CASE STUDY on:

Primary Infertility To Consider

Pelvic Factor Pituitary
Macroadenoma HbV Infection
 DEFINITI
ON
•Primary Infertility: This refers to the inability of a couple to conceive a child after at least
one year of regular, unprotected intercourse. It's important to determine the underlying
cause(s) of infertility, which can involve issues with the female reproductive system, male
reproductive system, or both.

•Pelvic Factor: Pelvic factors can contribute to infertility in women. These may include
conditions such as endometriosis, pelvic inflammatory disease (PID), blocked fallopian
tubes, or structural abnormalities of the uterus.

•Pituitary Macroadenoma: A pituitary macroadenoma is a tumor of the pituitary gland that

is larger than 10 millimeters in size. This tumor can affect hormone levels, potentially
disrupting the normal functioning of the reproductive system by altering the production of
hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which
are essential for ovulation and menstruation.

•HBV Infection: "Hepatitis B virus (HBV)" infection. HBV is a viral infection that can
affect the liver. Chronic HBV infection may lead to liver dysfunction, which can indirectly
impact fertility.
 CAUSES
• Primary Infertility- Primary infertility refers to the inability to conceive after one year of
regular, unprotected sexual intercourse. Common causes include ovulation disorders,
fallopian tube damage, uterine or cervical factors, male factor infertility, endocrine disorders,
age, lifestyle factors, genetic factors, and sometimes unexplained reasons. Seeking medical
help is important for diagnosis and exploring treatment options

• Pituitary macroadenomas- are noncancerous tumors larger than 1 centimeter on the

pituitary gland. Their exact cause is often unclear but may involve genetic predisposition,
hormonal imbalances, cell growth abnormalities, head trauma, radiation exposure, or
unknown factors. Hormonal disruptions, such as excess growth hormone or prolactin, can
contribute to tumor growth. Early detection and treatment are crucial for managing these
tumors and potential complications.

• HbV Infection- is caused by exposure to the virus through infected blood or body fluids.
Transmission can occur via unprotected sex, sharing needles, from mother to child during
childbirth, sharing personal items contaminated with infected blood, inadequately sterilized
medical equipment, or occupational exposure. Preventive measures like vaccination and safe
practices can reduce the risk of HBV transmission.
 RISK
FACTORS
• Primary Infertility carries several health risks and implications. These include psychological
stress, delays in starting a family, underlying health conditions, risks associated with fertility
treatments, financial strain, physical side effects of treatments, social stigma, missed opportunities
for early detection of health issues, impact on quality of life, and potential long-term health risks.
Seeking support from healthcare professionals and exploring available treatment options are
essential for managing primary infertility.

• Pituitary macroadenomas- pose various health risks and implications. These include hormonal
imbalances leading to symptoms such as headaches, vision problems, and hormonal dysfunction.
Additionally, large tumors can compress surrounding structures in the brain, causing neurological
complications. Treatment may involve surgery, medication, or radiation therapy, each carrying its
own set of risks and potential side effects. Regular monitoring and follow-up care are essential due
to the possibility of tumor recurrence.

• HBV infection-. HBV can cause acute or chronic liver inflammation, leading to liver damage,
cirrhosis, liver failure, or hepatocellular carcinoma (liver cancer). Prevention measures such as
vaccination, safe sex practices, and avoiding sharing needles are crucial. Chronic HBV infection
requires long-term management to prevent complications. Early diagnosis and treatment can help
reduce the risk of liver-related complications and transmission to others.
Nursing Management
Primary Infertility
• Comprehensive care, education, and support for individuals or couples facing
challenges in conceiving. Assess emotional and physical needs, offer empathy, and
provide education about causes, treatment options, and lifestyle changes. Assist
with medication administration, monitor treatment progress, and advocate for
access to specialized care. Offer support during procedures, promote coping
strategies, and provide culturally sensitive care. By addressing the holistic needs
of individuals, nurses play a crucial role in helping them navigate the complexities
of primary infertility and work towards achieving their reproductive goals.
Nursing Management
Pituitary Macroadenoma

