A COMPREHENSIVE CARE STUDY ON OVARIAN CYSTECTOMY

BY: NURSE ADEBAYO MARY O. (BABCOCK UNIVERSITY, ILISHAN REMO, OGUN STATE, NIGERIA).

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CHAPTER ONE: INTRODUCTION
1.0 . OVERVIEW
The normal ovary by nature is a partially cystic structure. Most ovarian cysts develop as
consequence of disordered ovulation in which the follicle fails to release the oocyte. The follicular
cells continue to secrete fluid and expand the follicle, which over time can become
cystic. Lawrence, S.A., (2015). Ovarian cysts are quite common and involve all age groups,
occurring in both symptomatic and non-symptomatic females. National Institutes of Health,
(2015).
1.1. BACKGROUND OF THE STUDY
This care study was written on Mrs. O.M, a 49 years old business woman, Parity of 5 but, 4 alive,
a known patient of the Obstetrics and gynecology (O&G) clinic been managed for ovarian cysts.
She presented at the O&G of Orile- Agege General hospital, Lagos, on the 1st of July, 2018,
around 11.37a.m. on account of lower abdominal pain which started last year (according to Her)
and recurrent. On examination, abdomen full, suprapubic mass palpated and slightly tender. A
repeated ultra -sonography sound scan was ordered and She was diagnosed of latent Right ovarian
cyst. Mrs O.M. was counselled and reassured and advised for cystectomy. She was admitted into
the maternity ward due to lack of space in the gynecology ward. Vital signs on admission were;
Temperature: 36.70C, Pulse :70b/m, Respiration: 24c/m and Blood pressure: 102/77mmHg. On
the 3rd of July, an informed consent and permission was taken from the patient before writing this
care study.
An ovarian cyst is a sac or pouch filled with liquid or semiliquid material that arises in an
ovary. Such cysts can be broadly classified as either functional or neoplastic. Neoplastic ovarian
cysts can be either benign or malignant. The American College of Obstetricians and
Gynecologists, (2017). Also, any ovarian follicle that is larger than about two centimeters is
termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange. Maria,
M., (2015).
In the United States, ovarian cysts are found in nearly all premenopausal women, and in up to
14.8% of postmenopausal women. Ovarian cysts affect women of all ages. Bionity, (2014). They
occur most often, however, during a woman's childbearing years. Some ovarian cysts cause
problems, such as bleeding and pain. Surgery may be required to remove cysts larger than 5
centimeters in diameter. Fulvio, T., Paola, A., Gianmaria, C., & Melchiorre, C., (2009).

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The development of ovarian cysts is a common condition in which one or more cysts form on the
ovary or ovaries of a woman's reproductive system. Ovarian cysts are generally not dangerous
and often go away by themselves within weeks to a few months while some may remain.
However, there are often no symptoms of ovarian cysts, but sometimes they can result
in abdominal pain, infertility and other health problems. During ovulation (the process during
which the egg ripens and is released from the ovary) the ovary produces a hormone to make the
follicles (sacs containing immature eggs and fluid) grow and the eggs within it mature. Once the
egg is ready, the follicle ruptures and the egg are released. Once the egg is released, the follicle
changes into a smaller sac called the corpus luteum. Ovarian cysts occur as a result of the follicle
not rupturing, the follicle not changing into its smaller size, or doing the rupturing itself. Valencia,
H., (2017).
Ovarian cysts can develop due to a woman's changing hormones that normally occur during the
monthly menstrual cycle. When a woman develops multiple ovarian cysts during each menstrual
cycle that do not go away, it is called polycystic ovarian syndrome or PCOS. The Center for
Menstrual Disorders, (2017). Ovarian cystectomy: Cystectomy is a surgical procedure during
which the ovarian cyst is removed either with laparoscopy, or an open surgery. Dr. Vadim, M.,
(2018).
By choosing this condition, I want to broaden my knowledge on the management of Ovarian
cysts, to also acquire more knowledge and skill in managing these conditions since ovarian
cyst has a high incidence among women of child bearing and rearing ages.

1.2. O BJECTIVES O F T HE ST UDY

 To identify the etiology and risk factors of ovarian cysts.

 To know the nursing history, personal data, health history and physical assessment of Mrs
O.M.
 To illustrate the anatomy and physiology and pathophysiology of the affected organ.
 To discuss and determine manifestation and complications of ovarian cyst.
 To develop an effective skill on how to manage care in patient with ovarian cyst.
 To provide the client a set of nursing care plans to assure for client’s total wellness during her
hospitalization up to the time of discharge.

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1.3 AETIOLOGY OF OVARIAN CYSTS
 Ovarian cysts often develop naturally in women who have monthly periods. They can also
affect women who have been through the menopause.
 Abnormal growth in the ovaries.
 Endometriosis
 Polycystic ovary syndrome (PCOS)
 As a result of risk factors such as;
- History of previous ovarian cysts
- Irregular menstrual cycles
- Increased upper body fat distribution
- Early menstruation (11 years or younger)
- Infertility
- Hypothyroidism or hormonal imbalance
- Tamoxifen therapy for breast cancer
National Health Scheme, (2016).
 TYPES OF OVARIAN CYSTS
There are various types of ovarian cysts, such as; Functional cysts, dermoid cysts, pathological
cysts and endometrioma cysts. However, functional cysts are the most common type. The three
types of functional cysts include Graafian follicle cyst, hemorrhagic cyst and corpus luteum cysts.
Bionity, (2014).
 Graafian Follicle cyst: During a woman’s menstrual cycle, an egg grows in a sac called
a follicle. This sac is located inside the ovaries. In most cases, this follicle or sac breaks
open and releases an egg. But if the follicle doesn’t break open, the fluid inside the follicle
can form a cyst on the ovary. Valencia, H., (2017).
 Hemorrhagic cyst: is also called a blood cyst, hematocele, and hematocyst. It occurs
when a very small blood vessel in the wall of the cyst breaks, and the blood enters the
cyst. Abdominal pain on one side of the body, often the right side, may be present. As the
blood collects within the ovary, clots form which can be seen on a sonogram. Occasionally
hemorrhagic cysts can rupture, with blood entering the abdominal cavity. No blood is seen
out of the vagina. If a cyst ruptures, it is usually very painful. Hemorrhagic cysts that
rupture is less common. Most hemorrhagic cysts are self-limiting; some need surgical

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 intervention. Even if a hemorrhagic cyst ruptures, in many cases it resolves without
surgery. Bionity, (2014).
 Corpus luteum cysts: Follicle sacs typically dissolve after releasing an egg. But if the
sac doesn’t dissolve and the opening of the follicle seals, additional fluid can develop
inside the sac, and this accumulation of fluid causes a corpus luteum cyst. Valencia, H.,
(2017).
 Dermoid cysts: sac-like growths on the ovaries that can contain hair, fat, and other tissue.
Valencia, H., (2017).
 Pathological cysts: Other cysts are pathological, such as those found in polycystic ovary
syndrome, or those associated with tumors. Bionity, (2014).
 Endometriomas: tissues that normally grow inside the uterus can develop outside the
uterus and attach to the ovaries, resulting in a cyst. Valencia, H., (2017).

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CHAPTER TWO: LITERATURE REVIEW

2.1 ANATOMY AND PHYSIOLOGY OF THE OVARIES

The ovaries are the female pelvic reproductive organs that house the ova and are also responsible
for the production of sex hormones.

