VII.

THERAPEUTIC MANAGEMENT
LIST OF PROBLEMS
1. Pain (Right Lower Quadrant Pain)
2. Tender Palpable mass 10x10cm
ADVICE AND INFORMATION
1.

2.

3.
4.

Educate the patient and her family about her

disease condition, its symptoms, risk factors,
and its potential harmful effects if not
treated.
Educate the patient as well as her family
regarding the different benefits of the drugs
taken and to watch out for its possible side
effects or adverse reactions.
Advice the patient to strictly follow her diet
regimen.
Advice patient to do deep breathing
exercises, follow a healthy diet plan (such as
high fiber diet), and observe proper hygiene,
adequate rest and sleep to promote well
being.

THERAPEUTIC OBJECTIVES
1. To treat the underlying cause of the pain
3. To maintain vital signs within normal range
4. To prevent further complications

NON-PHARMACOLOGIC MANAGEMENT
Pre-Operative Management:
1. Admit patient for surgical management.
2. Secure patients/parents consent.
3. Start venoclysis Plain LR 1L @ 10gtts/min.
4. Monitor vital signs every 4 hours.
5. Diet: NPO initially until cleared by Surgery and OBGynecology.
Intra-Operative (Surgical Management):
Due to the low frequency of malignancy in the pubertal
age group, OVARIAN SPARING SURGERY is the goal. The
treatment
consists
of
OPEN
LAPAROTOMY
and
CYSTECTOMY
since
the
patient
presented
with
10cmx10cm mass and pain which may indicate torsion.
1. Open Laparotomy
- Inspect the contralateral ovary. The current
treatment involves preservation of the
contralateral overy without biopsy if it grossly
appears normal.
2. Cystectomy is the operative treatment of choice,
with preservation of the remaining portion of the
ovary.
- Scalpel incision is made in ovary at
intersection of dermoid and normal ovary.
- Dermoid will be separated from the ovary.
- Reconstruction of the normal ovary.

PHARMACOLOGIC MANAGEMENT
DRUG NAME
EFFICACY
NONSTEROIDAL ANTI-INFLAMMATORY DRUG
Ketorolac (KETERO)
Ketorolac
inhibits
1mg/kg IV every 6
prostaglandin synthesis
hours for 2 days
by
decreasing
the
activity of the enzyme
Preparation: Ketero
cyclooxygenase, which
in 30mg/ml vial
results in decreased
formation
of
prostaglandin
precursors.
NARCOTIC ANALGESICS
Morphine (MST
Narcotic
agonistCONTINUS) 20mg
analgesic
of
opiate
every 12hrs
receptors;
inhibits
ascending
pain
Preparation:
pathways, thus altering
MST Continus MR tab response
to
pain;
10mg
produces
analgesia,
respiratory depression,
and
sedation;

SAFETY

SUITABILITY

Administration:
Inject
over 15 seconds.

For short-term
management of mild to
moderate post-op pain.

Contraindications:
Hypersensitivity
to
NSAIDS,
history
of
asthma and GI bleeding.

Administration: May be
taken with or without
food. Swallow whole, do
not break/chew/crush.
Contraindications:
Hypersensitivity,
paralytic ileus.

Prolonged relief
moderate to severe
post-op pain.

suppresses cough
acting
centrally
medulla

by
in

P-DRUGS
Ketorolac (KETERO)
1mg/kg IV every 6 hours for 2 days
FOLLOW-UP
1. OPD Follow-up:7 days after the patient was discharge, patient should have hER follow up check
up on the nearest health center or hospital.
2. Exercise
- Relaxation exercise
- Turning to sides every 2 hours if lying in bed for long hours
- do light activities such as walking, or sitting down
- Exercise social interaction with the family
3. Proper hygiene.
4. Diet: Proper diet such as eating nutritional foods that are rich in protein, fiber and Vit. C to
promote well-being. Increase oral fluid intake.

Rosheil Mae C. de los Santos, M.D

Silliman Medical Center
(035) 422-1333
Patient:
X,Y
Date:
07/23/2015
Address: Mabinay, Neg. Or. Age/Sex:
12y.o./Female

Ketorolac (KETERO)
30mg/ml vial
#12
Sig:
Administer 40mg IV every 6
hours for 2 days