Chapter 1

REVIEW OF THE THEORY

Medical Review
Understanding
Ovarian cysts are excessive or abnormal cell growth on the ovary that forms like bags of
tumors. Benign tumors can be epitecal, or come from particular gonat strauma. Clinically they
can give symptoms and signs are very similar so that diagnosis can only be made on the basis of
an examination of histopathology (Brunner and Suddarth, 2000).
Purified ovarian cysts are cysts of the ovaries containing multiple small filled with liquid,
yellow, dilute the serosa or at all stained by blood (medical dictionary Dorland, 812).

Etiology
Ovarian cysts are not known clearly and definitely, but it is estimated because there is the
possibility of a corpus luteum gravidatatis join raised. The corpus luteum is another potential
physiological organ nengalami cyst formation and bleeding, a mature follicle not released egg
thereby settled and grew up during the ovulatory stimulant cycle grows or purified from the
wpzoom develops simple cysts (normal), which influenced the process of antresia follicle, corpus
luteum which suffered a hematoma.

Physiological
The ovary is the well-formed gland a walnut located dikiri and right uterus under tuba
uterin and told on the back by the uterine broad ligaments. Each month a wpzoom develops
follicles and an ovum is released. The ovaries also called ovaries, in it there is a network of
tubules and the bulbus produce eggs (ova), the ovary is only found on the woman lying in the left
pelviks, right uterus. Networks that contain lots of blood capillaries and capillary nerve fibers. In
general the form of many small cysts found in the ovaries in follicles and corpus luteum. During
the process of ovulation follicle-purified which is ripe will release one egg. But on the formation
of cysts, on the process of ovulation the follicle can not eject the eggs so that the follicle enlarges
and becomes a cyst. In addition the corpus luteum is another potential physiological organ
experience the formation of cysts on the corpus luteum bleeding persistem rarely obtained in
 women who are not pregnant. If then were removed then the magnification one can due to
ovarian cyst formation in the center of a failed luteum shrink.

Pathophysiology

Ovulation

Hormone imbalance of estrogen and Follicle atresia

progesterone

The egg doesn't get out

The follicles could not release the egg

Ovum grows and wpzoom develops in the ovary

The corpus luteum hematom

Ovarian cysts
 On the process of ovulation occur esterogen and progesterone hormone imbalance so the
follicles can not release the ovum. In addition the follicle atersia occurs also causes the egg
doesn't get out in the ovaries. Egg cells grow and develop ovarian cyst causing. Ovarian cysts are
divided into two yairu cyst ovarian physiological and pathological occur an increase in intra
abdominal pressure can cause trauma to the tissue in some women cause disminore that cause
pain at the time of menstruation, because of ovarian cysts cause the ovulation process
terhambatnya so aminorea. In addition to ovarian cysts are pathological in the State before the
operation the cyst continues to evolve and grow can cause trauma to the tissues so that feels pain
and undergoing physical mobility disorders. Cysts that develop before the operation also allows
the occurrence of ruptured on the ovaries and cause intra abdominal bleeding so it is likely to
occur at high risk of infection because of the entry of microorganisms and the pain arises due to
lack knowledge of disease cyst then came ansietas. In the aftermath of operation i.e. after surgery
laparatormi happen perlukaan that causes tissue deformities which cause damage to the integrity
of the skin and allow the occurrence of infections due to high risk of deformities surgery process
the network can also cause pain that interfere with physical mobility.

Classification of cyst
Division of ovarian tumors
1 Non Neoplastic Tumor)
(1) the Tumor due to inflammation
(2) other: Tumor-cysts-Follicle
-The Corpus Luteum Cyst
-Lutein Cysts
Inclusion Cysts-germinal
-Endometrial Cysts
-Cysts stein – leventhal
2) Neoplastic Tumors
(1) benign Tumor
a. Kistoma ovarii Simplex
b. ovarii Kistadenoma serasum
c. dermoid cyst
d. Brenner Tumor
(2) a malignant Tumor of the ovary

Clinical Manifestations
As in ovarian tumors, malignant diseases can grow quietly and seldom causes symptoms
until after reaching a large size. When tumors develop abdominal distensi will occur. The
influence of heavy pressure on the bowel and bladder. Ovarian tumor growth can give symptoms
because of the magnitude, there are hormonal changes or penyulit happens. Ovarian benign
tumor of small diameter are often found by chance and does not provide a meaningful clinical
symptoms.

