UNIVERSITY OF THE CORDILLERAS

College of Nursing
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
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Website: www.bcf.edu.ph

LEIOMYOMA UTERI

A Case Presented to the

College of Nursing

In Partial Fulfillment of the requirements in the Course

Nursing Care Management 102

Submitted By:

AL-HAJJ, Meteab A.
AL-QUHAIT, Abdulaziz S.
AQUINO, Allyza Ashley V.
BARTOLOME, Gian Gabriel F.
BORCE, Hazel Mae M.
DAIT, Creiamee D.
EMBES, Cheizl Joy S.
FRONDA, Ihnel Louis C.
MOICO, Nhica Shane C.
OYANG-O, Sanclairy Zayde Y.
PIAMONTE, Yrvynn C.
RAMOS, Cresha L.
TABLAC, Viriel Tiffany C.
TOLIBAS, Eurika P.

(Date: May 6, 2019)

Noted and Approved for Presentation:

Name of Case Presentation Adviser or Panel/s

_______Ma’am Letty D. Midang_____

Signature of Adviser / Date
 ABSTRACT

TITLE: LEIOMYOMA UTERI (Uterine Fibroids). Identifying signs and symptoms, proper
management, risk factors and treatment or medications of Leiomyoma.

AUTHOR INFORMATION: Meteab A. Al-Hajj, Abdulaziz S. Al-Quhait, Allyza Ashley V. Aquino,

Gian Gabriel F. Bartolome, Hazel Mae M. Borce, Creiamee D. Dait, Cheizl Joy S. Embes,
Ihnel Louis C. Fronda, Nhica Shane C. Moico, Sanclairy Zayde Y. Oyang-o, Yrvynn C.
Piamonte, Cresha L. Ramos, Viriel Tiffany C. Tablac and Eurika P. Tolibas

BACKGROUND: Uterine Leiomyomas, commonly called uterine fibroids, are benign tumors
that develop from smooth muscle cells in the myometrium. It is the most common tumor of
the uterus. Prevalence increases in women ages 30 to 50 years, but decreases with
menopause. In the United States, it is estimated that myomas develop in 30% of white & 50%
of black women by the age of 50 years. The purpose of this study is to contribute to the
knowledge of the readers about the things that might affect or threaten the health of
women ages 30-50 years old, most especially those nulliparous and also to contribute
proper management of leiomyoma to those who already acquired it. Hence, this will also
help regain wellness or restore health of women experiencing this.

CASE DESCRIPTION: Uterine fibroids are noncancerous growths of the uterus that often
appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas,
uterine fibroids aren't associated with an increased risk of uterine cancer and almost never
develop into cancer. Fibroids range in size from seedlings, undetectable by the human eye,
to bulky masses that can distort and enlarge the uterus. A patient can have a single fibroid
or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it
reaches the rib cage. Many women have uterine fibroids sometime during their lives; most
women don't know they have uterine fibroids because they often cause no symptoms.
Many women who have fibroids don't have any symptoms. In those that do, symptoms can
be influenced by the location, size and number of fibroids. In women who have symptoms,
the most common symptoms of uterine fibroids include: heavy menstrual bleeding,
menstrual periods lasting more than a week, pelvic pressure or pain, frequent urination,
difficulty emptying the bladder, constipation and backache or leg pains. In our case, the
patient was diagnosed with Uterine Leiomyoma last August 2018. She undergone X-ray and
ultrasound due to the symptoms that was experienced by the patient which is excessive
and prolonged menstruation consuming seven soaked pads in a day, changes of the size
of abdomen, lower back pain and having difficulty in emptying her bladder. After having
the result of several diagnostic tests, it stated positive to intramural Uterine Leiomyoma. The
patient is single and nulliparous, 47 years of age and she is a farmer, this information of
patients was taken as factors contributing to the development of Uterine Leiomyoma.

CONCLUSION: Therefore, as researchers, we conclude that it is important for women most

especially to those in reproductive years to always assess ourselves and do not neglect
changes or abnormalities we experience. Everyone must understand that small changes or
problems may lead to a serious complication if not given attention. Hence, needs
immediate consultation from the physician. It is important to know that lifestyle and stress
are another contributors to the development of any diseases or illness in the body like
Leiomyoma.

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 TABLE OF CONTENTS

I. Introduction ...............................................................................................................................................３

II. Statement of Objectives .............................................................................................................................４

A. General Objectives..................................................................................................................................４

B. Specific Objectives ..................................................................................................................................４

III. Patient’s Profile.......................................................................................................................................４

IV. Chief Complaint ......................................................................................................................................４

V. Present History of Illness ............................................................................................................................４

VI. Past History of Illness..............................................................................................................................４

VII. Family Health History..............................................................................................................................５

VIII. Developmental History ...........................................................................................................................５

IX. Social and Environmental History ..........................................................................................................５

X. Lifestyle and Health Practices .....................................................................................................................５

XI. Health Assessment .................................................................................................................................６

A. General Survey........................................................................................................................................６

B. Head to Toe Assessment ........................................................................................................................６

C. 13 Areas of Assessment ..........................................................................................................................７

XII. Diagnostics ............................................................................................................................................. 11

XIII. Comprehensive Pathophysiology ......................................................................................................... 21
XIV. Treatment/Management ....................................................................................................................... 22
A. Drugs.................................................................................................................................................. 22
B. IV Fluids ............................................................................................................................................. 51
C. Surgery............................................................................................................................................... 57
XV. Nursing Care Plans ................................................................................................................................. 60
A. Prioritization of Problems ...................................................................................................................... 60
a.1. List of Problems ............................................................................................................................. 60
a.2. Basis for Prioritization ............................................................................................................... 60
B. Nursing Care Plans ................................................................................................................................ 63
NCP 1: Acute Pain related to increased pelvic pressure secondary to abnormal growth of tissue in the
uterus ......................................................................................................................................................... 63
NCP 2: Fluid volume deficit related to excessive blood loss as evidenced by vaginal bleeding ............... 67
NCP 3: Fatigue related to decreased hemoglobin count secondary to anemia ....................................... 65
NCP 4: Risk for infection related to tissue trauma secondary to surgical incision .................................... 69
NCP 5: Risk for fall related to body weakness .......................................................................................... 71
C. Discharged Plan ..................................................................................................................................... 73
XVI. Learning Insights .................................................................................................................................... 74
XVII. List of References .............................................................................................................................. 77
XVIII. Appendices................................................................................................................................................ 78

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 Appendix A ..................................................................................................................................................... 79
Appendix B ..................................................................................................................................................... 80

I. Introduction
Leiomyoma of the uterus also called uterine myoma or fibroids (Gale
Encyclopedia Medicine, 2008). It is the most common of all tumors found in women.
It may occur in any part of the uterus. It is a benign tumor that derived from a
smooth muscle, most often of the uterus (leiomyoma uteri) (Dorland, 2007). Fibroids
can be described based on where they are located in the uterus. The most common
type is intramural fibroid that develop within the wall of the uterus. Another type is
subserosal fibroid that come from myometrial cells at the perimetrium; this usually
detach from the uterus. Submucosal fibroids come from myometrial cells just below
the endometrium. It usually grows in the cavity of the uterus and changes its shape.
Lastly, cervical fibroids grow in the wall of the cervix (Robbins and Cotran, 2015).

Imbalance of the estrogen and progesterone can deeply affect the health of
women. Each of these hormones has a direct relationship to the development of the
reproductive organs. Long-term imbalances may be at risk for many conditions
including menstrual and premenopausal difficulties as well as fibroids. While the
cause of uterine fibroids is still unknown, there is a link between fibroids and estrogen
production. According to the National Institutes of Health, when estrogen levels are
too high, it can cause fibroid tumors to grow and when there is insufficient
progesterone present, there are no proper signals to stop this growth (NIH, 2007).
Leiomyoma usually occur during the third and fourth decades. They are usually
small, but may grow quite large and occupy most of the uterine wall; after
menopause, growth usually ceases (Mosby, 2009). Symptoms vary according to the
location and size of the tumors. As they grow they may cause pressure on
neighboring organs, painful menstruation, profuse and irregular menstrual bleeding,
vaginal discharge, frequent urination and enlargement of the uterus (Miller-Keane,
2003). An early menarche, before the age of 10, has been found to be risk factor for
uterine myomas, while a menarche over the age of 16 seems to decrease the same
risk. (S.K. Laughlin, 2010). Some studies stressed that a lower incidence and a
reduced number of clinically apparent myomas are linked to increased parity. This
could be due to a remodeling process of the extracellular matrix (ECM) and a
specific expression of receptors for peptide and steroids hormones induced
pregnancy and parturition. (M. Payson, 2006)

The cause of leiomyoma is unknown, but development of these tumors may

be estrogen dependent. By the age of 45 to 50 years, 67% of white women and 82%
of African American women and also 82% of Asian women (J. Wei, 2005). Yet, 20-40%
Filipino women have sonographic findings consistent with uterine fibroids, however it
is diagnosed by physical examination and confirmed by ultrasonography (Collins
Dictionary of Medicine, 2005).

３
II. Statement of Objectives
A. General Objectives
This case analysis aims to increase the understanding and knowledge
of student nurses on how to care for patients with LEIOMYOMA UTERI
effectively and efficiently.

B. Specific Objectives
Specifically, this case analysis aims to:
1. Define LEIOMYOMA UTERI and its effects to the body as a whole;
2. Illustrate the pathophysiology of LEIOMYOMA UTERI and in relation to
the signs and symptoms specifically observed in the patient;
3. Describe and identify the common signs and symptoms of
LEIOMYOMA UTERI;
4. Discuss the medical and surgical interventions for the management of
LEIOMYOMA UTERI;
5. Formulate appropriate nursing care plans suited for the patient based
on the assessment findings;
6. Identify care measures to be given to the patient and family to
promote continuity of care and independence after discharge.

III. Patient’s Profile

Name : Patient X
Ethnic Background : Ilocano
Civil Status : Single
Religion : Roman Catholic
Occupation : Farm Laborer

Admitting Diagnosis : G0, Abnormal uterine bleeding,

leiomyoma uteri
Final/Principal Diagnosis : G0, leiomyoma uteri, intramural status
post total abdominal hysterectomy and bilateral
salpingo-oophorectomy (March 1, 2019)
Date and Time Admitted : February 26, 2019 at 1:40pm
Date Handled : February 28, March 1-2, 2019

IV. Chief Complaint

Vaginal Bleeding

V. Present History of Illness

Two weeks prior to admission, patient noted vaginal bleeding consuming 7

moderately soaked regular pads with associated hypogastric pain. Patient sought
consult to a private physician and ultrasound was referred revealing myoma uteri.
Interminal and possible cancerous component secretory phase. Patient was referred
in the institution of Baguio General Medical center and was subconsciously
admitted.