• Provide holistic care and support to patients with these tumors. They play a central role in
assessment, education, and monitoring throughout the patient's journey. Educate patients
and their families about the condition, treatment options, and potential complications.
They assist with medication management, monitor for signs of hormonal imbalances or
neurological complications, and provide emotional support. Additionally, collaborate with
other healthcare professionals to ensure coordinated care and optimize outcomes for
patients with pituitary macroadenomas. Through their expertise and compassionate care,
nurses contribute significantly to the well-being and quality of life of patients with these
tumors.
Nursing Management
HBV Infection

• Focus on prevention, education, and support for individuals affected by the virus. Educate
patients about HBV transmission, prevention measures, and the importance of
vaccination. Provide emotional support, address concerns, and promote adherence to
treatment regimens for those with chronic HBV infection. Additionally, dvocate for
access to care, facilitate screening and testing, and provide resources for patients and their
families. By offering comprehensive care and support, nurses help individuals affected by
HBV infection manage their condition and improve their quality of life
MEDICATION (DRUG
STUDY) of:

Metoclopramide
Paracetamol
Cefoxitin
NAME OF THE ROUTE CLASSIFICATION INDICATION MECHANISIM OF ADVERSE NURSING
DRUG ACTION EFFECTS MANAGEMENT
(GENERIC,
BRAND NAME, &
DOSAGE)
Metoclopramide Oral Route and GI stimulants, •It is used to treat Metoclopramide is Common Side •Monitor BP
Metozolv ODT Parenteral (IM) Miscellaneous heartburn. a medication that Effects: carefully during IV
Parenteral (IM): 5 Route antiemetics •It is used to treat works on the upper •feeling restless; administration.
mg/mL or prevent upset digestive system •feeling drowsy or •Monitor for
Oral: 5-15mg stomach and muscles, tired; extrapyramidal
Recommended throwing up. increasing muscle •lack of energy; (involuntary facial
dosage for adult: •It is used to treat contractions and •nausea, vomiting; movements)
10mg gastroesophageal accelerating •headache, reactions, and
Recommended reflux disease stomach ejection. confusion; or sleep consult physician
dosage for (GERD; acid Its antiemetic problems if they occur.
children: 5mg reflux). action is due to its (insomnia) •Monitor diabetic
•It is used to treat a antagonist activity patients, arrange
slow moving GI at D 2 receptors in for alteration in
(gastrointestinal) the chemoreceptor insulin dose or
tract in some trigger zone, timing if diabetic
people. preventing nausea control is
•It may be given to and vomiting. At compromised by
you for other higher doses, 5-HT alterations in
reasons. Talk with 3 antagonist timing of food
the doctor. activity may also absorption.
contribute to its •Monitor severe
effect. diarrhea and
dehydration.
NAME OF THE ROUTE CLASSIFICATION INDICATION MECHANISIM OF ADVERSE NURSING
DRUG ACTION EFFECTS MANAGEMENT
(GENERIC,
BRAND NAME, &
DOSAGE)
Paracetamol Oral Route Miscellaneous It is used for the Paracetamol is a Serious side effects •Assess the
Panadol, Calpol, analgesics relief of: drug that provides of paracetamol patient’s pain level
Tylenol, Alvedon • analgesia and include: before
Oral Headache antipyresis by • administering the
(tablets/capsules): •Tension headache acting on the brain Allergic reactions, medication.
500mg •Migraine and peripheral which may be •Monitor the
Oral Suspension: •Backache system. It inhibits severe and include: patient’s response
5ml •Rheumatic and prostaglandin • Skin to the medication.
Recommended muscle pain synthesis by rashes, •Administer the
dosage for adult: •Mild blocking COX-1 itching or medication in the
500mg (1-2 arthritis/osteoarthri and COX-2 hives appropriate
tablets) tis enzymes, • Swelling dosage, as
Recommended •Toothache especially in low of the prescribed by a
dosage for arachidonic acid throat, healthcare
adolescent: 500mg and peroxide tongue or provider.
(1 tablet) conditions. - face •Administer
Recommended • Shortness acetaminophen
dosage for infants: of breath with a full glass of
2-5ml or water.
Recommended wheezing
dosage for
children: 5ml

Continuation…
NAME OF THE ROU CLA INDICATION MECHANISIM OF ACTION ADVERSE EFFECTS NURSING MANAGEMENT
DRUG TE SSIFI
(GENERIC, CATI
BRAND NAME, ON
& DOSAGE)

