Uterine

Myoma
 Presented by:
Abu, Camile
Granada, Glyde Pebbles
Landicho, Katrina
Linatoc, Jeanne Lyn
Luza, Ailen
Maralit, Ma. Krishna
Sim, Khay
Ulan, Darlene
Umali, Marianne Lyn
Avena, Gaudencio
Dimaculangan, Argenald Joseph
Hernandez, Michael Franklin
 INTRODUCTION
Uterine myoma is the most common tumors of
the female genitalia tract. Myoma commonly called
fibroid. It is the benign tumor of the smooth muscle in
the wall of the uterus. Hysterectomy has been a
common therapy in patients who have completed
reproduction. Total hysterectomy plus unilateral
salphingo oophorectomy TAHBSO- this procedure
removes the utereus, cervix, one ovary and one
fallopian tube, while one ovary and one fallopian tube
are left in places.
Fibroids can be present and be apparent. However
they are clinically apparent in up to 25 % of the
women. Although, myoma is generally considered to
be slowly growing tumor in 20-40% of women at the
age of 35 and more have uterine fibroids of
significant sizes with severe clinical symptoms.
Moreover, myoma can be relapse in 7-28% of patient
after surgical treatment and in certain case it may
even turn to malignant tumor, this could causes
significant morbidity including prolonged or heavy
menstrual bleeding, pelvic pleasure and pain and in
rare cases reproductive dysfunction. Myoma affects
one of every four women ¾ of woman with this
condition,however, experience no symptoms.
Uterine myoma is developing on the background of hyper
estrogen, progesterone, deficits in hyper gonodotrophine.
The majority of the researches say that the growth of
myoma depends on concentration of cystosolic receptors to
the sex hormones and their interactions, with the endrogen
or extrogen hormones. In accordance to clinical
observations, it can be admitted that both growth and
regressions of myoma are estrogen-dependent, is the tumor
size gets increased during pregnancy and is regressed after
menopause. The only that needs to clear is to find out
whether it is decreased in receptors numbers of estrogen,
progesterone and androgen- hormones quantities which
lead to regression in myoma size ( regarding androgen there
is an hypothesis that myoma is sensitive to androgen ) for
growth that formed tumors, the need to be further supported
by negative factors.
Abortions, long term used of inadequate contraceptive
pills, chronic sub-acute and acute inflammation of uterus
or its appendices, stress, ultraviolet radiation, cystic
formation of ovary etc. for example, the woman who had
ten abortions by the age of thirty have double to
developed uterine myoma at fourty years old. In fact,
uterine myoma = account for 20% of 650,000
hysterectomies performed annually in the U.S interest in
the uterine preservation and organ preserving surgery
through techniques minimally invasive surgery has
increased the first reports of laparoscopic myomectomy.
SPECIFIC OBJECTIVES

To be able to:

> know the disease ,its clinical manifestations, risk factors,

pathophysiology and diagnostic procedures for the disease.
> Identify different medical and surgical management of a
patient diagnosed with uterine myoma.
> Enhance our skills in caring a patient with uterine myoma.
> Familiarized us with the medications used to managed the
disease.
> Recognized appropriate nursing care and management.
> Help the patient realized her role in maintaining and
improving health.
 GENERAL OBJECTIVES

> Our group aims to be formulate a

comprehensive case analysis that would
provide essential knowledge and skills in
delivering quality health care to patient’s
diagnosis with uterine myoma.
 PATIENT’S PROFILE

PATIENT’S NAME: Lady L.

AGE: 48 years old
GENDER: Female
PERMANENT ADDRESS: Inosluban, Lipa City
BIRTHDATE: August 26, 1960
BIRTHPLACE: Lipa City, Batangas
CIVIL STATUS: Married
CITIZENSHIP: Filipino
RELIGION: Roman Catholic
ADMISSION DATE: August 22, 2008
ADMISSION DIAGNOSIS: Uterine Myoma
ATTENDING PHYSICIAN: Dra. Lovely Cacho
Dra. Alice Lojo
 HISTORY OF PRESENT ILLNESSS

Present condition started about 6 years prior to

admission. When patient noted heavy vaginal bleeding and
body weakness every menstrual period that last almost a
week. Due to that instance, she went to the hospital for
check-up and she found out that she has a myoma. Her
attending physician said that she need to undergo surgery
but they didn’t have enough money that time, they would
need to save for the hospitalization and operation that will
undergo. Until August 22, 2008, when her relative noted
her to be pale, having dizziness and body weakness
bought her to the hospital. After a series of examination,
she was scheduled and prepared her to surgery.
 PAST MEDICAL HISTORY

