A Case study

on Uterine
Myoma
Submitted by:
J-Jireh Abar
Kierzner Caores

Submitted to:
Jeselo O. Gorme RN
Clinical Instructor
 Introduction
Uterine myomas also called “fibroids” are tumors that grow
from the wall of the uterus.
Uterine fibroids are noncancerous growths of the uterus that
often appear during childbearing years.
The wall of the uterus is made of muscle tissue, so a fibroid is a
tumor made of muscle tissue. The fibroids start off very small,
actually from one cell, and generally grow slowly over years
before they cause any problems.
Some fibroids go through growth spurts, and some may
shrink on their own. Many fibroids that have been present during
pregnancy shrink or disappear after pregnancy, as the uterus
goes back to a normal size.
Fibroids range in size from seedlings, undetectable by the human
eye, to bulky masses that can distort and enlarge the uterus. They
can be single or multiple, in extreme cases expanding the uterus
so much that it reaches the rib cage.
Objectives

General Objectives:

After the Case presentation the level 3 students will know the disease
process and the general idea of uterine myoma

Specific Objectives:
After an hour of discussion the BSN-3 students will be able to:

 know the treatments of said disease

 enumerate and identify medical surgical & nursing

managements

 to trace the Pathophysiology of the disease

 identify the signs and symptoms of uterine myoma

Nursing Health History

Biographic Data:

Name: Lalaine Bahinting Lasmarias

Age: 19
Sex: Female
Race: Filipino
Marital status: single
Religion: Roman Catholic

Chief Complaint: Prior to admission the patient claims of vaginal

bleeding and feeling of fullness in the lower abdomen

History of Present Illness:

The patient noticed the presence of blood in the vaginal area and
she quickly asked her family for help. the family along with the
patient observed for 3 days if the bleeding was the result of
menstruation after the 3rd day the bleeding still continued So they
sought medical assistance
Past Health History:
 No allergies were claimed
 No medications were maintained
 No previous history of injuries and accidents

 No history of any surgical procedure

 Common childhood illnesses like fever, cough and diarrhea
have been experienced by the patient

Family Health History

 PT

HPN

Legend:

Male All 3 generations of the family are alive and

well the patients grandfather on his father
side suffers from hypertention but the patient
Female
does not have any symptoms of having the
condition herself
HPN Hypertention
Gordon’s Fundamental Health Pattern
I. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN

The patient states that health is very important and thus she gives
emphasis to it and her attention is fully dedicated. Patient also states
the presence of stress due to the condition and the expenses needed
for the treatment, she has no complains about the health care facility
or of the health care team and no alternate beliefs and traditions
related to health are stated.

II. NUTRITIONAL AND METABOLIC PATTERN

Prior to admission the usual diet of the patient is fish and an

assortment of fruits and vegetables. She has a good appetite. But
during hospitalization appetite is poor although her diet is full and all
nutritional needs are provided

III. ELIMINATION PATTERN

Prior to admission the patient usually defecates and urinates 3 times
per day and without any discomfort. During hospitalization she
defecates and urinates once every other day

IV. ACTIVITY-EXERCISE PATTERN

Prior to admission the patient experiences weakness due to the

vaginal bleeding during hospitalization the patient is lying on bed at all
times and weakness is still presence she constantly needs assistance
during ambulation and in the self care activities.

V. SLEEP-REST PATTERN

Prior to admission the patient’s sleeping pattern is constantly

interrupted and the sleeping hours only accounts to 4-5 hours. During
hospitalization the sleeping pattern is still interrupted she is not taking
any medication for sleeping she sleeps around 10 pm and wakes up at
5 am

VI.COGNITIVE-PERCEPTUAL PATTERN
Prior to admission the patient has no auditory impairment no
difficulties in learning and no changes of memory but she complains of
body weakness

During hospitalization, still there is no auditory, visual impairment and

no utilization of aiding devices. She has no changes in her memories
and no difficulties in learning.

VII. SELF PERCEPTION AND SELF CONCEPT PATTERN

Prior to admission patient stated she is worried of her condition,

she perceive herself as an unhealthy person.
During hospitalization, ‘’ambot lage kuya nahadlok naku aning
ahung condisyon lage” as verbalized by the pt

VIII. ROLE- RELATIONSHIP PATTERN

Prior to admission, she lives with her family. Financial problems

occur but handle it with her family through cooperation. They have a
good relationship with their neighbors.
During hospitalization

IX.SEXUALITY-REPRODUCTIVE PATTERN
The patient is sexually active
X. COPING STRESS PATTERN

Prior to admission the patient is worried about her condition but

she gains support from her family During hospitalization, her condition
is still tolerable, the pt. prefers to bear it but when severely stressed,
the patient tends to rest them as claimed by her.