GROSS STRUCTURE OF THE OVARIES

They are paired organs located on either side of the uterus within the broad ligament below
the uterine (fallopian) tubes. The ovary is within the ovarian fossa, a space that is bound by the
external iliac vessels, obliterated umbilical artery, and the ureter. The ovaries are responsible for
housing and releasing ova, or eggs, necessary for reproduction. At birth, a female has
approximately 1-2 million eggs, but only 300 of these eggs will ever become mature and be
released for the purpose of fertilization. The ovaries are small, oval-shaped, and grayish in color,
with an uneven surface. The actual size of an ovary depends on a woman’s age and hormonal
status; the ovaries, covered by a modified peritoneum, are approximately 3-5 cm in length during
childbearing years and become much smaller and then atrophic once menopause occurs. A cross-
section of the ovary reveals many cystic structures that vary in size. These structures represent
ovarian follicles at different stages of development and degeneration. Katz, Vern, L., &
Gretchen, M., (2010).

The Female Cycle

Each month, the ovaries go through a series of stages, depending on stimulation by the anterior
pituitary hormones the follicle stimulating hormone (FSH) and the luteinizing hormone (LH). A
typical female cycle lasts 28 days; however, this can range from 21-35 days.
The ovarian cycle has 2 distinct phases: the follicular phase (days 1-14) and the luteal phase (days
14-28). The follicular phase is characterized by follicle development and growth, the goal being
that one follicle matures and releases an egg at the time of ovulation, around day 14 of the female
cycle. The remaining immature follicles go through stages of degeneration up until day 28, when
the cycle repeats itself. The egg that is released is picked up by the fimbriae of the uterine tube,

6
and the egg is transported toward the uterus. If fertilization does not occur, the egg degenerates,
and menstruation occurs. Katz et al, (2010).

Ovarian Ligament

Several paired ligaments support the ovaries. The ovarian ligament connects the uterus and ovary.
The posterior portion of the broad ligament forms the mesovarium, which supports the ovary and
houses its arterial and venous supply. The suspensory ligament of the ovary (infundibular pelvic
ligament) attaches the ovary to the pelvic sidewall. This larger structure also contains the ovarian
artery and vein, as well as nerve supply to the ovary. Katz et al, (2010).
MICROSCOPIC STRUCTURE OF THE OVARIES

Cortex and Medulla

Histologically, the ovary has 2 main sections: the outer cortex and inner medulla. A germinal
layer coats the entire ovary, made of cuboidal epithelial cells.
The cortex is where the follicles and oocytes are found at various stages of development and
degeneration. The cortex is made of tightly packed connective tissue. The stroma of this cortical
connective tissue is composed of spindle-shaped fibroblasts that respond to hormonal stimulation
in a way different from that of other fibroblasts in the body. While, the medulla is where the
ovarian vasculature is found and is primarily loose stromal tissue. Katz et al, (2010).

Ovarian Follicles

The ovarian follicles are found within the stroma of the ovarian cortex. A follicle consists of an
oocyte surrounded by follicular cells called granulosa cells. Follicles go through stages of
development each month, with the goal of their maturation to release the oocyte for the purpose
of fertilization and reproduction. If the follicle fails to release the egg, it goes through
degeneration.

BLOOD SUPPLY, NERVE SUPPLY, AND LYMPH DRAINAGE

Blood supply to the ovary is via the ovarian artery; both the right and left arteries originate
directly from the descending aorta. The ovarian artery and vein enter and exit the ovary at the
hilum. The left ovarian vein drains into the left renal vein, and the right ovarian vein empties
directly into the inferior vena cava.

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Nerve supply to the ovaries runs with the vasculature via the suspensory ligament of the ovary,
entering the ovary at the hilum. Supply is through the ovarian, hypogastric, and aortic plexuses.
Lymph drainage of the ovary is primarily to the lateral aortic nodes; however, the iliac nodes
are also involved. Katz et al, (2010).

FUNCTIONS OF THE OVARIES

The ovaries have two main reproductive functions in the body which includes;
 Production of oocytes (eggs) for fertilization
 Production of reproductive hormones, estrogen and progesterone. Estrogen production
dominates in the first half of the menstrual cycle before ovulation, and progesterone
production dominates during the second half of the menstrual cycle when the corpus
luteum has formed. Both hormones are important in preparing the lining of the womb for
pregnancy and the implantation of a fertilized egg, or embryo. If conception occurs during
any one menstrual cycle, the corpus luteum does not lose its ability to function and
continues to secrete estrogen and progesterone, allowing the embryo to implant in the
lining of the womb and form a placenta. At this point, development of the fetus begins.
The function of the ovaries is controlled by gonadotrophin-releasing hormone released from
nerve cells in the hypothalamus which send their messages to the pituitary gland to
produce luteinizing hormone and follicle stimulating hormone. These are carried in the
bloodstream to control the menstrual cycle. YOU&YOUR
HORMONES, (2018)

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DIAGRAMMARTIC REPRESENTATION OF THE HUMAN OVARIES

Internal view of female reproductive organ, (2017)

Sh utterstock , (2018).

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LITERATURE REVIEW OF OVARIAN CYSTECTOMY

Cystectomy is a surgical procedure during which the ovarian cyst is removed either with
laparoscopy, or an open surgery. A laparoscopic cystectomy procedure is a minimally invasive
surgery during which a laparoscope, a long thin instrument with a camera attached at one end is
used. The procedure is usually done under general anesthesia and a small incision is usually made
below the navel. A laparoscope is inserted through this incision to see the inside of your pelvis
and abdomen. Carbon dioxide gas is introduced into the abdominal cavity to create more space
to work. Your surgeon identifies the cyst through the scope and removes the cyst. This technique
is usually used to remove small cysts.

A laparoscopic cystectomy removes only the cyst leaving the ovaries intact. However, if the cyst
is too large or connected to ovarian tissue, your surgeon removes all or part of the ovary.
Laparotomy is an open surgical exploration of the abdomen to examine the organs of the
abdomen. You will be administered general anesthesia and a single, large cut is made through the
abdominal wall. Then the abdominal muscles are separated to reach your ovary. In some cases,
the blood vessels supplying the ovary are clamped and tied off. Then the cyst is removed.
Alternatively, samples of tissues may be removed for further analysis. If the cyst is cancerous,
the doctor may need to take out the affected ovary. The abdominal muscles are sewed and the
incision is closed with stitches. Following ovarian cyst removal, complete recovery usually takes
about one to two weeks. Dr. Vadim, M., (2018).
Indications for Ovarian Cystectomy
Absolute indications for ovarian cystectomy include the following: definitive diagnostic
confirmation of an ovarian cyst, removal of symptomatic cysts, and exclusion of ovarian cancer.
Additional indications include cyst size larger than 7.6 cm, cysts that do not resolve after 2-3
months of close observation, bilateral lesions, and ultrasound imaging findings that deviate from
a simple functional cyst. Lawrence, S.A., (2015).

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2.2. PATHOPHYSIOLOGY OF OVARIAN CYSTS
Due to any of the risk factors of ovarian cystectomy such as; History of previous ovarian cysts,
endometriosis, early menstruation (11years or younger), etc. this causes hormonal imbalances
leading to failure of the Graafian follicles to ovulate or released and ruptured an egg resulting in
irregular menstruation, and infertility as it persists. The egg which failed to ovulate and rupture
grows and retains fluid and forms a cyst in any of the ovaries or both. As the growing ovaries
increase in size, abdominal girth increases resulting in increased pelvic pain, urinary frequency,
painful defecation, fatigue and feeling of heaviness in the pelvis. However, rupturing of the cyst
may result in hemorrhage, acute pain and sepsis.
2.3. CLINICAL MANIFESTATIONS

Often times, ovarian cysts do not cause any symptoms. However, symptoms can appear as the
cyst grows. Symptoms may include:

 abdominal bloating or swelling

 painful bowel movements

 pelvic pain before or during the menstrual cycle

 painful intercourse

 pain in the lower back or thighs

 breast tenderness

 nausea and vomiting

Severe symptoms of an ovarian cyst that require immediate medical attention include:

 severe or sharp pelvic pain

 fever

 faintness or dizziness

 rapid breathing

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 These symptoms can indicate a ruptured cyst or an ovarian torsion. Both complications can have
serious consequences if not treated early.