She has never been hospitalized except when

she had two breech presentations with her two
sons. Other than that, she usually experiences
cough, cold, fever and buys over the counter drugs
to treat the said illnesses. Prior to that, sometimes
she consults the said quack doctors or faith
healers if she thinks that it’s just that a simple
illness.
 SOCIO – CULTURAL

She is a friendly person. She is closed with her four

sons and loves them so much. She admitted that few
years ago, she used to smoke when she is defecating
and after eating. She said that she loves to eat
vegetables and she exercises regularly. She cooks in a
canteen in Lipa bus stop which sustains their basic
needs.
PHYSICAL ASSESSMENT
ACTUAL NORMAL INTERPRET
VITAL VALUES ATION
SIGNS
RR- 24 12-20 Normal
beats/min.
PR- 80 60-100 Normal
beats/min.
BP- 120/70 90/60- 130/90 Normal
mmHg
Height = 5’1 cm Weight = 57 Kg.

Body Technique Normal Actual Significance

Parts used findings findings
Head Inspection Normocep Normocep Normal
Palpation halic halic Normal
No No
abdominal abdominal
mass mass
Hair and Inspection Evenly Even Normal
scalp distributed, distributio
Thick hair, n of hair ,
no no
infection infection
and and
infestation infestation
Eyes Inspection Symmetric Sunken Not
to the face, eyeball Normal.
both Due to
eyes dehydratio
coordinated n
with
parallel
alignment.
External Inspection Hair evenly Evenly Normal
eye distributed, distributed
Structure Skin intact with skin
Eyebrows intact
Eyelashes Inspection Equally Equally Normal
distributed, distributed,
Curled Curled
slightly slightly
outward outward
Eyelids Inspection Skin intact, Skin intact, Normal
No no
discharge, discharge,
No no
discolorati discolorati
on, on, lids are
Lids close symmetric
symmetric al.
ally
Lacrimal Inspection No edema No edema Normal
gland or tearing. and tearing
Pupils Inspection Black in Black in Normal
(color , color, color,
shape and equal in equal in
symmetry size size 4mm
of size) normally in
3-7 mm in diameter
diameter,
round
smooth
border ,
iris flat
and round.
Ears Inspection Symmetri Positioned Normal
cally symmetricall
aligned to y to the face,
the face, No notable
firm and ear
not tender discharge,
with no clean and
discharge dry,.
d noted.
Nose Inspection Symmetri Symmetric Normal
c and and straight ,
straight, no nasal
no discharges
discharges noted, no
or flaring flaring noted
Mouth Inspection Uniform Uniform dark Not
Lips pink in color dry Normal
color, soft due to
and moist chemical
and content of
smooth cigarette
such as
nicotine.
Tongue Inspection Tongue at Dry and free Normal
midline of lesion
without
lesion
Teeth Inspection Complete, Incomplete, Not normal.
white, shiny missing teeth, Aging is a
tooth ill fitting factor
enamel, free dentures affecting
of debris loss of teeth
and also
insufficient
calcium and
fluoride.
Neck Inspection Coordinated Coordinated Normal
Palpation , smooth movement Normal
movement with no
with no discomfort
discomfort No masses,
No masses, tenderness
tenderness
Upper Inspection Pinkish in Pallor Not normal.
Extremitie color It is a
s manifestati
Skin on of in
adequate
circulating
blood or
hemoglobin
.
Palpation Slightly Poor skin Not normal
moist turgor due to
dehydration
 Palpation Normother Not warm, Normal
mia not cold to
touch, T=36
Arms Inspection Normally Normally Normal
Palpation firm, no firm, no Normal
contracture contracture,
, no no swelling,
swelling, equal size on
equal size both sides of
on both body
sides of Pulse rate: 80
body
Pulse Rate:
60-100
Nails Inspection Smooth, Pink, smooth Normal
Palpation highly texture, convex Normal
vascular and curvature
intact Capillary refill: 2
epidermis seconds
Capillary
Refill of 1-2
seconds
Chest and Inspection Symmetric Symmetric chest Normal
Lungs chest expansion, quiet,
expansion, rhythmic and
quiet, effortless
rhythmic and respiration
effortless
respiration
 Palpation No No retraction, Normal
retraction, no
no tenderness,
tenderness, no masses
no masses
Auscultati Quiet, Bronchovesic Normal
on rhythmic ular and
vesicular
breath sounds
Heart Auscultati Normal Cardiac rate Normal
on heart rate of 80
60-
100bpm
Abdominal Inspection Unblemish Lesions Not
ed skin, noted on the normal
uniform in surgical site because of
color post
procedure
done
Auscultation Average Audible Normal
normal bowel sound
bowel of 8 per
sounds 5- minute
25 per
minute
Lower Inspection No lesion, No edema, no Normal
extremiti Palpation can move deformities Normal
es freely and can move
Skin Capillary freely
refill: 1-2 Capillary
seconds refill: 2
seconds
 IV. ANATOMY AND PHYSIOLOGY
ANATOMY OF FEMALE REPRODUCTIVE ORGAN
 LOCATION &
STRUCTURE FUNCTION
DESCRIPTION