XI. VALUES-BELIEF PATTERN

Prior to admission the patient goes to mass every Sunday

During hospitalization the patient constantly prays to God for her
recovery

Physical assessment
A.General Survey
- Patient was conscious and coherent
- Appears anxious

B.Vital Signs
- Temp: 36.9 °C - RR: 20cpm
- Pulse: 79bpm - BP: 110/80mmhg

C.Integumentary
- Color is brown with no palpable lesions
- Moist skin surface
- Nail beds are pinkish with no inflammation

D.Eyes
- Conjunctiva is transparent, moist, no swelling/ lesions noted
- Cornea is transparent
- Iris is dark brown in color
- Pupils accommodated
- Eyelids intact with no swelling/ lesions noted

E.Ears
- Ear canal intact with little cerumen
- Able to hear soft words
- No discharges on both ear canals
- No tenderness upon palpation

F.Nose
- Nasal mucosa is intact
- No nasal flaring
- Nostrils are patent

G.Mouth
- Lips are slightly moist upon inspection
- Gums and tongue is pink
- Hard and soft palate intact

H.Neck
- Symmetrical without scars
- No palpable lymph nodes
I.Respiratory
- No nasal flaring
- No use of accessory muscle
- RR @ 20cpm
- Bilateral Chest expansion

J.Brest
- Sizes appropriate for age
- Symmetrical
- NO erythema

K.Abdomen
- No tenderness upon palpation
- No lesions/ scar
- No erythema

L.Reproductive
- Able to urinate regularly
- Appropriate for age

M.Muscuskeletal
- Ambulatory
- Able to move
- Can flex and extend body parts

N.Neurological
- Patient able to speak words clearly and logically
- Able to understand instructions and conversation

Developmental task
Theory:
-Erik Erikson’s theory of psychosocial development
-The adolescent
-Identity versus Role confusion

Basic:
-during this stage, adolescents must bring together everything they have learned
about themselves as a son or daughter, an athlete, a friend, a fast-food cook, a
student, a scout, and so on, and integrate these different image into a whole
that makes sense. If adolescents cannot do so, they are left with role confusion;
that is, they are unsure of what kind of person they are and are uncertain what
they can do or what kind of person they can become. Some adolescent seek a
negative identity: being identified as a drug abuser or runaway may be
preferable to having no identity at all.

Actual:
-The patient is not confused about her identity.

Theory:
-Piaget’s theory of Cognitive development
-The Adolescent
-Formal operational thought

Basic:
-When this stage reached, adolescent are capable of thinking in terms of
possibility what could be rather than being limited to thinking about what
already is . This makes it possible for adolescents to use scientific reasoning or
also understand deductive reasoning, or reasoning that proceeds from the
general to the specific.

Actual:
-The patient uses scientific reasoning.

Theory:
-Freud’s Psychoanalytic Theory
-The adolescent
Basic:
-During this stage Freud termed the adolescent period the “genital phase”
Freudian theory considers the main events of this period to be the
establishments of new sexual aims and the finding of new love objects.

Actual:
-The patient is on the process of what this stage needs.

Theory:
-Kohlberg’s Theory Moral Development
-The adolescent
-Postconventional development

Basic:
-In this stage, adolescent can carry out self-care measures even when someone
else is not present when they enter in this stage because they can understand
not only the importance of the measures to themselves but also the principle
that certain thing should be done simply because they are right.

Actual:
-The patient is able to understand and respect other people.

Definition of Terms:
Uterine Myoma is a growth of fibrous tissue in the uterus, usually a fibroma ,
fibromyoma or leiomyofibroma.
It is a benign encapsulated uterine tumor. The tumor may develop in the wall of
the uterus or be attached to a stalk of tissue originating in the wall. Symptoms
may include menstrual disorders and are also likely to be related to the location
of the tumor with respect to neighboring organs.

Source: Mosby’s Pocket Dictionary of Medicine, Nursing and Health Profession

pg.1430

Uterine Myomaarise from the muscle tissue of the uterus and can be solitary or
multiple in the lining, muscle wall and outside surface of the uterus.

Source: Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 12th

edition pg. 1453

Uterine myoma is a benign growth of smooth muscle in the wall of the uterus. A
uterine myoma is a solid tumor made of fibrous tissue, hence it is often called a
'fibroid' tumor.

