Philippine Christian University

MARY JOHNSTON COLLEGE OF NURSING

415 Morga Street, Tondo, Manila 1012, Philippines
Tel. No. +632-245-0824, Fax No. +632-245-0806
e-mail: [email protected], website: www.pcu-mjcn.com
Accreditation Level: Level III (2026 by ACSCU-AAI) Year Granted: 2020

Two Circles in One: A Case Study Left Ovarian New

Growth and Right Follicular Cyst
______________

A Case Study
Presented to
College of Nursing and Allied Health
PCU – Mary Johnston College of Nursing
Morga St., Tondo, Manila

______________

In Partial Fulfillment
Of the Requirements for the Subject
NCM 109

______________
Alabado, Naomi Jean A.
Bacor, Paul John P.
Bautista, Jullianne Rose C.
Delos Reyes, Rein Jester
Esguerra, Louise Valerie T.
Jumawan, Princess Joy
Rojo, Richmonde Ray C.
Vallesteros, Renee Faye D.

BSN – 2

February 2023
Table of Contents

I. Introduction............................................................................................................................................4
II. Demograhic Data..................................................................................................................................5
Client’s profile (Summarized):.............................................................................................................5
Chief Complaint/s: Hypogastric Pain..................................................................................................5
III. Nursing History...................................................................................................................................6
Health History........................................................................................................................................6
History of Present Illness......................................................................................................................6
Past Medical History.............................................................................................................................6
Obstetric History...................................................................................................................................6
Family History.......................................................................................................................................7
Social History.........................................................................................................................................7
IV. Gordon’s Functional Health Pattern.................................................................................................7
V. Physical Assessment (Head to Toe)...................................................................................................11
Through Assessment on affected System or Organ...........................................................................14
VI. Anatomy and Physiology of Affected Organ...................................................................................15
The Female Reproductive System......................................................................................................15
Ovaries..............................................................................................................................................15
Uterus...............................................................................................................................................15
Fallopian Tubes...............................................................................................................................16
Vagina...............................................................................................................................................16
Ovulation..........................................................................................................................................16
Menstrual Cycle...............................................................................................................................16
Fertilization and Pregnancy............................................................................................................17
Estrogen and Progesterone.............................................................................................................17
Infertility..........................................................................................................................................18
VII. Risk Factors.....................................................................................................................................18
VIII. Pathophysiology.............................................................................................................................20
IX. Diagnostics and Laboratory Test.....................................................................................................21
X. Drug Study..........................................................................................................................................25
XI. Course in the Ward...........................................................................................................................32
XII. Nursing Theories Used....................................................................................................................33
XIII. Conceptual Paradigm....................................................................................................................35
XIV. Nursing Care Plan..........................................................................................................................36
XV. Health Teaching...............................................................................................................................40
XVI. References.......................................................................................................................................42
XVII. Definition of Term........................................................................................................................44
I. Introduction
An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary.
The number of diagnoses of ovarian cysts has increased with the widespread implementation of
regular physical examinations and ultrasonographic technology. The discovery of an ovarian cyst
causes considerable anxiety in women owing to fears of malignancy, but the vast majority of
ovarian cysts are benign. These cysts can develop in females at any stage of life, from the
neonatal period to postmenopause. Most ovarian cysts, however, occur during infancy and
adolescence, which are hormonally active periods of development. Most are functional in nature
and resolve without treatment.1

There are several different types of ovarian cysts. The most common is a functional cyst. This
means it occurs normally and is not part of a disease process. It forms during ovulation. That
formation happens when either the egg is not released or the sac (follicle) in which the egg forms
does not dissolve after the egg is released.2

Symptoms of ovarian cysts include: pain or bloating in the abdomen; difficulty urinating or
frequent need to urinate; dull ache in the lower back; pain during sexual intercourse; painful
menstruation and abnormal bleeding; weight gain; nausea or vomiting; loss of appetite or feeling
full quickly. Symptoms of ovarian cysts can also be symptoms of ovarian tumors. And ovarian
cancer often spreads before it is detected. Some risk factors include: cigarette smoking,
pregnancy, endometriosis, severe pelvic infection, previous ovarian cyst.

The likelihood of the ovarian cyst becoming cancerous is less than one percent. According to
the World Health Organization, it is accounted that ovarian cancer in the Philippines ranked 10th
in the total affected women of any type of cancer, with new cases around 5,395, deaths around
3,379, and a five-year prevalence of 13,667 cases. It is important for women to be aware of the

1
DOH, “HEALTHbeat” https://doh.gov.ph/sites/default/files/health_magazine/HBeat70_0.pdf (accessed
February 25, 2023

2
Cleveland Clinic, “Ovarian Cyst”
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/ovarian-cysts/ (accessed
February 26, 2023)
potential risks and to speak with their healthcare provider if they think they might be at risk for
developing an ovarian cyst.3

II. Demograhic Data

Name: D. B. H. Nationality: Filipino

Age: 43 years old Religion: Roman Catholic

Gender: Female Address: Tondo, City of Manila

Date of Birth: April 23, 1979 Occupation: Housewife

Marital status: Married Educational attainment: High School

Graduate

Client’s profile (Summarized):

DBH is a 43-year-old and this February 2023, she was admitted with chief complaints of
hypogastric pain and diagnosed of Bilateral Ovarian New Growth probably benign. She thought
it was simple pain and she was bearing it for three years. The pain worsened when she went for
an ultrasound and eventually she was hospitalized after a few laboratory tests. Her operations
were Salpingo-Oophorectomy, Left Salpingo-Oophorocystectomy, Right at the same day.

Chief Complaint/s: Hypogastric Pain

The client described and shared the pain she experienced before as (following the PQRST
mnemonic Pain Assessment Method):

Provoking: The cause of her pain is due to symptoms of her bilateral ovarian new
growth.

Quality: The pain is described as throbbing and burning.

3
World Health Organization, https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-
sheets.pdf (accessed February 27, 2023)
 Radiation: The pain is only felt in the hypogastric area.

Severity: On a scale of 0 to 10, where 0 indicates no pain and 10 indicates severe pain,
the client rated her pain 9 out of 10. She stated that the pain she felt back then had a score of 5–
6/10.