During childbirth,
contractions of the
uterus will dilate the
cervix up to 10 cm
The lower narrower in diameter to allow
Cervix
portion of the uterus. the child to pass
through. During
orgasm, the cervix
convulses and the
external is dilates
 Extending Egg transportation from
Fallopian upper part of ovary to uterus
tubes the uterus on (fertilization usually takes
either side. place here).

Provides an environment
Ovaries Pelvic region on for maturation of oocyte.
(female either side of Synthesizes and secretes
gonads) the uterus. sex hormones (estrogen
and progesterone).
 Receives penis during mating.
Pathway through a woman’s
body for the baby to take during
Canal about 10-8 cm childbirth. Provides the route for
long going from the the menstrual blood (menses)
Vagina
cervix to the outside from the uterus, to leave the
of the body. body. May hold forms of birth
control, such as an IUD,
diaphragm, neva ring, or female
condom

Located in the center

of the pelvic cavity House and nourishes the fetus.
Uterus The innermost layer Contains glands that secrete
Endometrium of uterine wall. fluids that bathe the uterine
Myometrium Smooth muscle in the lining.
Perimetrium uterine wall. Contract to help expel the baby.
Outer layer of the Covers the uterus
uterus
 Located in the
center of the House and nourishes
pelvic cavity the fetus.
Uterus The innermost Contains glands that
Endometrium layer of uterine secrete fluids that bathe
Myometrium wall. the uterine lining.
Perimetrium Smooth muscle in Contract to help expel
the uterine wall. the baby.
Outer layer of the Covers the uterus
uterus
 ESTROGEN
It is the most important hormone during puberty
in female and is responsible for secondary sexual
characteristics (e.g. breast enlargement, menstruation,
pelvic enlargement, long bones). Generally secreted by
the ovary specifically secreted by the Grafian follicle.
Estrogen production

Hypothalamus
↓
GnRH
↓
Anterior Pituitary Gland
↓
FSH
↓
Graafian Follicle
↓
Estrogen
 V. PATHOPHYSIOLOGY

Pregnancy Early Menarche

(11 years old)

