR of to noted.
adults
Uterine Polyps I 37
UPPER AND LOWER EXTREMITIES
Color Inspection Color varies Normal

and depending on race Fair skin color, no
Observation and genetics. pallor was noted,
no cyanosis was
Dark to brown in noted.
color
Texture Palpation Smooth Smooth when Normal

touch.
Temperature Palpation 36.5°C-37.5°C 36.8°C normal in Normal

normal in adult. adult.
Mobility and Palpation Resilient. Skin Patient skin goes Normal

Turgor returns to a normal back to its
state within 1-2 previous state in
seconds when 1- 2 seconds.
pinched.
Lesions Inspection Absence of No nevi are Due to an

lesions noted, no accident.
birthmarks but The patient
have small scars fell into the
on the right leg drainage
approximately 1 system back
cm in length. in college.
(Not related
in the
disease
process)
Appearance Inspection Symmetrically Symmetrically Normal

aligned aligned
Absence of No deformities
deformities were noted
Uterine Polyps I 38
Uniformity Inspection Varies depending Normal

on areas that Patient has
exposed or not uniformed fair
exposed with the skin.
sun.
Moisture Palpation Moisture in the Moisture in the Normal

axilla and skin axilla and skin
folds (varies in folds is slightly
environmental present. This
temperature, body varies because of
temperature, and the
activity). environmental
temperature. (air-
conditioned
room)
Uterine Polyps I 39
ANATOMY AND PHYSIOLOGY
The Female Reproductive System
The female reproductive system provides several functions. Its functions include
producing gametes called eggs, secreting sex hormones, providing a site for fertilization, giving
birth to a baby, and breastfeeding a baby after birth. It includes both external and internal parts.
External Parts/Vulva
Labia majora. Also called the large lips, enclose and protect the other external
reproductive organs. During puberty, hair growth occurs on the skin of the labia majora, which
also contains sweat and oil-secreting glands.
Labia minora. Also called the small lips, lies just inside the labia majora, and surround
the opening of the vagina and urethra.
Clitoris. The two labia minora meet at the clitoris, a small, sensitive protrusion that is
covered by a fold of skin called prepuce and is very sensitive to stimulation. In most women,
engorgement results in an increase in the diameter, but not the length, of the clitoris. With
increased diameter, the clitoris makes better contact with the prepuce and surrounding tissues
and is more easily stimulated
Mons pubis. It is a tissue mound made up of fat located directly anterior to the pubic
bones. It functions as a source of cushioning during sexual intercourse.
Vaginal opening. It serves as the exit from the uterus during menses and childbirth.
Hymen. It is a piece of tissue covering or surrounding part of the vaginal opening. It’s
formed during development and present during birth.
Urethral opening. The opening to the urethra is the hole where the urine leaves from the
body. That hole from the inside to the outside is called the urethral meatus - ‘meatus’ refers to
any opening from the inside to the outside.
Internal Parts
Vagina. It is soft, stretchable tissue, and serves as a muscular canal that joins the cervix
to the outside of the body. It provides a passageway for blood and mucosal tissue from the uterus
during a woman’s monthly period. It also receives the penis during sexual intercourse and holds
the sperm until they pass into the uterus, and provides a passageway for childbirth.
Cervix. The cervix is the lowest part of the uterus. A hole in the middle allows the sperm
to enter and menstrual blood to exit. The cervix dilates to allow the baby to come out during a
vaginal childbirth.
Fallopian Tubes. These are narrow tubes that are attached to the upper part of the uterus
and serve as pathways for the ovum to travel from the ovaries to the uterus. Fertilization of an
egg by sperm normally occurs in the fallopian tubes. The fertilized egg then moves to the uterus,
where it implants into the uterine lining.
Ovaries. The ovaries are the female gonads. Paired ovals, they are each about 2-3 cm in
length, about the size of an almond that are located on either side of the uterus. The ovaries
produce eggs and hormones such as estrogen and progesterone. These hormones are
responsible for sexual development and preparing the uterine wall to nourish fertilized eggs during
pregnancy.
Uterus. Also called womb, an inverted pear-shaped muscular organ, located between the
bladder and the rectum. It functions to nourish and house a fertilized egg until the fetus, or
offspring, is ready to be delivered. The uterus is 6-8 cm (2.4-3.1 inches) long; its wall thickness is
approximately 2-3 cm (0.8-1.2 inches). It can stretch from the size of a lemon to the size of a
Uterine Polyps I 40
watermelon during pregnancy. The uterine cavity opens into the vaginal cavity, and the two make
up what is commonly known as the birth canal.
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’s main component is the uterine wall, which is the part of the uterus
that can hold embryo implantation and is shed during the menstrual cycle. The uterine wall is
composed of three distinct layers with different characteristics and functions. The innermost layer
of the uterine wall is the endometrium, also known as the mucosal layer or membrane. It is
composed of the epithelial layer and cell-rich connective tissue layer. The main function of the
endometrium is to prepare the optimal environment for the implantation of the embryo. In addition,
this layer prevents the adhesions between the opposed walls of the myometrium and maintains
the patency of the uterine cavity. Myometrium, on the other hand, is the middle layer of the
uterine wall and is composed of smooth muscles. The myometrium is important for the structural
support of the uterus. It also contracts in response to the hormones of the menstrual cycle to shed
the endometrium. It also contracts during labor and childbirth, and expands during pregnancy.
The myometrium is at its thinnest during menstruation and shed along with the endometrium. The
outer layer of the uterus, the perimetrium, is a thin serosal layer of epithelial cells that line the
uterus. The perimetrium secretes fluids that are important for lubrication and reducing friction.
Uterus during Polyps
The endometrium becomes too thick as the growth of cells becomes too excessive.
The Menstrual Cycle
The menstrual cycle consists of the periodic changes occurring in the ovaries and uterus
of a sexually mature, nonpregnant female that result in the production of a secondary oocyte and
prepare the uterus for implantation. Typically, the menstrual cycle is about 28 days long, although
it can be as short as 18 days in some women and as long as 40 days in others.
Menstruation Phase. This phase, which typically lasts from day one to day five, is the
time when the lining of the uterus is actually shed out through the vagina if pregnancy has not
occurred. The menstrual phase is the time between the beginning and the end of menstruation,
which is typically days 1–5 of the cycle. Menstruation begins because of a decrease in estrogen
and progesterone production in the previous cycle. Decreased blood delivery to the endometrium
results in cell death, the breakdown of the superficial endometrium, and some bleeding from the
damaged tissue. Uterine contractions expel the menstrual fluid from the uterus through the cervix
and into the vagina.
The proliferation phase is the time between the end of menstruation and ovulation.
During the proliferation phase, the number of cells in the endometrium rapidly increases and the
endometrium becomes thicker
Follicular Phase. This phase typically takes place from days 6-14. During this time, the
level of the hormone estrogen rises, which causes the lining of the uterus to grow and thicken. In
addition, another hormone, follicle stimulating hormone, causes the follicles in the ovaries to grow.
During days 10-14, one of the developing follicles will form a fully mature egg or the ovum.
Ovulation. This phase occurs roughly at about day 14 in a 28-day menstrual cycle. A
sudden increase in another hormone, the luteinizing hormone causes the ovary to release the
egg. Gonadotropin-releasing hormone produced by the hypothalamus stimulates the release of
FSH and LH from the anterior pituitary. These hormones affect follicle development, ovulation,
and corpus luteum development in the ovaries. The follicles and corpus luteum produce estrogen
and progesterone, which regulate changes in the endometrium in the uterus
Uterine Polyps I 41
The secretory phase is the time between ovulation and the beginning of the next
menstruation. During the secretory phase, the endometrium produces secretions and becomes
thicker.
Luteal Phase. This phase lasts from about day 15 to day 28. After the egg is released
from the ovary, it begins to travel through the fallopian tube to the uterus. The level of the hormone
progesterone rises to help prepare the uterine lining for pregnancy. If the egg becomes fertilized
by a sperm and attached itself to the uterine wall, pregnancy is likely to happen. If pregnancy
does not occur, estrogen and progesterone levels drop and the thickened lining of the uterus is
shed during the menstrual period.
Estrogen Production
Estrogen, also called oestrogens, are steroid compounds that are important for
development and functioning of females of the species. Estrogens are produced primarily by the
ovaries. They are released by the follicles on the ovaries and are also secreted by the corpus
luteum after the egg has been released from the follicle and from the placenta. The stimulation
for secretion of estrogen comes from the Luteinizing hormone (LH) from the anterior pituitary
gland. The estrogen is synthesized in the theca interna cells of the ovary.
The primary molecule that begins the synthesis of estrogen is cholesterol. It forms
androstenedione, a substance of moderate androgenic activity. This compound crosses the basal
membrane into the surrounding granulosa cells, where it is converted to estrone or estradiol,
either immediately or through testosterone. This conversion of testosterone to estradiol, and of
androstenedione to estrone, is catalyzed by the enzyme aromatase. Estradiol levels vary
throughout the menstrual cycle, with levels highest just before ovulation.
Some of the estrogens are also produced in smaller amounts by other tissues such as the
liver, adrenal glands, and the breasts. These secondary sources are important in women who
have already had their menopause. Fat cells are also sources of estrogen. This is the reason why
underweight or overweight women are at risk of infertility. Delicate balance of estrogen is
important for fertility. Excess or deficiency of this hormone affects fertility adversely.
Effects of Estrogen in Female Reproductive System
In females, estrogens affect the ovaries, vagina, fallopian tubes, uterus, and mammary
glands. In the ovaries, estrogens help to stimulate the growth of the egg follicle; they also
Uterine Polyps I 42
stimulate the pituitary gland in the brain to release hormones that assist in follicular development.
Once the egg is released, it travels through the fallopian tubes on its way to the uterus; in the
fallopian tubes, estrogens are responsible for developing a thick muscular wall and for the
contractions that transport the egg and sperm cells.
Estrogens also build and maintain the endometrium, the mucous membrane that lines
the uterus. They increase the endometrium’s size and weight, cell number, cell types, blood flow,
protein content, and enzyme activity. Estrogens also stimulate the muscles in the uterus to
develop and contract; contractions are important in helping the wall to slough off dead tissue
during menstruation and during the delivery of a child and placenta. The cervix, the tip of the
uterus, projects into the vagina and secretes mucus that enhances sperm transport; estrogens
are thought to regulate the flow and thickness of these mucous secretions. The growth of the
vagina to its adult size, the thickening of the vaginal wall, and the increase in vaginal acidity that
reduces bacterial infections are also correlated to estrogen activities. The young uterus, if
deprived of estrogens, does not develop into its adult form, and the adult uterus that does not
receive estrogens begins to show tissue degeneration.
Uterine Polyps I 43
PATHOPHYSIOLOGY
Uterine Polyps I 44
Uterine Polyps I 45
Uterine Polyps I 46
COURSE IN THE WARD
DATE AND DOCTOR’S ORDER RATIONALE INTERVENTION