VI. Past History of Illness

The patient had her first menarche at the age of 10. Normally, her menstrual
cycle usually lasts for 28 days, however, she verbalized that she had irregular

４
 menstruation as she reaches her middle age. During the onset of her menstruation,
patient X verbalized that she experienced spotting followed by a heavy menstrual
bleeding accompanied by a dull pain. In order to relieve the pain being felt, she
takes medication such as ibuprofen twice a day. She also added that she is anemic
but apart from that, she mentioned that there were no known allergies to food and
drugs as well as history of diabetes mellitus, arthritis, tuberculosis and kidney disease.
Last August 7, 2018, the patient was subjected to undergone dilatation and
curettage due to abnormal bleeding. The procedure was done at Baguio General
Hospital and Medical Center (BGHMC). She also added that other diagnostic tests
were also done such as transvaginal and transabdominal ultrasound wherein it
confirmed that a fibroid was formed in her uterine. Due to this, the patient was
scheduled for surgery last December 2018 however, the surgery was re scheduled on
March 2018 due to increase number of patients scheduled for surgery at BGHMC
during that month. On March 1, 2019 the patient finally undergone total abdominal
hysterectomy with bilateral salpingo-oophorectomy (TAHBSO).

VII. Family Health History

The patient claims neither to have any familial history nor hereditary disease
that is related to uterine leiomyoma. History of hypertension was noted on her
father’s side. Health problems such as diabetes mellitus, asthma, heart disease,
cancer and goiter were verbalized to be absent. No present illness is currently
experienced by any member of the family.

VIII. Developmental History

The patient is a 47 year old female who is classified under Generativity vs.
Stagnation which takes place during middle adulthood (40-65 years old) according
to Erik Erikson's stages of psychosocial developmental theory. She is the second child
out of the three siblings. Her younger brother died 2 years ago so she took full
responsibility in taking care of her niblings (1 nephew and 3 nieces) who are all in
grade school. The patient is single and has no children. The patient has successfully
completed Erik Erikson's psychosocial developmental theory of Generativity versus
Stagnation because she is active in church activities and verbalized that she has
feelings of usefulness because even though she has no child of her own, she already
have her nieces and nephews to raise and spend the rest of her life with. Hence, the
patient has the virtue of caring and giving back.

IX. Social and Environmental History

The patient interacts well with the people around her. She communicates well
and responds appropriately to verbal and nonverbal stimuli. The patient made
mention that she is able to interact with several group of people. She is active in
church activities and volunteers from time to time. The patient verbalized no difficulty
in interacting with other people and has a good relationship with her family
especially with her older sister and niblings who took care of her throughout her
hospitalization, as observed.

She lives in Sobol, Asingan, Pangasinan. She lives in a house made up of

cement with two bedrooms. Living with her is her family. The location of their house is
not easily accessible to hospitals and health centers. Drinking water is obtained from
a refilling station and water for domestic purposes is acquired from their local water
district. Garbage is collected and segregated twice a week.

X. Lifestyle and Health Practices

Patient X stated that she is applying the Filipino traditional meals, she is eating
rice for breakfast. She ensures that she receives adequate nutrients by allowing
herself to eat three complete meals a day including snacks. She added that she is
fond of eating chips, noodles, street foods and drinking flavored drinks such as juice,

５
 soda and coffee. The patient is non-smoker and non-alcoholic beverage drinker. No
verbalized vices were identified. She is able to brush her teeth twice a day and take
a bath once a day.

During admission, our patient eats rice with egg, meat, soup and vegetables.
Also, eats fruits such as apples and bananas. She drinks 500mL of water everyday.

XI. Health Assessment

A. General Survey
The patient was received awake, lying on bed on a supine position with
ongoing IVF of D5LRS infused on her left arm. With intact catheter connected to a
urine bag at 350ml level. Patient appears to be weak, tired and irritable in pain.
Minimal movement was observed due to the IVF and catheter hooked which
required assistance in her activities in daily living.

B. Head to Toe Assessment

1. Head Hair is thick, long, well distributed and has minimal oil. The
head is symmetrical, there are no nodules, masses and
tremors when palpated. The face is symmetric, no
distorted lesions and masses. It is freely movable, no
unusual movements observed like mannerisms.
2. Eyes Eyebrows and eye lashes are well distributed. Eyes are
sunken and hollow. Sclera is clear, no redness or marks
seen and conjunctiva is pinkish. The pupils are equally
round and reactive to light accommodation. Able to
perform the 6 field of gaze. The patient was able to
identify primary colors and not wearing reading glasses or
contact lens.
3. Ears The ears are symmetrical. When palpated there are no
tenderness, masses, and swelling observed and has
minimal presence of cerumen. Able to hear and respond
from a distance of 1-2 feet.
4. Nose and sinuses Appeared symmetrical, straight and uniform in color.
There was no presence of discharge or flaring. When
lightly palpated there were no tenderness, lesions,
inflammatory, or nodules on the frontal, sphenoid,
ethnocide and maxillary sinuses. No pain noted.
5. Mouth The lips are dry with crack and darken in color, has no
teeth cavities and dental carries. Oral mucosa is not dry
and pink in color. Tonsils are bilaterally present and not
inflamed. Uvula is located midline and with complete set
of teeth. Not wearing any dentures.
6. Neck Muscles are equal in size. The client showed coordinated,
smooth head movement with no discomfort. Lymph
nodes are not palpable; the trachea is placed in the
midline of the neck. Thyroid gland is not visible on
inspection and the glands ascend during swallowing but
are not very visible.
7. Chest Chest is symmetrical, has lighter complexion as compared
to her over all skin color. No lumps, masses, and nodules
palpated. No sounds of crackles, crepitus and wheeze.
When assessed, no shortness of breath observed.
Respiratory rate is regular and standard ranging from 16
to 21 cpm.
8. Cardiac Regular cardiac rate noted ranging from 85-95 bpm
(normal range: 60-100 bpm). There is also a decreased in
the blood pressure ranging from 90/80 to 120/80 (normal
range: 120/80-140/90).

６
 9. Breast/Chest Breasts are round and symmetrical upon observation.
Patient X stated that there are no masses and tenderness
upon palpation and secretion. No pain noted during self-
examination of breast.
10. Abdomen Abdomen’s color blends with the overall skin color of the
patient. Abdomen movements is symmetrical and
associated with Patient X’s respiration. Umbilicus is
centrally located and inverted. No dull sounds observed
when liver and spleen were percussed Incision site of the
operation was observed in the abdominal area.
11. Genitals Patient was having a hard time emptying her bladder
because the catheter has obstruction. She also has
bleeding from the date handled. She was wearing diaper
on the 1st and 2nd day of our duty and used napkin on the
third day since the bleeding has lessen.
12. Musculoskeletal Patient muscular strength is rated 3/5 on all extremities
using the scale for muscle strength (Bate’s Scale). 0 for no
muscular contraction, 1 for barely licker of contraction, 2
is for active movement with gravity removed, 3 is for
active movement against gravity, 4 is for active
movement against gravity and some resistance, 5 is for
active movement against full resistance with no fatigue.
Active movement against gravity means when the body
is put in a position that requires the muscle-in-question to
move a limb perpendicular to the floor and in an upward
motion. Patient is incapable of providing significant
resistance to the opposing force imposed. Able to react
from light to heavy palpation in extremities.
13. Integumentary Skin is light brown in complexion with presence of
paleness. Has scars on the left knee. The skin is warm
when touched. With presence of dryness in her overall
skin. Capillary Refill is 2-3 seconds. Patients skin turgor slaps
back to its normal position by grasping the skin between
two fingers. It was checked on the lower arm and
abdomen.
14. Reproductive Patients quantity of pubic hair was consistent with sexual
maturity expected for the patient’s age. No presence of
lice, scabies and fleas. No presence of lesion. Patient’s
first menstruation was in her 10 years of age.

C. 13 Areas of Assessment

1. Psychosocial and Psychological Status

Patient X is 47 years old, single, and resident of Sobol, Asingan, Pangasinan.
She lives with her nibling. She was a farmer. The patient together with her family
practices the belief of the religion Roman Catholic. The patient neither smoke nor
drink alcoholic beverages. The patient verbalized no difficulty in interacting with
other people and has a good relationship with her friends and family especially with
her sister who stayed with her throughout her hospitalization, as observed. She
verbalized that she has no problem in taking care of her nibling aside from financial
aspect.

2. Mental and Emotional Status

Patient X was seen awake and conscious. She responds appropriately to
verbal and non-verbal stimuli during the assessment. She is well oriented to time,
place and person. During the interview that took place, she was able to express her
feelings as evidenced by answering the questions being asked correctly and using
clear words. The level of understanding of the patient with regards to the disease

７
 was assessed, and noted as adequate, since as for her educational background,
she was able to finish High School. The patient was a bit emotional due to their
situation as a family, and was worried about their finances due to lack of resources.
She verbalized that she accepted the fact that she cannot bear a child of her own
due to her old age and the TAHBSO surgery. She also verbalized that she is
contented, having her niblings with her, which she considers as her own.

3. Environmental Status
Patient X is living with her niblings. She lives in a house made up of wood and
cement with two bedrooms. The location of their house is not easily accessible to
hospitals and health centers. Drinking water is obtained from a refilling station and
water for domestic purposes is acquired from City Water District. Garbage is
collected and segregated twice a week. Their house is near the vegetable garden
and surrounded by a creek or waste reservoir that flows from houses in the entire
barangay which might also affect the health of the patient. During hospitalization,
the patient was placed in the Gynecology ward of Baguio General Hospital and
Medical Center with a bed #13. She was exposed in a room with adequate lighting,
comfortable room temperature and proper air ventilation.

4. Sensory Status
a. Visual Status
Upon eye assessment, the patient was then known to have a visual acuity of
20/20, without any presence of irritation, redness or cataract noted. The patient
successfully demonstrated the six cardinal gazes without any abnormalities noted.

b. Auditory
During the assessment, she can also distinguish voice using the whisper test
even from a distance of 2-3 feet. No corrective auditory deficits and no auditory
device noted being used by the patient.

c. Olfactory Status
The patient is able to discriminate pleasant odor such as the soap and food,
and unpleasant odor such as rotten food. No unusual finding was reported by the
patient.

d. Gustatory Status
The patient verbalized that she has a good sense of taste. The patient is able
to distinguish sweet, sour, salty and bitter foods as evidenced by proper description of
the food she was taking in.

e. Tactile Status
With regards to the patient’s tactile status, she was able to distinguish sharp
and dull by us brushing the tip of the pen on to her skin , light and firm tough, able to
perceive heat, cold, pain in proportion to stimulus, and able to differentiate common
objects such as pillow, blanket, bottles and food by touch.

5. Motor Status
Prior to admission, the patient has limited movements due to tiredness that
she felt in her body as evidence by her fatigue. Patient was able to walk and
balance is quite vulnerable which indicates a risk for injury or fall. There are no
prosthetic devices use by the patient. During hospitalization, her movement is slow
paced. The patient verbalized that pain is felt when she moves.