Time: The pain happened during her ultrasound, when the pain worsened. She stated that
the pain was intermittent and that each bout of pain had an interval of less than an hour each
time, and she had been bearing the pain for three years already.

III. Nursing History

Health History
She has no known allergies to foods, medications, chemicals and environmental
allergens. She has no prior sickness before her admission. The client also stated that she doesn’t
have any history of injuries and accidents before.

History of Present Illness

She was admitted on February 19, 2023 with a chief complaint of hypogastric pain with a score
of 9/10 on the pain scale. Upon being interviewed, Patient DH stated that the pain she feels in the
hypogastric area is concentrated only within that area and that she’s been bearing the pain for three years
already, she stated that the pain she felt back then had a score of 5-6/10 on the pain scale, and that she
only went to a hospital for an ultrasound on February 11, 2023 when the pain worsened to a score of
10/10. Patient DH stated that the pain was intermittent and that each bouts of pain had an interval of less
than an hour each time. She stated that she didn’t take any measures to manage the pain and that she only
sits and lays down whenever she feels pain. Her current medications include Cefuroxime, an antibiotic
and Celecoxib, an analgesic, which are ordered by her physician post-operatively.

Past Medical History

Prior to Patient DH’s admission, she stated that she has not been admitted to any hospital and that
it was her first time to undergo any operation or procedure.

Obstetric History
Patient DH had 2 pregnancies throughout her life and she gave birth to them on October 24, 2002
(Health center) and April 15, 2008 (Metro doctors). Both of her daughters were delivered normally, full
term, and that she did not have any complications before, during, and after her pregnancy.
Family History
Patient DH’s mother has hypertension and other than that, her family members do not have any
health complications.

Social History
The client stated that her family is composed of four members, including herself, her husband,
and their two daughters. They live together in their house with the client's 7-year-old niece. Patient DH
also leads a simple life where she just does usual household chores, taking care of her daughters and
niece, and only going out to attend church masses in Quiapo and to bring and fetch her niece to and from
school. She also has friends from work back when she was still working as a saleslady in Divisoria.

IV. Gordon’s Functional Health Pattern

Date of Hospitalization: February 19, 2023

Time of Hospitalization: 7:58 PM

Gordon’s Functional Health Pattern

Other than the slight pain and discomfort, the

client is feeling on her surgical incision site,
she stated that she’s feeling fine. She does not
do any extra things to maintain and keep
herself healthy, she stated that she just eats
HEALTH PERCEPTION/HEALTH healthily and exercises every now and then.
MANAGEMENT PATTERN She doesn’t partake in any vices and that she
only drinks coffee twice a day and
occasionally drinks alcoholic beverages
during events or gatherings.

Pre-operatively, her meals consisted of viands

like vegetables, fish, pork, and beef,
alternately, paired with a cup of rice. She
 stated that she only eats twice a day with
lunch and dinner and that her daily fluid
NUTRITIONAL- METABOLIC intake includes an average of 6 glasses of
PATTERN water and 2 cups of coffee per day.

Now that she’s on a soft diet on her second

day post-operatively, she only eats rice
porridge and other soft foods. And she now
eats three times a day. She drinks the same
amount of water as before minus the coffee.

Pre-operatively, Patient DH defecates twice a

day and her stools are firm and brown. She
urinates 6 times daily and her urine is
yellowish clear. She feels no pain or difficulty
ELIMINATION PATTERN doing both of these.

Now, she defecates twice a day as well, with

her stool still brown and firm but slightly soft.
She urinates 8 times a day now with her urine
being yellowish. She feels no pain or
difficulty doing both of these.

Pre-operatively, her daily activities include

accompanying and fetching her niece to and
from school and the usual housewife
responsibilities like cooking, washing the
dishes, laundering the clothes, and likes. In
her leisure time, she just usually watches TV
 and uses her cell phone. As for her exercise
pattern, Patient DH stated that she exercises at
least for an hour 3 times a week.
ACTIVITY- EXERCISE PATTERN
Now, after her surgery, her usual daily and
leisure time activities only include laying
down while watching TV and using her
cellphone. She also stated that her only form
of exercise is just stretching her body every
body or whenever she feels too stiff from
laying on her bed for a long time.

All of her senses are intact and functioning

well before and after her surgery. She also
stated that sometimes she forgets about some
COGNITIVE- PERCEPTUAL PATTERN things. She is a high school graduate and a
housewife, but back then she was working as
a saleslady in Divisoria.

Pre-operatively, she sleeps for about 6 hours

per night on average and that she has no
problem or difficulty sleeping.
SLEEP-REST PATTERN

Now, she sleeps for an average of 8 hours per

night and still has no difficulty sleeping.

The client considers herself to be a person

who’s just quiet, appreciates her own personal
SELF-PERCEPTION/SELF-CONCEPT space, and dislikes places or people who are
PATTERN too noisy. She feels quite good about herself.

She lives with her 44-year-old husband, two

daughters who are 21 and 15 year olds, and a
7-year old niece. Patient DH stated that she
ROLE- RELATIONSHIP PATTERN has 6 siblings and that she’s the 4th oldest
among them. She has a friend group from her
time of being a saleslady at Divisoria.`

She first got her menstrual period at 16 years

old and since then she’s been getting them
irregularly. She stated that her periods usually
SEXUALITY- REPRODUCTIVE last for 5 days or so but when her hypogastric
PATTERN pain started 3 years ago, she only gets her
periods for 3 days only. She has 2 daughters
aged 21 and 15 years old. Both of them are
delivered normally and both are fed through
formula milks.

The client stated that she usually gets stressed

COPING/STRESS TOLERANCE whenever her daughters take too long to
PATTERN follow her commands or if they don’t follow
the rules she set, and the likes. And to cope
when she feels too stressed, she stated that she
just uses her phone to distract herself and it
was said to be effective.
 The client’s religion is Roman Catholic and
she regularly goes to Quiapo church before
her operation with her daughters and niece.
VALUE-BELIEF PATTERN She stated that she has no value or belief that
she lives by and that she just lives her life as it
is.

V. Physical Assessment (Head to Toe)

Integument

Skin Skin is thick, light brown, smooth and intact without rashes, edema,
bruising on the left arm. Right metacarpal vein is swelling, varicose
veins present on both legs with vaccine scars on both arms, discoloration
of both elbows and knees, presence of moles on lower and upper
extremities. Skin turgor is normal.