TIME
To facilitate room for ● Prepared and

02/20/23 Admit to the room of patient’s admission. assisted the patient
choice under the service to his room of choice.
of
Nothing by mouth is ● Informed the patient

NPO ordered prior to the about the order and its
possible upcoming purpose.
scheduled surgical ● Instructed the patient not
procedure. to drink and eat starting
at ordered time.
D5LRS is administered ● Prepared IV fluid to be

IVF: D5LRS x 12 hours to maintain body fluids, used.
nutrition, and ● Assisted in IV
rehydration. insertion.
● Ensured patency.
● Secured proper
placement with the use
of micropore.
● Attached IV label with
the IV fluid name, date
and time administered,
and flow rate.
● Regulated the level of
IV fluid accurately as
ordered.
● Continue monitoring
during and after the
infusion.
● Defined and explained

Laboratory: Complete blood count the procedure.
(CBC) with platelet count ● State the specific
Complete blood count is to assess for any purpose of the test.
Platelet count potential anemia or ● Explained that slight
discomfort may be felt
blood clotting
when the skin is
abnormalities that may punctured.
affect the patient's ability ● After the procedure is
to undergo the done, instruct the patient
hysteroscopic or the significant other to
polypectomy. apply pressure to the
Endometrial polyps can puncture site to prevent
hematoma.
cause irregular bleeding,
which may lead to
anemia over time.
Additionally, the
hysteroscopic procedure
may cause some
bleeding, so it is
important to ensure that
the patient's blood count
and clotting factors are
Uterine Polyps I 47
within normal limits

before proceeding.
● Defined and explained

Urinalysis with Urinalysis with PT is the procedure.
Pregnancy Test ordered to assess for ● State the specific
presence if infection as purpose of the test.
well as if the patient is ● Provide the patient with
instructions on how to
pregnant. Positive
collect a clean-catch
pregnancy may indicate urine sample, including
possible cancellation of proper hand hygiene and
the scheduled cleaning of the genital
hysterectomy area.
polypectomy due to ● Assist the patient with
inducing risk of infection collecting the urine
sample if necessary,
and abortion.
while maintaining their
privacy and dignity.
● Label the urine sample
container with the
patient's name, date and
time of collection, and
any other relevant
information as per the
hospital policy.
● Transport the urine
sample to the laboratory
in a timely and
appropriate manner.
● Monitor the patient for
any signs of discomfort
or difficulty during the
collection process, such
as pain, dizziness, or
nausea.
● Document the collection
process and any
relevant patient
information, including
vital signs, medications,
and other laboratory
values.
● Ensured again proper

For Hysteroscopic Hysteroscopic verification of the patient.
Polypectomy at 4pm polypectomy is a ● Verified if consent is
minimally invasive signed.
procedure used to ● Verified the patient’s
knowledge regarding the
remove endometrial
procedure.
polyps. ● Informed the patient
regarding the time of her
procedure.
● Provided emotional
support.
● Educated the patient
regarding the benefit of
early ambulation after
Uterine Polyps I 48
surgery.
To ensure that patients ● Referred the patient

Refer to Dr. J.B.P. are seeing the correct accordingly.
providers for the specific
conditions. And for the
continuation of care.
Is recommended for ● Administered

Evening Primose Oil 4 patients with endometrial medication following
caps / vagina Q4 B.I.D polyps because it the 14 Rights of drug
contains gamma- administration.
linolenic acid (GLA), ● Explained the
which is an omega-6 purpose of
fatty acid that can help medication to the
reduce inflammation in patient and
the body. significant other.
Inflammation may ● Monitored the
contribute to the patient for any
development and growth adverse reactions,
of endometrial polyps, so such as vaginal
reducing inflammation irritation or itching,
with evening primrose oil and report any
may help to reduce the symptoms to the
risk of developing new healthcare provider.
polyps or prevent
existing ones from
getting larger.
Nothing by mouth is ● Informed the patient

02/20/23 NPO ordered for the about the diet and its
preparation of the purpose.
10:46 am upcoming hysteroscopic ● Instructed the patient not
polypectomy. to drink and eat starting
at ordered time.
● Reminded the
patient about her
surgery.
Refer to any abnormal ● Assessed the need to