6. Thermoregulatory Status
The patient’s temperature ranges from 36.0°C to 37.2 °C (normal range: 36.5-
37.5°C). The result is a manifestation of afebrile. There is no episode of fever during
the whole shift.

８
 Date Time Temperature
7am 36.6 °C
February 28, 2019 10am 36.7 °C
2pm 36.8 °C
7am 36.0 °C
March 1, 2019 10am 36.6 °C
2pm 36.8 °C
7am 37.2 °C
March 2, 2019 10am 36.8 °C
2pm 36.2 °C

7. Respiratory Status
The patient’s respiratory rate ranges from 16-21cpm (normal range: 12-20
cpm) and SPO2 ranges from 90%-97%. The result is a manifestation of normal
breathing.

Date Time RR SPO2

7am 16 cpm 90 %
February 28, 2019 10am 18 cpm 94 %
2pm 18 cpm 95 %
7am 20 cpm 92 %
March 1, 2019 10am 18 cpm 95 %
2pm 20 cpm 97 %
7am 21 cpm 93 %
March 2, 2019 10am 18 cpm 92 %
2pm 21cpm 95 %

8. Circulatory Status
The patient’s cardiac rate ranges from 85- 95 bpm (normal range: 60-
100bpm), her capillary ranges from 1-2 seconds (normal range: 1-2 seconds) and
blood pressure ranges from 90/80- 120/80 (normal range: 120/80-140/90).

Date Time CR Capillary Blood Pressure

February 28, 2019 7am 89 bpm 90/80
10am 91 bpm 1-2 seconds 90/80
2pm 95 bpm 100/70
March 1, 2019 7am 88 bpm 90/80
10am 85 bpm 1-2 seconds 100/80
2pm 87 bpm 110/80
7am 98 bpm 100/60
March 2, 2019 10am 85 bpm 1-2 seconds 110/70
2pm 95 bpm 120/80

9. Nutritional Status
Prior to hospitalization, patient X was not quite sure having enough nutrients in
her body because they usually eat vegetables and eats meats very often but she
loves drinking coffee, she usually consume approximately 1,000mL of coffee and
taking 300mL of water every day and for her snack, she is fond of eating chips or junk
foods and drinks carbonated drinks like coke. During hospitalization, the patient eats
rice, egg, meat, soup, vegetables and fruits such as apples and bananas. The
patient denied any indigestion or vomiting.

９
10. Elimination Status
Patient X was catheterized, and her urine output was approximately 300-
400mL per 8-hour shift. The patient verbalized of having abnormal vaginal bleeding
with approximately seven pads a day. As for her stool, the patient reported that she
only defecates once a day. Her stool is formed and dark brown in color.
When patient was administered IVF, her urine output increased to 500-600mL
per 8-hour shift.

11. Sleep, Rest and Comfort Status

Prior to admission, she has a good sleep pattern at night-time, though she
feels lower back pain which radiates in her abdomen most especially during day
break which interrupts her comfort and rest sometimes. During hospitalization, the
patient verbalized that she cannot sleep well due to the environment in the hospital
which makes her uncomfortable. She also verbalized that she feels restless and tired
due to her fatigue

12. Fluids and Electrolytes Status

Prior to admission the patient’s fluid intake ranges approximately 1000-1200
including coffee and water intake. During hospitalization, the patient usually drinks
500mL of water every day and she avoided coffee for the mean time as advised by
the healthcare team. Also, ongoing IVF D5LRS was administered to the patient.

13. Integumentary Status

Patient X has brown skin in complexion with presence of paleness. There are
no wounds notes or reported by the patient prior to surgery. She has scars due to the
work she had on the farm. Postoperatively, she had a midline surgical incision.

１０
XII. Diagnostics
Diagnostic
Description of the Procedure
Procedure
Chest X-ray Chest radiography is the first
investigation performed to
assess lungs because it is simple,
inexpensive, rapid, and
noninvasive; however, it is much
less sensitive than chest CT in
detecting a small
pneumothorax, blebs, and
bullae.
Transvaginal and A transvaginal ultrasound, also
Transabdominal called an endo vaginal
Ultrasound ultrasound, is a type of pelvic
ultrasound used by doctors to
examine female reproductive
organs this includes the uterus,
fallopian tubes, ovaries, cervix
and vagina. Unlike a regular
abdominal or pelvic ultrasound,
where the ultrasound wand
(transducer) rest on the outside
of the pelvis, this procedure
involves the doctor or a
technician inserting an
ultrasound probe about 2 or 3
Significance/Purpose of the
Procedure
It is used to determine any
complication to the patient’s
body such as broken bones,
tumors and presence of
foreign bodies. It is also use to
determine the progress of her
medical and surgical
management.
This is used to produce image
of the reproductive organs of
the patient. Having this
diagnostic test may determine
the location and size of the
tumor.
Date of
Findings & Implications
Procedure
February 26, 2019 No active lung opacities.
Heart is not enlarged.
Pulmonary vascular markings are within normal.
Both hemi diaphragms and costophrenic sulci are
intact.
Visualized osseous and soft tissue structures are
unremarkable.
NORMAL CARDIOPULMONARY FINDINGS
August 6, 2018 The uterus is anteverted with irregular contour and
heterogeneous echo pattern measuring
18.7x11.3x9.1cm. The cervix measures 4.9 x 2.8x1.7cm
with distinct endocervical canal and homogeneous
stroma. There is a well-circumscribed heterogeneous
mass measuring 11.8 x10.0x8.3 cm within the right
posterolateral myometrium from the level of the
isthmus to the midcorpus, intramural with subserous
and possible submucous components.
Myoma uteri, intramural with subserous and possible
submucous components secretory phase
endometrium. Normal ovaries.
11
 inches into your vaginal canal.

Prothrombin time/ The prothrombin time (PT) is a This is used to determine the February 26, 2019 Result Reference Range
partial thromboplastin test that measures the number bleeding problem of the
of seconds it takes for a clot to patient. Also, it is used whether Patient 13.60 12.2-14 seconds
form in a person’s sample of the medications for prevention
Control 14.80 11.5-15.5 seconds
blood after substances of blood clots is working. This
(reagents) are added. The PT is test measures clotting factors INR 1.03
often performed with a partial to prevent other complications
thromboplastin time and related to blood. % Activity 95.00
together they assess the
amount and function of proteins
called coagulations factors that
are an important part of proper
blood clot formation. PT
measures the overall speed at
which blood clots by means of
two consecutive series of
biochemical reactions known as
the “intrinsic” and common
coagulation pathways.

12
 Diagnostic Description of procedure Significance/ Purpose of Significant findings Nursing Implications Nursing Responsibilities
procedure and the procedure
date done

Complete blood A CBC may be ordered To determine general Hemoglobin A low hemoglobin level Dx:
count when a person has any health status, screen, Normal Range: indicates decreased oxygen
number of signs and diagnose, or monitor any 120-160 g/L circulating in the red blood - Assessed capillary refill and
February 26, 2019 symptoms that may be one of a variety of diseases Result: cell. It may also indicate general appearance
related to disorders that and conditions that affect 107 anemia. - Assessed vital signs of the
affect blood cells. When blood cells, such as patient
an individual has an anemia, infection, - Monitored oxygen saturation
infection, inflammation, inflammation, bleeding
Tx:
bruising, or bleeding, a disorder or cancer.
doctor may order a CBC - Assisted in medication intake
to help diagnose the - Assisted the patient to
cause and/or determine develop ways to incorporate
its severity. the therapeutic plan in every
activities
Hematocrit A low hematocrit indicates - Regulated Packed Red Blood
Normal Range: decreased percentage of red Cell
0.37-0.47 L/L blood cell in the blood.
Edx:
Result:
0.32 - Emphasized to increase
green leafy vegetable and
RBC Count A low red blood cells count
incorporate food high in
Normal Range: may indicate iron deficiency
vitamin c
4.04-5.48 10^12/L anemia.
- Encouraged to increase fluid
intake
Result:
- Instructed to report possible
3.57
adverse effects

13
Leucocyte (WBC) Within the normal range. Dx:
Normal Range:
5.0-10.0 - Assessed for signs of infection
- Assessed for vital signs
Result: - Assessed the skin for color,
4.43 texture, elasticity and
moisture
Neutrophils Within the normal range.
Normal Range: Tx:
50-70%
- Routinely monitored the
Result: patients WBC count, serum
46 protein and serum albumin
- Helped patient change
position frequently
- Wear gloves during any
contact with blood, mucus
and other bodily fluids

Edx:

- Encouraged adequate rest

- Encouraged patient to eat
balance diet
- Educated the patient on the
drug therapy

Lymphocytes Within the normal range.

Normal Range:
20-40%

Result:
25

14
 Monocytes Within the normal range.
Normal Range:
0-10%
Result:
6
Eosinophils Within the normal range.
Normal Range:
0-7%
Result:
1

Basophils Within the normal range.

Normal Range:
0-1%

Result:
1
Platelet Count Within the normal range.
Normal Range:
150-400 10^9/L

Urinalysis A urinalysis (UA) is a set of
tests that detect cells,
February 26, 2019 cell fragments, and
substances such as cryst
al or casts in the urine. It
may be used as part of a
health exam or when a
Result:
388
To determine the presence PHYSICAL EXAMINATION
of microorganism, the
type of organism and the Color Within the normal range.
antibiotics to which the
Normal:
organisms are sensitive.
Pale yellow -Yellow
To assess the color, odor an
Result:

15
person has symptoms, d consistency of the urine Yellow
and results can help and the presence of clinic
detect a urinary tract inf al signs of UTI.
ection, kidney disorder,
liver problem, diabetes or
other metabolic
problems.
Appearance Suggestive of pyuria and slight Dx:
hematuria - Assessed physical health
Normal: status of the patient
Clear - Assessed the patient’s
pattern of elimination
Result: - Monitored vital signs
Slightly turbid Tx:
- Assisted in medication intake
- Assisted the patient to
develop ways to incorporate
the therapeutic plan in every
activities

Edx:
- Encourage to increase fluid in
take
- Encourage the patient to voi
d every 2-3 hours
CHEMICAL EXAMINATION
Specific Gravity Within the normal range.
Normal:
1.005-1.025
Result:
1.015

16
pH Within the normal range.
Normal:
4.5-8
Result:
8
Leukocyte Within the normal range.
Esterase
Normal:
Negative
Result:
NEGATIVE
Nitrites Within the normal range.
Normal:
Negative