Source: Ellaine Marieb; Anatomy and Physiology page 453

Etiology
Predisposing Factors Basic Actual
Age Fibroids are most √
common in women who
are their 30s through
early 50s. (After
menopause, fibroids tend
to shrink.) About 20 -
40% of women age 35
and older have fibroids of
significant enough size to
cause symptoms.
Race Uterine fibroids are
particularly common in
African-American
women, and these
women tend to develop
them at a younger age
than white women.
Heredity Family history, having a √
mother or sister who had
fibroids, may increase
risk.
Early Menarche Women whose first √
period was before age 10
are more likely to have
uterine fibroids.
Nulliparty nulliparity appeared to
be the most potent risk
factor for uterine fibroid
in the
population studied.

Precipitating Factors Rationale Actual

Alcohol Intake Higher alcohol intake is
associated with a higher
 prevalence of uterine
fibroids.
Obesity Obese women are
considered to have two
to three times the risk of
developing fibroids than
women of average
weight.
Anxiety/Stress Cause the body hormonal √
signals get confused and
result in estrogen and
progesterone level
getting knocked out of
balance.
Oral Contraceptives Women taking birth
control pills are less likely
to develop significant
uterine fibroids.
Anatomy and Physiology

Female Reproductive System Anatomy

Ovaries

The ovaries are a pair of small glands about the size and shape of almonds,
located on the left and right sides of the pelvic body cavity lateral to the superior
portion of the uterus. Ovaries produce female sex hormones such as estrogen
and progesterone as well as ova (commonly called "eggs"), the female gametes.
Ova are produced from oocyte cells that slowly develop throughout a woman’s
early life and reach maturity after puberty. Each month during ovulation, a
mature ovum is released. The ovum travels from the ovary to the fallopian tube,
where it may be fertilized before reaching the uterus.

Fallopian Tubes

The fallopian tubes are a pair of muscular tubes that extend from the left and
right superior corners of the uterus to the edge of the ovaries. The fallopian
tubes end in a funnel-shaped structure called the infundibulum, which is covered
with small finger-like projections called fimbriae. The fimbriae swipe over the
outside of the ovaries to pick up released ova and carry them into the
infundibulum for transport to the uterus. The inside of each fallopian tube is
covered in cilia that work with the smooth muscle of the tube to carry the ovum
to the uterus.

Uterus

The uterus is a hollow, muscular, pear-shaped organ located posterior and

superior to the urinary bladder. Connected to the two fallopian tubes on its
superior end and to the vagina (via the cervix) on its inferior end, the uterus is
also known as the womb, as it surrounds and supports the developing fetus
during pregnancy. The inner lining of the uterus, known as the endometrium,
provides support to the embryo during early development. The visceral muscles
of the uterus contract during childbirth to push the fetus through the birth canal.

Vagina

The vagina is an elastic, muscular tube that connects the cervix of the uterus to
the exterior of the body. It is located inferior to the uterus and posterior to the
urinary bladder. The vagina functions as the receptacle for the penis during
sexual intercourse and carries sperm to the uterus and fallopian tubes. It also
serves as the birth canal by stretching to allow delivery of the fetus during
childbirth. During menstruation, the menstrual flow exits the body via the
vagina.

Functions of the Female Reproductive System

The Reproductive Cycle

The female reproductive cycle is the process of producing an ovum and readying
the uterus to receive a fertilized ovum to begin pregnancy. If an ovum is
produced but not fertilized and implanted in the uterine wall, the reproductive
cycle resets itself through menstruation. The entire reproductive cycle takes
about 28 days on average, but may be as short as 24 days or as long as 36 days
for some women.
Oogenesisand Ovulation
Under the influence of follicle stimulating hormone (FSH), and luteinizing
hormone (LH), the ovaries produce a mature ovum in a process known as
ovulation. By about 14 days into the reproductive cycle, an oocyte reaches
maturity and is released as an ovum. Although the ovaries begin to mature many
oocytes each month, usually only one ovum per cycle is released.

Fertilization

Once the mature ovum is released from the ovary, the fimbriae catch the egg
and direct it down the fallopian tube to the uterus. It takes about a week for the
ovum to travel to the uterus. If sperm are able to reach and penetrate the ovum,
the ovum becomes a fertilized zygote containing a full complement of DNA.
After a two-week period of rapid cell division known as the germinal period of
development, the zygote forms an embryo. The embryo will then implant itself
into the uterine wall and develop there during pregnancy.