Most of the signs and symptoms are the result of:

1) Symptoms due to growth
(1) give rise to a sense of weight in the lower part of the abdomen
(2) Interfere or miksi defekasi
(3) the pressure of the tumor may cause constipation or edema in the lower limb
2) Symptoms due to hormonal changes
The ovary is the main source of female hormones, so when dealing with menstrual disorders
cause tumors, tumor cells granulase
3) Clinical Symptoms due to complications occur in tumors
(1) Bleeding into the Cyst (intra tumor)
When bleeding occurs in great numbers can cause sudden abdominal pain and require fast action.
(2) the Torn wall cyst
On the torque stalk cyst occurs there is likely a tear so that the contents of the cyst is spilling
over into the abdominal space.
(3) a malignant degeneration of ovarian cysts
Ovarian cysts are common malignancy
a. Cyst at the age before menarche
b. the cyst at the age above 48 years
(4) Sindrome Meigs
 The syndrome was discovered by meigs ovarian fibroma, there is mention of the acites and
hidrothorak with ovarian fibroma operation action then SUDS will disappear by itself.

Complementary Examinations
1) Laparascopy
Useful to know whether derived from mammals, and can also specify its nature.
2) Ultrasound
Allows visualization of the cyst can range in diameter of 1-6 cm. Is useful to allow the location
and its boundary and can also differentiate between fluid in the abdominal cavity which is free
and not free
3) Photo Rongent
Useful to determine the presence of hidrothoraks, further on a dermoid cyst can sometimes be
seen the presence of teeth on the cyst

Management
1) On ovarian cyst with complaints of abdominal pain do laparatomi
2) pvarium cysts are asymptomatic At a magnitude of more than 10 cm is done laparatomi
3) a small Cyst (< 5 cm) generally do not require operative action
4) 5-10 Cysts cm requires observation if persist or grow up to do laparatomi
5) If there is suspicion of malignancy laparatomi on, patients need to be referred to a more complete
hospital for evaluation and treatment.
Clinical Observation of patient 6)
7) measurements of the levels of hematorit and hemoglobin
8) prevention of serious complications arising from surgery

A review of Nursing Care

The study of
Anamnesa
1) Does the stomach feels heavy?
2) Whether the mother can CHAPTER and a smoothly?
3) is regular menstruasinya?
4) are there any abnormalities while menstruating?
 5) Whether ever bleeding outside of menstruation
6) Are on a lower limb swelling?
7) Are in the belly of the felt pain?
physical examination
1) Inspection
If there is bleeding from the vagina?
How much bleeding is removed from the vagina?
2) Palpation
Where lies the bumps cysts?
How the size of the cyst?
3) Auscultation
How noise gut and how many times?
If an extra sound in abdomen or uterus?

Nursing Care Plan

Ansietas associated with less knowledge about the disease and the prognosis
1) purpose:
The patient indicates the exact range of feelings and decreased anxiety or fear.

2) Criteria results:
(1) a feeling of fear or anxiety reduced
(2) the patient looked relaxed and reported ansietas reduced in level can be overcome.
(3) a patient may demonstrate the use of the mechanism of koping effective and active participation
in the therapeutic rules
3) implementation and rationale
(1) push the patient to express thoughts and feelings
R: provides an opportunity to examine the realistic fear as well as the concept of fault diagnosis.
(2) Provide an open environment where patients feel safe to discuss feelings or refused to talk.
R: helping patients to feel welcome on the existence of conditions without feeling judged and increase a
sense of control.
(3) Maintain contact with the patient are often
R: Give confidence in the patient that the patient does not own or give respect and acceptance is denied
individuals develop confidence.
(4) Provide accurate, consistent information about prognosis. Avoid debating about the patient's
perception of the situation.
R: can decrease ansietas and allows patients to make choices or decisions based on reality.
(5) Explain the procedure, give an honest answer to ask and
R: accurate information enables patients deal with situations more effectively with reality, because it
can reduce the ansietas and fear because of ignorance.
(6) Describe the recommended treatment, the goal, the potential side effects of assisting patients
prepare treatment.
R: the treatment could include surgery so expect patients actually ready to execute it