Refer findings regarding the refer patients for
patient’s current assistance with actual or
condition and to provide potential problems.
proper management. ● Recognized the need for
referrals and obtained
necessary orders.
● Referred accordingly.
7:10 pm Status post It indicates that the ● Monitored vital signs,

hysteroscopic patient has already including blood
polypectomy undergone the pressure, heart rate,
procedure. This order is and temperature, to
added to the patient's assess for any signs
chart to inform the of complications
healthcare team that the such as bleeding,
infection, or fever.
Uterine Polyps I 49
procedure has been ● Provided the patient

completed. with education on
postoperative care,
including instructions
on how to care for
the surgical site,
when to change the
dressing, and when
to report any signs
of complications
such as excessive
bleeding or infection.
● Monitored for signs
of nausea and
vomiting, which can
occur due to the
effects of anesthesia.
● Assessed the
patient's urinary
output to ensure
adequate hydration
and to monitor for
any signs of urinary
retention.
● Documented the
patient's response to
the procedure,
including any
adverse reactions or
complications.
Diet as tolerated Diet as tolerated is a ● Informed the patient

common order given to about the diet and its
patients after any purpose.
surgical procedure. It ● Assessed the
means that the patient patient's appetite,
can resume their normal food preferences,
diet as soon as they feel and any food
ready and can tolerate it. allergies or
This order is particularly intolerances.
important for patients ● Monitored the
who may experience patient's intake of
nausea or vomiting after food and fluids,
the hysteroscopic including the
polypectomy. amount, type, and
frequency of intake.
● Assessed the
patient's
gastrointestinal
symptoms, such as
nausea, vomiting, or
diarrhea.
Uterine Polyps I 50
● Encouraged the
patient to eat small,
frequent meals
throughout the day to
help prevent
gastrointestinal
discomfort and
promote adequate
intake.
The first hour after ● Monitored the vital signs

Vital signs every 15 surgery is very crucial. of the patient every 15
minutes Taking the vital signs minutes as ordered.
every 15 minutes is ● Vital signs taken are
necessary to rapidly properly documented in
identify any physiological the patient’s chart.
change in condition and
prevent any complication
after the surgery.
To maintain hydration ● Monitored and

IVF: D5LRS x KVO and electrolyte balance regulated the level of
while minimizing the risk IV fluid. as ordered.
of fluid overload. ● Ensured patency.
● Checked the IV site for
redness, swelling or
infiltrations.
● Administered medication
To consume This medication is a following the 14 Rights of
medications: nonsteroidal anti- drug administration.
inflammatory drug ● Explained the purpose of
Mefenamic acid 500g (NSAID) that is medication to the patient
cap TID x 3 days and significant other.
commonly used for pain
● Monitored the patient for
relief. It is often signs of gastrointestinal
prescribed to manage distress, such as
the pain and cramping nausea, vomiting, or
that can occur after a abdominal pain.
hysteroscopic ● Advised the patient to
polypectomy. take the medication with
food to minimize the risk
of gastrointestinal
irritation.
● Administered medication
Co-amoxiclav 625g BID x This medication is a following the 14 Rights of
7 days combination of drug administration.
amoxicillin and ● Explained the purpose of
clavulanic acid and is medication to the patient
and significant other.
commonly used as an
● Monitored the patient for
antibiotic. It may be signs of allergic
prescribed after a reactions, such as rash,
hysteroscopic itching, or difficulty
polypectomy to prevent breathing.
infection or to treat an ● Advised the patient to
existing infection. complete the full course
of the medication as
prescribed, even if they
Uterine Polyps I 51
start to feel better before

the medication is
finished.
Keep patient warm By keeping the patient ● Monitored the

warm after surgery, patient's temperature
healthcare providers can regularly to assess
help to prevent for hypothermia.
hypothermia and ● Covered and used
minimize its adverse warming blankets to
effects. help raise the
patient's body
temperature.
● Ensured that the
PACU environment
is warm and
comfortable, with
adequate heating
and ventilation.
● Monitored the patient
for signs of shivering
or discomfort and
adjust interventions
as needed.
Refer to any abnormal ● Assessed the need to

Refer findings regarding the refer patients for
patient’s current assistance with actual or
condition and to provide potential problems.
proper management. ● Recognized the need for
referrals and obtained
necessary orders.
● Referred accordingly.
02/21/23 May remove indwelling Once the patient has ● Prepare the
foley-catheter recovered from the necessary
9:19 am anesthesia and is able to equipment, such as
urinate on her own, the sterile gloves and
catheter may be antiseptic solution,
removed to reduce the and maintain aseptic
risk of infection. technique
throughout the
procedure.
● Assessed the
patient's urinary
output and bladder
function before and
after removing the
catheter.
● Taught the patient on
the procedure,
including the reason
for catheter removal,
Uterine Polyps I 52
the sensation they

may feel, and any
potential
complications or
risks.
● Ensured that the
patient is in a
comfortable and
appropriate position,
such as lying down
or sitting up.
● Deflated the balloon
on the catheter by
gently pulling on the
inflation port or using
a syringe filled with
sterile water to
withdraw the fluid.
● Removed the
catheter slowly and
gently, ensuring that
the patient does not
experience any
discomfort or pain.
● Observed the patient
for any signs of
urinary retention or
discomfort after the
catheter is removed.
● Encouraged the
patient to drink
adequate fluids to
promote bladder
function and to
prevent urinary tract
infections.
● Documented the
procedure and the
patient's response,
including any
adverse reactions or
complications.
For possible discharge It means that the patient ● Provided the patient
this afternoon is making progress in with education on
their recovery and is post-discharge care,
likely to be discharged including instructions
soon, pending further on medication
assessment and administration,
evaluation. The rationale activity restrictions,
behind this decision is to and follow-up
prepare the patient and appointments.
their family for the
Uterine Polyps I 53
possibility of discharge, ● Reviewed the

and to initiate any patient's discharge
necessary arrangements medications and
that will ensure a smooth ensured that they
transition from the have an adequate
hospital to home. supply and
understanding of
how to take them.
● Documented the
patient's condition
and response to
treatment, as well as
any relevant
education or
instructions provided
to the patient and
family.
02/21/23 May go home It means that the patient ● Provided the patient
is stable and well enough with education on
1:16 PM to continue their post-discharge care,
recovery at home. The including instructions
rationale behind this on medication
decision is that many administration,activit
patients recover better in y restrictions, and
their own environment, follow-up
surrounded by their appointments.
family and familiar ● Reviewed the
surroundings. Being at patient's discharge
home can also reduce medications and
the risk of hospital- ensured that they
acquired infections and have an adequate
other complications supply and
associated with hospital understanding of
stays. how to take them.
● Documented the
patient's condition
and response to
treatment, as well as
any relevant
education or
instructions provided
to the patient and
family.
Home medications: This medication is a ● Explained the purpose of

combination of medication to the patient
Co-amoxiclav 625g BID x amoxicillin and and significant other.
7 days clavulanic acid and is ● Instructed the patient to
report immediately to the
commonly used as an
physician for any signs of
antibiotic. It may be allergic reactions, such
prescribed after a as rash, itching, or
Uterine Polyps I 54
hysteroscopic difficulty breathing.

polypectomy to prevent ● Advised the patient to
infection or to treat an complete the full course
existing infection. of the medication as
prescribed, even if they
start to feel better before
the medication is
finished.
HNBB Hyoscine N- ● Explained the purpose of

Butylbromide, also medication to the patient
known as Buscopan, is a and significant other.
medication that is ● Instructed the patient to
report immediately to the
commonly used to
relieve abdominal adverse effects such as
cramps and pain caused dry mouth, blurred
by smooth muscle vision, or urinary
spasms in the retention.
gastrointestinal and ● Advised the patient to
genitourinary systems. It drink plenty of fluids and
to report any changes in
works by relaxing the urinary output or bowel
smooth muscles in these movements.
areas, which can help
alleviate discomfort.
● Explained the purpose of

Vitamin C 1000mg , once An essential nutrient that medication to the patient
a day plays a critical role in and significant other.
various physiological ● Instructed the patient to
functions, including report immediately to the
immune system support,
adverse effects such as
collagen synthesis, and nausea, vomiting,
antioxidant protection. It diarrhea, or stomach
is also involved in the cramps and allergic
synthesis of steroid reactions.
hormones and may have ● Advised the patient to
a positive effect on take this with food to help
improve its absorption,
fertility in the patient’s reduce the risk of
case. gastrointestinal side
effects, and support
overall digestive health.
● Instructed the patient