Menstruation

While the ovum matures and travels through the fallopian tube, the
endometrium grows and develops in preparation for the embryo. If the ovum is
not fertilized in time or if it fails to implant into the endometrium, the arteries of
the uterus constrict to cut off blood flow to the endometrium. The lack of blood
flow causes cell death in the endometrium and the eventual shedding of tissue
in a process known as menstruation. In a normal menstrual cycle, this shedding
begins around day 28 and continues into the first few days of the new
reproductive cycle.

Pregnancy

If the ovum is fertilized by a sperm cell, the fertilized embryo will implant itself
into the endometrium and begin to form an amniotic cavity, umbilical cord, and
placenta. For the first 8 weeks, the embryo will develop almost all of the tissues
and organs present in the adult before entering the fetal period of development
during weeks 9 through 38. During the fetal period, the fetus grows larger and
more complex until it is ready to be born.
Symptomatology
Signs and Symptoms Rationale Actual
Heavy Menstrual Bleeding The most common √
symptom is prolonged and
heavy bleeding during
menstruation. This is
caused by fibroid growth
bordering the uterine
cavity. Menstrual periods
may also last longer than
normal.
Menstrual Pain Heavy bleeding and clots √
can cause severe cramping
and pain during menstrual
periods.
Abdominal Pressure and Large fibroids can also √
Pain cause pressure and pain in
the abdomen or lower back
that sometimes feels like
menstrual cramps
Abdominal and Uterine As the fibroids grow larger, √
Enlargement . some women feel them as
hard lumps in the lower
abdomen. Very large fibroids
may give the abdomen the
appearance of pregnancy and
cause a feeling of heaviness
and pressure. In fact, large
fibroids are defined by
comparing the size of the
uterus to the size it would be
at specific months during
 gestation.
Pain during Intercourse Fibroids can cause pain
during sexual intercourse
(dyspareunia).
Urinary Problems Large fibroids may press
against the bladder and
urinary tract and cause
frequent urination or the
urge to urinate, particularly
when a woman is lying
down at night. Fibroids
pressing on the ureters (the
tubes going from the
kidneys to the bladder) may
obstruct or block the flow
of urine
Constipation Fibroid pressure against the
rectum can cause
constipation.
 Pathophysiology
Predisposing Precipitating
Factor Factor
>Age Etiology >High fat diet
>Race >Obesity
>Heredity >Anxiety/Stress
>Early Menarche >Oral
>Nulliparity Contraceptives
>Hormone
Estrogen
Replacement
Dominance or
Therapy
Increase estrogen >Coffee/Caffeine

S/Sx:
>Swelling of the
Proliferation of cells breast
in uterus >Depression
>Loss of sex
drive
>Dysmenorrhea
Overgrowth in the
endometrial lining

Myoma
Development of
uterine fibroid

S/Sx:
Uterine cavity >Pain
begins to stretch or >Increased
increase in size Pelvic Pressure

Interference in
the vascular
supply

Degeneration of S/Sx:
the interior part >Hypermenorrhea
of fibroid
 Anemia S/Sx:
>Fast or abnormal
heartbeat
>Pale
Rapid Irregular
Heartbeat

Cardiac Arrhythmia

Congestive Heart
Failure

Bad Prognosis

DEATH
Medical Management

Ultrasound

An ultrasound probe is inserted into the vagina or over the pelvis on the
abdomen, and high-frequency sound waves reflect off the uterus and pelvic
structures. An image of the uterus is then displayed on a monitor and fibroids
are visualized.

Sonohysterogram

A water solution is injected into the uterus through the vagina and cervix, and an
ultrasound is then done. It then possibly shows uterine fibroids or other
abnormal masses in the uterus

Hysteroscopy

A tube with a lighted viewer on its tip (endoscope) is advanced into the uterus,
and a video screen shows the uterus interior. Hysteroscopy can detect uterine
fibroids projecting into the uterus, but cannot see any part of a fibroid in the
uterus wall or outside the uterus.

Magnetic resonance imaging (pelvic MRI)

An MRI scanner uses a high-powered magnet and a computer to create highly

detailed images of the uterus and other pelvic structures. Pelvic MRI can confirm
the presence of uterine fibroids.