2.4. GENERAL INVESTIGATION

Normal Value
Diagnostic/ Laboratory
Indications or Purposes (Units used in the
Procedures
hospital)
1. Complete Blood Count; CBC is a screening test, used to diagnose and
manage numerous diseases. The results can
reflect problems with fluid or loss of blood.
Hemoglobin determines the RBC that carries
oxygen and carbon dioxide throughout the
body. Hgb: 120-140g/L
a. Hemoglobin Hemoglobin is a protein in red blood cells
that carries oxygen.
b. Hematocrit Hematocrit determines the concentration of Hct: 0.37-0.47
RBC within the blood volume

c. Leukocytes Leukocytes are used to measure the no. of WBC count:

WBC in the blood. They are the major 5-10x 109/L
infection-fighting cells in the body.
d. Neutrophils Neutrophils is the first WBC component that Neutrophils:
phagocytize invading microorganism. 0.45-0.65
e. Lymphocytes It determines if there are enough cells that Lymphocytes:
produce antibodies and other chemicals 0.20-0.35
responsible for destroying microorganisms.
2. Urinalysis: It is a routine
screening to determine urine diagnostic tool because it can help detect
complications and possible substances or cellular material in the urine
abnormal components (e.g. associated with different metabolic and
kidney disorders.

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glucose, blood, pus) or  Color Yellow-Clear
infection.

 Transparency Clear

 pH 4.6-6.5

 Specific Gravity
1.003-1.030

 Albumin Negative

 Sugar Negative
0.2HPF
 Red Cells
None
 Epithelial Cells

IMAGING STUDIES

Ultrasonography

Ultrasonography is the most favored imaging modality to assess ovarian cysts. Transabdominal
ultrasonography allows for a better overall view of the abdomen and pelvis in visualizing large
ovarian masses and their subsequent complications. It is best performed with a full bladder to use
as an acoustic window in order to better visualize structures. Transvaginal ultrasonography with
a higher-frequency probe allows better resolution of the ovary than a transabdominal lower-
frequency probe, on a sonogram, ovarian cysts have a thin rounded wall and a unilocular
appearance that is either hypoechoic or anechoic. The posterior acoustic enhancement (a
hyperechoic area) may be visible deep to the fluid-filled cyst. The corpus luteum has a varied
appearance ranging from a simple cyst to a complex cystic lesion with internal debris and thick
walls.
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Computed Topography scanning (CT)

CT scanning is more sensitive but less specific than ultrasonography in detecting ovarian cysts.
The addition of CT scanning in the workup of ovarian cysts offers very little additional
information and usually does not alter treatment plans.

CT scanning is best in imaging hemorrhagic ovarian cysts or hemoperitoneum due to cyst rupture.
It can also be used to distinguish other intra-abdominal causes of acute hemorrhage from cyst
rupture. However, CT scanning should be avoided in pregnancy, if possible, to prevent radiation
exposure to the fetus. MRI is a better option in these patients when ultrasonography cannot clearly
elucidate the adnexal mass.

Magnetic Resonance Imaging (MRI)

MRI in conjunction with ultrasonography may provide marginal improvements in specificity, but,
in most cases, the additional cost in not justified. MRI is reserved for cases in which
ultrasonography and CT scanning findings are indeterminate in identifying the mass as an ovarian
cyst safely in a pregnant patient.

Simple ovarian cysts show a low signal intensity with T1-weighted images and a high signal
intensity with T2-weighted images owing to the intra-cystic fluid.

Hemorrhagic cysts result in a high signal on T1-weighted images and intermediate to high signal
on T2-weighted images. Hemoperitoneum after cyst rupture appears bright on T2-weighted
images and slightly hyperintense on T1-weighted images.

2.5. MEDICAL SURGICAL NURSING MANAGEMENT

Nursing Management;

Pre-Operative Care

 On admission, welcome patient calmly to the ward and explain all routine procedures to
the patient
 Monitor vital signs including temperature, respiration, pulse and blood pressure
 Monitor weight gain pattern, notifying the physician if weight loss occurs
 Explain patient’s health condition, medical and surgical procedures to the patient.

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  Provide emotional support before, during and after diagnostic investigations and
procedures
 Teach patient to report any new signs and symptoms of pain and bleeding including those
she should report immediately
 Maintain patient on Nil per Oral.
 Administer all parenteral medication as prescribed.
 Check the patient’s history for hypersensitivity to the anesthetic.
 Make sure laboratory work is completed and results are reported before the surgical
procedure.
 Instruct the patient to empty her bladder just before the surgical procedure
 Encourage patient to lie on her left side to relieve pain at the right iliac fossa
 Check and record preoperative vital signs
 Supervise signing of the informed consent
 Prepare the patient for surgery.

INTRA OPERATIVE NURSING CARE

 Prepare and assist for anesthesia.

 Maintain homeostasis and asepsis.
 Assist the surgeon and the whole team
 Assist in transferring the patient to the Operating table in a supine position.
 Ask patient to remove any jewelry or other objects that may interfere with the procedure.
 Ask patient to remove clothing and be given a gown to wear.
 Check for patency of the IV system.
 Monitor client’s HR, BP and breathing and report abnormalities.
 The skin over the surgical cite will be cleansed with an antiseptic solution

Postoperative Care
 Maintain patient on parenteral fluids and medications until cough and gag reflex returns
and bowel sound is heard.
 Maintain patient on left-lateral position to prevent aspiration.

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  If patient is on blood transfusion, note for signs of pulmonary edema and other transfusion
reactions
 Provide analgesics has prescribed.
 Note surgical site for signs of hemorrhage and symptoms of infection and notify the
physician.
 Monitor strictly intake and output to prevent cardiac overload
 Ensure hourly monitoring of vital signs until patient becomes more stable.
 Instruct the patient to restrict activity for 2 to 7 days.
 Explain that abdominal and shoulder pain should disappear within 24 to 36 hours.
 Ensure close monitoring.
 Monitor the patient for adverse reactions to anesthetic. Daisy, J. A. , (2010).

MEDICAL MANAGEMENT
 About 95% of ovarian cysts are benign, meaning they are not cancerous.
 Treatment for cysts depends on the size of the cyst and symptoms. For small,
asymptomatic cysts, the wait and see approach with regular check-ups will most likely be
recommended.

 Pain caused by ovarian cysts may be treated with: pain relievers, including acetaminophen
(Paracetamol), nonsteroidal anti-inflammatory drugs such as ibuprofen, or narcotic pain
medicine (by prescription) may help reduce pelvic pain. NSAIDs usually work best when
taken at the first signs of the pain.
 A warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the
ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate
circulation and healing in the ovaries. Bags of ice covered with towels can be used
alternately as cold treatments to increase local circulation.
 Combined methods of hormonal contraception such as the combined oral contraceptive
pill -- the hormones in the pills may regulate the menstrual cycle, prevent the formation
of follicles that can turn into cysts, and possibly shrink an existing cyst. The American
College of Obstetricians and Gynecologists, (2017).
 Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.