Result:
NEGATIVE
Protein Within the normal range.
Normal:
Negative

Result:
NEGATIVE
Glucose Within the normal range.
Normal:
≤130 mg/d

Result:
NEGATIVE

17
Ketones Within the normal range.
Normal:
Negative

Result:
NEGATIVE
Bilirubin Within the normal range.
Normal:
Negative

Result:
NEGATIVE
Erythrocyte A positive 1 result may Dx:
Normal: indicate a blood disorder such
Negative as anemia. - Assessed capillary refill and
general appearance
Result: - Assessed vital signs of the
POSITIVE 1 patient
- Monitored oxygen saturation

Tx:

- Assisted in medication intake

- Assisted the patient to
develop ways to incorporate
the therapeutic plan in every
activities
- Regulated Packed Red Blood
Cell

Edx:

- Emphasized to increase

18
 green leafy vegetable and
incorporate food high in
vitamin c
- Encouraged to increase fluid
intake
- Instructed to report possible
adverse effects

MICROSCOPIC EXAMINATION
Pus Cells Within the normal range.
Normal:
0-5/hpf

Result:
3-5/hpf
Red Blood Cells A high result of RBC in the Dx:
Normal: urine may indicate infection or - Assessed for signs and
0-3/hpf hemophilia. Hemophilia is a symptoms of urinary tract
bleeding disorder that makes infection
Result: it harder for person’s blood to - Assessed for risk factors for UTI
8-10/hpf clot. This results in easy - Monitored WBC count
bleeding. Tx:
Bacteria A few bacteria in the urine - Discontinued catheter when
Normal: may indicate leading to or report of discomfort was
None beginning of the urinary tract mentioned
infection. - Assisted in medication intake

19
Result:
FEW Edx:
- Encouraged the client to
void often every 2 to 3 hours
a day and completely empty
the bladder
- Encouraged to increase oral
fluid intake
- Instructed to take vitamin c
to help in the acidification of
the urine
Yeast Cells Within normal range.
Normal: None

Result:
NONE
Epithelial Cells Within the normal range.
Normal:
Moderate
Result:
MODERATE
Mucus Threads Within the normal range.
Normal:
None
Result:
None
Uric Acid Within the normal range.
Normal:
pH<6
Result:
NONE

20
XIII. Comprehensive Pathophysiology

PREDISPOSING FACTORS PRECIPITATING FACTORS

Female Lifestyle
47 years old (Caffeine)
Nulliparity
Pre-menopausal stage
Early menarche (10 years old)

Steroid Hormone
Increase estrogen and progesterone

Intermingled varying amounts of

fibrous connective tissues

Resembling the muscles in the

walls of the organ

_____ Fibroid Growth_____

Pressure to the pelvic Pressure in the uterine lining

---CHRONIC PAIN--- Heavy vaginal bleeding Excessive blood loss

 Pain rate of 7 out of 10 Hypotension

Decreased red blood cells Decreased WBC
(hematocrit: 0.32)

Weakened immune system

Anemia

Decreased oxygen-carrying --RISK FOR INFECTION --

ability of blood
(hemoglobin: 107)

---FATIGUE---

---DEFICIENT FLUID VOLUME---

Body weakness
(Vulnerable body balance)

---RISK FOR INJURY---

CONFIRMED INTRAMURAL FIBROID GROWTH

THROUGH DIAGNOSTICS- TRANSABDOMINAL
AND TRANSVAGINAL ULTRASOUND AND CBC

TAHBSO

21
XIV. Treatment/Management

A. Drugs

DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES

CONTRAINDICATION
Generic: Produces analgesic, anti- Indications: CNS: BEFORE:
inflammatory effects by - Dizziness, drowsiness,
Naproxen Sodium inhibiting prostaglandin - Mild to moderate pain headache, vertigo Dx:

Brand: synthesis. This medication was Contraindications: - Assessed patient’s

given to reduce the pain the CV: condition before starting
Flanax patient is experiencing post - Hypersensitivity, cross - Edema, palipitations the therapy
operatively. sensitivity to aspirin, GI - Assessed patient’s and
Class: active bleeding, ulcer EENT:
Source: family’s knowledge of drug
disease - Tinnitus, auditory - Monitored CBC,
Anti-inflammatory
2010 Lippincott’s Nursing disturbances, visual electrolytes, renal and
Therapeutic: Drug to Drug Interaction: disturbances
Drug Guide hepatic functions
Non-steroidal - NONE - Monitored vital signs
GI:
Pharmacologic: Drug to Food Interaction: - Abdominal pain, Tx:
constipation, diarrhea,
NSAIDS - NONE dyspepsia, epigastric - Established baseline data
pain, heartburn, - Provided comfort to the
Dosage: patient
nausea, blood loss,
peptic ulceration, - Give drug with food or milk
500 mg
stomatitis, thirst to minimize GI upset
Route:
Edx:
HEMATOLOGIC:
Oral
- Ecchymosis, increased - Instructed the patient to
1 tab

22
BID bleeding time report feeling of concerns
- Educated about the
RESPIRATORY: possible adverse effects
- Dyspnea - Advised to avoid
discontinuing medication
DERMATOLOGY:
- Diaphoresis, pruritus, DURING:
purpura Dx:

- Assessed patients who

develop severe diarrhea
and vomiting
- Assessed mental status
- Assessed tolerance for long
term therapy

Tx:

- Give drug with food or milk

to minimize GI upset
- Do not increase or double
dosage
- Provided comfort to the
patient

Edx:

- Instructed client to report

any signs of distress
- Educated about the
adverse effects that would
23
 be felt such as drowsiness,
dizziness, abdominal pain,
edema, etc.
- Advised to minimize
movements that will risk for
fall

AFTER:

Dx:

- Documented accordingly
- Assessed current health
status
- Assessed for allergic history

Tx:

- Provided comfort and rest

- Give drug with food or milk
to minimize GI upset
- Do not increase or double
dosage

Edx:

- Instructed to report blurred

visions, ringing or roaring
ears
- Encouraged to report
change in urine pattern,
weight increase, edema,
24

DRUG NAME MECHANISM OF ACTION
Generic: Bactericidal:
Cefuroxime Inhibits synthesis of bacterial
cell wall, causing cell death.
Brand: This type of medication was
Zoltax given to the patient to treat
bacterial infections most
Class: especially post operatively.
The patient undergone a
Antibiotic, Cephalosporin surgical operation, and this
medication is to prevent an
Therapeutic:
infection from occurring.
Antibiotic
Pharmacologic:
Source:
Second-generation
2010 Lippincott’s Nursing
cephalosporin
Drug Guide
Semisynthetic antibiotoc
Dosage:
INDICATION /
CONTRAINDICATION
Indications: CNS:
- Treatment of the
following infections
caused by susceptible
GI:
organisms: Respiratory
tract infection, skin and
skin structure infections,
bone and joint
infections (not cefaclor
or cefprozil), urinary
tract infections (not
cefprozil). Meningitis,
gynecologic infections, GU:
and lyme disease.
Contraindications:
HEMATOLOGIC:
- Contraindicated with
allergy to
Cephalosporins or
ADVERSE EFFECT
BEFORE:
- Headache, Dizziness, Dx:
Lethargy, Paresthesias
- Nausea, Vomiting,
Diarrhea, Anorexia,
Abdominal pain,
Flatulence,
Pseudomembranous
Colitis, Hepatotoxicity
Tx:
- Nephrotoxicity
- Bone Marrow
pain increase in joints, fever
blood in urine, black stools
and flu-like symptoms
- Advised to report adverse
effects felt
NURSING RESPONSIBILITIES
- Assessed for history in
hepatic and renal
impairment, lactation and
pregnancy.
- Assessed for infection at
beginning and during
therapy.
- Assessed for physical status,
renal function tests, culture
of affected area.
- Do not confuse cefotetan
with cefuroxime.
- Do not administer within 1
hour of antacids.
- Provide comfort to the
patient
25
500 mg Penicillins. Use
cautiously with renal
Route: failure, lactation, HYPERSENSITIVITY:
Oral pregnancy.
BID
1 tab
Drug to Drug Interaction:
- Increased LOCAL:
Nephrotoxicity with
Aminoglycosides.
Increased bleeding
effects with oral anti-
coagulants. Risk of
Disulfiram-like reaction
OTHERS:
with alcohol.
- Probenecid decrease
excretion and increase
blood levels. If alcohol
is ingested within 48-72
hours of cefotetan, a
disulfiram-like reaction
may occur. Cefotetan
may increase risk of
bleeding with anti-
coagulants,
antiplatelet agents,
thrombolytics, and
NSAIDs. Antacids
Depression
- Ranging from rash to
fever to Anaphylaxis;
serum sickness
reaction
- Pain, abscess at
injection site, phlebitis, DURING:
inflammation at IV Dx:
site.
- Superinfections,
disulfiram-like reaction
with alcohol
Tx:
Edx:
- Educated that this drug is
specific for this infection
and should not be used to
self-treat other problems.
- Instructed why this drug is
given.
- Advised patient that
sharing of this medication
may be dangerous.
- Observed patient for signs
and symptoms of
anaphylaxis. Discontinue
the drug immediately if
these symptoms occur.
- Keep epinephrine, an
antihistamine, and
resuscitation equipment
close by in the event of an
anaphylactic reaction.
- Give IM and IV injection
sites and frequently for signs
of phlebitis.
- Gives oral drug with food to
decrease GI upset and
enhance absorption.
26
 decreases absorption - Stress the importance of
of cefaclor. taking the drug.
Concurrent use of - Do not crush tablets, take it
as a whole
aminoglycosides or
loop diuretics may Edx:
increase risk of
nephrotoxicity. - Tell patient to take drug as
prescribed.
Drug to Food Interaction: - Instructed the client to
swallow tablets whole, do
- NONE not crush them, take the
drug with food.
- Advised patient to take oral
suspension with food to
enhance absorption.

AFTER:

Dx:

- Assessed any side effects

after taking the drugs.
- Determined if the patient
still have discomfort
- Assessed current health
status.
Tx:

- Discontinued if
hypersensitivity reaction
occurs.
- Monitored bowel function,

27
 diarrhea, abdominal
cramping, fever, and
bloody stools. These should
be reported to health care
professional promptly as a
sign of pseudomembranous
colitis.
- Provided comfort to the
patient

Edx:

- Educated the client that

they make experience
these side effects: stomach
upset or diarrhea.
- Instructed patient to take
medication around the
clock at evenly spaced
times, and to finish the
medication completely,
even if feeling better.
- Instruct patient to notify
prescriber about rash, loose
stool, diarrhea or evidence
of superinfection.