Uterine biopsy

A small piece of tissue (biopsy) taken from the uterus is used for examination if
the doctor suspects of a cancer and not a myoma is manifesting. A uterine
biopsy may be done through the vagina, or may require surgery.
Surgical Management

Hysterectomy: Surgery to remove the entire uterus and all uterine

fibroids. Hysterectomy cures uterine fibroids and prevents them from
ever returning. Women with symptoms from uterine fibroids who
don’t want a future pregnancy often undergo hysterectomy.

a. Vaginal hysterectomy - Instead of making a cut into the

abdomen, the surgeon removes the uterus through the vagina.
b. Robotic hysterectomy - The surgeon sits at a console near the
patient and guides a robotic arm to perform laparoscopic
surgery.
c. Laparoscopic surgery – a small incision is done on the lower
abdomen to facilitate the entrance a rod apparatus

Myomectomy : Surgery to remove uterine fibroids while leaving the

uterus in place. Myomectomy is often done for women wishing to
have children. New uterine fibroids may grow, requiring a later
procedure in up to a third of women after myomectomy.

Endometrial Ablation
Surgery that destroys the lining of the uterus. It is used to treat small
fibroids inside the uterus. Two common ways of doing an ablation are
with a heated balloon, and with a tool that uses microwave energy to
destroy the uterine lining and fibroids.
Laboratory Results

Parameters results Normal values significance

WBC 7.8 5.00 – 10.00 normal
HCT 29 35.00 – 55.00 Below normal

Interpretation:
Decreased Hematocrit indicates anemia or hemorrhage due to persistent blood loss related to
abdominal uterine bleeding
Assessme diagnosis Planning Interventio rationale evaluation
nt ns
Subjective: Fear related to After 8 *Identify *Defines After 8
change in hours of patient’s scope of hours of
“Nakulbaan nursing
health status. perception of individual nursing
ko ky intervention
threat in the problem, intervention
ngdugo ko Inference: s, the
situation. s, the
og kalit ” as patient will
patient was
Dysfunctional report fear
verbalized *Encourage
able to
uterine and anxiety *Provides
by the patient to
are reduced
report fear
bleeding is opportunity
patient. acknowledge
to a and anxiety
abnormal for dealing
and express
manageable are reduced
Objective: uterine with
fears.
level to a
bleeding in the concerns,
*restlessnes manageable
absence of clarifies
s level.
clinical or reality of
ultrasonograph fears, and
*Increased
ic evidence of reduces
tension
structural anxiety to
*Feelings of abnormalities, manageabl
helplessness inflammation, e level.
*Provides
or pregnancy.
opportunity *identify
Treatment is
for discussion patients
usually with
of personal perspective
oral typical
feelings or on current
adenomatous
concerns and situation.
hyperplasia,
future
predisposes to
expectations.
endometrial
cancer.

Reference:
 Maternal volume *Focuses
1 8th edition by attention on
William and *Identify
own
Wilkins 899-934. previous
capabilities,
coping
increasing
strengths of
sense of
the patient
control.
and current
areas of
control and
*Provides
ability.
actives
*Encourage manageme
use of nt of
relaxation situation to
technique reduce
like deep feelings of
breathing, helplessness
guided .
imagery.
*For
*Monitored baseline
vital signs data.

*To provide
supervision
*Advice SO to
be with patient
all the time

Assessment diagnosis Planning Interventio rationale evaluation

 ns
Subjective: Ineffectiv After 8 *determine *to identify After 8
“na stress e coping hours of individual patients hours of
nman ko pattern nursing stressors main nursing
dong wa related interventio problem intervention
naku to ns the the patient
kahibaw situation patient will *provide a will be able
unsai al crisis be able to quite *anxiety is to manage
buhatun” as on cope with environme increased in the stress
verbalized current stressors nt noisy and
by patient condition and find environment verbalizes
as n effective s understandi
evidence solutions *Explain ng and relief
Objective: d by on disease
inability problems process to *helps client
-lack of goal to focus the patient to express
oriented on task emotions,gra
behavior sp situation
Referenc and feel
-inadequate e: *encourag more in
problem e control
solving NANDA verbalizatio
edition n of fears *provides a
-poor 11 page and anxiety comfortable
concentrati 223-227 situation and
on relieves
*use reality patient
-unable to orientation
meet role (clocks, * helps
expectation calendars, patient
s bulletin manage the
boards) stressors by
providing
references