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  Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal
women, may indicate more serious disease and should be investigated through
ultrasonography and laparoscopy, especially in cases where family members have had
ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be
taken before surgery to check for elevated CA-125, a tumor marker, which is often found
in increased levels in ovarian cancer, although it can also be elevated by other conditions
resulting in a large number of false positives.
 For more serious cases where cysts are large and persisting, doctors may suggest surgery.
Some surgeries can be performed to successfully remove the cyst(s) without hurting the
ovaries, while others may require removal of one or both ovaries.
SURGICAL MANAGEMENT
 Laparoscopic surgery: The surgeon fills a woman's abdomen with a gas and makes small
incisions through which a thin scope (laparoscope) can pass into the abdomen. The
surgeon identifies the cyst through the scope and may remove the cyst or take a sample
from it.
 Laparotomy/Cystectomy: This is a more invasive surgery in which an incision is made
through the abdominal wall in order to remove a cyst.

 Surgery for ovarian torsion: An ovarian cyst may twist and cause severe abdominal pain
as well as nausea and vomiting. This is an emergency, surgery is necessary to correct it.

2.6. NURSING THEORY/MODEL

The nursing theory adopted in this study is DOROTHEA E. OREM SELF-CARE DEFICIT
THEORY.
Orem’s theory defined Nursing as “The act of assisting others in the provision and
management of self-care to maintain and improve human functioning at all level of
effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the
practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health and well-being.
Orem's theory is comprised of three related parts:
 Theory of self-care
 Theory of self-care deficit

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  Theory of nursing system.
The theory of self-care: Includes self-care, which is the practice of activities that an individual
initiates and performs on his or her own behalf to maintain life, health, and well­being; self­care
agency, which is a human ability that is "the ability for engaging in self-care," conditioned by
age, developmental state, life experience, socio-cultural orientation, health, and available
resources; therapeutic self­care demand, which is the total self­care actions to be performed over
a specific duration to meet self-care requisites by using valid methods and related sets of
operations and actions, and self-care requisites, which include the categories of universal,
developmental, and health deviation self-care requisites.
Theory of self-care deficit: According to Orem, nursing is required when an adult is incapable
or limited in the provision of continuous effective self-care. The theory identifies five methods
of helping: acting for and doing for others; guiding others; supporting another; providing an
environment, promoting personal development in relation to meet future demands; and teaching
another.
Theory of Nursing System: The theory of nursing systems describes how the patient's self-care
needs will be met by the nurse, the patient, or by both. Orem identifies three classifications of
nursing system to meet the self-care requisites of the patient: wholly compensatory system,
partly compensatory system, and supportive educative system.
The Nursing system that is applicable to a patient undergoing surgery is the wholly compensatory
system. Patient is assisted by the Nurse in carrying out some of her immediate activities like;
perinea care, maintenance of personal hygiene before total recuperation.
Orem's approach to the nursing process provides a method to determine the self-care deficits and
then to define the roles of patient or nurse to meet the self-care demands. The steps in the approach
are thought of as the technical component of the nursing process. Orem emphasizes that the
technological component "must be coordinated with interpersonal and social pressures within
nursing situations.
The nursing process in this model has three parts. First is the assessment, which collects data to
determine the problem or concern that needs to be addressed. The next step is the diagnosis and
creation of a nursing care plan. The third and final step of the nursing process is implementation
and evaluation. The nurse sets the health care plan into motion to meet the goals set by the patient

18
and her health care team, and, when finished, evaluates the nursing care by interpreting the results
of the implementation of the plan. Nursing Theories, (2012).

2.7. COMPLICATIONS AND THEIR MANAGEMENT

Complications of ovarian cystectomies are generally related to bleeding and inadvertent cyst
rupture intraoperatively. Bleeding can usually be controlled with electrocautery. Ovarian
preservation is essential for patients desiring future fertility, so not destroying a large portion of
the ovary while achieving hemostasis is important. The addition of hemostatic agents such as
Surgicel fibrillar, Evisel, Surgiflo or Floseal and Gelfoam in some cases may be appropriate.
Baxter, I., & Deerfield, I. L, (2016).
The frequency of intraoperative cyst rupture at laparoscopic cystectomy ranges from 6-27% and
occurs more frequently than at laparotomy. Inadvertent spillage of the contents of an
endometrioma may result in subsequent spread of the condition to other parts of the pelvis.
Spillage of the contents of a cystic teratoma may result in peritoneal irritation, while the rupture
of a malignant cystic structure is more serious. It may result in tumor dissemination and adversely
affect the patients' survival. When spillage occurs, the pelvis should be copiously irrigated.
Smorgick, N., Barel, O., Halperin, R., Schneider, D. & Pansky, M., (2009).

2.8. PREVENTION and CONTROL OF OVARIAN CYST

For women who are not planning to become pregnant, prevention could be as simple as taking
birth control pills or other hormone medications that prevent follicles from forming. Medications
that make ovulation less frequent reduce a woman’s chances of developing ovarian cysts.
Some foods are also thought to contribute to ovarian cysts, specifically foods high in
carbohydrates or estrogen. Abstaining from alcohol and caffeine, reducing sugars and increasing
your intake of foods rich in vitamin A and carotenoids (e.g., carrots and salad greens) may help
reduce cyst-related pain. In addition, essential fatty acids found in fatty fish such as trout and
salmon may help promote hormonal balance, which may be beneficial in alleviating ovarian cysts.
Florida Hospital Research, (2018)

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CHAPTER THREE: INFORMATION ABOUT THE CLIENT

3.1 Client's Biodata

 Initials- Mrs. O.G.

 Sex- Female
 Age- 48years
 Occupation- Business
 Ethnicity- Yoruba
 Religion- Christianity
 Marital Status- Married
 No of Children – 5 (Youngest child= 18 years old)
 Sibling [No of brothers and sisters]- Three brothers and Five sisters
 Date of Admission- 1st July, 2018
 Provisional diagnosis- Ovarian tumor
 Date of Discharge-???
 Final Diagnosis- Right Ovarian cyst had ovarian cystectomy done.
 Obstetric and Gynecological History- Mrs. O.G.’s Last menstrual period was about
5years ago. Gravidity of 5, Parity of 4 alive.

3.2. NURSING HISTORY OF CLIENT USING GORDON MAJORITY ELEVEN

FUNCTIONAL HEALTH PATTERNS

 HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN: Patient doesn’t

have colds in the past. The most important thing of the patient is to keep healthy and to
have a proper diet and rest. She doesn’t use cigarettes and not an alcohol drinker. Patient
described her usual health before the admission to be good but now she considered it to
be fair. This is because of the lower abdominal pain caused by her growing ovarian cyst
and the fears of surgery.
 Nutritional / Metabolic Pattern- Patient eats all kind of food except Yam. She consumes
more than 6 glasses of water a day and ate thrice in a day.