Increase the lifetime exposure

Increase Estrogen production
to estrogen

Stimulates the growth of fibroid

Grows in the anterior wall of the uterus

 Pelvic pain

Deform uterine cavity

Menorrhagia

Myoma
VI. COURSE IN THE WARD
 Day 1
A 48 years old female was admitted at exactly 2:16:07 p.m last
August 22, 2008, accompanied by her son, with a chief complaint
of body weakness. She was admitted under the service of Dra.
Lovely Cacho and Dra. Alice Lojo and following orders are
given. Diet as tolerated, temperature, pulse rate and respiratory
rate must be recorded every shift, for chest x-ray posterior-
anterior, for electrocardiogram x 12 leads, for complete blood
count blood typing and for chem. 7. It was done at the same day.
The physician ordered a 5% Dextrose in Lactated Ringers 1 liter
plus 1 ampule of EC to be regulated at 20 gtts/min. The physician
ordered four units of whole blood that are properly typed and
cross matched to be run for 4-6 hours. The physician also ordered
“Lady L” that may have full diet at 4:40 p.m. The first unit of
whole blood with a serial number B-08-4660 started at 10:00
p.m.. Diphenhydramine 1 ampule intravenous 30 min. prior to
blood transfusion.
 Day 2
The above unit of blood finished at August 23, 2008, 2:20 a.m. There
is no reaction during and after the blood transfusion. At the same
time, the second unit of whole blood with a serial number B-08-4681
was hooked and consumed at 7:20 a.m. The third unit of blood with a
serial number B-08-4666 was started at same time. The blood
transfusion site was transferred from left to right at 11:20 a.m. At
12:30 p.m., the third unit of whole blood with a serial number B-08-
4668 was consumed and followed up of fourth unit of whole blood
and consumed at 4:30 p.m. Intravenous fluid number one consumed
and followed the number two 5% Dextrose in Lactated Ringers 1 liter
plus one ampule of EC regulated at the same rate. By 11:10 p.m.
“Lady L” is under nothing per orem. “Lady L” informed about Total
Hysterectomy Bilateral Salphingo Oophorectomy with signed consent
of her husband and her son at the same day. Anesthesiologist on deck
was informed. Cefuroxime 750 mg, intravenous started every 8 hours
after negative skin testing. At 11:40 p.m. Valium tablet 5 mg one
tablet was given as pre-operative drugs.
 Day 3
August 24, 2008, at exactly 7:00 a.m. “Lady L” was brought to
the operating room. At 4:50 p.m. post-op orders were given.
Monitor vital signs every 15 minutes until fully stable. Nothing
per orem temporarily. The patient was instructed to lie flat on bed
and low back rest for pneumonia precaution. Oxygen inhalation
administered at 3 liters per minute. Suction secretion when
necessary. Intake and output were recorded hourly. 5% Dextrose
Lactated Ringers 1 liter post-op to run at 15gtts/min then to
follow 5% Dextrose Lactated Ringers 1 liter at same rate. Last
dose of Cefuroxime to consumed, Metronidazole 500 mg slow
intravenous push every 6 hours. Tramadol 500 mg after negative
skin testing every 6 hour. Intravenous fluid regulated at 30
gtts/min when blood transfusion finished. Repeat hemoglobin
and hematocrit.
At 5:20 p.m. the operation ended and at 6:40 p.m. patient was
bought to the intensive care unit and hooked to ventilator and
Furosemide 40 mg IV was given. At around 8:45 p.m
Omeprazole 40 mg IV was given. Serum, sodium, potassium,
chloride, prothrombin time, partial prothrombin time done and
result in “Lady L” was nebulized if Combivent 1 neb and
maintained every 8 hours potassium 30 millequivalent
incorporate to her intravenous fluid and decrease it to 8 hours.
Another one unit of packed red blood cell, Calcium gluconate
one ampule was given thru slow intravenous push.
 Day 4
August 25, 2008, 5a.m. patient was brought to room 206 and then
nebulization started and extubated at the time and secretion
suctioned. Oxygen maintained at 4 liters per minutes via nasal
canula. Diphenhydramine one ampule was given at 3:30 p.m, 30
minutes prior to blood transfusion. Blood type “B” with a serial #
of BO8-445 run at 4-6 hours. At 6:05 p.m “Lady L” was
confirmed that she is positive in flatulence and may sips of water
and hot soup. Measuring drained output was recorded shiftly.
 Day 5
1 a.m. of August 26, 2008, to follow intravenous fluid 5%
Dextrose Lactated Ringers 1 liter regulated at same rate and
encouraged patient to turn side to side. Serum, creatinine, and
complete blood count done. At 9:37 a.m. the physician advised to
continue medications. At 10:00 p.m. patients temperature is
38.2˚C and paracetamol 200 mg one ampule was given thru
intravenous. At 11:03 a.m. nebulization was stopped. The
physician suggests changing Cefuroxime to Tazocin 4.5 grams
intravenous every 8 hours. Above intravenous fluid consumed
and followed up of 5% Dextrose in Lactated Ringers 1 liter
regulated at same rate. At 3:15 p.m. incentive spirometer every 8
hours and two minutes oxygen inhalation was discontinued.
Patient was encouraged to ambulate. At 8:30 p.m. intravenous to
follow of 5% Dextrose Lactated Ringers 1 liter regulated at same
rate. Foley catheter was removed at 9:15 p.m. At 10:45 p.m
“Lady L” was gargled a one tablespoon of Orahex solution plus
30 cc water every 6 hours.
 Day 6
Nursing care done. Vital signs are monitored and recorded.
Intravenous fluid regulated at 15 gtts/min “Lady L” has no
further complaint. The patient is ambulatory. Tazocin 4.5 grams
intravenous every 8 hours was given. Attending Physician did not
visit’s the patient and no new orders were made that day.
 Day 7
August 28, 2008, patient may have clear liquid then soft diet at 4
p.m., above intravenous fluid consumed and followed up of 5%
Dextrose Lactated Ringers 1 liter regulated at the same rate. For
possible discharge on the next day.