Assessment Diagnosis Planning Interventio Rationale Evaluation

 n
Subjective: Deficient After 8 *Monitor *Maintain After 8
fluid hours of active fluid accurate hours of
-“naa koy volume nursing was from input and nursing
napancn related to intervention wound output. interventio
dugo sa blood loss , client will drainage, n the client
akua” as be able to: bowel was able
evidence movements to”
Objective: d by *Experience , bleeding ,
vaginal adequate urine and *Goal met.
-Decreased fluid volume Patient was
bleeding vomiting.
hemoglobin and experience
and *For
Inference: electrolyte *Monitor d adequate
hematocrit baseline
balance. vital signs. fluid
count. Formatio data.
volume and
n of the *Will be *Encourage
-Pale *Oral fluid electrolyte
tumor in able to patient to
discoloratio the replacemen balance as
identify drink evidenced
n noted t is
muscles some prescribed
indicated to by urine
of the managemen fluid output
-Dry mild fluid
uterus t to amount. greater
mucous deficit.
maintain than 30/hr,
membrane Presence
health normal vital
of vaginal signs and
-Dry skin *Monitor
bleeding *Elevated normal skin
turgor serum
& blood hemoglobin turgor.
loss electrolytes
-lethargic and
and urine *Goal met.
and irritable elevated
Reference and report
blood urea The patient
: abnormal was able to
nitrogen
result. understand
NANDA (BUN)
suggest the
edition 11
fluid deficit. importance
Page320- Urine of taking
327 specific supplement
gravity is s especially
likewise iron and
eating
 increased. nutritious
food.
*Administe *For iron
r anti supplement
anemia because of
drug. bleeding

*Encourage *To supply

patient to nutrients
eat
nutrition
foods with
emphasis of
multiple
servings of
fruits and
vegetables.

Assessmen Diagnosis Planning Interventio rationale Evaluation

t n
Subjective: Activity After 8 *Assess *Influences Patient
in hours of patient’s choice of reveals an
“nagluya tolerance nursing ability to interventions increase in
ko labi na related intervention perform or needed activity
ug mu to s the patient normal task assistance. tolerance,
barug or imbalanc will be able or activities demonstratin
mag e to report an of daily g a reduction
trabaho sa between increase in living. in
balay “ as oxygen activity of *May physiological
verbalized supply tolerance indicate signs of
by the and including *Note neurological intolerance
patient. demand. activities of changes changes and
daily living imbalance/ associated laboratory
Objective: disturbance, with vitamin values within
muscle B12deficienc normal range.
-Fatigue y, affecting
weakness
patient safety
-droopy or risk of
eyes energy.

-Poor skin
turgor
*Enhances
-Dry rest to lower
mucous body and
membrane *Recommen oxygen
d quiet requirements
atmosphere, and reduces
bed res tif strain on the
indicated. heart and
lungs

*Enhances
lung
expansion to
maximize
*Elevate the
oxygenation
head of the
for cellular
bed as
update
tolerated.
*helps
determine if
the pt is able
to perform
*Plan activity the activity
progression
with patient,
including
activities
that the
patient views
essential.
Increase
levels of
activities as *Helps the
tolerated. patient to
minimize
 workload
*implement and helps
energy saving save
technique like energy for
sitting activities
that are
strenuous

Assessm diagnosis planning Interventi rationale Evaluation

ent on
Subjectiv Risk for After 8 *Assess *low After 8
e: infection hours of nutritional nutritional hours of
related to nursing status, status may nursing
“sakit exposure of interventi weight affect the intervention
dapit sa surgical ons will be loss, bodies client was
akoa wound in the able to serum and response to able to:
gkan mn environment. free from albumin. pathogens.
lage ko g infection Goal met.
raspa” Inference: as *Encourag *This The patient
evidenced e intake of maintains was free
Objective Precipitating by normal protein optimal from
: factor(Presen vital signs and calorie nutritional infections
ce of surgical and rich foods. status. brought by
-Facial wound) harmful
absence of
expressio *Educate *Friction microorganis
purulent
n Exposure of patient of and running ms as
drainage
indicates the surgical importanc of water evidenced
from
slight wound to e of affectively by normal
wounds,
discomfo harmful
infections, frequent remove vital signs
rt microorganis
and tubes hand microorganis and absence
ms. washing ms from of purulent
-guarding and other hand. drainage in
behavior Unable to caregivers Washing her surgical
protect the to wash between
-facial drainage.
body or hands procedures
grimacin unable to
before reduces the
g combat the contact risk of
observed invading patient transmitting
organism and pathogens
adequately. between from one
procedure area of the
Reference: s with body to
patient. another.
NANDA
handbook *Provide a *provides
13th Risk for clean and comfort
infection well relaxation to
page 102- ventilated the patient
106 environme
nt.