28
 DRUG NAME MECHANISM OF ACTION
Generic: Ferrous Sulfate replaces iron
stores found in hemoglobin in
Ferrous Sulfate red blood cells, myoglobin
Brand: and other hemo enzymes in
the body. Additionally,
Feosol ferrous sulfate allows the
transportation of oxygen via
Class:
hemoglobin. Approximately
60% of iron is stored in
Enzymatic Mineral and Iron
hemoglobin in red blood
Preparation
cells, while 9% is stored in
Therapeutic: myoglobin and other hemo
Anti enemics enzymes. Additionally, 25% is
held in reserve
Pharmacologic: reticulocytes of the liver,
spleen and bones.
Hematological agents
Most stored iron is bound to
Dosage:
the protein ferritin. While
being transferred in the body.
200mg
Fe2+ iron is converted to
Route: Fe3+ by ceruloplasmin so it
can be then be found to the
Oral protein transferrin.
1 cap
In the diagnostic test of the
OD
patient, it shows a low count
of red blood cell,
INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Indications: CNS: BEFORE:
- Headache
- Prevention and Dx:
treatment of iron
EENT: - Assessed nutritional status
deficiency anemia due
to inadequate diet, - Swelling of the mouth, and dietary history to
malabsorption face, lips, tongue or determine possible cause
pregnancy and blood throat
of anemia and need for
loss
patient teaching
- Dietary supplement for GI:
iron - Monitored serum iron, total
- Vomiting, iron – binding capacity,
constipation, dark hemoglobin and ferritin
Contraindications:
stool - Checked for allergy to the
- Contraindicated in drug
in patients receiving CV:
repeated blood - Trouble breathing, Tx:
transfusions and in tightness of the chest
those with - Performed a thorough
GU: physical assessment to
hemosiderosis, primary
- Severe abdominal establish baseline data
hemochromatosis,
pain before drug therapy
hemolytic anemia
- Gave between meals with
unless iron deficiency
DERM: water
anemia is also present,
- Rash - Restricted amount of drug
peptic ulceration,
available to the patient
ulecerative colitis, or
regional enteritis. Use Edx:
cautiously on long term
basis. - Advised patient to take
29
hemoglobin and hematocrit.
This medication helps restore
the deficiency in the blood
content.
Source:
2010 Lippincott’s Nursing
Drug Guide
medication as prescribed
- Instructed to take
Drug to Drug Interaction: medication with meals
- NONE - Ensured the patient takes
the tablet as a whole and
Drug to Food Interaction: not crushed
- NONE DURING:
Dx:
- Monitored hemoglobin
level, hematocrit and
reticulocyte count during
therapy
- Monitored vital signs
- Assessed physical status of
the patient
Tx:
- Administered the right drug
in the right dose and route
at the right time
- Assisted patient in taking
medication
- Limited drug access if
patient is suicidal to
decrease risk of overdose
30
Edx:

- Advised patient not to take

dug with neither antacids
nor tetracyclines unless
prescribed
- Instructed patient not to
crush medication
- Cautioned patient not to
substitute one iron salt for
another

AFTER:

Dx:

- Assessed for clinical

improvement, record of
relief of symptoms (fatigue,
irritability, pallor, and
headache)
- Monitored side effects
- Monitored daily pattern of
bowel activity and stool
consistency
- Assessed for serotonin
syndrome

Tx:

- Discontinued the drug and

31

DRUG NAME MECHANISM OF ACTION
Generic: Disturbs DNA synthesis in
susceptible bacterial
Metronidazole organisms Another type of
antibiotic that was given to
Brand:
the patient. It was given to
Flagyl stop the development of
certain bacterias and
Class:
parasites in the body.
Anti- infective, Source:
notified physician or other
health care personnel
- Taken the drug in a whole
form
Edx:
- Advised to report severe GI
upset, lethargy, respirations
and constipation
- Instructed patient to
verbalize feelings and
concerns
- Encouraged to report if any
adverse effects has been
manifested
INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Indications: CNS: BEFORE:
Dx:
- Flagyl is indicated in - Dizziness, headache,
the treatment of ataxia, vertigo, - Assessed for any allergy of
asymptomatic t. incoordination, the medication
Vaginalis infection in insomia, fatigue. - Assessed physical status of
females when the the patient
organism is associated EENT: - Monitored vital signs
with endocervicitis, - Rhinitis, sinusitis,
cervivitis, or cervical pharyngitis.
32
Antiprotozoal Jones & Bartlett Lerning, 2011, erosion. GI: Tx:
Nurse’s Drug Handbook 10th
Therapeutic: Edition Contraindications: - Nausea, vomiting, - Ensured that she ate
diarrhea, abdominal something before
Pharmacologic: - Hypersensitivity to drug, pain, furry tongue, administering medication.
other nitroimidazole glossitis, dry mouth, - Performed a thorough
Netroemidazole derivatives, or anorexia. physical assessment to
parabens establish baseline data
Dosage: GU:
Drug to Drug Interaction: before drug therapy
500mg - Dysuria, dark urine, - Restricted amount of drug
- Increased risk of incontinence. available to the patient
Route: leukopenia.
Oral HEMATOLOGIC:
Drug to Food Interaction: Edx:
1 tab - Leukopenia
TID - NONE - Instructed to eat something
DERMA: prior to taking medication.
- Instructed to take
- Rash, urticaria, medication with meals
burning, mild skin - Ensured the patient takes
dryness, skin irritation, the tablet as a whole and
transient redness. not crushed
Others: DURING:
- Unpleasant or metallic Dx:
taste, superinfection,
phlebitis at IV site. - Assessed physical status of
the patient
- Assessed tolerance for long
term therapy

33
 - Monitored for food intake

Tx:

- Assisted her to take the

medication in every
prescribed time.
- Give drug with food or milk
to minimize GI upset
- Do not increase or double
dosage

Edx:

- Instructed to take medicine

with full glass of water and
should be in sitting position.
- Instructed to take
medication with meals
- Ensured the patient takes
the tablet as a whole and
not crushed

AFTER:

Dx:

- Assessed knowledge/
teach patient appropriate
use, interventions to reduce
side effects, and adverse
34
 symptoms.
- Assessed vital signs
- Monitored for effectiveness
as exhibited by a decrease
in symptoms.

Tx:

- Taken vital signs

continuously
- Discontinued if
hypersensitivity reaction
occurs.
- Provided comfort to the
patient

Edx:

- Educated about
importance compliance to
drug therapy.
- Instructed patient to
verbalize feelings and
concerns.
- Instructed not to
discontinue drug intake

35
 DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Generic: This medication reduces Indications: BODY AS A WHOLE: BEFORE:
intensity of pain stimuli
Tramadol incoming from sensory nerve - Moderate to - Malaise Dx:
endings. After her moderately severe
Brand: CARDIOVASCULAR: - Assessed patients who
hysterectomy operation, pain pain (extended
have previously
Ultram will be felt in the incision site. release formulations demonstrated
- Vasodilation
Tramadol was given in order indicated for patients hypersensitivity to tramadol,
Class: to act as a pain filler. who require around opioids or to any
CNS:
the clock pain component of this product.
Analgesic Source: - Checked the time and
management) - Anxiety, Confusion,
dosage before
Therapeutic: Coordination
2010 Lippincott’s Nursing administering medication
Contraindications: disturbance,
Analgesic Drug Guide - Assessed type, location
Euphoria, Miosis,
and intensity of pain
- Hypersensitivity, cross- Nervousness, Sleep
Pharmacologic: Tx:
sensitivity with opioids disorder.
Synthetic derivative may occur; Patients - Administered drug at right
who are acutely GASTROINTESTINAL: time, dosage and patient
Dosage: intoxicated with - Ask if the client is still in pain
- Abdominal - Implemented appropriate
alchohol, sedatives/ pain, Anorexia, Flatule
50mg manual therapy
hypnotics, centrally nce. techniques, physical agents
Route: acting analgesics, and therapeutic exercises
opioid analgesics, or MUSCULOSKELETAL: to reduce pain and help
Oral wean patient off centrally
psychotropic agents;
OD - Hypertonia acting analgesics as soon
Patients who are as possible
physically dependent SKIN:
on opioid analgesics Edx:
- Rash
- Instructed the patient to
36
Drug to Drug Interaction: SPECIAL SENSES: eat before taking the
medication
- Tylenol, Paracetamol, - Visual disturbance. - Reiterated potential side
Panadol, Mapap, effects
Tylenol Arthritis Pain, UROGENITAL: - Educated patient in
Tylenol Extra Strength, possible side effects
Ofirmev, Perfalgan, - Menopausal
symptoms, Urinary DURING:
Arthritis Pain Relief,
frequency, Urinary
Efferalgan, Dafalgan, Dx:
retention
Tempra, Children's
Tylenol, Doliprane, - Assessed if any
RESPIRATORY:
contraindicated drugs
Paracetamol Teva,
were given before
Feverall, Cetafen, - Dyspnea
administering tramadol
Altenol, Cipla - Assessed if the patient has
Genpharm taken the medication
Paracetamol, - Checked if patient has
Paracetamol Almus, taken the medication
Lemsip Max,
Tx:
Paracetamol Ranbaxy,
Infant's Tylenol, - Obtained BP and RR before
Tactinal, Panadol and periodically during
ActiFast, Promax, administration
Tylenol 8 Hour, Lemsip - Advised patient to avoid
Original, Panadol alcohol and other CNS
depressants because of the
Soluble
increased risk of sedation
Drug to Food Interaction: and decreased CNS
function.
- NONE - Monitored patient for
seizures. May occur within
recommended dose range.
37
 Risk increased with higher
doses and in patients
taking antidepressants
opioid analgesics, or other
durgs that decrese the
seizure threshold.

Edx:

- Reiterated the importance

of drug taken
- Encouraged to report if
severe nausea, dizziness,
severe constipation
- Encouraged patient to
report problems with bowel
and bladder function

AFTER:

Dx:

- Check if patient manifested

any adverse effects
- Assessed the effectiveness
of the analgesic
- Assessed bowel and
bladder function

Tx:

- Obtained vital signs

- Monitored other changes in

38
 mood and behavior,
including euphoria,
confusion, malaise,
nervousness, and anxiety.
Notify physician if these
changes become
problematic.
- Discontinued drug and
notified physician if S&S of
hypersensitivity occur.