Day 8
August 29, 2008, removal of jackson-pratt drain was done and
intravenous fluid was terminated. There is no o objection for
discharge. Home medications instructed and patient may go
home and start oral medication. At 8 p.m. patient was discharged
accompanied by her son via the wheelchair.
VII. LABORATORY
 AUGUST 22, 2008
ULTRASOUND
Transvaginal Ultrasound

Transabdominal pelureus shows an enlarged uterus measure

about 12.6x7.5x9.1 cm (LxWxAP). There is a large hypo echoic
mass in the posterior lower segment of the uterus, measuring
approximately 10.0x10.0x9.0 cm.
There is a cystic structure with internal echoes and septations in
the night adnexae, measuring about 60x4.5x4.3 cm.
There is no fluid in the posterior culde-sac.

Impression:
Enlarged uterus with large sub serous myoma wit
intramural component, posterior lower segment consider ovarian
cyst at the right. Normal left ovary.
 AUGUST 22, 2008
CLINICAL CHEMISTRY

Laboratory Test Normal Value Result Significance/Int

erpretation
FBS 3.89-5.84 4.24 mmol/L Normal
mmol/L
BUN 2.5-8.33 mmol/L 2.80 mmol/L Normal
Creatinine 45-235 u/L 89.0 u/L Normal
Bld. Uric Acid 143-345 mmol/L 179.0 mmol/L Normal
Triglyceride 0.11-2.37 0.58 mmol/L Normal
mmol/L
HDL 0.25-2.65 1.50 mmol/L Normal
mmol/L
LDL 1.10-3.81 2.52 mmol/L Normal
mmol/L
 AUGUST 22,
2008
HEMATOLOGY
Diagnostic/Labor Normal Value Result Significance/Interpre
atory Test tation
Hemoglobin M 13.0-18.0 6.93 g/dL Anemia, recent
g/dL hemorrhage
F 12.0-16.0
g/dL
Hematocrit M 40-54% 21 % Anemia
F 37-47%
WBC 5,000-10,000 5,000 Normal

Platelet Count 150,000- 337,000 Normal

450,000 cu/mm cu/mm
Segmenters 0.51-0.57 0.70

Lymphocytes 0.21-0.35 0.20

Monocytes 0.02-0.35 0.10 Normal

 AUGUST 23, 2008
HEMATOLOGY
Diagnostic/Labor Normal Value Result Significance/Interpre
atory Test tation
Hemoglobin M 13.0-18.0 10.8 g/dL Anemia, recent
g/dL hemorrhage
F 12.0-16.0
g/dL
Hematocrit M 40-54% 36.70 % Anemia
F 37-47%
WBC 5,000-10,000 6,500 Normal
Platelet Count 150,000- 247,000 Normal
450,000 cu/mm
cu/mm
Segmenters 0.51-0.57 0.83 Infection
Lymphocytes 0.21-0.35 0.11 Infection
Monocytes 0.02-0.35 0.06 Normal
 AUGUST 24, 2008

HEMATOLOGY
Diagnostic/Laborat Normal Value Result Significance/Interpreta
ory Test tion
Hemoglobin M 13.0-18.0 12.5 g/dL Normal
g/dL
F 12.0-16.0 g/dL
Hematocrit M 40-54% 37.5 % Normal
F 37-47%
WBC 5,000-10,000 20,600 Infection

Platelet Count 150,000-450,000 225,000 cu/mm Normal

cu/mm
Segmenters 0.51-0.57 0.93 Infection

Lymphocytes 0.21-0.35 0.03 Infection

Monocytes 0.02-0.35 0.04 Infection

Eosinophill 0.01-0.04 Infection

 AUGUST 24, 2008
CLINICAL CHEMISTRY

Laboratory Normal Result Significance/

Test Value Interpretatio
n
Sodium 135-145 142.3 mmol/L Normal
mmol/L
Potassium 4-4.5 mmol/L 3.133 mmol/L Hypokalemia
Chloride 99.9-110 106.7 mmol/L Normal
mmol/L
Pro- time 12-15 seconds 13 seconds Normal
 AUGUST 24, 2008
CHEST X-RAY AP

> There are no active parenchemal infiltrates.