Hair Last cleaned Feb 19 2023. It is black in color, evenly distributed thin
hair, presence of oiliness, no signs of lice and lesions and has presence of
dandruffs

Nails It is intact with the epidermis, has presence of dirt in some nails, rounded
and pink in color and Tested for capillary refill it returns to color in less
than 2 seconds

Head The head is round normocephalic without tenderness or palpable masses

or scarring.

Skull There are no nodules or masses and depression when palpated.

Face The face of the client appeared smooth, had uniform consistency and no
presence of nodules or masses.

Eyes and Visual

Eyebrows Thin hair is evenly distributed, eyebrows are symmetrically aligned, and
showed equal movement when asked to raise and lower eyebrows.

Eyelashes Eyelashes appear to be equally distributed and eyelashes are short and
straight.

Eyelids No presence of redness and swelling, there’s no presence of discharges,

no discoloration and lids close symmetrically and blinks approximately
15-20 times per minute

Eyes Client’s eye distant visual acuity is checked and normal and near visual
acuity checked and normal, side visual acuity checked and normal,
conjunctiva is clear, sclera is white, and pupil is black. She showed signs
of PERRLA (pupils equally round and reactive to light accommodation).
Palpebral conjunctiva is pinkish, both eyes dilated upon checking the
cornea and lens, tested the accommodation of pupils showed normal.

Ears The external ear and canal has no signs of swelling and no signs of
discharge, auricles are symmetrical and have the same color as facial
skin. Hearing is intact with good acuity to normal and whispered voice

Nose and Sinus

Nose The nose appeared symmetric, straight and uniform in color and good
airflow on both nostrils and there is no presence of discharge and flaring

Mouth

Lips Lip is thin and pale with discoloration and moist and smooth

Teeth and Gums Gums are pinkish in color with no lesion, the client’s teeth in the upper
 jaw is only 1 molar while the in the lower is 9. The client uses dentures.

Tongue The tongue of the client is small and in midline, it is pink in color, moist
and rough. There is presence of a thin whitish coating.

Neck

Neck Trachea is in midline, no signs of masses and bumps. Presence of carotid

pulse and the client showed coordinated, smooth head movement with no
discomfort.

Thorax, Lungs and Abdomen

Lungs and Chest Upon auscultation, lungs are clear and have no signs of rales, rhonchi
and wheezes. Chest has no signs of pain and lumps, the nipple is
downward, brown and small, visible superficial venous patterns. Chest
wall is symmetric without deformity, and has no signs of respiratory
distress.

Hearts Heart rate is 93 bpm and rhythm is normal, no murmurs and has no signs
of abnormal sounds. Present “lub dub” sound.

Abdomen Abdomen is slightly bloated and has incision site with abdominal binder

Extremities

Upper Upper and lower extremities have no signs of tenderness and edema, full
Extremities and range of motion is noted to all joints, pulses are palpable and steady gate
Lower noted.
Extremities

Genital

Genitalia Shaved pubic hair, has no signs of pain according to post op surgery.

Muscles
 Muscles They are normally firm and show smooth, coordinated movements.

Bones

Bones There was no presence of bone deformities, tenderness and swelling.

Neurological

Neurological The client’s awake, coherent and responsive. Has some signs of mood
swings. No visual or auditory hallucinations, asked about her
demographic data, client responded correctly.

Through Assessment on affected System or Organ

 The urinary bladder is distended. The wall is smooth. No evidence of stone. Post void
study shows minimal residual urine.
 The uterus is within normal size measuring 5.6 x 4.3 x 4.7 cm. It is anteverted showing
homogeneous echotexture. The endometrial stripe is thickened measuring about 0.9 cm.
Negative for mass nor gestational sac.
 There is a complex mass noted at the right adnexae measuring about 8.8 x 7.8 cm. The
left adnexae and cul-de-sac are unremarkable.
 Mild pelvocaliectasis, bilateral minimal residual urine 12% urinary retention
 Normal sized anteverted uterus with thickened endometrium
 Complex mass, right adnexae left adnexae and cul-de-sac – Negative

VI. Anatomy and Physiology of Affected Organ

The Female Reproductive System
The female reproductive system is framed to perform different functions. It creates egg cells that
are essential for reproduction known as ova. The system is organized to deliver the ova to the region of
fertilization. The egg fertilization takes place in the Fallopian tubes along with the sperm. The implanting
in the walls of the uterus and initiating the stages of pregnancy is the next step of fertilized eggs. Apart
from the above-mentioned functions, the female reproductive system is also involved in the production of
female sex hormones to maintain the reproductive cycle.4

The female reproductive system is composed of a pair of ovaries along with oviducts, vagina,
cervix, uterus, and the external genitalia that are located in the pelvic region. These parts along with a pair
of mammary glands that are integrated both functionally and structurally also support the process of
ovulation, fertilization, birth and finally the child care. 5

Ovaries
Ovaries act as the main female sex organs that produce the female gamete and various hormones.
These organs are situated on both sides of the lower abdomen. Each ovary measures about 2 to 4 cm in
length which is then connected to the uterus and pelvic wall through ligaments. The ovary is surrounded
by a thin covering of epithelium, encloses the ovarian stroma and is divided into two zones – outer cortex
and the inner medulla.6

The cortex consists of various ovarian follicles in different stages of development. The ovarian
follicle is called the basic unit of the female reproductive system. Each oviduct is divided into three
anatomical regions- ampulla, isthmus, and infundibulum.7

Uterus
A uterus is also called the womb. It is a muscular, inverted pear-shaped organ of the female
reproductive system. The walls of the uterus consist of three layers- the inner glandular layer, the middle
thick layer, and the outer thin layer. These three layers are maintained by ligaments which are attached to
the pelvic wall which then opens into the vagina from a narrow cervix. The cervical canal along with the
vagina creates the birth canal. The vagina is a muscular tube which starts at the lower end of the uterus to
the outside.8

4
BYJU’S, “The Female Reproductive System”,
https://byjus.com/biology/female-reproductive-system/#:~:text=The%20primary%20sex%20organs%20in,minora
%2C%20labia%20majora%20and%20clitoris. (accessed February 26, 2023)