Paracetamol •Period pain It also activates • Breathing •Do not exceed the maximum
(dysmenorrhea) descending serotonergic problems recommended daily dose of
•Colds and flu pathways that modulate • Liver problems acetaminophen when combined
symptoms pain perception, • Nausea, sudden with opioids
•Sore throat influences cannabinoid weight loss, loss •Advise patients to seek medical
•Sinus pain receptors, and affects the of appetite and attention if they experience
•Post-operative pain hypothalamus, increasing jaundice can occur signs of overdose, such as
•Fever (pyrexia) heat dissipation and blood nausea, vomiting, loss of
flow. appetite, sweating, confusion, or
yellowing of the skin or eyes.
NAME OF THE ROUTE CLASSIFICATION INDICATION MECHANISIM OF ADVERSE NURSING
DRUG ACTION EFFECTS MANAGEMENT
(GENERIC,
BRAND NAME, &
DOSAGE)
Cefoxitin Parenteral Route Second generation This medication is The bactericidal Common side •Give oral drug
Mefoxin (IV) cephalosporins a broad-spectrum action of cefoxitin effects of cefoxitin with food to
Parenteral Route cephalosporin results from may include: decrease GI upset
(IV): ranges from antibiotic, inhibition of cell •pain, bruising, and enhance
1-10grams prescribed for wall synthesis. swelling, or other absorption.
Recommended serious infections Cefoxitin, a 2nd- irritation where the •Give oral drug to
Dosage for adults: such as: generation injection was children who can
1gram for •respiratory tract cephalosporin given; swallow tablets;
uncomplicated infection, antibiotic, inhibits •diarrhea; crushing the drug
infections, 2grams •urinary tract bacterial cell wall •fever; or results in a bitter,
for moderately infection, synthesis by •rash, itching unpleasant taste.
severe to severe •septicemia, binding to •Discontinue if
infections, 3grams •bone and joint penicillin-binding hypersensitivity
for infections that infections, and proteins, blocking reaction occurs.
need higher others. the final
dosage It works by transpeptidation
fighting against the step.
bacteria in the
body.

Continuation…
NAME OF THE ROU CLA INDIC MECHANISIM OF ACTION ADVERSE EFFECTS NURSING MANAGEMENT
DRUG TE SSIFI ATION
(GENERIC, CATI
BRAND NAME, ON
& DOSAGE)
Cefoxitin Its high stability against β- Cefoxitin may cause serious side •Ensure proper dosage, route, and timing.
lactamases is due to its 7-α effects. Call your doctor at once •Monitor the patient’s response to
methoxy group in its β- if you have: treatment.
lactam ring, resulting in a •severe stomach pain, diarrhea •Monitor for adverse effects such as
bactericidal effect. that is watery or bloody (even if allergic reactions, diarrhea, or
it occurs months after your last superinfections.
dose); •Report any adverse reactions promptly.
•a light-headed feeling, like you
might pass out;
•little or no urination;
•jaundice (yellowing of the skin
or eyes);
•a seizure;
•fever, chills, tiredness; or
•easy bruising, unusual bleeding,
pale skin, cold hands and feet
 Anatomy and
Physiology:
Primary infertility involves understanding the intricate
anatomy and physiology of the reproductive system. In
females, this includes the ovaries, fallopian tubes, uterus,
cervix, and vagina, while in males, it encompasses the
testes, epididymis, vas deferens, prostate gland, seminal
vesicles, and penis. Conception occurs when sperm
fertilizes an egg in the fallopian tube, leading to embryo
development and implantation in the uterus. Factors
affecting fertility can range from hormonal imbalances and
reproductive disorders to genetic, age-related, lifestyle,
and environmental factors. Understanding these dynamics
is crucial for diagnosing and managing primary infertility
effectively.
 Nursing Care Plan
Nausea and vomiting related to HBV infection