Follow up check up on To monitor the patient's and their significant
February 28, 2023 progress, adjust other to adhere to her
treatment if needed, and follow-up appointment.
provide additional
education or support.
Following up with a
patient after a medical
procedure or treatment
can help doctors assess
a patient's progress and
ensure that they are
healing properly.
Uterine Polyps I 55
LABORATORY AND DIAGNOSTICS
IMMUNOSEROLOGY SECTION
DATE: February 20, 2023
RAPID ANTIGEN TEST
PARAMETER RESULT METHOD
Covid-19 Antigen Test Negative Immunochromatography
REMARKS:
1. Any clinical decision-making use requires RT-PCR correlation. A positive antigen result has
to be confirmed by RT-PCR.
2. Sensitivity depends mostly on the timing of testing in relation to the stage of infection.
Specificity may be adversely affected by prior infection with SARS and other related illnesses
(e.g. Coronavirus-borne Illnesses).
3. Symptomatic patients who tests negative need a follow up Antigen Test after a few days,
but an RT-PCR is recommended for any patient if the history is very suspicious or probable for
the infection especially if the patient has comorbidities (i.e. hypertension, diabetes mellitus and
obesity) associated with severe COVID-19 illness.
4. There is no current data regarding infectivity of patients who are asymptomatic and RT-PCR
positive but are serologically reactive.
5.A negative result may occur if the concentration of antigen in a specimen is below the
detection limit of the test or if the specimen was collected or transported improperly, therefore
a negative result does not eliminate the possibility of SARS-Cov-2 infection and should be
confirmed by RT-PCR.
6. The assay performance of this test is currently verified, and these notes may be revised
depending on the result of the verification studies.
HEMATOLOGY
PARAMETER RESULT UNIT REFERENCE REMARKS

INTERVAL
RBC Count 4.08 x10^12/L 4.5-6.0 NORMAL
Hemoglobin 124 g/L 120-160 NORMAL
Hematocrit 0.367 Vol Frac. 0.37-0.47 NORML
MCV 90 fL 81-99 NORMAL
MCH 30.4 Pg 27-31 NORMAL
MCHC 338 g/L 310-360 NORMAL
Uterine Polyps I 56
RDW 11.4 % 11.5-14.5 Normal. The slightly low

RDW levels are not
significant.
Platelet Count 338 x10^9/L 150-450 NORMAL
WBC 5.4 x10^9/L 4.5-11.0 NORMAL
Differential
Count
Netrophils
38 % 35-65 NORMAL
Lymphocytes 42 % 20-40 Elevated levels of

lymphocytes, monocytes,
and eosinophils are
possible indications of
Monocytes 8 % 2-6 infection and
inflammation in the inside
of the uterus due to the
Eosinophils 12 % 0-5 presence of polyps.
Basophils 0 % 0-1 NORMAL
CLINICAL CHEMISTRY:
URINALYSIS
PARAMETER RESULT REMARKS
Physical Examination Light Yellow NORMAL
Color
Transparency Clear NORMAL
Chemical Examination NORMAL
Reaction 6.5
Specific gravity 1.015 NORMAL
Sugar Negative NORMAL
Protein Negative NORMAL
Ketones Negative NORMAL
Blood Negative NORMAL
Uterine Polyps I 57
Bilirubin Negative NORMAL
Urobilingen Normal NORMAL
Leukocytes Trace There is a presence of

leukocytes in the urine due to
bacterial infection possibly
caused by polyps.
Nitrite Negative NORMAL
PREGNANCY TEST
PARAMETER Result Method
Pregnancy Test Negative Immunochromatography
Uterine Polyps I 58
BACHELOR OF SCIENCE IN NURSING – LEVEL III
NURSING CARE PLAN

Activity Intolerance Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION
INTERVENTION RATIONALE
Subjective: Activity Intolerance After an hour of nursing ● Ensured safety by ● To prevent falls, harm, Goal Met.
• “Hindi pa ako (Level III) related to interventions, the patient will be raising the bedside rails, injury that may occur
masyadong post-surgical able to identify methods and lowering the bed and during the provision of After an hour of nursing
makagalaw ng procedure techniques to reduce activity securing locks on bed. care. interventions, the patient
mabuti kasi manifested by body intolerance. was able to identify
kakatapos lang ng weakness or ● Assessed patient’s ● This will allow the nurse methods and techniques to
operasyon ko insufficient physical present level of activity to evaluate and develop reduce activity intolerance
parang mahina pa energy. and tolerance to activity. a patient specific activity such as performing an
katawan ko” as plan. active range of motion
verbalized by the exercises, sitting up in bed,
patient. ● Assessed patient’s vital ● This gives the nurse a standing up with assistance
signs. baseline and way to of her S.O., and walking a
Objective: gauge potential changes few steps with rest in
and fluctuations in vital between.
● Status Post signs.
hysteroscopy
polypectomy ● Assessed potential need ● Assessing if assistive
● Weak looking for assistive devices. devices are needed,
making them available
can increase a patient's
activity level/tolerance.
● Encouraged SO to let the

patient participate in self- ● As much as possible and
care activities as as tolerated by the
tolerated. patient, involve them in
Uterine Polyps I 59
promoting a sense of
control, this reduces
helplessness.
● Taught patient energy ● These techniques can

conservation techniques help reduce oxygen
( i.e., frequent position consumption allowing for
changes & placing a more prolonged
frequently used items activity.
within easy reach).
● Taught the patient on ● This will help allow

how to safely increase patient independence
activity level and ability to take control
progressively (e.g., of their own health and
sitting up in bed, improvement.
standing up with
assistance, walking a
few steps with rest in
between).
● Over time, repeated
● Encourage the patient to exercises help increase
perform an active range tolerance, which is vital
of motion exercises. to perform ADLs.
Uterine Polyps I 60
Mild Anxiety Nursing Care Plan

Subjective: Mild anxiety related to Within 8 hours of nursing Goal Met.

• “Nag-woworry pa rin fear of specified interventions, the patient ● Established rapport. ● Establishing rapport
ako kasi baka may consequences will be able to apply the with the client helps Within 8 hours of nursing
possibility pa rin na as evidenced by use of positive coping them to cooperate intervention, the patient was
hindi ako mabuntis verbalization of feelings strategies in reducing her during the deliverance able to apply the use of positive
kahit natanggal na and concerns. anxiety. coping strategies in adjusting to
of care.
yung polyps ko”, as her current situation as
verbalized by the ● Monitored patient’s vital ● Vital signs are obtained manifested through verbalizing,
patient. signs. to monitor physical “Kanina nung nag-ooverthink
responses such as na naman ako, very helpful
increased blood talaga yung calm music.” She
Objective: pressure and pulse that also added, “Thankful din ako
● Uneasiness was are associated with
sa partner ko kasi every time na
noted during the nagsasabi ako na parang
● Acknowledged anxiety. kinakabahan or natatakot ako
interview
awareness of a ● Acknowledgement of na baka hindi na naman kami
patient's anxiety. the patient’s feelings makabuo, always niyang
validates the feelings pinapagaan loob ko.”
and communicates
acceptance of those
feelings.
● Provided a quiet and ● A quiet and calm
calm environment. atmosphere helps in
decreasing stress and
making it more
Uterine Polyps I 61
comfortable to rest
● Taught the patient ● Coping techniques help

about the different the patient promote
coping techniques such relaxation and reduce
as expressing feelings,
stress levels that are
listening to music,
spending time or beneficial in relieving
having communication anxiety.
with family, and
encouraged the patient
to do so.
● Observed how the ● Asking questions
patient uses coping requiring informative
techniques to cope with answers helps identify
anxiety.
the effectiveness of
coping strategies
currently used by the
patient.
● Established a working ● An ongoing relationship
relationship with the establishes a basis for
patient through comfort in
continuity of care.
communicating anxious
feelings.
● Allowed the patient to ● Talking about anxiety-
talk about anxious producing situations
feelings and examine and anxious feelings
anxiety-provoking can help the patient
situations if they are
perceive the situation
identifiable.
Uterine Polyps I 62
realistically and
recognize factors
leading to the anxious
feelings.
Uterine Polyps I 63
Situational Low Self-Esteem Nursing Care Plan

Subjective: Goal Partially Met.