20
 Elimination Pattern- Patient’s bowel elimination pattern 1-2 times daily, with no
discomforts in bowel eliminating. Her urinary elimination pattern frequency is 4 times a
day, with no discomforts and problem controlling urinating.
 Activity-Exercise Pattern- before hospitalization, patient wakes up early in the morning
to perform activities of daily living unassisted, but patient's children help with the cooking
and cleaning whenever she is tired. On hospitalization, patient is being assisted with
activities of daily living after she had ovarian cystectomy done. She was also encouraged
on active exercise on the bed.
 Sleep/Rest Pattern- before the hospitalization, the patient usually sleeps at night
around 9:30pm and wakes up early in the morning at 7am. During hospitalization, she
usually sleeps early at night around 8pm and wakes up at around 5am.
 COGNITIVE-PERCEPTUAL PATTERN- Patient doesn’t have any hearing difficulty.
She wears eyeglasses. No changes in memory. Her easiest ways to learn things is to have
focus on what she wants to do. She managed it by taking her medicines, her pain relievers
and take a nap for her to relieved the pain. She is a fluent speaker of Yoruba, English and
Edo Languages but a poor speaker of Hausa Language.
 Self- Perception/Self- Concept Pattern- She described herself as a happy mother and
happy Wife. Most of the time she feels not so good because of the cyst at her ovary.
 Role/Relationship Pattern- patient lived with her husband and described her support
system and family interaction as good. She communicates, cooperate, listen, follow
instructions easily and believed she will recovered quickly after the surgical intervention.
 Sexuality/ Reproduction- patient is sexually active, last menstrual period was about 5
years ago. She had no history of contraceptives [but withdrawal method and the use of
condoms was used as a family planning method], nil sexually transmitted disease.
Gravidity of 5, 4 alive.
 Coping/ Stress Tolerance Pattern- She copes with stress by praying and singing praises.
 Value/ Belief Pattern- She beliefs in God.

21
3.3. PHYSICAL EXAMINATION

Physical Measurement-

Urinalysis- the color of the urine was pale yellow, odor was aromatic, specific gravity
was1.010, deposit was absent and nil abnormalities was seen.

General Inspection: [Head to Toe]-

 General- seen patient conscious, alert and oriented to person, place and time.
However, was weak and lying on her bedside.
 Vital signs- on admission were; Temperature 36.7 0 C, Pulse 70 b/m, Respiration
24c/m, and Blood Pressure 102/77mmhg. Patient's Height was 1.66m and weight
60kg.
 Nutrition- no history of weight loss.
 Mental Status- patient was anxious due to unknown outcome of the surgery, she
perceived the hospitalization to be a bundle of joy and believed that she would
recover quickly after the scheduled surgical intervention.
 Skin- patient is light in skin color, no wrinkle and warm to touch. Nil abrasions,
lesions and patient's nail bed appeared pink in color.
 Head- patient's hair is black in color, widely distributed on her head, nil abrasion,
laceration and swelling on the scalp.
 Eyes- no swelling on patient's eyelids, nil yellowish of the conjunctiva and nil
discharges. She wears eye glasses.
 Ears- auricle are symmetrical and has the same color with her facial skin, nil
swelling and nil bleeding. The patient was able to hear whispering sound in both
ears.
 Nose and Sinuses- patient's nose is well anatomically placed, no septum defect
and nil bleeding/discharges or flaring.
 Mouth and pharynx- patient's lip appears moist with smooth texture, nil bruises
and discoloration of the gum and teeth, buccal mucosa appears pink and moist,
tongue is centrally positioned and moist, uvula is positioned in the midline of the
soft palate and moves with mouth opening.

22
 Neck- no palpable lymph nodes and thyroid gland, no distended jugular vein and
absent of masses.
 Peripheral Vascular- patient's peripheral pulses present, not feeble, nil edema
and nodes in the lower limbs.
 Thorax and Lungs- patient's chest wall is intact with no tenderness and masses,
chest moves with respiration, chest clear, nil rhonchi and wheezing sound heard.
 Heart- no visible pulsations on the aortic and pulmonic areas. Lub -dub sound
was heard on auscultation and nil murmurs.
 Breast and Axillae- patient's breast is round and full, with nil retracted nipples,
has uniform color with the chest wall, nil lumps were palpated and nil palpable
lymph nodes.
 Abdomen- pain, 8 in pain scale where 1 is the lowest and 10 is the highest skin
color is consistent with body’s color
 Inguinal Area- nil enlargement and absent inguinal hernia.
 Perineum- pubic hair was shaved, nil laceration or abrasion seen, external
genitalia was normal, vagina warm and moist.
 Spine and Extremities [musculoskeletal]- spine is vertically aligned, nil bone
deformities, swelling and tenderness.
 Spine and Extremities [neurological]- patient's gait is balance. Also, good patella
reflex on the lower limb.

23
3.4. INVESTIGATIONS CARRIED OUT ON MRS.O.M.

The following are the Laboratory investigations of Mrs. O.M.;

DATE Test Name Normal Readings Patient SIGNIICANCE

OF RESULT,
HIGH, LOW,
NORMAL

01/07/18 Color Yellow Pale yellow Normal

,, Reaction(pH) 6.0 7 Normal

,, Sp. Gravity 1.030 g/ml 1.010g/ml Normal

,, Albumin Negative Negative Normal

,, Sugar Negative Negative Normal

02/07/18 Full Blood count

(FBC)
 Packed cell Female- 30- 45% 31.0% Low
volume
[PCV] 2.5- 10x10 Normal
 White cell 5800
count [WBC] 54- 62% Normal
 Neutrophils 25- 40% 56.0% Normal

 Lymphocytes 1- 6% 33.6% Normal

 Monocytes 1- 8% 5% Normal

 Eosinophils 0.1% 5.3% Normal

Female- 0.1% Normal
 Basophils
0- 15mm/hr
 Electrolyte
sedimentation
10mm/hr
rate [ESR]

24
02/07/18 Electrolyte, Urea &
Creatinine [E/U/Cr] Normal
 Sodium [Na] 130-146mmol/L 131mmol/L Normal
 Potassium 3.0- 5.0mmol/L Normal
[K] 3.8mmol/L
 Bicarbonate 18- 28mEq/L 21mEq/L
[HCO3] Normal
 Chloride [Cl] 97mmol/L
 Urea 95- 110mmol/L Normal
 Creatinine 47mg/dl
10- 50mg/dl Normal
[Cr] 0.81mg/dl
0.5- 1.5mg/dl
 Fasting blood
90mg/dl
sugar [FBS] Normal
50- 105mg/dl

01/07/18 Obstetric Scan A normal ovary is ovarian Abnormal

2.5-5 cm long, 1.5- cysts
3 cm wide, and measure
0.6-1.5 cm thick. 2.5-15 cm
In the follicular in diameter,
phase, several with thin
follicles are rounded
usually visible wall. Right
within the ovarian ovary
tissue. visible and
deep to the
fluid-filled
cyst.

04/07/18 Packed cell volume Female- 30- 45% 33% after 2

[Post-operative PCV] pints was
transfused.

25
3.5. DRUGS, DIET, SPECIAL PROCEDURES

S/N DRUGS ACTION NURSINGIMPLICATIONS ADVERSE

EFFECTS
1. Injection. It reduces fever by  Give right drug, right  Rash
Paracetamol acting directly on the dose, right route to the  Chills
1g b.d x3/7 hypothalamic heat right patient.  Anorexia
regulatory center to  Do not give patient  Vomiting
cause vasodilation with allergy to  Dizziness
and sweating which acetaminophen.  Chest pain
help dissipate heat  Do not exceed the  Diarrhea
recommended dose  Hapatic
 Discontinue drug if Toxicity
hypersensitivity
reactions occur.
 Give drug with food.
2. Intravenous It is a bactericidal  Monitor for signs  Headache
Cefuroxime agent that acts by /symptoms of  weakness
1g 12 hourly inhibiting bacterial hemolytic anemia  Dry mouth
cell wall synthesis,  Check vital signs  Constipation
both gram positive before drug  Fatigue
and gram negative administration  Vomittting
aerobic and  Do not administer  Rash
anaerobic bacteria. drug with
hypersensitivity to the
drug
 Monitor vital signs
after drug
administration