5
Ibid.

6
Cf. Ibid

7
Ibid.

8
Cf. Ibid
Fallopian Tubes
Fallopian tubes are a pair of muscular tubes and funnel-shaped structures, extend from the right
and left of the superior corners of the uterus to the edge of the ovaries. These tubes are enclosed in small
projections called fimbriae that swipe over the ovaries to pick up released ova and deliver them to the
infundibulum for supplying the uterus. Each fallopian tube is covered by cilia that functions by carrying
the ovum to the uterus.9
Vagina
The vagina is a muscular and elastic tube that connects the cervix to the external body. It
functions as the receptacle for the penis in sexual intercourse and delivers sperm to the fallopian tubes and
uterus. It also acts as a birth canal by expanding to allow delivery of the fetus during childbirth. The
external genitalia comprise the labia minora, labia majora and clitoris

Ovulation
Ovulation is the process of releasing the eggs from the ovaries. This process takes place
as soon as the follicle is fully grown and reaches its size along with the accumulation of liquid in
the follicle without a significant rise in pressure. As the follicle swells out, a small oval-shaped
area, the stigma or macula pellucida appears sticking outward as a clear cone area and later
undergoes localized changes in color, integrity, and translucency. The secretion of estrogen
hormones reaches the maximum level before the ovulation. After the surge of luteinizing
hormone, ovulation occurs at the site of the stigma. This surge is essential for ovulation.10

Menstrual Cycle
All females, after reaching their puberty, produce mature egg cell every month during a
process called the menstrual cycle. During this period, an ovary discharges a mature egg, which
travels to the uterus. In the uterus, if the egg is not fertilized, the lining in the uterine sheds away
and a new cycle begins. Overall a menstrual cycle lasts for 28 days, in some cases, these cycles
may either last for 21 days or as long as 35 days in some individuals. The entire process of the
menstrual cycle is controlled by the endocrine system and the hormones involved are FSH, LH,
estrogen, and progesterone. Both FSH and LH hormones are produced by the pituitary gland,
whereas estrogen and progesterone hormones are produced by the ovaries.11
9
Ibid.

10
Cf. Ibid.

11
Ibid.
 Along with the hormonal disorders, there are many other factors, which are responsible
for the disturbance in the menstrual cycle. The responsible factors include diet, exercise, stress
and weight gain or loss affects the menstrual cycle. The cycle may be irregular at times,
especially during puberty. The menstrual cycles occur every month from the time of puberty up
to the age of 45 to 55, except during pregnancy. After the age of 55 ovaries slows down their
production of hormones and release of mature eggs. Progressively, the menstrual cycle stops,
therefore, the woman is no longer able to become pregnant.12

Fertilization and Pregnancy

Following implantation, the placenta originates from maternal and fetal tissues,
producing human chorionic gonadotropin (HCG) that helps in maintaining the level of corpus
luteum in the ovary until the placenta begins synthesizing its own progesterone and estrogen
hormones.13

Estrogen and Progesterone

Estrogen and progesterone hormones are produced by the ovaries that foster the
development of reproductive organs by maintaining the proper uterine cycle and by developing
female secondary sex characteristics. During menopause, usually between age 45 and 55, the
uterine cycle stops, and the ovaries no longer produce estrogen and progesterone hormones.

Infertility
In general, infertility can be defined as the failure in couples of not getting pregnant,
despite having carefully timed, unprotected sex for one year. It is estimated to be around 15% of
all couples undergo infertility.14

VII. Risk Factors

12
Cf. Ibid.

13
Ibid.

14
Cf. Ibid.
 Age. Ovarian cysts can occur at any age but are more likely to occur during reproductive
years and increase in menarcheal females.15

Genetics. Studies have shown that ovarian cysts have a genetic component and appear to
run in families. A person is more likely to develop an ovarian cyst if they have an immediate
family member with a history of ovarian cysts.16

Hormonal Imbalance. Hormonal imbalance can lead to a higher chance of developing an

ovarian cyst. Hormonal imbalance can be triggered by ongoing fertility treatments or other
underlying issues. 17

Infertility Treatment. Patients treated with gonadotropins or other ovulation induction

agents may develop cysts as part of hyperstimulation syndrome.18

Endometriosis. If abnormal tissue growth caused by endometriosis develops outside the

uterus and reaches the ovaries, it can form an ovarian cyst.19

PCOS. This condition causes the ovaries to enlarge and follicles to arrange on the outer
lining of the organ, creating a polycystic appearance.20

Pregnancy. Ovarian cyst may form in the second trimester when hCG levels peak.21

Hypothyroidism. Hypothyroidism is known to affect the ovaries in a similar way as

PCOS causing the enlargement of the ovaries and the formation of cysts.22

15
Medscape, “Ovarian Cyst”, https://emedicine.medscape.com/article/255865-overview#a4 (accessed
February 26, 2023)

16
Ibid.

17
Cf. Ibid.

18
Ibid.

19
Cf. Ibid

20
Ibid.

21
Cf. ibid.

22
Ibid.
 Maternal gonadotropins. The transplacental effects of maternal gonadotropins may lead
to the development of fetal ovarian cysts.23

Cigarette smoking. Studies have shown that the relative risk of diagnosed ovarian cyst
among smokers was higher than that of non-smokers.24

Tubal ligation. Functional cysts have been associated with tubal ligation sterilization.25

VIII. Pathophysiology

Different factors that can lead to ovarian cyst, but for the case of our patient, we have
noted two significant factors: advancing age and hormone imbalances. As for the advancing age,
Ovarian cysts can occur at any age but are more likely to occur during reproductive years and
increase in menarcheal females.26 For the hormone imbalances, Hormonal imbalance can lead to

23
Cf. ibid

24
Ibid.

25
Cf. Ibid
26
Ibid.
a higher chance of developing an ovarian cyst. Hormonal imbalance can be triggered by ongoing
fertility treatments or other underlying issues. When these factors are present, the probability of
liquid or semi-liquid duct then arises from the ovary, which then leads to the development of
ovarian cyst.27