• "Iniisip ko kung Situational low self- After an hour of nursing ● Established rapport. ● Establishing rapport with
mag-kakababy pa esteem related to interventions, the patient will be the client helps them to After an hour of nursing
ba kami kasi difficulty conceiving as able to identify feelings and cooperate during the interventions, the patient
syempre bisang evidenced by having methods for coping with a was able to identify feelings
deliverance of care
babae nakakahiya low self-image and negative perception of self. and methods for coping
sa partner ko. fear of failure or with a negative perception
Nakakawala ng emcarrassment of self such as writing down
● Private discussions need the positive things about
confidence." as ● Provided patient’s
to take place in a setting herself. She then
verbalized by the privacy by closing the
where the patient is free verbalized, “mas
patient. door.
to express feelings pagtutuunan ko na ng
without being overheard. pansin siguro ang sarili ko
● Provided time with the kaysa umikot ang mundo ko
Objective: ● Having enough time for sa mga negative na bagay-
patient; set aside
the patient conveys the bagay.” The patient also
enough time so that the
nurse’s interest in and verbalized, “‘be kind to
• Having low self- encounter is calm and
acceptance of the yourself’ sabi nga nila.”
image. deliberate.
patient’s feelings. A
trusting relationship is an
• Fear of failure or
important factor in
embarrassment
building self-esteem.
● Acknowledged
● The feeling of being
statements the patient
unworthy, and
reveals about herself.
incompetent is often
expressed by patients
Uterine Polyps I 64
with low self-esteem.

The patient often
presents herself unable
to manage the current
situation.
● Applied active listening
and open-ended ● These communication
questions. methods permit the
patient to verbalize
interests, concerns,
worries, and thoughts
without interruption.
● Enhanced the patient’s
self-esteem by providing ● It encourages good
positive feedback and repetitive behavior.
support for her effort to
change.
● Encouraged the patient
to state positive things ● Positive affirmations
about herself every day. such as being grateful in
life can help an individual
deal with the stresses in
life and appear happier.
● Encouraged the patient
to open up with her ● This approach may help
partner when she feels the patient to release
sad about her current anxiousness. Having
situation. someone who
understands the
situation can be
beneficial to prevent
situational low self-
Uterine Polyps I 65
esteem.
● Increase patient
engagement by involving ● By engaging the patient
her in the planning in the planning process,
process. they can better
understand their illness
and improve their coping
abilities. It would also
give them a sense of
purpose, increasing their
willingness to cooperate
with healthcare
providers. Additionally,
this intervention can
address critical aspects
of the care plan, enabling
more individualized care.
Uterine Polyps I 66
Readiness for Enhance Coping Nursing Care Plan

Subjective: Readiness for After 2 hours of planning the • Evaluated the patient’s and ● Understanding the Goal Met
• The patient Enhance Coping patient is able to verbalize significant others’ patient’s and SO’s
verbalized, related to patient’s understanding of the health knowledge of the disease current knowledge After 2 hours of
“Willing po ako desire to get pregnant education given in order to process of recurrence of enables the nurse to get intervention, the patient
gawin ang lahat and prevent prevent endometrial polyps and polyps. Determine prior baseline information to was ablt to understand the
para mabuntis recurrence of increase the chance of getting coping strategies to deal prepare a tailored care concepts given to her as
saka para ‘di na endometrial polyps, pregnant. with the disease by asking plan. Additionally, there evidenced by “Susundan
ulit bumalik ‘yung as evidenced by, open-ended questions. is no guarantee that ko po lahat ng sinabi n’yo.
polyps ko, “Willing po ako gawin knowledge gained Lalo na sap ag inom ng
Ma’am.” ang lahat para during health education gamot Ma’am, gusto ko na
mabuntis saka para will be kept, as factors po kasi magka-baby.”
Objective: ‘di na ulit bumalik such as fear and the
• The patient ‘yung polyps ko, introduction of new
showed Ma’am.” concepts may impede
willingness to recall. This intervention
learn more about also aims to open up
changes in order discussion of concerns
to obtain her regarding the condition
health goals. and what to expect.
• Offer assistance and ● Open dialogues help
emotional support to the reassure the patient that
patient, such as active their feelings are valid,
listening, the reiteration of thus fostering a sense of
no right or wrong feelings, a self-worth in the event
non-judgmental approach, that he or she begins to
Uterine Polyps I 67
and having open have negative views

communication for about oneself. It
questions and concerns. prevents the patient from
feeling ashamed or like a
burden. Moreover,
depreciation in the
patient’s self-esteem
could partially diminish
her coping mechanism.
• Instructed the patient ● Obesity, diabetes, and
regarding a healthy diet hypertension are known
consisting of proper risk for developing
distribution of vegetables, endometrial polyps.
lean and red meat. Also, Having a healthy lifestyle
include the importance of prevents these
the patient’s continuation of conditions.
her brisk walking activity
every 30 minutes as a good
form of exercise.
• Instructed the patient to • The patient previously
follow the prescribed admitted to stopping her
medication regimen given by medication a week before
her physician. her procedure, reminding
her of the importance of
following the regimen given
to her helps in increasing her
chance to conceive.
• Instructed the patient to • Follow up check-ups is the
attend to her follow-up best way to determine the
checkups. progress of the patient’s
condition regarding her
conceiving as wells as if
Uterine Polyps I 68
there are any recurrence of

polyps.
• Asked the patient to • This is an assessment in
verbalize her understanding which determines the
of the stated interventions. understanding of the patient
regarding the interventions
as well as to correct any
misconception and answer
questions.
Uterine Polyps I 69
Risk for Infection Nursing Care Plan

Objective:
Risk for infection Within 8 hours of nursing ● Assessed for any signs ● An elevated temperature
● Presence of related to presence of interventions, the patient will be of infection such as may indicate infection.
indwelling indwelling foley able to remain free from any signs fever. And monitored Monitoring the patient's
catheter
catheter. of infection. and recorded patients’ temperature can help
● Traced
leukocytes temperature. identify any potential
infection early and allow
for prompt treatment.
● Assessed the amount, ● Cloudy, turbid, foul-

color and odor of urine. smelling urine with
visible sediment is
indicative of urinary tract
or bladder infection.
● Aseptic technique
● Maintained strict asepsis
decreases the chances
for catheter handling.
of transmitting or
spreading pathogens
interrupting the chain of
infection.
● Encouraged the patient ● Adequate fluid intake

to have adequate fluid helps to flush out
Uterine Polyps I 70
intake. bacteria and other

pathogens from the
urinary tract and
maintain healthy urine
flow, which can reduce
the risk of catheter-
associated urinary tract
infections (CAUTI).
● Promoted frequent hand ● Hand hygiene is crucial

hygiene. in preventing the spread
of infection. Healthcare
providers and patients
should frequently wash
their hands before and
after handling the
catheter or the
surrounding area.
● Proper hygiene
● Educated the patient and
techniques, such as
significant other in
hand washing and
proper draining of the
cleaning the catheter
urine.
and surrounding area
with soap and water, to
prevent the spread of
infection.
Uterine Polyps I 71
● Instructed on how to ● Proper handling and

properly handle and disposal can help
dispose of urine minimize the risk of
drainage bags to infection, promote
minimize the risk of healing, and improve
contamination. overall patient
outcomes.
Uterine Polyps I 72
DRUG STUDY
Co-Amoxiclav Drug Study
Name of Drug Mechanism of Action Indication Contraindications Adverse Effects Nursing Responsibilities
● Generic Name : Description: Co-amoxiclav Co-amoxiclav is Co-amoxiclav contraindicated in CNS: Before:

Co - amoxiclav (beta-lactam antibacterial indicated for the patients with a history of Nausea, vomiting, ● Followed the 14 Rights of Drug
penicillin coformulated with treatment of the hypersensitivity to beta-lactams headache Administration.
a beta-lactamase inhibitor) following infections e.g. penicillins and ● Instructed the patient that it is
● Brand Name: is an antibiotic agent with a due to susceptible cephalosporins; in patients with a CV: consumed with or without
Augmentin notably broad spectrum of strains of sensitive previous history of amoxicillin- Chest pain, palpitations food.
activity against the organisms: clavulanate-associated ● Determine of hypersensitivity
commonly occurring • Lower respiratory jaundice/hepatic dysfunction. GI: reactions to penicillin,
● Dosage: 625 mg 1 bacterial pathogens in tract infections Diarrhea, gas, stomach cephalosporins before therapy
cap B.I.D x 7 days general practice and - bronchitis, pain os initiated.
hospital. The beta- pneumonia,
lactamase inhibitory action bronchiolitis DERM: During:
of clavulanate extends the • Otitis media Skin rash or itching
● Route: Oral spectrum of amoxicillin to (middle ear ● Assess bowel pattern
embrace a wider range of infection) during treatment as
organisms, including many • Sinusitis pseudomembranous colitis
resistant to other beta- • Skin and skin may occur.
● Classification: lactam antibiotics. structure infections - ● Assess respiratory status.
Penicillins cellulitis (infection of ● Ensure that the patient has
Pharmacokinetics: the dermis and adequate fluid intake during
Absorption: The two subcutaneous any diarrhoea attack.
components of co- tissue), erysipelas ● If the patient develops a rash,
amoxiclav, amoxicillin and (infection of dermis wheezing, itching, fever or
clavulanic acid, are fully or hypodermi), swelling in the joints, this could
dissociated in aqueous folliculitis indicate an allergy and should
solution at physiological (inflammation of the be reported.
Uterine Polyps I 73
pH. Both components are hair follicles), ● Patients must ensure they
rapidly and well absorbed furuncles (boils), take the full course of the
by the oral route of carbuncles, medicine.
administration. Absorption abscesses, ● The medicine must be taken in
of co-amoxiclav is impetigo (large equal doses around the clock
optimised when taken at the vesicles or to maintain level in the blood.
start of a meal. honey-crusted ● Report diarrhea, cramping and
sores), infected blood in stools as
Distribution: Following i.v. ulcers, infected pseudomembranous colitis
administration, therapeutic burns, and other. may occur.
concentrations of both • Urinary tract After:
amoxicillin and clavulanic infections (UTI) - ● Documented following the 14
acid may be detected in the infections of the rights of administration.
tissues and interstitial fluid. kidneys, ureters,
Therapeutic concentrations bladder and urethra
of both drugs have been (for more details
found in the gall bladder, read Augmentin for
abdominal tissue, skin, fat, UTI treatment)
and muscle tissues; fluids
found to have therapeutic
levels include synovial and
peritoneal fluids, bile and
pus.
Metabolism: Amoxicillin:
Metabolised to a limited
extent to form inactive
penicilloic acid.
Clavulanic acid:
Extensively metabolised.
Excretion: Amoxicillin:
Uterine Polyps I 74
Mainly via urine (approx 60-

80% as unchanged drug).
Elimination half-life: Approx
1.3 hours.
Clavulanic acid: Via urine
(approx 25-40% as
unchanged drug); faeces;
expired air. Elimination half-
life: Approx 1 hour.
Uterine Polyps I 75
Mefenamic Acid Drug Study

• Generic Name: Description: Mefenamic Carefully consider the Hypersensitivity to CNS: headache, Before:
Mefenamic Acid acid, an anthranilic acid potential benefits and risks mefenamic acid; history of dizziness, ● Followed the 14
derivative, is an NSAID with of mefenamic acid and hypersensitivity reaction insomnia Rights of Drug
analgesic and antipyretic other treatment options (e.g. asthma, rhinitis, Dermatologic: Administration.
• Brand Name: properties. It reversibly before deciding to use angioedema, urticaria) to rash, pruritus, ● Instructed the
Ponstel , Ponstan SF inhibits cyclooxygenase-1 mefenamic acid. Use the aspirin or other NSAIDs. sweating patient that it is
and 2 (COX-1 and 2) lowest effective dose for the Inflammatory bowel consumed with
enzymes resulting in shortest duration consistent disease, history of Gl: nausea, GI food.
• Dosage: 500 mg 1 cap decreased formation of with individual patient gastrointestinal bleeding or pain, diarrhea, ● Educate patient that
T.I.D x 3 days prostaglandin precursors. treatment goals. perforation related to constipation prolonged use of
previous NSAID therapy, drug may damage
Pharmacokinetics: active gastrointestinal GU: dysuria, renal liver
• Route: Oral Absorption: Rapidly ulceration or bleeding, impairment During:
absorbed from the history of recurrent peptic ● Give drug with food,
gastrointestinal tract. Time ulcer disease or Hematologic: milk or
• Classification: to peak plasma haemorrhage (≥2 distinct bleeding, platelet antacids
Nonsteroidal Anti- concentration: 2-4 hours. episodes of proven inhibition with ● Do not increase or
Inflammatory Drugs Distribution: Enters breast ulceration or bleeding), higher doses, double the dose,
(NSAIDs) milk (small amounts). severe heart failure. Use in neutropenia follow exactly as
Volume of distribution: 1.06 the setting of CABG prescribed and
L/kg. Plasma protein surgery. Severe renal and Respiratory: indicated
binding: >90% to albumin. hepatic impairment. dyspnea, ● Administer drug
Pregnancy (3rd trimester). hemoptysis, with full glass of
Metabolism: pharyngitis water
Predominantly metabolised ● Do not break, chew
in the liver by CYP2C9 Other: peripheral or crush
isoenzyme into 3- edema, capsule and tablet
hydroxymethyl mefenamic anaphylactoid ● Do not administer
acid, which may be oxidised reactions to with
Uterine Polyps I 76
further into 3- anaphylactic shock anticoagulants and

carboxymefenamic acid; other drug that
both metabolites undergo causes Gl upset
secondary conjugation to After:
form glucuronides. ● Documented
following the 14
Excretion: Via urine rights of
(approx 52%; 6% as administration.
unchanged drug, 25% as 3- ● Instruct
hydroxymethyl mefenamic discontinuation of
acid, 21% as 3- medintravAgaif
carboxymefenamic acid); adverse effect
faeces (approx 20%, mainly occurs
as unconjugated 3-
carboxymefenamic acid).
Elimination half-life: Approx
2-4 hours.
Uterine Polyps I 77
EPO (Evening Primrose Oil) Drug Study

• Generic Name: EPO Description: Cervical ripening & Don't take evening primrose Gl: gastrointestinal upset Before:
(Evening Primrose Oil) Evening primrose oil presents a dilatation during labor if you have a bleeding (abdominal pain, ● Followed the 14
content of 74% Linolenic acid induction & pre-op disorder. Oral use of the indigestion, nausea, Rights of Drug
and 9% Gamolenic acid from hysteroscopy. Relief of supplement might increase softening of stools) Administration.
• Brand Name: Eveprim, which the latter seems to be the symptoms of the risk of bleeding. If you're ● Don't take evening
everose key active ingredient of this oil. premenstrual planning to have surgery, CNS: headaches, dizziness primrose if you
These major essential fatty syndrome & stop taking evening have a bleeding
acids are required for the menopausal primrose two weeks disorder.
• Dosage: 4 caps/vagina normal structure of cell discomfort. beforehand. Also, don't take
Q4 B.I.D membranes and they are not evening primrose if you
synthesized endogenously. The have epilepsy or During:
therapeutic activity of evening schizophrenia.
• Route: Intravaginal primrose oil is attributed to the ● Assess bowel
direct action of its essential fatty pattern
acids on immune cells as well ● Assess respiratory
• Classification: as to an indirect effect on the status.
Supplements & synthesis of eicosanoids. The ● Instructed patient to
Adjuvant Therapy actions of highly unsaturated elevate legs by
fatty acids in tissues and using 1-2 pillows to
eicosanoids are thought to be prevent the
implicated in inflammatory and medication from
immunologic pathogeneses. spilling out through
the vagina.
Pharmacokinetics: ● Provide support
Absorption: evening primrose with ambulation if
oil is mainly studied by dizziness occurs
analyzing its active ingredient ● Ensure that the
gamolenic acid. after patient has
administration, gamolenic acid adequate fluid
Uterine Polyps I 78
is rapidly absorbed and intake