26
  Discontinue drugs if
hypersensitivity
reaction occurs.
3. Intravenous It inhibits nucleic  Discontinue therapy  Rash
Metronidaz acid synthesis by immediately if  fever
ole 500mg 8 disrupting the DNA symptoms of CNS  headache
hourly of microbial cells. it toxicity develop  Ataxia
also interacts with  Monitor vital signs  Abdominal
DNA leading to before and after cramps
inhibition of DNA administration  Fatigue
synthesis and DNA  Ensure patient do not  bitter taste
degeneration leading drink alcohol during  Constipation
to death of the the therapy  Dysuria
bacteria.
 Decreased
libido
4. I.M. It binds to opioid  Assess patient degree  Weakness
Tramadol receptors and of pain and swelling  Dizziness
100mg b.d inhibits the reuptake  Assess type, location  Headache
serotonin and and intensity of pain  Confusion
norepinephrine in the before and 2 to 3  Dry mouth
CNS hours after  Pruritus
administration  Hypertonia
 Assess blood pressure  Skin Rash
and respiratory rate  Nausea
before and  Vomiting
periodically during
administration.
 Assess bowel
function routinely

27
  Assess patient for
allergy to opioids.
 Instruct patient not to
take more than
prescribed dosage
 Advise patient to
notify health care
worker immediately if
signs and symptoms
of gastrointestinal
toxicity [abdominal
pain] occurs
5. Injection It is responsible for  Discontinue use with  Dizziness
Diclofenac anti-inflammatory, onset of ringing or  headache
75mg 12 antipyretic and buzzing in the ears,  Drowsiness
hourly analgesic action. It impaired hearing,  Rash
inhibits dizziness, GI  pruritus
prostaglandin discomfort, or  Dyspepsia
synthesis by bleeding and notify
 nausea
inhibition of physician.
 abdominal
cyclooxygenase  Monitor vital signs pain
[COX]. It also  Monitor for signs of
 cramps
exhibits Gastrointestinal
 constipation
bacteriostatic irritation and
 diarrhea
activity by inhibiting ulceration.
 Hyperglycemi
bacterial DNA  Avoid alcohol or
a
synthesis. other CNS
 Tinnitus
depressants.
 Observe and report
signs of bleeding

28
 (e.g., petechiae,
ecchymoses, bleeding
gums, bloody or black
stools, cloudy or
bloody urine).
 Monitor BP for
hypertension and
blood sugar for
hyperglycemia.

29
6. Tab. Cefuroxime works  Each dose should be  Diarrhoea.
Cefuroxime by interfering with taken with food.  Nausea.
[Zinnat] the ability of bacteria  Zinnat tablets should  Abdominal
500mg daily to form cell walls. be swallowed whole pain.
The cell walls of with liquid and not  Headache
bacteria are vital for chewed, broken or  Dizziness.
their survival. They crushed.
keep unwanted  Bottles of suspension
substances from should be shaken
entering their cells before measuring out
and stop the contents a dose. Only use the
of their cells from measuring spoon
leaking out. provided with the
Cefuroxime impairs suspension. You
the bonds that hold should not use a
the bacterial cell wall regular teaspoon or
together. This allows tablespoon to take the
holes to appear in the medicine, as this will
cell walls and kills not give an accurate
the bacteria. dose.
 Discontinue drug if
hypersensitivity
reaction occurs.
7. Tab. Water-soluble  Give oral solutions  Nausea
Vitamin C vitamin essential for mixed with food.  vomiting
synthesis and  Dissolve effervescent  heartburn
maintenance of tablet in a glass of  diarrhea
collagen and water immediately  abdominal
intercellular ground before ingestion cramps
substance of body
tissue cells, blood

30
 vessels, cartilage,  Discontinue drug if  Acute
bones, teeth, skin, any hypersensitivity hemolytic
and tendons. reaction occurs. anemia
 insomnia
 Urethritis
 dysuria
8. 0.9% Normal saline  0.9% sodium chloride  hypernatrem
normal replaces water and should not be use in ia
Saline electrolytes patients with
500ml congestive heart
failure as circulatory
overload can be
easily induced.
9. Intravenous It provides source of  Monitor vital signs  infection at
infusion 5% water, carbohydrates  Assess for signs of the injection
Dextrose and electrolytes. cardiac overload site
Saline  Assess injection site  Phlebitis
500ml for redness and febrile  Venous
response thrombosis
 Maintain optimum  Extravasatio
sterility when n
infusing the patient.  Hypervolem
ia

Karch, A.M., (2010).

31
Procedure Action Nursing Implication Adverse Effect
Laparotomy/Ovarian It is a minimally  Witness informed consent  Pain
Cystectomy invasive surgery  Educate patient on the  Swelling
used in removing present conditions and  Scar
ovarian cysts. clarify all misconceptions formation
 Ensure all pre-operative  Itching
investigations results are
retrieved
 Give prescribed drugs before
the surgery
 Allay patient's fear and
anxiety
 Place patient in the
appropriate position.
 Monitor vital signs before,
during and after the surgery.
 Administer prescribed anti-
coagulant, analgesics and
antibiotics agents.

3.6. DAY TO DAY CARE OF THE CLIENT

DAY 1- 01/07/2018 [Admission day]

Mrs. O.M, a 49 years old business woman, Parity of 5 but, 4 alive, a known patient of the
Obstetrics and gynecology (O&G) clinic been managed for ovarian cysts. She presented at the
O&G of Orile- Agege General hospital, Lagos, on the 1st of July, 2018, around 11.37a.m. on
account of lower abdominal pain which started last year (according to Her) and recurrent. On
examination, abdomen full, suprapubic mass palpated and slightly tender. A repeated ultra -
sonography sound scan was ordered and She was diagnosed of latent Right ovarian cyst. Mrs
O.M. was counselled and reassured and advised for cystectomy. She was admitted into the

32
maternity ward due to lack of space in the gynecology ward. Vital signs on admission were;
Temperature: 36.70C, Pulse :70b/m, Respiration: 24c/m and Blood pressure: 102/77mmHg. She
was placed on the following admission orders;

 Tabs. Co- amoxiclav 625mg twice daily for 1 week

 Tabs. Diclofenac 100mg (after food) twice daily for 1 week

DAY 2- 02/07/18

Mrs. F.B. had assisted bed bath done with tepid water, she did oral toileting herself and her bed
linen was removed and replaced with a clean linen. Vital signs at 6am were; temperature- 36.10C,
pulse- 80b/m, respiration- 20c/m, and blood pressure- 120/82mmhg. At 8am, she was reviewed
with her obstetric scan result by Dr. Bankole and Dr. Omoniloro, which revealed right ovarian
cyst and was scheduled was cystectomy the next day. Her husband was informed and blood
sample was collected for Packed cell volume. Patient fear and anxiety was allayed and she was
closely monitored.

Investigations result was retrieved, informed consent was supervised and patient was prepared
physically and psychologically for surgery.

DAY 3- 03/07/18 (OPERATION DAY)

Patient was met in a fair condition with vital signs of; temperature- 36.50C, pulse- 70b/m,
respiration- 22c/m, and blood pressure- 110/80mmhg. Pubic hair was shaved, urethra catheter
was passed, she was gowned in theater attire and. All jewelries were removed and handed over
to her husband. At 11.42a.m. patient was moved to the theatre with 2 pints of blood in a fair but
calm condition. She was received warmly into the theater and was made comfortable on the
theater table. Epidural Anesthesia was administered by Dr. Akinsuyi, vital signs was checked and
documented. Surgery commenced at 2:00pm and the surgery was performed by Dr. Omoniloro.
The abdomen was cleaned with savlon and methylated spirit. Total estimated urine output during
was 600ml, patient received in total 2 pints of blood (1 before the surgery and the other during
the surgery), intravenous 0.9% normal saline 1500ml was given, and estimated blood loss was
350ml. The surgery was finished at 2:24 pm.