> The heart is not enlarged.
> Aorta is tortous.
> The rest of the findings are unremarkable.
> ET at level of T4.

Impression:
> Tortous Aorta
`
AUGUST 24, 2008
ABDOMEN AP

> Hx: S/P TAHBSO

> Free air is noted at the pelvic cavity.
> There are feces filled undilated bowel loops obscuring the renal and psoas shadows.
> The flank stripes are intact
> No abnormal calcification noted.

Impression:
>Pneumoperitoneum, likely post surgical.
 AUGUST 25, 2008
HEMATOLOGY

Diagnostic/La Normal Result Significance/Inter

boratory Value pretation
Test
Hemoglobin M 13.0-18.0 10.5 g/dL Anemia, recent
g/dL hemorrhage
F 12.0-16.0
g/dL

Hematocrit M 40-54% 32.70 % Anemia

F 37-47%
WBC 5,000- 16,600 Infection
10,000
Platelet 150,000- 206,000 Normal
Count 450,000 cu/mm
cu/mm

Segmenters 0.51-0.57 0.96 Infection

Lymphocytes 0.21-0.35 0.02 Infection

Monocytes 0.02-0.35 0.01 Infection

Eosinophill 0.01-0.04 0.01 Normal

 AUGUST 26, 2008

HEMATOLOGY

Diagnostic/La Normal Result Significance/Inte

boratory Value rpretation
Test

Hemoglobin M 13.0-18.0 11.4 g/dL Anemia, recent

g/dL hemorrhage
F 12.0-16.0
g/dL
Hematocrit M 40- 35.10 % Anemia
54%
F 37-47%

WBC 5,000- 15,200 infection.