The ovarian cyst can be then differentiated into two categories: functional cyst and
neoplastic cyst. In the follicular phase, follicular cysts may result from a lack of physiologic
release of the ovum due to excessive FSH stimulation or lack of the normal LH surge at
midcycle just before ovulation. Hormonal stimulation causes these cysts to continue to grow.
Follicular cysts are typically larger than 2.5 cm in diameter and manifest as a discomfort and
heaviness. Granulosa cells that line the follicle may also persist, leading to excess estradiol
production, which, in turn, leads to decreased frequency of menstruation and menorrhagia.28

Neoplastic cysts arise via the inappropriate overgrowth of cells within the ovary and may
be malignant or benign. Malignant neoplasms may arise from all ovarian cell types and tissues.
The most frequent by far, however, are those arising from the surface epithelium (mesothelium);
most of these are partially cystic lesions. The benign counterparts of these cancers are serous and
mucinous cystadenomas.29

IX. Diagnostics and Laboratory Test

February 7, 2023

Sonogram: A computer picture of areas inside the body created by high-energy sound waves. The
sound waves are bounced off internal tissues or organs and make echoes. The echoes form a picture of
the body tissues on a computer screen.

Test: Sonogram

27
Cf. Ibid.

28
Ibid.

29
Cf. Ibid
Doctor: Referring physician: Dra. T. Reyes
Sonologist: Ariel S. Aquino M.D., FPCR
Place: Mt. Olives Medical Imaging and laboratory services
Result: Both kidneys are normal in size. Right kidney measures (10.7x5.1 cm)
Left kidney (9.8 x 5.7 cm) pelvocalyceal structures of both kidneys are slightly dilated with no
evidence of mass nor stone.
Urinary bladder is distended. The wall is smooth. No evidence of stone. Post void study shows
minimal residual urine.
The uterus is within normal size measuring 5.6 x 4.3 x4.7 cm. It is anteverted showing
homogeneous echotexture. The endometrial stripe is thickened measuring about 0.9 cm Negative
for mass nor gestational sac
There is complex mass noted at the right adnexae measuring about 8.8 x 7.8 cm The left adnexae
and cul-desac are unremarkable
Impression:
Mild pelvocaliectasis, bilateral minimal Residual Urine 12% Urinary retention Normal sized
anteverted uterus with thicked endometrium complex mass, right adnexae left adnexae and Cul-
de-sac -NEGATIVE
Interpretation: Uterus has a homogeneous echotexture, endomentrial stripe is thicked and right
adnexae have complex mass
Nursing Implication: Informed the patient of why she need to do this test and what to expect.

February 11, 2023

Diagnostic ultrasound is a non-invasive diagnostic technique used to image inside the body.
Ultrasound probes, called transducers, produce sound waves that have frequencies above the
threshold of human hearing

Test: Ultrasound
Doctor: Eleyneth I. Valencia, MD, FPOGS, FPUOG
Place: Mary Johnston Hospital
Result: ADNEXAE: Within the right ovary are 2 cystic structures (1) measuring 2.8 x 2.9 x 2.3
cm. And (2) 2.8x 2.4x1.8., unilocular, thin- walled with low level echoes within,no color flow (CFI)
Left ovary 9.8cm x 10.8 cm x 9.3 cm located:posterolateral
Left posterior to the uterus is the left ovary, cystically enlarged as measured, multicular with low
level echoes within and hyperechoic structure at the inferior portion measuring 3.6 x 1.8 cm.
Which moves on real time scan. (+) calcification within and posterior acoustic shadowing with
septal flow (CF2) suggestive of Ovarian New Growth with benign sono morphologic features,
chance of benignity is 99.1% and Risk of Malignancy 0.9% (-) fluid in cul de sac
Diagnosis: Normal sized Retroverted uterus with thickened endometrium cystic follicles, Right
ovary, Ovarian new growth, left with benign sono morphologic features by iota adnex model
suggest correlation clinically and with other ancillary procedure
Interpretation: Left ovary has enlarged cyst chances is benign in 99.1% while in right ovary there
is 2 cystic structures.
Nursing Implication: Informed the patient about the procedure and what she need to do and
expect

February 14, 2023

Electrocardiography is the process of producing an electrocardiogram, a recording of the heart's

electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a
graph of voltage versus time of the electrical activity of the heart using electrodes placed on the
skin.

Test: Electrocardiogram (ECG)

Doctor: Radiologist: M. Cartrini O. Cruz, M.D
Attending Physician: Dr. Recio Charito
Place: Mary Johnston Hospital
Result: lungfields are clear, Heart is not enlarged, Diaphragm and costophrenic sulcu are
unremarkable.
Impression:
Normal chest findings
Interpretation: Normal
Nursing Implication: explain the procedure and reassure the patient

February 14, 2023

Uses imaging technology to diagnose and treat disease.
Test: Radiological consultation
Doctor: Cardiologist:Aquino,Camilo Oliver , MD
ECG Technician: Angela Ramasasa
Place: Mary Johnston Hospital
Result: Normal sinus rhythm, Incomplete right bundle branch block. Non- specific ST-T wave
changes
Interpretation: Normal
Nursing Implication: Explain the procedure and reassure the patient

February 19, 2023

Hematology is the branch of medicine concerned with the study of the cause, prognosis,
treatment, and prevention of diseases related to blood.

Test: Hematology
Doctor: John Arnel H. Amata MD
Place: Mary Johnston Hospital
Result:
Hemoglobin 13.0 (NORMAL)
Hematocrit 39.0 (NORMAL)
RBC Count 4.56 (NORMAL)
MCV 8.5 (NORMAL)
MCH 28.5 (NORMAL)
Leukocyte Count H 11.05 (HIGH)
Segmenters 62 (NORMAL)
Lymphocytes 28 (NORMAL)
Monocytes 8 (NORMAL)
Eosinophiles 2 (NORMAL)
Basophiles 0 (NORMAL)
Platelet Count 309 (NORMAL)
Interpretation: leukocyte Count is High
Nursing Implication: To asses Patient for the Result

A healthcare provider can use the test results to identify the specific allergic triggers that may be
contributing to the symptoms.

Test: Allergy Report

Nurse-on-duty: Marian B. Acantilado, RN
Place: Mary Johnston Hospital
Result: No allergy
Interpretation: No allergy
Nursing Implication: To assess Patient for any allergies or previous reactions to antigens.