33
She was received into the recovery room by matron Adesunya with; temp- 36.30C, resp- 24c/m,
pulse- 110b/m and Bp- 128/70mmHg. Intravenous 0.9% normal saline 500ml was put up,
dripping minimally on one hand while the remaining blood on the other hand and urethra catheter
in-situ draining clear urine. Operation site dressed and neatly covered with no signs of
hemorrhage. Post-Operative orders include; Intravenous 5% dextrose saline 500ml 4hrly,
intramuscular tramadol 100mg 12hourly, intravenous paracetamol 1g 6hrly, intravenous
Cefuroxime 1g 12hrly, intravenous metronidazole 500mg 8hrly was administered respectively.
She was closely monitored, strict intake and output ensured and specimen was sent for
histopathology.

DAY 4- 04/07/18 [ 1ST DAY POST-OP]

Patient had assisted bed bath, oral toileting and dressing done, her bed linen was changed. Surgical
site neat and clean with no sign of hemorrhage. Vital signs at 6am were- temperature- 36.30C,
pulse- 82b/m, respiration- 24c/m, blood pressure- 110/70mmhg. Intravenous antibiotics and
analgesics was administered respectively. Patient still on Nil per oral.

Vital signs checked at 10am were- temperature- 36.1, pulse- 88b/m, respiration- 18c/m and blood
pressure- 120/80mmhg. All other due nursing care was rendered.

DAY 5- 05/07/18

Mrs. O.M. had assisted bed bath and oral toileting done, her bed linen was removed and replaced.
The incision area was examined, cleaned and dressed. Vital signs were done and documented,
due analgesics and antibiotics was administered and she was closely monitored. Patient was
anxious about when she will eat, she was educated about her condition and was reviewed by the
managing physician, who checked her bowel sound. Bowel sound was active, she commenced
graded oral sips [water of about 2 to 5ml]. She was also allowed to asked questions and all
misconceptions was clarified. All other nursing care was rendered.

DAY 6- 06/07/18

Mrs. O.M. had assisted bed bath and oral toileting done. The incision area was examined
thoroughly to check if there is any swelling. Vital signs were done and documented. She had pap
as breakfast and was encouraged to ambulate and do range of motion exercises. All drugs

34
administered and she had breakfast, lunch and dinner respectively. Urethra catheter was
discontinued.

DAY 7- 07/07/18

Mrs. O.M. had assisted bed bath done with tepid water, she did oral toileting herself, bed linen
was removed and replaced with a clean linen. Vital signs at 6am were; temperature- 36.20C, pulse-
88b/m, respiration- 20c/m and blood pressure- 114/70mmhg. At 10am, she ate by herself and had
tab. Cefuroxime 500mg, tab. Paracetamol 1g and tab. Vitamin C 200mg administered and all due
nursing care was rendered.

DAY 8- 08/07/18

Mrs. O.M. had assisted bed bath done with tepid water, she did oral toileting herself, bed linen
was removed and replaced with a clean linen. Vital signs at 6am were; temperature- 36.20C, pulse-
94b/m, respiration- 18c/m and blood pressure- 105/80mmhg. Due oral medications were
administered. Incision site was cleaned and dressed.

DAY 11-11/07/18

Mrs. O.M. had her bath with tepid water, she did oral toileting herself, bed linen was removed
and replaced with a clean linen. Vital signs checked and documented per chart, she had all due
oral drugs administered.

DAY 12- 12/07/2018

Patient had bath with tepid water, she did oral toileting herself, bed linen was removed and
replaced with a clean linen. vital signs checked and documented, patient had breakfast served and
all due drugs was administered. At 10am, she was discharged home by the managing physician
on the following oral -

 tab. Cefuroxime 500mg b.d

 tab. Vitamin C 100mg t.d.s
 tab. Flagyl 400mg b.d
 tab. Paracetamol 1g tds for 3days

35
 Patient was given outpatient appointment on the 27th of July, 2018. She was duly counseled on
the importance of follow-up, sleep and rest, maintenance of personal hygiene and breastfeeding.

3.7. NURSING CARE PLAN: IDENTIFIED NURSING DIAGNOSIS

PRE-OPERATIVE CARE PLAN
S/N NURSING OBJECTIVE NURSING SCIENTIFIC EVALUATION
DIAGNOSIS INTERVENTION RATIONALE
1. Chronic pain Within 4­5 hrs.  Assess pain  Assessment After 4­5 hours
related to of nursing characteristics: of the pain of nursing
increase pressure interventions Severity (to 10, experience is interventions
to ovary patient will with 10 being the the first step patient
secondary to verbalize most severe) in planning verbalized
ovarian cyst reduction of  Eliminate pain reduction of
pain. additional management pain.
Source: stressors or strategies
Microsoft sources of  The pt.’s
Student with discomforts experiences
Encarta whenever of pain may
Premium 2009 possible. become
DVD  Provide rest exaggerated
periods to as the result
facilitate comfort, of fatigue.
sleep, and  Rest brings
relaxation about a
 Administer relieve of
analgesics as pain.
indicated  Analgesic
(Ibuprofen). Give agent helps to
doses to provide block pain
pathway and

36
 analgesia around relieve of
the clock. pain.

2. Disturbed sleep Within 3­4 hrs.  Assess past  Sleep patterns

pattern related to of nursing patterns of sleep are unique to
fear for the out interventions in environment. each
coming surgical patient will  Recommend an individual.
procedure. verbalize environment  Many people
Source: improvement conducive to sleep better in
Nursing Care in sleeping sleep or rest cool, dark,
Plan pattern  Provide nursing quite
6th edition aids (backrub, environments
Gulanick/Myers comfortable  These aids
Page 68 position, promote rest.
relaxation  Reduces
techniques. sensory
 Provide soft stimulation by
music or white blocking out
noise other
 Organize nursing environmental
care: sounds that
 Teach about the could
possible causes interfere with
of sleep restful sleep
difficulties and  This allows
optimal ways to patients to
treat them participate in
 Teach on non­ their care.
pharmacological  This
sleep technique can

37
 enhancement be used
techniques throughout a
lifetime. Phar.
Should be
used for a
limited time

POST-OPERATIVE CARE PLAN

S/N NURSING OBJECTIVE NURSING SCIENTIFIC EVALUATION
DIAGNOSIS INTERVENTION RATIONALE
1. Acute pain Within 1­2hrs.  Assess pain  Assessment of After 1 hour of
related to of nursing characteristics: the pain nursing
surgical interventions Severity (to 10, experience is the interventions
procedure. patient will with 10 being first step in patient
verbalize the most severe) planning pain verbalized
reduction of  Eliminate management reduction of
pain. additional strategies pain.
stressors or  The pt.’s
sources of experiences of
discomforts pain may become
whenever exaggerated as
possible. the result of
 Provide rest fatigue.
periods to  Rest brings about
facilitate a relieve of pain.
comfort, sleep,  Analgesic agent
and relaxation helps to block
 Administer pain pathway and
analgesics as relieve of pain.
indicated

38
 (Ibuprofen).
Give doses to
provide
analgesia around
the clock.