10,000
Platelet 150,000- 196,000 Normal
Count 450,000 cu/mm
cu/mm

Segmenters 0.51-0.57 0.90 Infection

Lymphocyte 0.21-0.35 0.08 Infection

s
Monocytes 0.02-0.35 0.02 Normal
 AUGUST 26, 2008
CLINICAL CHEMISTRY

Laboratory Normal Result Significance/Inte

Test Value rpretation

Potassium 4-4.5 3.56 Hypokalemia

mmol/L mmol/L

Creatinine 45-235 u/L 102.0 u/L Normal

IX. DRUG STUDY
 NAME CLASSIFI- ACTION INDICATION ADVERSE NURSING
CATION &DOSAGE REACTION CONSIDE-
RATION
Generic Antiprotozoals Direct -acting >Amebic liver >CNS: > Monitor liver
Name:Metroni or trichomonacide abcess>To headache, function test
dazoleBrand Antimicrobia and amebicide prevent post seizure, fever, result carefully
Name:Flagyl that works operative vertigo, ataxia, in elderly
inside and infection in dizziness>CV: patient.>
outside the contaminated flattened T Observe pt. for
intestines. It’s or potentially wave, edema, edema
thought to enter contaminated flushing>EEN especially if
the cells of colorectal T: rhinitis, receiving
microorganism surgery sinusitis, corticosteroid>
s that contain Dosage:500mg pharyngitis>GI Record number
nitroreductase, IV : nausea, and character
forming abdominal of stools when
unstable cramping or drug is used to
compounds pain, stomatitis, treat.
that bind to vomiting,
DNA and diarrhea>GU:
inhibit vaginitis,
synthesis, darkened urine,
causing cell polyuria,
death.
 NAME CLASSIFI- ACTION INDICATION ADVERSE NURSING
CATION &DOSAGE REACTION CONSIDE-
RATION
Generic Cephalosporins Inhibits cell Serious lower > CV: > Before giving
name:Cefuroxi wall respiratory tract thrombophlebit drugs, ask
meBrand synthesizes infection, UTI, is, phlebitis > patient if he
Name: Zinacef promoting skin structure GI: diarrhea, allergic to
osmotic infection, bone nausea, penicillin or
instability or joint vomiting, cephalosporins
infection, anorexia> > Obtain
gonorrheaDosa Skin: maculo specimen for
ge:750mg IV papular, culture and
erythematous sensitivity test
rashes before giving
first dose
 NAME CLASSIFI- ACTION INDICATION ADVERSE NURSING
CATION &DOSAGE REACTION CONSIDE-
RATION
Generic Opioid > Bind to > Moderate to > CNS: > Monitor CV,
Name:Tramado Analgesic opioid moderately dizziness, and respiratory
lBrand receptors and severe headache, status withhold
Name:Ultram inhibit reuptake painDosage:50 vertigo, dose and notify
of mg IV anxiety, prescriber if
norepinephrine confusion> respiration
or serotonin CV: decrease or rate
vasodilation > is below
EENT: visual 12bpm>
disturbances> Monitor bowel
GI: and bladder
constipation, function > For
nausea , better analgesic
vomiting, effect give drug
abdominal before onset of
pain> GU: intense pain.
menopausal
symptoms
urine retention
 NAME CLASSIFI- ACTION INDICATION ADVERSE NURSING
CATION &DOSAGE REACTION CONSIDE-
RATION
Generic Anti Ulcer > Inhibits > Symptomatic > CNS: > Drug
Name:Omepraz Drug activity of acid GERD without asthenia, increases its
oleBrand pump and bind esophageal dizziness, bioavailability
Name:Losec to hydrogen lesion> short headache> GI: with repeated
potassium term treatment abdominal doses. Drug is
adenosine, of active pain, unstable in
triphosphatase benign gastric constipation, gastric acid;
at secretory ulcerDosage:40 nausea, less drug is loss
surfaces of mg IV vomiting to hydrolysis
gastric parietal because drug
cells to block increases
formation of gastric
gastric acid pH.>Dosage
adjustment may
be necessary in
Asians and
patients wit
hepatic
impairment.
 NAME CLASSIFI- ACTION INDICATION ADVERSE NURSING
CATION &DOSAGE REACTION CONSIDE-
RATION
Generic Bronchodilato >Relaxes >To prevent or >CNS: >Drug may
Name:Salbuta rs bronchial, treat tremor, decrease
molBrand uterine and bronchospasm nervousness, sensitivity of
Name:Combive vascular in patients with headache spirometry
nt smooth muscle reversible >CV: used for
by stimulating obstructive tachycardia , diagnosis of
beta2 receptors. airway palpitations, asthma.>Use of
diseaseDosage: hypertension> a AeroChamber
1 nebule EENT: dry may improve
and irritated drug delivery
nose>GI: to lungs.>Tell
nausea, patient to
vomiting,anor remove canister
exia and wash
inhaler with
warm, soapy
water at least
once a week.
 NAME CLASSIFI- ACTION INDICATION ADVERSE NURSING
CATION &DOSAGE REACTION CONSIDE-
RATION
Generic Antibiotics >Inhibits cell- >Moderate to >CNS: >Before giving
Name:Piperacil wall synthesis severe headache, drug, ask
lin during bacterial infections from insomnia, fever patient about
SodiumBrand multiplication. piperacillin- >CV: allergic
Name:Tazocin resistantDosag hypertension, reactions to
e:4.5g IV tachycardia, penicillins>Obt
chest ain specimen
pain>EENT: for culture and
rhinitis >GI: sensitivity test
diarrhea, before giving
nausea, first
vomiting dose.>Monitor
patient’s
sodium intake.
X. NURSUNG CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTIONS EVALUATIO
N
SUBJECTIVE: Pain related to After 4 hours INTERVENTIONS RATIONALE After 4 hours
“Masakit ang tissue trauma of nursing of nursing
tahi ko” as and incisional intervention intervention
verbalized by discomfort as patient’s pain Change the Pain is sometimes the patient
the patient. manifested by evidenced by position of the due to the position reported pain
OBJECTIVE: grimace and pain scale =7 patient of the patient was lessened
Restlessness pain scale =7. be reduced to Provide comfort  To reduce the to pain scale
Irritability 3. measures discomfort =3.
With cold Assist patient in To assist in
clammy skin breathing techniques muscle and
Excessive Provide quiet generalized
perspiration environment relaxation
Facial grimace Relay on the For patient
Increased patient report of comfortabili-ty and
respiration pain lessen the
RR=26 bpm Encourage discomfort.
Pain scale = divertional activities To reduce anxiety
7: pain scaling Monitor vital sign felt by the patient
of 1-10 where 1 Administer To divert the
is the least analgesic as ordered attention from pain
painful and 10 is by the AP to activities
the most painful Usually altered in
Impaired pain.
thought To maintain
acceptable level of
ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTIONS EVALUATION
OBJECTIVE: Fluid volume After 8 hours INTERVENTIO RATIONAL After 8 hours of
Poor skin deficit related of nursing NS E nursing
turgor to the risk of intervention intervention, the
Change To protect
Dry lips post-operative the patient patient was
dressings the skin and
Weak in hemorrhage. will maintain maintained fluid
frequently monitor
appearance fluid at a as manifested by
Provide losses
Pale looking functional good skin turgor
frequent oral care To prevent
v/s of: level.
Measure input injury from
BP = 100/80
and output dryness
PR = 64
Monitor v/s Helps
RR = 26
Administer IV maintaining
T = 37.8
fluids as indicated fluid in the
Give body
medications as To monitor
ordered by the fluids in the
attending body
physician To assess
the patient
and it serve
as base line
data
To reduce
blood loss
ASSESSMENT DIAGNOSI PLANNING NURSING EVALUATION
S INTERVENTIONS
SUBJECTIVE: Impaired After 8 hours INTERVEN- RATIONA- After 8 hours of
“Hindi ako mobility of nursing TIONS LE nursing
makagalaw ng related to intervention Provide To reduce intervention, the
ayos” as decreased the patient activities with the fatigue patient was able
verbalized by muscle will be able adequate rest Promotes to move safely
the patient. strength as move safety period. well being and
OBJECTIVE: manifested and Encouraged and independently.
Impaired by limited independentl adequate intake maximize
ability to turn ROM. y. of fluids energy
side to side. Advise to production
Cannot eat To
move hands
without support and legs slowly exercise/mob
Slowed  Encourage ilization of
movement participation in body parts
Irritable
self care and develop
Limited ROM
muscle
strength
Enhances
self concept
and sense of
independenc
e
XI. DISCHARGE PLANNING