converted directly to dihomo- ● Monitor uterine
gamma-linolenic acid and other contractions and
precursors. When orally observe for and
administered, the tmax was report excessive
directly dependent on the time vaginal bleeding
of administration, being 2.7 and cramping pain
hours in the evening and 4.4 ● Patients must
hours in the morning. The cmax ensure they take
and auc were registered to be the full course of
approximately 21 mcg/ml and the medicine.
274 mcg.h/ml. The ● Report diarrhoea,
bioavailability of gamolenic acid cramping
acid is influenced by triglyceride
composition, cellular kinetics of After:
phospholipases and ● Documented
acyltransferases. following the 14
rights of
Metabolism:main component administration.
of evening primrose oil, ● Observe patient
Linolenic acid is usually carefully, after
desaturated by delta-6- insertion of the
desaturase which transforms drug.
this fatty acid to Gamolenic acid.
This metabolic activity usually is
limited by external factors such
as stress, aging, alcohol,
smoking, inflammation,
diabetes, etc. In presence of
these circumstances, the
linoleic acid gets accumulated
in the body and it inhibits the
Uterine Polyps I 79
activity of the enzyme delta-6-

desaturase. In proper
conditions, Gamolenic acid
forms Dihomo-gamma-linolenic
acid by the action of elongases
and it can further act as a
substrate for production of
prostaglandins or to be
denaturated to arachidonic acid.
Excretion: The major

components of the primrose oil
are highly metabolized and the
majority of the generated
metabolites are excreted in the
urine.
Uterine Polyps I 80
Hyoscine N-butylbromide Drug Study

• Generic Name: Description It is an antispasmodic used Hyoscine-N-butylbromide is CNS: Dizziness, Before:

Hyoscine N- Tablet: 1 sugar coated (s.c.) for gastrointestinal tract contraindicated in: patients headache, restlessness, ● Followed the 14
butylbromide tablet contains 10 mg spasm, spasm and who have demonstrated disorientation, irritability, Rights of Drug
Hyoscine-N-butylbromide. dyskinesia of the biliary prior hypersensitivity to fever, impaired memory, Administration.
Excipients: dibasic calcium system and genitourinary Hyoscine-N-butylbromide delirium, hallucination, ● Instructed the
• Brand Name: Buscopan phosphate, maize starch, tract spasm. or any other component of confusion, drowsiness, patient that it is
starch soluble, aerosil 200, Injection: Acute gastro- the product; myasthenia dizziness, increased ICP, consumed with
tartaric acid, stearic acid, intestinal gravis, mechanical stenosis anaphylactic reactions, food.
• Dosage: 10 mg T.I.D polyvidone, saccharose, in the gastrointestinal tract, anaphylactic shock.
talc, acacia, titanium paralytical or obstructive CV: Palpitations, During:
dioxide, polyethylene glycol ileus, megacolon. tachycardia, flushing, ● Take this drug 30
• Route: Oral 6000, carnauba wax, Tablet: In case of rare hypotension. minutes to 1 hour
beeswax white. hereditary conditions that EENT: dilated pupils, before meals.
Injection: Each mL may be incompatible with blurred vision, ● Buscopan will
• Classification: contains: Hyoscine-N- an excipient of the product, photophobia, increased potentiate the effect
Antispasmodics butylbromide 20 mg. the use of the product is intraocular pressure, of alcohol and other
Excipients: sodium contraindicated. difficulty in swallowing. CNS depressants.
chloride, water for injection. Injection: untreated narrow GI: Constipation, nausea, ● Do not take
angle glaucoma, vomiting. antacids and
Pharmacokinetics: hypertrophy of the prostate GU: Urinary retention antidiarrheal 2 to 3
Injection: Absorption and with urinary retention, Local: Pain in the hours prior to raking
Distribution: After tachycardia. injection site. this drug.
intravenous administration By intramuscular injection, Musculoskeletal: Muscle ● Examine the
hyoscine butylbromide is Hyoscine-N-butylbromide weakness. patient’s mouth to
rapidly distributed (t½α = 4 ampoules are Respiratory: Dyspnea, ensure that the
min, t½β = 29 min) into the contraindicated: in patients bronchial plugging, medicine was
tissues. The volume of being treated with depressed respiration. ingested.
distribution (Vss) is 128 L anticoagulant drugs since Skin: Rash, dryness, ● Stay with the patient
(corresponding to approx. intramuscular haematoma swelling of the hands or to observe whether
Uterine Polyps I 81
1.7 L/kg). Because of its may occur. In these feet, itching the medication has
high affinity for muscarinic patients, the subcutaneous any acute side
receptors and nicotinic or intravenous routes may effects.
receptors, hyoscine be used. After:
butylbromide is mainly ● Documented
distributed on muscle cells following the 14
of the abdominal and pelvic rights of
area as well as in the administration.
intramural ganglia of the ● Provide
abdominal organs. Plasma safetymeasures
protein binding (albumin) of (e.g.adequatelightin
hyoscine butylbromide is g, raisedside rails,
approximately 4.4%. etc.) to prevent
Animal studies injuries.
demonstrate that hyoscine ● Provide comfort
butylbromide does not pass measures (e.g.
the blood-brain barrier, but voiding before
no clinical data to this effect dosing, taking
is available. Hyoscine food with drug,
butylbromide (1 mM) has etc.) to help
been observed to interact patient tolerate
with the choline transport drug effects
(1.4 nM) in epithelial cells of
human placenta in vitro.
Metabolism and
elimination: The main
metabolic pathway is the
hydrolytic cleavage of the
ester bond. The half-life of
the terminal elimination
phase (t½γ) is
Uterine Polyps I 82
approximately 5 hours. The

total clearance is 1.2 L/min.
Clinical studies with
radiolabeled hyoscine
butylbromide show that
after intravenous injection
42 to 61% of the radioactive
dose is excreted renally and
28.3 to 37% faecally.
The portion of unchanged
active ingredient excreted
in the urine is approximately
50%. The metabolites
excreted via the renal route
bind poorly to the
muscarinic receptors and
are therefore not
considered to contribute to
the effect of the hyoscine
butylbromide.
Uterine Polyps I 83
DISCHARGE PLAN
COMPONENTS ACTIONS RATIONALE
• Instructed the patient and • Proper adherence to the

MEDICATIONS their S.O about the proper medication regimen of the patient
adherence to the can help in managing her condition.
medication regimen of the
patient.
• This helps facilitate compliance
and proper intake of the
• Reminded the patient of the medication.
dosage, frequency, and any - Co-Amoxiclav is an
special instruction on take antibiotic used for
home medications like bacterial infections. It is
o Co Amoxiclav 625g also served as
BID x 7 days prophylaxis for the
o HNBB patient post-operatively.
o Vitamin C 1000mg - HNBB is an
OD anticholinergic agent that
is use to relax smooth
muscle of the patient’s
genital tract.
- Vitamin C is an
antioxidant and promote
healthy reproductive
system. It regulates the
patient’s menstrual cycle
and promote normal
ovulation.
• Encouraged the patient • Exercise may help balance
EXERCISE and SO that the patient hormones which can help boost
should do minimal exercise fertility and reduce the risk of
that her body can polyps’ recurrence.
accommodate. It is better
to start with non-strenuous
activities like brisk walking.
• Remind the patient and • A well-balanced diet is associated
DIET their S.O to adhere to a diet with improved fertility. They can
that benefits the patient. help get off to a healthy start in
The patient should eat a pregnancy. Low-fat diet also
well-balanced diet contributes to reducing risk for
consisting of: polyps’ recurrence.
o Foods, such as
vegetables, low-fat
dairy products, cooked
beans, lean meats, and
fish. • Reduce your unhealthy fat intake
o Low-fat food options to help lower your risk of
reproductive system problems.
• Remind the patient and
their S.O that the patient
should stay hydrated and to
avoid refined sugar, oily
foods, and junk foods.
• Explained to the patient the • To maintain a proper and healthy
HEALTH importance of continuous lifestyle that promotes fertility.
TEACHINGS adherence to the
physician’s order.
• This is to increase patient’s
• Provided the patient and understanding more about the
SO an information about
Uterine Polyps I 84
the treatments and condition and to properly manage

management regarding her infertility.
infertility and signs of
potential complications of
this condition.
• Instructed the patient to • Follow-up appointments can help
OUT-PATIENT- adhere if the doctor makes the doctor monitor the patient’s
FOLLOW-UP a follow-up appointment health and if treatment and
CARE management should be modified.
• Encouraged the patient and • Prayer tends to strengthen a