2. Risk for Within 1-2hrs.  Monitor Vital  Indicators of After 1hour of

adequacy of
ineffective tissue of nursing signs, palpate nursing
systemic
perfusion related interventions peripheral perfusion, fluid/ intervention,
blood needs, and
to tissue trauma patient’s tissue pulses note patient’s tissue
developing
and surgical will be capillary refill, complications. was perfused.
procedure. adequately assess urinary
 Proximity of
perfused. output, / large blood
vessels to
characteristics,
operative site
evaluate and/ or potential
for alteration of
changes in
clotting
mentation mechanism (e.g.
cancer) increase
 Inspect
risk of
dressings and postoperative
hemorrhage.
perineal pads,
noting color,  Prevents stasis
of secretion and
amount, and
respiratory
odor of complication.
drainage. Weigh
 Creative vascular
pads and stasis by
compare with increasing pelvic
congestion and
dry weight if pooling of blood
client is in the
extremities,
bleeding potentiating risk
heavily. of thrombus
formation.

39
 Turn client and  Movement
enhance
encourage
circulation and
frequent prevents stasis
complications.
coughing and
deep breathing  may be indicative
of development
exercises.
of
 Avoid high thrombophlebitis/
pulmonary
Fowlers position
embolus
and pressure
 Replacement of
under the knees
blood losses
or crossing of maintains
circulating
legs.
volume and
 Assist with/ tissue perfusion.
instruct in foot
and legs
exercises and
ambulate as
soon as able.
 Note erythema,
swelling of
extremity, or
reports of
sudden chest
pain with
dyspnea
 Administer IVF,
blood products
PRN

40
3.8. HEALTH EDUCATION OF MRS. O.M. ON DISCHARGE

 Exercise- patient was educate on practicing minimal weight bearing exercise

 Breastfeeding
 Personal hygiene
 Importance on follow-up care- this is to know if Mrs. O.M. is improving
 Cleaning and dressing of the incision area at the outpatient department
 Importance of compliance with medications
 Mrs. O.M. was also educated to report any signs of discomfort immediately

41
CHAPTER FOUR:
4.1. SUMMARY OF CLIENT CARE

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. The ovaries are
two organs each about the size and shape of an almond located on each side of the uterus. Eggs
(ova) develop and mature in the ovaries and are released in monthly cycles in childbearing years.
Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little
or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment
within a few months.

However, ovarian cysts especially those that have ruptured sometimes produce serious symptoms.
The best way to protect your health is to know the symptoms and types of ovarian cysts that may
signal a more significant problem, and to schedule regular pelvic examinations.

Clinical symptoms alone can’t diagnose if an individual has an ovarian cyst and in some cases no
symptoms at all. Or if there is, the symptoms may be similar to those of other conditions, such as
endometriosis, pelvic inflammatory disease, ectopic pregnancy or ovarian cancer. Even
appendicitis and diverticulitis can produce signs and symptoms that mimic a ruptured ovarian
cyst.

Still, it’s important to be watchful of any symptoms or changes in the body and to know which
symptoms are serious. Signs and symptoms of ovarian cyst includes;

 Menstrual irregularities
 Pelvic pain: a constant or intermittent dull ache that may radiate to your lower back and
thighs
 Pelvic pain shortly before your period begins or just before it ends
 Pelvic pain during intercourse (dyspareunia)
 Pain during bowel movements or pressure on your bowels
 Nausea, vomiting or breast tenderness similar to that experienced during pregnancy
 Fullness or heaviness in your abdomen
 Pressure on your rectum or bladder: difficulty emptying your bladder completely

The signs and symptoms that signal the need for immediate medical attention include:

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 Sudden, severe abdominal or pelvic pain
 Pain accompanied by fever or vomiting

The ovaries normally grow cyst-like structures called follicles each month. Follicles produce the
hormones estrogen and progesterone and release an egg when you ovulate.

Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known
as a functional cyst. This means it started during the normal function of your menstrual cycle.

Treatment depends on patient’s age, the type and size of cyst, and presenting symptoms. The
physicians may suggest:

 Watchful waiting. Patient can wait and be re-examined in one to three months if in
reproductive years, patient may have no symptoms and an ultrasound shows patient has a
simple, fluid-filled cyst. The doctor will likely recommend that patient gets follow-up pelvic
ultrasounds at periodic intervals to see if the cyst has changed in size.

Watchful waiting, including regular monitoring with ultrasound, is also a common treatment
option recommended for postmenopausal women if a cyst is filled with fluid and is less than
2 centimeters in diameter.

 Birth control pills. The doctor may recommend birth control pills to reduce the chance of
new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit
of significantly reducing the risk of ovarian cancer. The risk decreases the duration of the
birth control pills.
 Surgery. The doctor may suggest removal of a cyst if it is large, doesn’t look like a
functional cyst, is growing or persists through two or three menstrual cycles. Cysts that cause
pain or other symptoms may be removed.

Some cysts can be removed without removing the ovary in a procedure known as a
cystectomy. The doctor may also suggest removing the affected ovary and leaving the other
intact in a procedure known as oophorectomy. Both procedures may allow the patient to
maintain fertility if still in her childbearing years. Leaving at least one ovary intact also has
the benefit of maintaining a source of estrogen production.

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 If a cystic mass is cancerous, however, the doctor will advise a hysterectomy to remove both
ovaries and uterus. After menopause, the risk of a newly found cystic ovarian mass being
cancerous increases. As a result, doctors more commonly recommend surgery when a cystic
mass develops on the ovaries after menopause.

4.2. CONCLUSION

Ovarian cysts are actually quite common. Women usually don't realize they have them because
they grow undetected and go away undetected a month or so later. Rarely, however, these growths
become problematic. For this reason, women must understand how to recognize ovarian cyst
signs. Symptoms usually aren't pleasant, but if they indicate a real health problem, early detection
is important.
Ovarian cyst signs, symptoms, and clues often begin with pain. Pain sometimes comes as sharp
pelvic or abdominal pain. Sometimes women notice a dull ache in their legs or upper thighs. Also,
they might notice breast tenderness, more painful than during a regular menstrual cycle.
Sometimes pain only occurs during certain times, or when performing certain actions. For
example, a woman may feel completely normal until her period when she experiences abnormal
pelvic pain. Also, women usually indicate pain during sex as common ovarian cyst signs or
symptoms.
When women feel something strange or abnormal around their pelvic region, they might easily
come to the conclusion that something is wrong with their reproductive organs. Other symptoms
of ovarian cysts, however, aren't as easy to diagnose. Some women experience vomiting and
nausea and have trouble urinating. Coupling these signs with other common symptoms helps
women and doctors indicate the real source of the problem.
Again, while most ovarian cysts aren't anything to worry yourself about, some represent a serious
health problem. Some cyst symptoms indicate a medical emergency and women should seek
medical care immediately. These include dizziness and sudden strong abdominal pain. Also, if a
woman experiences all three signs of a fever, vomiting, and pelvic pain, she should see a doctor.
Since most ovarian cysts go away on their own, doctors usually recommend coming back for a
reevaluation after about two months for a re-check. If the cyst hasn't shrunk in size, or if it's
grown, they will perform a laparoscopy to remove it. Then, some doctors prescribe birth control
pills to prevent the woman from ovulating and developing more cysts in the future.

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Although the pain associated with some ovarian cysts is extremely strong, in most cases, it is
nothing to worry about. As long as the woman keeps a close eye on her body and pays attention
to any changing symptoms, ovarian cysts usually lead to nothing serious.

4.3. RECOMMENDATIONS

 Government and non-government organization should create awareness on the

importance of routine monthly checkups.
 Nurses should health educate women on importance of personal hygiene especially
perineal cleanliness.
 Nurses should educate pregnant women about the causes of ovarian cysts.
 Government should support the financial aspect of patients requiring surgeries and
provide more bed spaces in the hospital wards.
 Nurses should gain more knowledge in managing ovarian cysts.

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