February 20, 2023

Blood typing is a method to tell what type of blood you have. Blood typing is done so you can
safely donate your blood or receive a blood

Test: Blood typing

Doctor: Pathologist: John Arnel H. Amata, MD
Medical Technologist : Gian Jofer A. Baui, RMT
Place: Mary Johnston Hospital
Result: ABO (B)
RH (Positive)
Interpretation:Gives B+,AB+ Receives B+,B-,O+,O-

Nursing Implication: To assess what blood or blood components will be safe for the patient to
receive

X. Drug Study
 February 19, 2023
Generic Name: Bisacodyl
Brand Name: Dulcolax
Classification: Stimulant laxative
Order: 1 tab at 9pm
Date ordered: Feb. 19, 2023
Date discontinued: Feb. 20, 2023
Indication: Used on a short-term basis to treat constipation. Also used to empty bowels
before surgeries and certain medical procedures.
Reason why it is given to the patient: To empty bowels before surgery, treatment or some
examinations.
Significant side effects and adverse effects: Excessive diarrhea, electrolyte and fluid
imbalance, abdominal cramping, nausea and vomiting.
Important nursing considerations: Use with caution during pregnancy and lactating
mothers.

Generic Name: Fleet Enema

Brand Name:
Classification: Laxative (Saline)
Order: Fleet enema at 8am
Date ordered: Feb. 19, 2023

Date discontinued: Feb. 20, 2023

Indication: Occasional constipation or bowel cleansing before rectal exam
Reason why it is given to the patient: Preparing for surgery or procedure to make sure that
there will be no problems from infection. It is very important if the patient have bowel
surgery
Significant side effects and adverse effects: Rectal bleeding or bright red bowel movements;
or. dehydration symptoms of dizziness, vomiting, thirst, little or no urinating
Important nursing considerations: Urge the patient to empty his or her bladder since fluid
entering the rectum might cause discomfort in a full bladder. Make certain the patient gets
privacy. Make sure a commode or toilet is nearby since performing an enema frequently
causes the patient to feel the need to defecate.

Generic Name: Cefuroxime

Brand Name: Profurex
Classification: Cephalosporin antibiotic
Order: 750mg IV at 1:45pm
Date ordered: Feb. 19, 2023
Date discontinued: Feb. 21, 2023
Indication: Prophylaxis against infection to abdominal, pelvic, orthopedic, cardiac,
pulmonary, esophageal, and vascular surgery where there is increased risk of infection;

Day 2 (February 20, 2023)

Generic Name: Cefuroxime
Brand Name: Profurex
Classification: Cephalosporin antibiotic
Order: 750mg IV at 1:45pm
Date ordered: Feb. 19, 2023
Date discontinued: Feb. 21, 2023
Indication: Prophylaxis against infection to abdominal, pelvic, orthopedic, cardiac,
pulmonary, esophageal, and vascular surgery where there is increased risk of infection;
respiratory tract infections, e.g., acute and chronic bronchitis, infected bronchiectasis,
bacterial pneumonia, lung abscesses, and post-operative chest infections
Reason why it is given to the patient: It is given to treat bacterial infections. Used for a brief
period after surgery in order to prevent the patient from getting an infection.
Significant side effects and adverse effects: Effects reported include rashes, gastrointestinal
disturbances and candida intertrigo
Important nursing considerations: History: Hepatic and renal impairment, lactation,
pregnancy

Physical: Skin status, LFTs, renal function tests, culture of affected area, sensitivity tests.

Generic Name: Ketorolac

Brand Name: Toradol
Classification: Nonsteroidal anti-inflammatory drug (NSAIDs)
Order: 90mg in 150cc D5W
Date ordered: Feb. 20,2023
Date discontinued: Feb. 21,2023
Indication: Indicated for short term management of acute pain that requires the calibre of
pain management offered by opioids
Reason why it is given to the patient: To treat moderate to severe pain from the procedure
being done.
Significant side effects and adverse effects: Respiratory: rhinitis, hemoptysis, dyspnea; GI:
GI pain, diarrhea, vomiting, nausea; CNS: dizziness, fatigue, insomnia, headache;
Hematologic: neutropenia, leukopenia, decreased Hgb or Hct, bone marrow depression;
Dermatologic: sweating, dry mucous membrane, pruritus
Important nursing considerations: Don't forget to evaluate the patient first before providing
this medication: know the patient's history of allergies, renal impairment, and physical
condition (reflexes, ophthalmologic and audiometric evaluation, orientation, clotting times,
serum electrolytes, etc.) Make sure that emergency equipment is ready in case of
hypersensitivity. Administer it every six hours to maintain serum levels and efficiently
reduce pain.

Generic Name: Tramadol

Brand Name: Conzip
Classification: Opiate (narcotic) analgesics
Order: 50mg IV
Date ordered: Feb. 20, 2023
Date discontinued: Feb. 21, 2023
Indication: Specific indications for moderate to severe pain
Reason why it is given to the patient: To tolerate the management of postoperative pain
where intravenous conventional opioids are often used to relieve pain.
Significant side effects and adverse effects: feel dizzy, tired and have low energy – these can
be a sign of low blood pressure, hallucinations feel confused and feel very sleepy.
Important nursing considerations: Should not breastfeed while taking tramadol. Tramadol
can cause shallow breathing, difficulty or noisy breathing, confusion, more than usual
sleepiness, trouble breastfeeding, or limpness in breastfed infants

Generic Name: Morphine Sulfate

Brand Name:
Classification: Opioid agonist
Order: 10cc x2 doses Epidural Catheter
Date ordered: Feb. 20, 2023
Date discontinued: Feb. 21, 2023
Indication: Indicated for the relief of moderate to severe acute and chronic pain where use
of an opioid analgesic is appropriate.
Reason why it is given to the patient: To manage postoperative pain and help for fast
recovery.
Significant side effects and adverse effects: Sedation, lightheadedness, dizziness, nausea,
vomiting, constipation, and diaphoresis. These effects seem to be more prominent in
ambulatory patients and in those who are not experiencing severe pain.
Important nursing considerations: Monitor blood pressure prior to administration. Monitor
patient's respiratory rate prior to administration. Reassess pain after administration of
morphine. Monitor for respiratory depression and hypotension frequently up to 24 hours
after administration of morphine.