*Monitore *determine
d for any if symptoms
unusualitie still persist
s or any new
symptoms
arise
*Advice *provides
SO not to safety and
leave support to
patient the patient
unattende by helping in
d. ADL
*Instructe
*inhibits the
d patient
growth of
to perform
any infection
perineal
and stops
hygiene.
any
pathogens
from
entering
surgical sight
assessment diagnosis planning interventions rationale evaluation
Subjective : Acute pain Within 8 *Assess pain *Useful in After 8
related to hours of noting monitoring hours of
“Sakit lage growth of nursing
nursing location, effectiveness
ahong fibroid in intervention
intervention characteristics, of
pus.on dapit the uterine goal is fully
the client severity (0-10). medications,
“ as wall met as
will be able Investigate and progression
verbalized evidenced
to report report changes of healing.
by pain scale
by the
relief from in pain as Changes in of 1
patient”
pain. appropriate. characteristics
of

*Relieving
Objective:
*Keep rested
abnormal
in semi-fowlers
-Facial tension, which
position.
grimace attenuated by
supine
-Guarding
position.
behavior, c
*Provide
with pain * promote
comfort
scale of 8- safety
measures such
10.
as raising the
side rails to
-Limited
prevent injury
movement

*deep *Its enhances

breathing client’s ability
excercises. to cope pain.

*Explain the * encourages

 cause of pain. patient to
participate in
health care

*Provide
* instills
therapeutic
knowledge to
communication
patients on
on concerns
how to cope
and issues
with pain
associated to
pain.

*Administer *medical
analgesic and management
anti- for pain and
relief from
inflammatory
pain
drugs as
prescribed by
the physicians.

Drug Study
Generic Name:
Ferrous sulfate
Trade Name:
Classification:
Iron Preparation
Dose, Route PO
freq: BID
MECHANISM OF ACTION
Elevates the serum iron concentration which then helps to form High or trapped
in the reticuloendothelial cells for storage and eventual conversion to a usable
form of iron.
INDICATIONS
• Prevention and treatment of iron deficiency anemia
• Dietary supplement for iron.
CONTRAINDICATIONS
• Hypersensitivity
• Severe hypotension.
ADVERSE EFFECT
• Dizziness
•N&V
• Nasal Congestion
• Dyspnea
• Hypotension
• CHF
• MI
• Muscle cramps
• Flushing
NURSING RESPONSIBILITIES
• Advise patient to take medicine as prescribed.
• Caution patient to make position changes slowly to minimize orhtostatic
hypotension.
• Instruct patient to avoid concurrent use of alcohol or OTC medicine without
consulting the physician.
• Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of
hands and feet and hypotension occurs.
• Inform patient that angina attacks may occur 30 min. after administration due
reflex tachycardia.
• Encourage patient to comply with additional intervention for hypertension like
proper diet, regular exercise, lifestyle changes and stress management.

Generic name: Mefenamic Acid

Classification: NSAID

Dosage: 500mg PO followed by 250mg q6h

MOA: Anti-inflammatory, analgesic and antipyretic activities related to

prostaglandin synthesis; exact mechanisms of action are not known

Indication: relief of pain, treatment of primary dysmenorrhea

Precaution: use cautiously with asthma, renal, hepatic impairment,

pregnancy, ulcers & heart failure

Contraindications: hypersensitivity to mefenamic acid, aspirin allergy

and as treatment for pre-operative pain

Side Effects: bloody urine, bloody, black or tarry stool, heartburn,

indigestion & stomach bloating

Adverse effects: rash, pruritis, sweating, dysuria, dyspnea, peripheral

edema, insomnia & bleeding

Nursing consideration:

 Note history of allergies, renal & hepatic

 Avoid during pregnancy
 Note adventitious sounds
 Renal function & clotting time
Generic name: Cefalexin

Classification: antibiotic, cephalosporin

Dosage: 250mg PO q6h or 1-4g/day in divide doses

MOA: bactericidal: inhibits synthesis of bacterial cell wall, causing cell

death

Indication: respiratory tract infection - strep-pneumoniae, skin and

skin structure infection – streptococcus, otitis media – S. pneumonia,
GU infections – E.coli

Precaution: renal failure, lactation & pregnancy

Contraindications: allergy to cephalosporins or penicillins

Adverse effects

CNS: headache, dizziness, lethargy, paresthesias

GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain,

GU: Nephrotoxicity

Hypersensitivity: rash, fever, anaphylaxis

Nursing Considerations:

 Note history of penicillin and cephalosporin allergy, pregnancy &

Lactation
 Evaluations and Implications
Nursing Research

Nursing Research is made to improve and develop new schemes on preventing

the problem. Much medical research on Uterine Myoma helps health care team
to formulate and enhance interventions which aids in good decision making.

