OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING

A CASE STUDY

OF

TOTAL ABDOMINAL HYSTERECTOMY BILATERAL SALPHINGO OOPHORECTOMY

Submitted by:
MANSUETO, LOVELY MARIE

MASULA, JESSEL

MENDEZ, GRACELLE

MENDOZA, JUAN PAULO

MENESES, ANGELY

MIRANDA, GIAN CARLO

PANGILINAN, EYMARD

RESURRECCION, CRYSTAL JADE

 INTRODUCTION
In the span of our duty, we can notice how one differs from the other, how one
exerts effort from the other and how one loses from the other. For the sick, it is
hardly imagine the pain they are going through and for the significant others,
their hardships are imaginable because we all had experienced a loved one being
sick but everyone varies in dealing with problems.

The severity of the problem greatly affects ones attitude towards it but if one has
a positive disposition in life, no matter how heavy the loads you give and no
matter how deep it will reach, it will be handled as though nothing bad will going
to happen. Honestly, this case is what our group chose in particular because our
attention was caught especially by the physical appearance of the patient. Patient
Mrs. X appears to be a happy person that smiles even to strangers but her being
seriously sick is not hidden to many due to surgery happens before we start our
duty removing her total reproductive system.

Patient Mrs.X was diagnosed with Ovarian New Growth with ultrasound result to
determine if it is malignant or benign. Ovarian new growth is sac filled with liquid
or semiliquid material that arises in an ovary. They often become very large and
can extend up into the abdomen. The diagnoses of the disease require a
widespread implementation of physical examination and ultrasonography
technology.

It is divided into three categories: benign, borderline, and malignant. Survival is

largely dependent on the histology of the tumor, with a 10 year survival rate of
100% for benign tumors, 60% for borderline tumors, and only 34% for the
malignant subtype.

There is some difference in ages of the peak incidence for the different subtypes
with considerable overlap as described below. In general, benign tumors tend to
present earlier, while malignant tumors are often seen later in life. Women
diagnosed of such have anxiety and fear of it being malignant but vast majority
are benign.
 It is developed in women at any stage of life from neonatal period to post
menopause. However, most occur during infancy and adolescence, which are
hormonally active periods of development.

SIGNIFICANCE OF THE STUDY

On the present, we are learning, adopting and enjoying the benefits of the
advanced technologies that we have especially in the medical field. There are new
machines that help in diagnosing and treating certain diseases. There is also new
equipment that is very useful in the daily routine of healthcare professionals. Yet,
with all this advancements it is still hard to beat the will of the Almighty because
some fatal diseases are still left without any means of diagnostic procedure and
before you know it, you already have it. In this study, we will dig deeper on what
are the factors that contributes to the disease for prevention in our self and to
determine if this factors are already enough to justify the result. It will help us to
know the proper managements for our future patients. It will give us additional
knowledge that will help us manage it in our patients of the same disease in the
future.

REASONS WHY YOU CHOSE THE CASE

As a nurses, we are exposed to different areas, different people, and different
diseases that some are communicable and some are not and with that, we see
lots of unfamiliar cases. As something new to us, we want to learn more about
this disease and hopefully to be knowledgeable about the disease for in the
future, we can deal with it properly and correctly
General Objectives
This case study aims to identify and determine the health problems and needs of the patient
with an admitting diagnosis of TAHBSO.

 Nurse-Centered Objectives:
 Upon conclusion of case study, the nurse must should be able to:
 Identify the risk factor contributing occurrence of Myoma
 Formulate significant nursing diagnosis with nursing care plan.
 Identified different medications administered for their disease their indications,
contraindications, side effect and specific responsibility.
 To be able trace the Pathophysiology of the disease
 To be able to formulate recommendation and health teaching.

 Client-Centered Objectives:
 Understand of her awareness.
 Learn and understand why such laboratory and some procedures are being done.

Description of the Disease:

Myoma is a condition where there is a benign growth or tumor of smooth muscle in the wall of
the uterus. The said growth is made up of fibrous tissue; hence it is often called a fibroid tumor.
Uterine fibroids can be present and be in apparent. Fibroids vary in size and number, and are
most often slow-growing and usually cause no symptoms. It may grow as a single nodule or in
clusters, and may range in size from 1 mm to more than 20 cm in diameter.

Myomas are the most frequently diagnosed tumor of the female pelvis, and the most common
reason for hysterectomy. Although they are often referred to as tumors, they are not
cancerous. Most myomas develop in women during their reproductive years. Myomas do not
develop before the body begins producing estrogens.

Myomas tend to grow very quickly during pregnancy when the body is producing extra
estrogen. Once menopause as begun, the myoma generally stops growing and may begin to
shrink due to the loss of estrogen. Fibroids may be removed if they cause discomforts or if they
are associated with uterine bleeding.
 PATIENT’S PROFILE
Name: Patient X Age: 50 Attending physician: Dr.Y

Birthday: Nov. 12,1967 Sex: Female Nationality: Filipino Religion: Catholic

Address: San Narcisco, Quezon Province Admission date: December 13, 2017

Civil status: Married Menstrual History:

Obstetrical History: G9P4L4A5 Menarche: 13y/o

LMP: Duration: 5 days / Interval: 33 days

Amount: 2 pasador

Chief Complaint: AUB, PAIN

Past Medical History:

1. (-) UTI
2. (-) HPN
3. (-) DM
4. (-) ASTHMA

Family Medical History:

1. (-) HPN
2. (-) DM
3. (+) PTB – Mother Side
4. (-) CANCER

Personal and Social:

1. (-) SMOKER
2. (-) ALCOHOLIC DRINKER

Behavioral attitudes toward illness: cooperative

 GORDON’S FUNCTIONAL HEALTH PATTERN
PRIOR DURING
HEALTH PERCEPTION/ She doesn’t buy over the She follow the physician
HEALTH MANAGEMENT counter drugs but goes to prescribed orders and usually
hospitals or health center for walking at their place for like
check ups 10-15 mins in the ward.
NUTRITIONAL-METABOLIC The patient eats 2-3 times per The client eats 3-4 times a day
day and drinks 1.5-2.5L and drinks 6-7 glasses of
everyday water per day. She is in
average of height and
medium built.
ELIMINATION She urinates 3-4 times a day She urinates 4-5 times a day
and eliminates 1-2 times per and eliminates once daily.
day.
COGNITIVE-PERCEPTUAL She was able to communicate She was able to visualize, feel
or interact with others. and smell appropriate and
clear auditory.
SLEEP-REST She sleeps atleast 8hrs a day She sleeps 6-8 hours per day.
and a nap of 1hr. every day. And has siesta of 1hr during
afternoon after giving meds.
SELF-PERCEPTION She is aware that she must The patient is confident and
fulfill the care and needs of cooperative during has a good
the family. posture and normal tone of
voice, and maintain eye
contact.
ROLE-RELATIONSHIP She has good relationship She has good relationship
with his mother and father with other patients and has
when it was still alive. several numbers of friends.
SEXUALITY-REPRODUCTIVE She admits that she had sex The patient is now inactive
with her husband only. and stated “hindi na po kami
nagkakaroon ng siping simula
ng ako ay makaramdam ng
sakit”.
VALUE-BELIEF She is catholic. She is catholic and cannot
attend mass because of her
condition. She pray at night.
 PHYSICAL ASSESSMENT
GENERAL The patient is alert and oriented properly
hygiene.
INTEGUMENTARY The patient’s hair is in uniform in color.
The hair of the client is thin.
With healed scratches and scars in her legs.
HEAD Generally round with prominences in the
frontal and occipital area. (Normochepalic)
No tenderness noted on palpation.
EYES Evenly placed and in line with each other.
None protruding.
Equal palpebral fissure.
Pupil equals, round, react to light,
accommodation.
EARS Appropriate auricles of the ears for
parallelism, size position, appearance and skin
color.
NOSE Nose in the midline
No discharges.
No bone and cartilage deviation noted on
palpation.
No tenderness noted on palpation.
NECK The neck is straight.
No visible mass or lumps.
RESPIRATORY Normal breathing pattern.
Normal expansion of chest.
CARDIOVASCULAR Normal apical pressure.
ABDOMEN Skin color is uniform in color, Stitches are
present.
MUSCULOSKELETAL ROM is appropriate.
NEUROLOGIC The patient is alert, attentive and follow
commands.
Frontal: Awake and coherent.
Parietal: R-L orientation
Temporal: Intact memory
Occipital: Recognize familiar object.
 ANATOMY AND PHYSIOLOGY

THE FEMALE REPRODUCTIVE SYSTEM

The main external structures of the female reproductive system include:

Labia majora:

The labia majora enclose and protect the other external reproductive organs. Literally

translated as "large lips," the labia majora are relatively large and fleshy, and are comparable to
the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty,
the labia majora are covered with hair.

Labia minora:

Literally translated as "small lips," the labia minora can be very small or up to 2 inches wide.
They lie just inside the labia majora, and surround the openings to the vagina (the canal that
joins the lower part of the uterus to the outside of the body) and urethra (the tube that carries
urine from the bladder to the outside of the body).

Bartholin's glands:

These glands are located beside the vaginal opening and produce a fluid (mucus) secretion.

Clitoris:

The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable to the
penis in males. The clitoris is covered by a fold of skin, called the prepuce, which is similar to
the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive to stimulation
and can become erect.

The internal parts include:

Vagina:

The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It

also is known as the birth canal.

Uterus (womb):

The uterus is a hollow, pear-shaped organ that is the home to a developing fetus. The uterus is
divided into two parts: the cervix, which is the lower part that opens into the vagina, and the
main body of the uterus, called the corpus. The corpus can easily expand to hold a developing
baby. A channel through the cervix allows sperm to enter and menstrual blood to exit.

Ovaries:

The ovaries are small, oval-shaped glands that are located on either side of the uterus. The
ovaries produce eggs and hormones.

Fallopian tubes:

These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels
for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization of an
egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then moves to the
uterus, where it implants into the lining of the uterine wall.
 HEALTH HISTORY

 Family Health History

It has been said that Patient X that both of paternal and maternal line ages have no history of
hypertension, diabetes and heart disease. The common sicknesses of the family are cough,
colds and fever. But her maternal grand has a history of PTB.

The father of the patient work as a Farmer, sometimes in a day. While the mother is just a
housewife. Since only the father work, all of the family’s expenses depended on him. They are
five children in the family; all of them had their own family. Patient X as the 2nd oldest among
her siblings.

 History of present illness