Generic Name: Tranexamic Acid

Brand Name: Cyklokapron
Classification: Antifibrinolytics

Order: 500mg IV
Date ordered: Feb. 20, 2023
Date discontinued: Feb. 21,2023
Indication: Is for heavy menstrual bleeding and short-term prevention in patients with
hemophilia. Intravenous. Is commonly used in severely bleeding patients requiring massive
transfusion protocols or when hyper-fibrinolysis is demonstrated
Reason why it is given to the patient: To control and prevent excessive surgical blood loss
after the trauma and hemorrhage.
Significant side effects and adverse effects: Seizures, headaches, backache, abdominal pain,
nausea, vomiting, diarrhea, fatigue, pulmonary embolism, deep vein thrombosis, anaphylaxis,
impaired color vision, and other visual disturbances

Important nursing considerations: Monitor blood pressure, pulse, and respiratory status as
indicated by severity of bleeding. Monitor platelet count and clotting factors prior to and
periodically throughout therapy in patients with systemic fibrinolysis.

Day 3 (February 21, 2023)

Generic Name: Cefuroxime
Brand Name: Cefurex
Classification: Second-generation cephalosporins
Order: Cefuroxime 500mg P.O
Date ordered: Feb. 21, 2023
Date discontinued: Feb. 22, 2023
Indication: Is a cephalosporin indicated for the treatment of a variety of infections
including acute bacterial otitis media, several upper respiratory tract infections, skin
infections, urinary tract infections, gonorrhea, early Lyme disease, and impetigo.
Reason why it is given to the patient: To prevent and treat the patient from getting an
infection after the surgery.
Significant side effects and adverse effects: Large doses can cause cerebral irritation and
convulsions; nausea, vomiting, diarrhea, GI disturbances; erythema multiforme, Stevens-
Johnson syndrome, epidermal necrolysis. Potentially Fatal: Anaphylaxis, nephrotoxicity,
pseudomembranous colitis.

Important nursing considerations: History: Hepatic and renal impairment, lactation,

pregnancy. Physical: Skin status, LFTs, renal function tests, culture of affected area,
sensitivity tests

Generic Name: Celecoxib

Brand Name: Coxidia
Classification: COX-2 inhibitors
 Order: Celecoxib 200 mg P.O
Date ordered: Feb. 21, 2023
Date discontinued: Feb. 22, 2023
Indication: Is used to relieve pain, tenderness, swelling and stiffness caused by
osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid
arthritis (arthritis caused by swelling of the lining of the joints), and ankylosing
spondylitis (arthritis that mainly affects the spine)
Reason why it is given to the patient: Is given because it is a part of the pain care plan to
help manage pain and reduce inflammation caused by the surgery being done.
Significant side effects and adverse effects: As for NSAIDs in general, serious skin reactions
such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis
have been reported with celecoxib. Other hypersensitivity reactions including
anaphylaxis and angioedema, have also occurred. The most frequent adverse effects of
celecoxib are gastrointestinal disturbances, especially diarrhea.
Important nursing considerations: Take drugs with food or meals if GI upset occurs. Take
only the prescribed dosage; do not increase dosage. You may experience these side
effects: Dizziness, drowsiness (avoid driving or the use of dangerous machinery while
taking this drug). Report sore throat, fever, rash, itching, weight gain, swelling in ankles
or fingers; changes in vision.

XI. Course in the Ward

Day 1 (February 19, 2023)

 Hospitalization and admission
 Pre-operative day

Day 2 (February 20, 2023)

  Ongoing operation on 4pm
 IVF #1 D5LR1Lx8 30 gtts/min
 Cefuroxime 750mg TIV at 12mn 1st dose ketorolac 90 mg in 250cc D5W at 10 gtts/min
x 2 cycles
 Celecoxib 50mg 1 cap BID
 Tramadol 50mg with q6 PRN
 Morphine so4 10cc for EC q12 x 2 doses
 Tranexamic acid 500mg IV q6 x 3 doses
 Dr. Vivar to give anesthesia

Day 3 (February 21, 2023)

 Post-operative day
 Cefuroxime 500 mg BID to start at 8pm
 Celecoxib 200 mg 1 cap BID to start at 8am
 Bisacodyl 1 tab at 9pm
 Fleet Enema at 8 am
 #3 D5NM 1L x 8
 With epidural catheter

Day 4 (February 22, 2023)

 Post-operative day
 No IVF
 With abdominal binder

Day 5 (February 23, 2023)

 Discharged at 9am

XII. Nursing Theories Used

The self-care theory by Dorothea Orem, the adaptation model by Callista Roy, and the
health promotion model by Pender provide the theoretical foundation of our nursing care. These
three ideas are separate from one another, yet depending on their fundamental concepts during
the process, they may be related.

According to the self-care theory, nurses or other health care professionals help patients
manage their own care to preserve or enhance their bodily functions. This approach requires the
expertise of the health care providers which they will share information, by means of teaching
them, focusing in the health management.30

According to the adaptation model, people keep a balance between a number of stimuli,
which enables them to deal with illnesses, sadness, and stress in an effective manner. The nurses'
job encourages adaptive adaptation by encouraging environment contact and assisting the patient
in responding favorably to stimuli.31

Health promotion helps to define the variables that motivate a person to be engaged or to
acquire health enhancing activities. Health promotion tends to change how an individual
interacts with their environment, which involves awareness of factors such as action benefits,
action barriers, self-efficacy, activity-related affect, and others.

The unified theories seek to promote health. A holistic approach is offered by the self-
care theory and adaptation model, which places special emphasis on the client's improvement of
their mental and physical health. Together, these two theories support health promotion, as the
patient learns to adapt to their shifting environment and searches for and takes precautions
against any potential risks they may face. This will help the patient to be fully aware of both the
advantages and disadvantages of their behavior. 32

For our patient who underwent surgery and experienced changes to her physical
composition, emotional state, and some of her routines, we selected these theories. Our intention
is for her to carry out interventions for health promotion, which require her to adapt to those

30
Nurselabs, “Dorothea Orem: Self-Care Deficit Theory” https://nurseslabs.com/dorothea-orems-self-
care-theory/ (accessed February 26, 2023)

31
Nurselabs, “Sister Callista Roy: Adaptation Model of Nursing”, https://nurseslabs.com/sister-callista-
roys-adaptation-model/ (accessed February 26, 2023)

32
Nursing Theory, “Pender’s Health Promotional Model”
https://nursing-theory.org/theories-and-models/pender-health-promotion-model.php (accessed February 26, 2023)
changes and practice both mental and physical self-care. Sustaining these actions fosters health
promotion, which offers healthy development.