SPIRITUAL the SO to seek God’s help patient’s faith and thus leads to
CARE and guidance by means of better coping with her condition.
praying and holding their
faith to our Almighty God.
Uterine Polyps I 85
REFERENCES:
Anatomy of the Uterus - Health Encyclopedia - University of Rochester Medical Center. (n.d.).
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=34&Content
ID=17114-1
Endometrial polyps: MedlinePlus Medical Encyclopedia. (n.d.).
https://medlineplus.gov/ency/article/007636.htm
Female Reproductive System: Structure & Function. (n.d.). Cleveland Clinic.
https://my.clevelandclinic.org/health/articles/9118-female-reproductive-system
Hill, D. A., MD. (2020, November 13). Endometrial Polyps. Contemporary OB/GYN.
https://www.contemporaryobgyn.net/view/endometrial-polyps
Irregular Periods & Fertility | Loma Linda Fertility Center | CA. (2021, September 13). Loma Linda
University Center for Fertility & IVF.
https://lomalindafertility.com/infertility/women/irregular-periods/
Ivf, L. (2022, June 11). Uterine Polyps and Miscarriages |. https://laivfclinic.com/.
https://laivfclinic.com/blog/uterine-polyps-and-miscarriages/
Mansour, T. (2022, November 14). Endometrial Polyp. StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK557824/
News-Medical.net. (2019, April 19). What is Estrogen? https://www.news-
medical.net/health/What-is-
Estrogen.aspx#:~:text=Estrogens%20are%20produced%20primarily%20by,follicle%20a
nd%20from%20the%20placenta.
Nijkang, N. P., Anderson, L., Markham, R., & Manconi, F. (2019). Endometrial polyps:
Pathogenesis, sequelae and treatment. Sage Open Medicine, 7, 205031211984824.
https://doi.org/10.1177/2050312119848247
Philippine Journal of Obstetrics and Gynecology. (n.d.). http://pjog.org/article-
detail.php?id=96&fbclid=IwAR02QCll4BMfj9uqUyq5RaOJ1AtlGUGWmf3cGqjcqzpjbSkQ
zLjP50rzzcA
Rasheed, H. a. M., & Hamid, P. (2020). Inflammation to Infertility: Panoramic View on
Endometriosis. Cureus. https://doi.org/10.7759/cureus.11516
Reese, D. (2018, September 28). Uterine Polyps. WebMD.
https://www.webmd.com/cancer/cervical-cancer/uterine-polyps
Team, C. B. M. (n.d.). Search Drug Information, Interactions, Images, Dosage & Side Effects |
MIMS. https://www.mims.com/
Texas Fertility Center. (2018, December 19). Endometrial Polyps - Abnormal Bleeding - Causes
of Infertility - Austin. https://txfertility.com/female-infertility/endometrial-polyps/
The Editors of Encyclopaedia Britannica. (1998, July 20). Estrogen | hormone. Encyclopedia
Britannica. https://www.britannica.com/science/estrogen
Torborg, L. (2018, July 31). Mayo Clinic Q and A: Uterine polyps rarely are cancerous. Mayo
Clinic News Network. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-
a-uterine-polyps-rarely-are-
cancerous/#:~:text=The%20odds%20of%20a%20uterine,risk%20is%205%2D6%20perc
ent
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University of Saint Louis

Tuguegarao City, Cagayan 3500

Endometrial Polyps: A Case Presentation

Title Page ------------------------------------- 1

Table of Contents ------------------------------------- 2

Disease Description ------------------------------------ 4

Predisposing and Precipitating Factors ------------------------------------- 7

Signs and Symptoms ------------------------------------- 9

Treatment and Management ------------------------------------- 15

Patient Information ------------------------------------- 17

NURSING HISTORY ------------------------------------- 18

GORDON’S 11 FUNCTIONAL PATTERNS ------------------------------------- 21

PHYSICAL ASSESSMENT ------------------------------------- 27

ANATOMY AND PHYSIOLOGY ------------------------------------- 40

COURSE IN THE WARD ------------------------------------- 47

LABORATORY AND DIAGNOSTICS ------------------------------------- 57

NURSING CARE PLAN ------------------------------------- 60

DRUG STUDY ------------------------------------- 74

DISCHARGE PLAN -------------------------------------- 86

Furthermore, this paper also aims to:

• Provide a comprehensive knowledge and understanding of Endometrial Polyps.

Source: National Library of Medicine, (2019).

Source: National Library of Medicine

Use of Hormone Replacement Therapy (HRT) for Postmenopausal Symptoms. Post

Signs and Symptoms

Uterine Bleeding. Endometrial polyps continuously stimulate the endometrium due to

Mechanical obstruction may result in several consequences, such as hindering sperm

Transvaginal Ultrasonography (TVUS). Endovaginal Ultrasound or Transvaginal

Hysterosonography/ Sonohysterography/ Saline Infusion Sonography (SIS). It is a

Moreover, it is best to perform hysterosonography immediately after the menstrual period

Furthermore, urinalysis with PT is also used before a Hysterectomy Polypectomy because

Treatment and Management

Medication. Progestins and gonadotropin-releasing hormone agonists such as leuprolide,

Hysteroscopic Polypectomy. Hysteroscopic Polypectomy is a surgical procedure in

Progesterone Hormone Therapy. Post-hysteroscopic progesterone hormone therapy

Levonorgestrel IUD releases progesterone that inhibits the synthesis of estrogen

Endometrial Ablation. Endometrial ablation is a surgical procedure that destroys

Age: 30 years old

Birthdate: July 12, 1992

Birthplace: Tuguegarao City

Address: Lapu-Lapu Street, San Gabriel, Tuguegarao City,

Religion: Roman Catholic

Educational attainment: College Graduate

Occupation: Government Employee

Civil Status: Single

Date of Admission: February 20, 2023 at 8:10 am

Chief Complaint: Scheduled Polypectomy

Admitting Diagnosis: Endometrial Polyp

Preoperative Diagnosis: Endometrial mass to consider Endometrial Polyp

Post-Operative Diagnosis: Endometrial mass to consider Endometrial Polyp

Admitting Physician: Dr. J.B.P.

Attending Physician: Dr. J.B.P.

Date Handled: February 21, 2023 at 9:00 am

ADMITTING VITAL SIGNS CURRENT VITAL SIGNS

Blood Pressure: 120/80 mmHg Blood Pressure: 120/80 mmHg

Pulse Rate 62 bpm Pulse Rate 94 bpm

Respiratory Rate 20 cpm Respiratory Rate 20 cpm

Temperature 36.3°C Temperature 36.8°C

Oxygen Saturation: 95% Oxygen Saturation: 99%

History of Present Illness

The patient's sister, a college student, is diagnosed with asthma.

GORDON’S 11 FUNCTIONAL PATTERN

FUNCTIONAL BEFORE HOSPITALIZATION DURING HOSPITALIZATION