Nursing Practice
Knowledge, skills and ability should always be as one. It is an essential
aspect that we carry out nursing action and interventions bearing in mind its
underlying principle and standard for the plan of care that we provide to our
patients and clients.
Nursing Education
Knowledge about the disease process is hints in evaluating patients that
are at risk for the probable problem that may arise. This study aims to improve
and prevent further complications that may show the way to worst case
scenarios. As a nursing student it is important for us to know what are the
rightful actions and interventions that we can do in order to avoid and lessen
additional complications.

Journal Reading
Uterine fibroids (leiomyomas) represent the most common tumor in women.
These lesions disrupt the functions of the uterus and cause excessive uterine
bleeding, anemia, defective implantation of an embryo, recurrent pregnancy
loss, preterm labor, obstruction of labor, pelvic discomfort, and urinary
incontinence and may mimic or mask malignant tumors. By the time they reach
50 years of age, nearly 70% of white women and more than 80% of black women
will have had at least one fibroid; severe symptoms develop in 15 to 30% of
these women. Uterine fibroids in black women are significantly larger at
diagnosis than those in white women, are diagnosed at an earlier age, and are
characterized by more severe symptoms and a longer period of sustained
growth. Approximately 200,000 hysterectomies, 30,000 myomectomies, and
thousands of selective uterine-artery embolizations and high-intensity focused
ultrasound procedures are performed annually in the United States to remove or
destroy uterine fibroids. The annual economic burden of these tumors is
estimated to be between $5.9 billion and $34.4 billion.
Uterine fibroids are monoclonal tumors that arise from the uterine smooth-
muscle tissue (i.e., the myometrium). Histologically, fibroids are benign
neoplasms composed of disordered smooth-muscle cells buried in abundant
quantities of extracellular matrix. The cells proliferate in vivo at a modest rate.
Formation of the extracellular matrix also accounts for a substantial portion of
tumor expansion. Uterine fibroids are almost always benign.
A striking feature of uterine fibroids is their dependency on the ovarian steroids
estrogen and progesterone. Ovarian activity is essential for fibroid growth, and
most fibroids shrink after menopause. The sharp elevations and declines in the
production of estrogen and progesterone that are associated with very early
pregnancy and the postpartum period have a dramatic effect on fibroid growth.
Gonadotropin-releasing-hormone (GnRH) analogues, which suppress ovarian
activity and reduce circulating levels of estrogen and progesterone, shrink
fibroids and reduce associated uterine bleeding.
A limited number of genetic defects transmitted by germ cells have been
associated with familial uterine fibroid syndromes. Most notable are germline
mutations causing fumarate hydratase deficiency, which predisposes women to
the development of multiple uterine fibroids. In addition, a variety of somatic
chromosomal rearrangements have been described in up to 40% of uterine
fibroids. Recently, whole-genome sequencing showed that chromosomal
rearrangements are often complex, best described as single events consisting of
multiple chromosomal breaks and random reassembly. In an earlier study, a
somatic single-gene defect was found in a majority of uterine fibroid tumors;
this group of mutations affects the gene encoding mediator complex subunit 12
(MED12).
There are also genomewide differences in DNA methylation between fibroid
tissue and the adjacent normal myometrium. A large number of other molecular
defects involving transcriptional and posttranscriptional events, microRNAs
(miRNAs), and signaling pathways have also been described. Although some of
the effects of uterine fibroids on cell proliferation, apoptosis, and extracellular
matrix formation have been identified, little is known about their effects on
other cellular processes in fibroid growth, such as autophagy and senescence.
This review focuses on some recent developments in fibroid research, including
the role of stem cells, somatic genetic and epigenetic defects, and the action of
estrogen and progesterone and their cross-talk with various signaling pathways.
Reference:
American College of Obstetricians and Gynecologists. ACOG practice bulletin.
Alternatives to hysterectomy in the management of leiomyomas. Obstet
Gynecol. 2008;112:387-400.
Borkan J. Uterine Fibroids. In: Ferri F.: Ferri's Clinical Advisor. 1st ed.
Philadelphia, Pa: Mosby Elsevier; 2014 Section 1 U.
Katz VL. Benign gynecologic lesions: Vulva, vagina, cervix, uterus, oviduct, ovary.
In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive
Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 18.
Rodriguez MI, Warden M, Darney PD. Intrauterine progestins, progesterone
antagonists, and receptor modulators: a review of gynecologic applications. Am J
Obstet Gynecol. 2010 May;202(5):420-8. Epub 2009 Dec 23. Review.
Moss J, Cooper K, Khaund A, et al. Randomised comparison of uterine artery
embolisation (UAE) with surgical treatment in patients with symptomatic uterine
fibroids (REST trial): 5-year results. BJOG. 2011 Jul;118(8):936-944