XIII. Conceptual Paradigm

 XIV. Nursing Care Plan

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Constipation After 8 hours of  If indicated,  To help the After 8 hours of nursing
“Hindi pa ako related to nursing administer bowel intervention, the client
makadumi kanina insufficient intervention, the the move and was able to:
pa, pero gusto ko fluid and client will be appropriate make it soft  Reported the relief
at hindi lang ma- fiber intake, able to: stool so she can from discomfort of
ilabas” as as evidenced  Report the softener/ excrete constipation
verbalized by the by decreased relief from laxative more easily
client stool discomfort suppository  To allow
frequency of  Assist to her client to
Objective: constipation comfortable have a

 The client position, and bowel

is seen place a movement

lying in bedpan or while they

bed with diaper on, are in bed

ongoing and changed or cannot

IV (GL a new diaper ambulate

after  Adequate
diet)
 Encourage fluid intake
 The client
has an to increase makes the

epidural the fluid stool softer

catheter intake as and easier

and tolerated to pass

cannot throughout

ambulate. the large

intestine
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Alteration in After 8 hours  Make - Environmental After 8 hours of

N/A comfort related to of nursing environmental changes to the nursing
physical intervention changes to patient’s intervention the
Objective: discomfort as the patient will improve preference might patient was able
 Weak in appearance evidenced by be able to: patient’s give him or her a to:
 Grimaces when moving restlessness  Maintain comfort feeling of
 Inable to sit still in one an  Reposition the control and
place acceptable patient increase  Maintain an
 Recently had level of frequently and comfort. acceptable
Sapingooopherectomy comfort encourage level of
and when ROM exercise - Changes in comfort
Salpingooocystectomy possible  Provide patient position when
several help relieve possible
relaxation pressure points
techniques that and may help
may decrease with pain
discomfort management. In
addition, early
mobilization
might help with
discomfort from
bed rest.

- These
techniques help
shift the focus
away from the
currently
experienced
pain, anxiety,
 and tension and
instead focus on
more pleasant
experiences.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective Data: Risk for After 8 hours  Observe and  Change in mental After 8 hours of
“Nung Monday infection of nursing report signs status, fever, nursing intervention,
(February 20, related to intervention, of infection shaking, chills, the patient will be
2023) ako post-op the patient such as and hypotension able to identify ways
naoperahan.” as surgical will be able redness, are indications of to reduce risk for
verbalized by the incision to identify warmth, and sepsis infection.
client ways to increased  Disruptions of
reduce risk body skin integrity at or
for infection. temperature. near the operative
 Examine skin site are sources of
Objective Data: for breaks or contamination to
- A pain scale irritation, and the wound.
rating of 5-6/10 in signs of  Friction and
the incision site infection. running water
- Surgical incision  Wash hands effectively
at lower abdomen or perform remove
with dressing and hand hygiene microorganisms
abdominal binder before having from hands.
- Ordered contact with Washing between
Cefuroxime 500 the patient. procedures
mg 1 tab BID  Emphasize reduces the risk of
the transmitting
importance of pathogens from
handwashing one area of the
technique. body to another.
 Emphasize  It serves as a first
 necessity of line of defense
taking against infection.
antibiotics as  Premature
ordered. discontinuation of
treatment when
client begins to
feel well may
result in infection.

XV. Health Teaching

XVI. References

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XVII. Definition of Term

1. Sonography - a diagnostic medical procedure that uses high-frequency sound waves (ultrasound)
to produce dynamic visual images of organs, tissues or blood flow inside the body. This type of procedure
is often referred to as a sonogram or ultrasound exam.
2. Pelvocalyceal - The pelvicalyceal system consists of minor calyces, major calyces and the renal
pelvis. Calyx is the cavity of the kidney, through which urine passes.
3. Echotexture - The patterning of echogenicity in a diagnostic image.
4. Adenexae - the region adjoining the uterus that contains the ovary and fallopian tube, as well as
associated vessels, ligaments, and connective tissue.
5. Cul-de sac - It literally means "bottom of a sack”. A vessel or tube with only one opening.
6. Unilocular - containing a single cavity.
7. Posterolateral - Situated on the side and toward the posterior aspect.
8. Hyperechoic - This term means "lots of echoes." These areas bounce back many sound waves.
They appear as light gray on the ultrasound.
9. sono morphologic – Sono means sounds and morphologic means structure
10. Retroverted - when your uterus is tilted backward toward your spine.
11. Endometrium - The layer of tissue that lines the uterus.
12. Iota - an extremely small amount.
13. Ancillary - providing necessary support to the primary activities or operation of an organization,
institution, industry, or system.
14. Costophrenic sulci - a chest radiograph sign usually indicative of a small pleural effusion
15. ST-T - Nonspecific ST-segment and T-wave (ST-T) changes represent one of the most prevalent
electrocardiographic abnormalities in hypertensive patients.
16. Leukocyte - A type of blood cell that is made in the bone marrow and found in the blood and lymph
tissue.
17. Antigens - any substance that causes your immune system to produce antibodies against it.
18. Prophylaxis – it measures designed to preserve health (as of an individual or of society) and prevent
the spread of disease.
19. Ultrasound - an imaging test that uses sound waves to create a picture (also known as a sonogram) of
organs, tissues, and other structures inside the body.
20. Electrocardiogram (ECG) - is a simple test that can be used to check your heart's rhythm and
electrical activity.
21. Radiological consultation - an appointment with a radiologist to obtain his opinion about a patient's
condition and the best possible treatment.
22. Allergy Report - Which test is used to detect allergies?
23. A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions to as
many as 50 different substances at once. This test is usually done to identify allergies to pollen, mold, pet
dander, dust mites and foods.
24. Blood typing - a method to tell what type of blood you have