Assessment Diagnosis Planning Implementation Evaluation

Subjective Data •Risk for dehydration related •Reduce nausea and •Administer antiemetic medications as Goal met
prescribed to relieve nausea and prevent
• "Suka po ako to vomiting and inadequate vomiting episodes. vomiting.
ng suka at fluid intake. •Maintain or restore fluid •Encourage small, frequent meals or snacks
nahihilo" said •Imbalanced nutrition: less and electrolyte balance. that are easy to digest and low in fat to
reduce the likelihood of triggering nausea.
the patient than body requirements related •Improve nutritional intake •Offer clear fluids or ice chips between
to decreased oral intake due to and prevent complications meals to maintain hydration and prevent
Objective Data nausea and vomiting. of malnutrition and dehydration.
•Provide oral hygiene care to freshen the
• Pale skin dehydration. mouth and alleviate unpleasant tastes or
• Poor skin . odors that may contribute to nausea.
turgor •Implement relaxation techniques, such as
deep breathing exercises, guided imagery,
or aromatherapy, to promote relaxation and
reduce stress-induced nausea.
•Monitor the patient's fluid intake and
output, assess for signs of dehydration, and
encourage adequate hydration.
•Monitor the patient's nutritional status and
intake, provide nutritional counseling, and
offer high-calorie, nutrient-dense foods and
supplements as needed.
•Collaborate with the healthcare team to
identify and address underlying causes of
nausea and vomiting related to HBV
infection, such as liver dysfunction,
metabolic imbalances, or medication side
effects.
 Nursing Care Plan
Headache related to Pituitary Macroadenoma

Assessment Diagnosis Planning Implementation Evaluation

Subjective Data •Pain related to headache •Alleviate or reduce • Administer analgesic medications as Goal met
prescribed to relieve headache pain and
• "masakit po symptoms associated with headache symptoms discomfort.
ang ulo ko " pituitary macroadenoma. associated with pituitary • Encourage the patient to maintain
said the •Risk for impaired comfort macroadenoma. hydration by drinking adequate fluids
throughout the day.
patient related to frequent or severe •Identify and address • Promote stress reduction techniques,
headaches. triggers for headaches. such as relaxation exercises, deep
Objective Data •Deficient knowledge related •Educate the patient about breathing exercises, guided imagery, or
mindfulness meditation.
• Pain scale of 1- to headache management headache management and • Educate the patient about potential
10 the patient strategies, pituitary prevention strategies. headache triggers, such as stress,
said 8 macroadenoma, and treatment •Improve the patient's ability fatigue, dehydration, or hormonal
changes, and encourage avoidance or
options. to cope with and manage management of these triggers.
headache symptoms. • Collaborate with the healthcare team to
assess the effectiveness of current
treatment modalities for pituitary
macroadenoma and identify any
interventions that may help alleviate
headache symptoms.
• Monitor the patient's vital signs and
neurological status closely, and assess
for signs of increased intracranial
pressure or neurological deterioration.
• Provide information and resources
about headache management and
prevention, including relaxation
techniques, stress management
strategies, dietary modifications, and
medication management option
 Nursing Care Plan
Primary Infertility To Consider Pelvic Factor Pituitary Macroadenoma HbV Infection
Assessment Diagnosis Planning Implementation Evaluation
• Subjective Data • Anxiety related to the • Reduce anxiety and •Monitor the patient's physical and Goal met
emotional well-being, assess treatment
: "Bakit hindi ako mag complex nature of improve coping responses, and communicate any concerns
ka anak ano ang infertility, as evidenced mechanisms related to or changes to the healthcare team.
gagawin ko" said the by ultrasound stating infertility, pituitary •Provide emotional support and
reassurance to address anxiety and
patient pituitary macroadenoma macroadenoma, and promote coping strategies.
and HBV infection. HBV infection. •Offer education and information about
B. Objective Data • Enhance understanding infertility treatments, including assisted
reproductive technologies, and discuss
• Ultrasound, MRI, of treatment options potential risks and benefits.
or Ct scan confirms and promote active •Collaborate with healthcare providers to
presence of involvement in coordinate fertility treatments, pituitary
macroadenoma management, and HBV
pituitary decision-making. infection monitoring and treatment.
macroadenoma • Facilitate access to •Encourage lifestyle modifications, such
• Lab results came multidisciplinary care, as maintaining a healthy diet, regular
exercise, stress reduction techniques, and
back positive for including fertility avoiding alcohol and tobacco use.
HBV infection specialists, •Facilitate access to support groups,
endocrinologists, counseling services, or patient advocacy
organizations specializing in infertility,
hepatologists, and pituitary disorders, and liver diseases.
mental health •Provide information and resources about
professionals fertility preservation options, such as
sperm or egg freezing, if applicable.