Medication
Ciprofloxacin 500 mg 1tablet 3x a day for 1 week
Metronidazole 500 mg 1 tablet 3x a day for 1
week
Tramadol (Dolcet) 1 tablet 3x a day for pain

Environment
Instruct patient’s relative to provide the patient an
environment conducive for her easy recovery. Her
place/room in their house must be the most accessible
area. Her environment should be free from
contamination and infection.
Treatment
The patient should follow the physician’s prescription and
should take his home medication on the right time and right dose.

Health Teaching
Instruct the patient the importance of proper taking of medication
on time.
Instruct the patient and her family the proper wound care to avoid
contamination and infection at surgical site.
Instruct the patient to eat nutritious foods.
Encourage ambulation for early recovery.
Good sanitation is advised.
Out Patient Department
The patient should return on the scheduled date of her
follow up check-up on September 5, 2008 in Metro Lipa Medical
Center from 4:30 pm to 6:30 pm and should continuously take
her home medication as prescribed by her physician. The patient
should visit her physician whenever she feels any discomfort.

Diet
Diet as Tolerated. In order to attain proper diet, the
patient should be guided to the prescribed foods as advised by her
physician. Her meals should include Vitamin C-rich foods for
wound healing.
Spiritual
Patient should enhance her spiritual relationship with
God. Have faith and trust in God’s divine power, and believed
that the lord will help in her early recovery. Keep on praying,
because praying is the number one key to live a healthy life and
to be close to God.
 XII. PROGNOSIS
The mortality rate in uterine myoma is low provided early
diagnosis and management are made and no complication will
occur. According to the attending physician the case of Lady L
greatly improved after the management, therefore, the prognosis
is good.
 XII. EVALUATION
Date 22 23 24 25 26 27 28 29

D5LR √ √ √ √ √ √ √
1L

BT √ √
FWB

TPR
temp 36.7 36.2 36 37.3 36.8 36.2 37.6 36.2

BP 120/70 120/80 120/70 130/80 130/80 110/70 140/90 120/70

RR 24 20 21 24 22 20 28 22
PR 80 90 72 91 68 75 80 68
MEDS 22 23 24 25 26 27 28 29
Omepra √
zole
Salbuta √ √ √ √ √
mol
(combiv
ent)
Piperacil √ √ √ √ √ √
lin
(Tazocin
)
Tramado √ √
l
(ultram)
Diphenh √ √ √ √
ydramin
e HCl
(Benadr
yl)
Metroni √ √ √ √ √ √
dazole
(Flagyl)
Metronidazol √ √ √ √ √ √
e (Flagyl)

Cefuroxime √
(Zinacef)

Paracetamol √

CXR AP √

Abdomen AP √
UTZ √

Clinical √ √ √
Chemistry

Cross √
Matching

Hematology √ √ √ √ √

DIET 22 23 24 25 26 27 28 29

DAT √ √

Soft diet √

NPO √ √ √ √