Less knowledge about the condition, prognosis and treatment needs associated with the interpellation of
information about diseases.
1 Goal)
(1) States the understanding of conditions
(2) identify the relationship of the sign or symptom related to surgical procedures and action to
accept it.
2) Interventions
(1) Give an explanation of all the problems related to disease
R: right information adds to the insights clients so that clients know about the State of her
(2) push the appropriate activity tolerance with periodic rest periods
R: Prevent frailty, improve healing and feeling healthy and make it easier to return to normal activities.
(3) the anticipated Problems during healing
R: factors of physical, emotional, social and cumulative influence can slow healing.
(4) identification of dietary needs
R: Facilitate healing or tissue regeneration
(5) the incision care phased when appropriate
R: Facilitating self care independently
 Post op
Pain associated with the breaking of the continuity of the secondary network against operating
action SOD.
1 Goal)
Pain decreases within 2 x 24 hours after done action
2) Criteria results
(1) the Pain can disappear or controlled
(2) the General State of the patient's good
(3) the patient seems calm
4) Intervensi
(1) review the pain, make a note of the location
R: useful in the surveillance of the effectiveness of the drug, the progress of healing
(2) Create a quiet and comfortable environment
R: a quiet and comfortable Environment to make patients feel safe and confident that he is treated well.
(3) Teach relaxation techniques of breath in
R: Reducing abdominal tension so that it can reduce pain
(4) Monitor EN
R: to know and to know the circumstances of the development of storage the patient early.

(5) the observation level pain

R: Will know the location and length of travel
(6) a collaboration with doctors in administering analgesics
R: relief of pain ease cooperation with other therapeutic interventions.

physical mobility Disorders associated with discomfort secondary presence wound surgery
1) purpose: patients can do activities within 2 x 24 hours
2) Criteria results:
(1) the patient saying no pain at wound surgery
(2) the patient does not seem to be grinning in pain
(3) the patient does not protect areas of pain
(4) reduced pain Scale
 3) Interventions:
(1) the observation TTV
R: can avoid fear and discomfort
(2) the evaluation of pain on a regular basis
R: provides information about the effectiveness of interventions
(3) do repositioning as directed e.g. semi fowler
R: reducing the pain and circulation
(4) Teach the use of relaxation techniques such as deep breathing exercises
R: Release emotional tension and muscle
(5) Collaboration in administering analgesics
R: lose pain and muscle spasme

Damages the integrity of the skin associated with mechanical interruption on the skin, skin surger
or appointment jaringa
1) goal: reaching the operating Wound Healing just in time
2) Criteria results:
(1) achievement of a wound healing
(2) prevent complications
(3) a network not arising

3) Interventions:
(1) check the wound regularly, make a note of the characteristics and the integrity of the skin
R: observing the existence of the failure process of wound healing
(2) Advise patients not to touch the injured area
R: prevents contamination of the wound

(3) carefully remove the bandage and adhesive when replacing the wrap
R: reduce the risk of trauma to the skin
(4) Collaboration in administering antibiotics
R: given prophylactic or to treat specific infections and improve healing.
 Resti infections associated with surgical tissue trauma, invasive procedures
1) purpose: infection does not occur during treatment in hospital
2) Criteria results:
(1) the patient's body temperature within normal limits (36 – 37 o C)
(2) there is no sign of infection
(3) there is no pus in wounds of patients
3) implementation and Rationale:
(1) the observation TTV
R: can identify infection occurs
(2) take the keperawatam in septic and antiseptic wound
R: prevents contamination of the wound
(3) inspection of the fluffy exudate or against abdominal bloating
R: State seepage can signify the hematoma, impaired penyatuaan stitches or wound desisiensi
(4) push the oral fluid input and high calorie protein diit, vitamin C and iron
R: speed up the healing process
(5) and clean the wound dressing bandage when wet
R: humid environments is the best medium for bacterial growth
(6) Increase breaks
R: rest lowers the metabolic processes, allowing the O2 and nutrients used for healing

(7) a collaboration with doctors in administering antibiotics

R: antibiotics prevent infection

The evaluation of the

1) Patients declared controlled ansietas
2) patient can understand his condition
3) Pain decreases within 2 x 24 hours after done action
4) patient can do activities without the help of others
5) with no signs of tissue damage
6) Patients showed no infection process
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