Edx:

- Encouraged to verbalize
feelings if any adverse
effects occur
- Advised patient that
centrally acting analgesics
are usually more effective if
given before pain
becomes severe;
emphasize that adequate
pain control will allow
better participation in
physical therapy.
- Warned patients to not
breastfeed while taking
drug

39
 DRUG NAME MECHANISM OF ACTION
Generic: Destroys bacteria by
inhibiting bacterial cell-wall
Sulbactam- Ampicillin synthesis during microbial
multiplication. Addition of
Brand:
sulbactam enhances drug’s
Unasyn resistance to beta-
lactamase, an enzyme that
Class:
can inactivate ampicillin.
Anti-bacterial The patient was given
ampicillin because she has
Therapeutic:
undergone operation which
Antibiotic
can cause a risk for infection,
and ampicillin is an anti-
Pharmacologic:
bacterial drug which acts
Betalocktamase inhibitor against sensitive organism.
Source:
Dosage:
2010 Lippincott’s Nursing
1.5 grams Drug Guide
Route:
Intravenous
INDICATION /
CONTRAINDICATION
Indications: CNS:
- Treatment for infections
caused by susceptible
strains of H influenza.
- Intra-abdominal,
gynecologic and skin- CV:
structure infections
caused by susceptible
beta-lactamase-
producing strains. GI:
Contraindications:
- Contraindicated to
patients with allergies
to penicillin,
GU:
cephalosporin, or other
beta-lactamase
inhibitors.
HEMATOLOGIC:
Drug to Drug Interaction:
- NONE
Drug to Food Interaction:
ADVERSE EFFECT NURSING RESPONSIBILITIES
BEFORE:
- Lethargy, Dx:
hallucinations ,
seizures - Assessed for allergies to
penicillin, cephalosporin, or
other allergens and renal
disoders
- Congestive heart - Check physicians order
failure
- Monitored vital signs
Tx:
- Glossitis stomatitis,
- Culture infected area
gastritis, sore mouth before treatment, re-
furry tongue
culture area if response is
not as expected.
- Administered drug at right
time, dosage and patient
- Nephritis
- Restricted amount of drug
available to the patient
- Anemia, Edx:
thrombocytopenia,
- Educated about the
leucopenia,
neutropenia, adverse effects that may
prolonged bleeding occur
time. - Instructed the patient to
eat before taking the
medication
40
- NONE - Reiterated potential side
effects
HYPERSENEITIVITY:
DURING:
- Rash, fever, wheezing,
anaphylaxis. Dx:

LOCAL: - Assessed vital signs

- Assessed if any
- Pain, phlebitis, contraindicated drugs
thrombosis at were given before
injection site administering medication
(parenteral) - Monitored food intake

Tx:
Other: - Assisted her to take the
medication in every
- Superinfections – oral
prescribed time.
and rectal moniliasis.
- Give drug with food or milk
to minimize GI upset
- Do not increase or double
dosage

Edx:

- Teach patient to report

patients pain
- Encourage to report
discomfort sites, unusual
bleeding or bruising, mouth
sores, rash, hives, fever,
41
 itching, severe diarrhea
difficulty breathing .
- Reiterated the importance
of drug taken
-
AFTER:

Dx:

- Assessed IV site carefully

for signs of thrombosis or
drug reaction
- Assessed knowledge/
teach patient appropriate
use, interventions to reduce
side effects, and adverse
symptoms.
- Monitor for effectiveness as
exhibited by a decrease in
symptoms.

Tx:

- Provided comfort
- Taken vital signs
continuously
- Discontinued if
hypersensitivity reaction
occurs.

42

DRUG NAME MECHANISM OF ACTION
Generic: Stimulates peristalsis by
directly irritating the smooth
Bisacodyl muscle of the intestine,
possibly the colonic
Brand:
intramural plexus; alters water
Dulcolax and electrolyte secretion
producing net intestinal fluid
Class: accumulation and laxation.
Laxative, Stimulant
Source:
Therapeutic:
2010 Lippincott’s Nursing
Stimulant laxative Drug Guide
INDICATION /
CONTRAINDICATION
Indications: GI:
- Constipation
Contraindications:
- Ileus, intestinal F&E:
absorption , acute
surgical abdominal
conditions, severe
constipation, nausea,
vomiting, fecal MS:
impaction, use of
rectal suppository in
presence of rectal,
Edx:
- Instructed patient to
verbalize any feeling of
concerns
- Instructed not to
discontinue drug intake
- Instruct patient to notify
prescriber about rash, loose
stool, diarrhea or evidence
of superinfection.
ADVERSE EFFECT NURSING RESPONSIBILITIES
BEFORE:
- Abdominal cramps, Dx:
nausea, diarrhea,
rectal burning. - Assessed vital signs
- Assessed for any drug
allergy
- Checked for the doctor’s
- Hypokalemia (chronic order
use)
Tx:
- Administered at bedtime
- Muscle weakness
for morning results.
(Chronic use) - Administered drug at right
time, dosage and patient
43
Pharmacologic: ulcerative, proctitis. - Restricted amount of drug
MISC: available to the patient
Diphenylmethane derivative Drug to Drug Interaction:
- Protein-losing Edx:
Dosage: - NONE enteropathy tetany
(chronic use) - Advised patient that
10mg Drug to Food Interaction: laxatives should be used
Route: - NONE only for short-term therapy
- Educated that prolonged
Oral use of medicated may
OD lead to electrolyte
imbalance & dependence
- Instructed the patient to
eat before taking the
medication

DURING:

Dx:

- Assessed patient’s and

family’s knowledge of drug
therapy
- Assessed patients physical
status
- Monitored food intake

Tx:

- Do not crush or chew

enteric coated tablets.

44
 Take with full glass of water
or juice.
- Assisted in medication
intake
- Do not increase or double
dosage

Edx:

- Advised to increase oral

fluid intake to1500-2000
ml/day to prevent
dehydration
- Reiterated potential side
effects
- Educated that that
laxatives should be used
only for short-term therapy

AFTER:

Dx:

- Assessed patient for

abdominal distension,
presence of bowel sounds
and usual pattern of bowel
function.
- Check if patient manifested
any adverse effects
- Monitored vital signs

45
Tx:

- Do not administer oral

doses within 1 hour of milk
or antacid causes gastric
irritation
- Taken vital signs
continuously
- Discontinued if
hypersensitivity reaction
occurs.

Edx:

- Advised patient that

bisacodyl should not be
used when constipation is
accompanied by
abdominal pain, fever, N/V
- Report any signs of unusual
symptoms.
- Educated the patient
about the drug taken

46
 DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Generic: Stimulates normal Indications: CNS: BEFORE:
erythropoiesis and
Folic Acid nucleoprotein synthesis. Megaloblastic or macrocytic - General malaise, Dx:
anemia from folic acid or confusion, irritability,
Brand: Source: nutritional deficiency, hepatic hyperactivity. - Checked for allergy
disease or excessive hemolysis - Assessed for history of
Vitamin B9 2010 Lippincott’s Nursing GI: seizure disorders
Class: Drug Guide - Assessed vital signs
- Anorexia, nausea,
Contraindications: flatulence, bitter taste TX:
Vitamins
.
Therapeutic: Contraindicated in patients - Performed a thorough
with undiagnosed anemia Respiratory : physical assessment to
Vitamin supplement
and in those with vitamin B12 establish baseline data
deficiency. - Bronchospasm before drug therapy
Pharmacologic:
Skin: begins, to determine the
Folic acid derivative effectiveness of therapy,
- Allergic reaction, and to evaluate for the
Dosage: including rashes, occurrence of any adverse
Drug to Drug Interaction: pruritus, and effects associated with
5mg
erythema. drug therapy.
Route: Drug to Food Interaction: - Give between meals with
water but may give with
Oral - NONE
meals if gastrointestinal
discomfort occurs
- Provided comfort and rest

47
Edx:

- Instructed patient to take

medication with meals.
- Insured the patient takes
the medication as
prescribed
- Encouraged to verbalize
feelings of concern

DURING:

DX:

- Monitored hemoglobin
level, hematocrit, and
reticulocyte count during
therapy
- Monitored for adverse
effects (e.g Diarrhea,
Dehydration,
Hyperventilation, etc.)
- Monitor hemoglobin,
hematocrit, iron levels

Tx:

- Assisted patient in taking

medication.
- Limit drug access if patient
is suicidal to decrease the

48
 risk of overdose to cause
harm.
- Provided comfort and rest

Edx:

- Instructed patient not to

crush sustained-release
preparations.
- Cautioned patient to make
position changes slowly to
minimize orthostatic
hypotension.
- Encouraged to verbalized
feelings of concerns

AFTER:

Dx:

- Monitored for side effects.

- Assessed for serotonin
syndrome.
- Monitored daily pattern of
bowel activity and stool
consistency.

Tx:

- Discontinued the drug and

notified physician or other
health care professional
immediately if these

49
 symptoms occur.
- Inform patient that angina
attacks may occur 30 min,
after the administration due
to reflex tachycardia.
- Taken drug on a full
stomach

Edx:

- Advised patient to report

constipation and change in
stool color or consistency.
- Educated patient about
adverse effects
- Instructed to avoid
discontinuing drug

50
B. IV Fluids

Name Classification Component/s Use & Effects Nursing Responsibilities

Generic: Hypertonic non- - Electrolytes in 1000 Along with its needed effects, IVF BEFORE:
pyrogenic, parental ml solution may cause some
DSLR (5% Dextrose in fluid, electrolyte and - Sodium 130ml unwanted effects : Dx:
Lactated Ringer's nutrient replenisher - Potassium 4mmol
Solution) o Body pain - Obtained history of the patient’s fluid
- Calcium 1.4 mmol and electrolyte status before therapy
- Chloride 109 mmol o Blurred vision
Brand: o Chills and reassess regularly.
- Lactate 28mmol - Assessed vital signs
o Decreased urine
o Dizziness - Assessed physical health status
Classes: o Convulsions Tx:
o Confusion
Hypertonic o Dry mouth - Do not administer unless solution is clear
o Irregular hearbeat and container is undamaged
Dosage:
o Loss of appetite - Observed aseptic technique when
1000ml o Muscle pain before administering the IV fluid.
o Nausea or vomiting - Provided comfort and rest
Route: o Pale skin
Edx:
Intravenous
- Instructed the client to use only as a
temporary measure to relieve
constipation. Do not take if abdominal
pain, nausea or vomiting occurs.
- Educated to report any signs of unusual
symptoms.
- Educated the patient about the drug
taken

51
DURING:

Dx:

- Do not give IVF with abdominal pain,

nausea, or vomiting.
- Monitored vital signs
- Assessed physical health status

Tx:

- Check for patient’s comfort

- Observed aseptic technique during
administering the IV fluid.
- Provided comfort and rest

Edx:

- Educated the client that they may

experience certain adverse effects such
as blurred vision, chills, convulsions and
irregular heartbeat. If this occurs,
discontinue drug and consult your health
care provider.
- Caution must be exercised in the
administration of parenteral fluids,
especially those containing sodium ions
to patients receiving
- Educated about the drug information

52
AFTER:

Dx:

- Assessed for any redness or swelling of

the ongoing IVF
- Assess for any signs of phlebitis/ infection
- Check correct solution, medication and
volume

Tx:

- Provided necessary comfort for the

patient
- Be alert of fluid overload.
- Regulate the drop rate properly
- Do not stop solutions abruptly

Edx:

- Instructed the client to report sweating,

flushing, muscle tremors, or twitching,
inability to move extremities.
- Evaluated patients’ knowledge on the
therapy
- Instructed to report any unusual finding
to a health provider

53
 Name Classification Component/s
Generic: Isotonic Intravenous The solution is 9grams of 
Solution sodium chloride (NaCl)
Plain Normal Saline dissolved in 1L of water. The
Solution
mass of 1 millimeter of
Brand: normal saline is 1.0046

grams at 22°C. The
 Contraindication: Patients
molecular weight of sodium
chloride is approximately 58
Classes:
grams per mole, so 58
grams’ sodium chloride
Isotonic
equals 1 mole. Since
Dosage: normal saline contains 9
grams of NaCl, the  Infection, hypotension
1000ml concentration on is 9 grams
per liter divided by 58
Route:
grams per mole, or 0.154
moles per liter. Since NaCl
Intravenous
dissociates into two ions
(sodium and chloride) 1
molar NaCl is 2 osmolar.
Thus NS contains 154 mEq/L
of Na and Cl.
Use & Effects
Indication: Used because it has
little to no effect on the tissues and
make the person feel hydrated
preventing hypovolemic shock or
hypotension.
experiencing heart failure,
pulmonary edema, renal
impairment and sodium retention.
Side effects: fever, injection site
swelling, redness, or
Adverse Effects: febrile response,
infection at the site of injection,
venous thrombosis or phlebitis
extending from the site of
injection, extravasation and
hypervolemia.
Nursing Responsibilities
BEFORE:
Dx:
Obtained history of the patient’s fluid
-
and electrolyte status before therapy
and reassess regularly.
Assessed patient and provide a baseline
-
data
- Assessed vital signs of the patient
Tx:
- Before giving the bottle, check for the
correct patient to be administered
- Observed aseptic technique when
before administering the IV fluid.
- Provided comfort and rest
Edx:
- Educated patient about the possible
adverse effects such as fever, swelling
and redness
- Instructed to report any unusual finding
- Ensured about the information about the
drug therapy
DURING:
54
Dx:

- Assessed the site where it is inserted

- Provided baseline date
- Monitored vital signs

Tx:

- Provided rest and comfort

- Upon inserting the chamber to another,
make sure that it is inserted well.
- Check for patient’s comfort.

Edx:

- Educate the client that they may

experience certain adverse effects such
as fever, swelling and redness. If this
occurs, discontinue drug and consult
your health care provider.
- Ensured about the information about the
drug therapy
- Instructed to report any unusual finding

AFTER:

Dx:

- Assess the site of insertion for any swelling

or redness
- Assess for any signs of phlebitis/ infection

55
 - Check correct solution, medication and
volume
- Watch out for signs of hypervolemia
- Check drop rate
- Monitor fluid intake and output carefully
- Monitor patients for signs of mental
confusion

Tx:

- Monitor patient frequently for:

 signs of infiltration or sluggish flow
 signs of phlebitis or infection
 well time of drop rate
- Be alert of fluid overload.
- Regulate the drop rate properly
- Do not stop solutions abruptly

Edx:

- Evaluate patient’s knowledge of

therapy.
- Instruct the client to report sweating,
flushing, muscle tremors, or twitching,
inability to move extremities.
- Instructed to report any unusual finding
to a health provider
-

56
C. Surgery
Procedure Description & Indication
Dilatation and Dilation and curettage is a procedure in which
Curettage contents from the inside of the uterus are evacuated.
“Dilation” refers to the opening of the cervix and
(August 7,2018) “curettage” refers to the aspiration or removal of
tissue within the uterus. It is used to diagnose and treat
many conditions that affect the uterus such as
abnormal bleeding. A D&C may help diagnose or
treat growths such as fibroids, polyps, hormonal
imbalances or uterine cancer. It clears out the tissues
that the uterus contains, and a sample of uterine
tissue is viewed under the microscope to check for
abnormal cells.
Total Abdominal This is the most common type of hysterectomy. During
Hysterectomy and a total abdominal hysterectomy, the doctor removes
Bilateral Salpingo- the uterus, including the cervix. The scar may be
oophorectomy horizontal or vertical, depending on the reason the
procedure is performed, and the size of the area
(March 1, 2019) being treated. Cancer of the ovary(s) and uterus,
endometriosis and uterine fibroids are treated with
total abdominal hysterectomy. Clearly a woman
cannot bear children after this procedure, so it is not
performed on women of childbearing age unless
there is a serious condition. Total abdominal
hysterectomy allows the whole abdomen and pelvis
to be examined, which is an advantage in women
with cancer or investigating growths of unclear.
Nursing Care/Responsibilities
 The nurse should inform that the patient should have no intake of food or
fluid before the procedure.
 The nurse should obtain pre-operative vital signs of the patient
 Conduct health education before the operation on the following topics:
o Signs and symptoms of infections like increasing body temperature,
foul smelling discharges from the perineum, moderate to severe
abdominal cramps
o Advise that if any of these signs and symptoms occur, report
immediately to any healthcare provider
 Educate about good perineal hygiene and use of tampons is
contraindicated, use perineal pads instead
PRE-OPERATIVE
 Assess patient. The health history and the physical and pelvic examinations
are completed and the laboratory tests are performed.
 Encourage patient to share details of her menstrual history, the date of her
last menstrual period, the events leading up to admission and the current
degree of vaginal blood loss or discharge.
 Assess client’s knowledge of her condition and the surgery.
 Perform skin operation: The lower half of the abdomen and the pubic and
perineal area may be shaved and these areas may be cleaned with soap
and water. To prevent contamination and injury to the bladder or intestinal
tract, the bladder and intestinal tract need to be empty before the
patient is taken in to the OR.
 Preoperative medications may be administered before surgery to help the
patient relax. The patient must be allowed time to talk and ask questions.
57
Salpingo-oophorectomy is the removal of the ovary
and its adjacent fallopian tube. This procedure is
performed for cancer of the ovary, removal of
ovarian tumors, or Fallopian tube cancer (which is
very rare).
 The nurse must know what information the physician has given the patient
about the surgery.
 Encourage patient to practice foot and leg exercises before operation to
understand how to carry out the exercises while in bed after surgery
INTRA OPERATIVE
 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
POST OPERATIVE
 Evaluate psychological manifestations.
 Monitor Foley catheter to prevent susceptibility to UTI and temporary
urinary retention
 Assist GI functions by listening to bowel sounds. Note distention and
palpate whether abdomen is soft or firm
 Assess abdominal incision for bleeding and intactness.
 Assess vaginal bleeding.
 Educate about the diet. Remember that all post-op surgical patients need
protein to aid in healing. Include fiber in your post op diet anddrink lots of
water.
 Educate to avoid heavy lifting for about 6 weeks to prevent straining the
abdominal muscles and surgical sites.
 Educate the patient about the importance of reporting any fresh bleeding
58
 and any abnormal vaginal discharge to surgeon.
 Advise for return for follow-up care as requested by the surgeon.
 Encourage early ambulation to facilitate the return of normal peristalsis.
 Monitor and manage potential complications such as:
Hemorrhage: Count perineal pads used, assess the extent of saturation
with blood and monitor vital signs.
Deep Vein Thrombosis: Encourage and assist patient to change position
frequently and exercise leg and feet while in bed. Instruct patient to avoid
prolonged sitting in the chair with pressure on the knees, sitting cross legs
and inactivity.

59
XV. Nursing Care Plans

A. Prioritization of Problems

a.1. List of Problems

1. Chronic Pain related to increased pelvic pressure secondary to abnormal
growth of tissue in the uterus
2. Fatigue related to decreased hemoglobin count secondary to anemia
3. Fluid volume deficit related to excessive blood loss as evidenced by
vaginal bleeding
4. Risk for infection related to impaired immune system as evidenced by low
white blood cells
5. Risk for fall related to body weakness

a.2. Basis for Prioritization

NURSING DIAGNOSES JUSTIFICATION

1. Chronic Pain related to
increased pelvic pressure
secondary to abnormal
growth of tissue in the
uterus
According to Faye Glenn Abdellah’s 21 Nursing
problems, the maintenance of physical comfort is
the first basic care need that must be fulfilled
because pain can affect the patient’s mood, sleep,
and ability of the patient to do activities of daily
living and to think clearly. Acute pain should be
prioritized first in order for the patient to be
comfortable and will be able to do activities of daily
living without assistance. If pain is not relieved, the
human body cannot function properly and will
ultimately fail. Hence, relief from acute pain should
be prioritized first.

2. Fluid volume deficit This is ranked as second because according to Faye

related to excessive
blood loss as evidenced
by vaginal bleeding
Glenn Abdellah’s 21 Nursing problems, it is a sustenal
need to facilitate the maintenance of fluid and
electrolyte balance because having enough blood
to supply the human body especially its vital organs
is important in order for the human body to function
properly. If there is a decrease in circulating blood
volume, this can lead to complications such as
dehydration, hypotension, tachycardia and other
cardiovascular alterations which is life threatening.

In comparison with the Acute Pain which is the first

prioritized problem, as health care providers, we
should prioritize the patient's initial complaint first
which is pain, in order for her to be free from stress,
to be comfortable and for her to be cooperative
with the Nursing and Medical interventions to be
performed in the treatment of the underlying
disease; hence, Acute Pain should be prioritized first
and followed by Fluid Volume Deficit.

In addition, Excessive blood loss is prioritized first

before fatigue because according to the ABC
protocol (Airway-Breathing-Circulation), these are
paramount in any kind of treatment. The patient’s
airway and breathing are fine but the circulation is
in danger. Therefore, it is important to maintain the
circulation of blood in the body to decrease the
occurrence and severity of its complications. Hence,
excessive blood loss must be corrected and

60
 prioritized first before fatigue.

3. Fatigue related to According to Faye Glenn Abdellah’s 21 Nursing

decreased hemoglobin problems, the promotion of optimal activity, rest,
count secondary to sleep and the facilitation of the maintenance of
anemia oxygen supply to all body cells are basic and
sustenal care needs. This must be prioritized in order
for the patient to have energy to function optimally
and perform the activities of daily living
independently.

In comparison with the second prioritized problem,

the Fluid Volume Deficit is an actual problem which
must be prioritized first before Fatigue because the
patient has excessive blood loss which must be
treated first. The blood contains iron within the red
blood cells in the center of the heme whereas it
binds with oxygen. Hemoglobin is found exclusively
in the red blood cells wherein its main function is to
transport oxygen to the different parts of the body. If
there is not enough iron, there would also be not
enough oxygen for transportation and use; therefore
resulting to weakness or fatigue which the patient
experiences. If Deficient Fluid Volume is treated, the
problem with the patient’s fatigue would also be
treated. Hence, Deficient Fluid Volume must be
prioritized before Fatigue.

4. Risk for infection related According to Faye Glenn Abdellah’s 21 Nursing

to impaired immune problems, the promotion of safety through the
system as evidenced by prevention of the spread of infection is a basic need
low white blood cells to all patients. Having an infection may lead to
further complications; therefore, Risk for Infection
must be prioritized.

In addition, the patient had excessive blood loss

which means that her white blood cells have
decreased, without the white blood cells, especially
the neutrophils which are the key components in the
system of defense against infection, the body of the
patient cannot fight the possibility of microorganisms
that will invade the body. The patient is neutropenic
which makes her vulnerable to infections.

In comparison with the third prioritized problem,

Fatigue is an actual problem which must be
prioritized before the Risk for Infection because
according to Maslow’s Hierarchy of Needs, the
physiological and biological needs are thought to
be given the utmost importance. If these needs are
satisfied, the next in line would be the safety needs.
Maslow considered physiological needs as the most
important and all the other needs such as safety
needs become secondary until these needs are
met. Hence, risk for infection is prioritized as fourth.

5. Risk for fall related to This is ranked as fifth because according to Faye
body weakness Glenn Abdellah’s 21 Nursing problems, the
promotion of safety through the prevention of
accident, injury or other trauma is a basic need for

61
the patient. Because the patient has Fatigue, she is
at risk for fall. This could harm the patient if safety
devices such as walker, bed side rails, good lighting,
etc. are not provided. The patient would also require
partial assistance in doing activities of daily living
therefore, significant others must be with her to
prevent falls; hence, this is ranked as the fifth
prioritized problem.

In comparison with the above mentioned nursing

problems, Risk for Fall is prioritized as the fifth
problem because if Deficient Fluid Volume is
treated, Fatigue will also be treated and therefore,
Risk for Fall will be prevented. If these problems are
solved, the patient would be moved towards health.

62
 B. Nursing Care Plans

NCP 1: Acute Pain related to increased pelvic pressure secondary to abnormal growth of tissue in the uterus
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: Since the patient had an STO: Dx: Dx: STO:
abnormal growth of
“Masakit po yung sa tissue in the uterus, The After 30-45 minutes of  Assessed for referred  To help determine After 30-45 minutes of
ibaba ng likod at fibroids pressed against effective nursing pain possibility of underlying nursing intervention
tiyan ko” rated pain the muscles and nerves intervention patient will condition or organ patient was able to
as 7 out of 10 of the lower back be able to report that dysfunction requiring verbalize non
surface of the uterus treatment.
pain is relieved,  Obtained clients pharmacological
Objective: causing pain. The quality  In order to fully understand
of pain is stabbing which controlled, or lessened description of pain clients pain symptom methods that provide
 Observed radiates around her including location, relief
lower back, uterus and LTO: characteristics, onset,
evidence of LTO:
abdomen, the patient duration, frequency,
pain, After 8 hours of nursing quality and intensity
grimaces when in pain
grimaces and rated the pain as 7 intervention patient will  Observed nonverbal  Observations may not be After 3 days of
when in pain, out of 10 using the be able to verbalize non- cues and pain behaviors congruent with verbal effective nursing
guarding numerical rating scale. pharmacological reports or may be only intervention patient
indicator present when was able to report that
behavior methods that provide
client is unable to verbalize pain is controlled and
noted, with relief lessened from 7/10 to
TX:
expressive 3/10
behavior  Accepted the clients  Pain is a subjective
description of pain experience and cannot
Nursing Diagnosis: be felt by others
 Administered analgesics  To maintain acceptable
Chronic Pain related level of pain
as needed
to increased pelvic  Reduces defensive
 Acknowledged the pain
pressure secondary responses, promotes trust,
experience and convey
to abnormal growth
63
of tissue in the uterus acceptance of clients and enhances
response to pain cooperation with regimen

Edx:

 Encouraged
verbalization of feelings  To evaluate coping
when in pain such as abilities and to identify
concern about tolerating areas of additional
about tolerating pain, concern
anxiety, pessimistic
thoughts

 Encouraged diversion  To help lessen the pain felt

activities
 Encouraged adequate  To prevent fatigue that
rest period can impair ability to
manage or cope with pain

64
NCP 2: Fatigue related to decreased hemoglobin count secondary to anemia
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: Hemoglobin is STO: Dx: Dx: STO:
responsible for the cell’s
“Nanghihina ako at ability to transport Within 1 hour of effective  Monitored vital signs  To help determine current GOAL MET
nahihilo minsan.” oxygen and carbon nursing interventions, the health status.
patient will be able to  Assessed sleep patterns  Multiple factors can Within 1 hour of
Objectives: dioxide. Anemia is a effective nursing
condition marked by a verbalize understanding and note changes in aggravate fatigue,
of the need to increase thought processes and including sleep interventions, the
 Decreased reduction in the patient will be able to
activity hematocrit and/ or activity level gradually. behavior. deprivation, emotional
distress, side effects of verbalize
 Overwhelming hemoglobin content of
lack of energy LTO: drugs and understanding of the
the blood.
 Inability to chemotherapies, and need to increase
perform daily Within 48 hours of activity level gradually.
effective nursing developing CNS disease.
routines
intervention, the patient  Assessed ability to  Influences choices of LTO:
 Hemoglobin-
107g/L will report improve sense perform normal task, interventions/ needed
 Hematocrit- of energy; participate in noting reports of assistance. GOAL MET
0.32 L/L desire activities at level of weakness, fatigue, and
 RBC- 3.57 x ability; and identify Within 48 hours of
difficulty in
10^12/L individual areas of control effective nursing
and engage in energy accomplishing task.
intervention, the
Nursing diagnosis: conserving technique. patient will report
Tx: Tx: improve sense of
Fatigue related to  Instructed to change energy; participate in
 Postural hypotension may desire activities at level
decreased position slowly and
hemoglobin count cause dizziness and of ability; and identify
monitor for dizziness. increased risk of injury. individual areas of
secondary to anemia
 Assisted patient when  To conserve energy and control and engage in
moving. avoid injury. energy conserving
technique.

65
Edx: Edx:

 Encouraged  To determine whether

verbalization of feelings
and concerns.
 Educated on the use of
energy conservation
techniques.
 Encouraged nutritional
intake
interventions are successful
or not.
 To reduce oxygen
consumption.
 Adequate intake or
utilization of nutrients is
necessary to meet
increased energy needs
for activity.

66
NCP 3: Fluid volume deficit related to excessive blood loss as evidenced by vaginal bleeding
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: The patient experienced STO: Dx: Dx: STO:
excessive blood loss After 30 to 45 minutes of  Monitored vital signs,  Changes in vital signs are (Goal met)
“Maraming dugo because of the increase nursing interventions, the compare with patient’s associated with fluid
ang lumalabas” production of FSH and patient will be able to: normal or previous volume loss and/or After 35 minutes of
Estrogen that leads to - Demonstrate readings. hypovolemia nursing interventions,
Objective: hyperexcitability of behaviors to  Noted changes in usual  These signs may indicate the patient was able to
uterine muscles that monitor and mentation, behavior and sufficient dehydration to demonstrate behaviors
- Vaginal causes severation and correct deficit, as functional abilities cause poor cerebral to monitor and correct
bleeding damage to blood vessels indicated perfusion or can reflect the deficit, as indicated.
noted, which leads to vaginal - Verbalize effects of electrolyte She was also able to
consuming 7 bleeding. understanding of imbalance verbalize
moderately the purpose of understanding of
soaked therapeutic  Monitored intake and  Provide guidelines for fluid purpose of therapeutic
regular pad. interventions and output replacement interventions and
- Infusion of 2 medications. medications.
units of PRBC Tx: Tx:
LTO:  Maintained bed rest  Activity increases LTO:
After 24 to 48 hours of intrabdominal pressure (Goal partially met)
nursing interventions, the and can predispose to
Nursing diagnosis: patient will be able to: further bleeding After 24 to 48 hours of
- Maintain fluid  Established 24-hr fluid  This prevents peaks and nursing interventions,
Fluid volume deficit volume at a replacement needs and valleys in fluid level the patient was able to
related to excessive functional level routes to be used. maintain fluid volume
blood loss as - Have scanty or if  Provide proper  To avoid other fluid loses at a functional level
evidenced by ever no vaginal ventilation and cool through excessive but have moderate
vaginal bleeding bleeding environment sweating vaginal bleeding.
 Offered ice chips  Fluid electrolyte
followed by clear liquids replacement provides oral
replacement therapy
 IVF administered as  To deliver fluids accurately
67
 ordered and maintained at desired rates
at proper regulation
Edx: Edx:
 Discussed factors related  To reduce risk of
to occurrence of fluid recurrence
deficit as individually
appropriate
 Discussed signs or  This promotes timely
symptoms indicating intervention
need for emergent or
further evaluation and
follow-up like dry mouth,
muscle cramps, oliguria
and heart palpitations.

68
NCP 4: Risk for infection related to impaired immune system as evidenced by low white blood cells
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: Low hemoglobin and STO: Dx Dx: STO:
hematocrit may indicate  Assessed for local or  Opportunistic infections Goal met
Objective: anemia wherein anemia After 30- 45 minutes of systemic signs of can easily develop,
may weaken the effective nursing infection, such as fever, especially in After 30 minutes of
 Bleeding / immune system. intervention the patient chills, swelling, pain, and immunocompromised effective nursing
hemorrhage Weakened immune will able to: body malaise. clients. intervention the patient
 Abnormal system will have a hard  Reviewed drugs being  Identified drugs that may verbalized
laboratory time in fighting invasive - Verbalize administered interfere with the immune understanding of the
bacteria that may lead system condtion and was able
 Hemoglobin- understanding of
to infection. Tx: Tx: to identify ways and
107g/L the condition  Monitored WBC count  A low white blood cell techniques to prevent
 Hematocrit-
count (leukopenia) is a infection
0.32 L/L LTO:
decrease in disease-
 RBC- 3.57 x
fighting cells (leukocytes) LTO:
10^12/L After 48 hours of effective
in your blood. In general, Goal met
 WBC- nursing interventions the
for adults a count lower
4.43 patient will be able to:
than 4,000 white blood After 48 hour of
- Reduce the risk of
cells per microliter of blood effective nursing
Nursing Diagnosis: infection
is considered a low white intervention the patient
- Hemoglobin count
Risk for infection blood cell count. the risk of infection was
displaces to
related to impaired  Instructed the patient to  These can be a source of reduced, hemoglobin
normal
immune system as avoid contact with infection for the count displaces to
evidenced by low people with existing immunocompromised normal.
white blood cells infections.
 Instructed the client to  These food items can
avoid eating raw fruits harbor bacteria. A low
and vegetables and bacterial diet protects the
uncooked meat client from exposure to
pathogens.

69
Edx: Edx:
 Stressed the importance  These preventive measures
of daily hygiene, mouth help avoid skin breakdown
care, and perineal care. and lessen the risk of
infection.
 Oriented the patient and  Practicing hand hygiene is
visitors the proper hand an effective way to
washing prevent infections.
Washing hands can
prevent the spread of
germs, including those that
are resistant to antibiotics.

70
NCP 5: Risk for fall related to body weakness
Assessment Explanation of the
Problem
Subjective: Increased susceptibility
to falling that may cause
Objective: physical harm due to
weakness of the body.
 Observed The patient is risk for fall
limited because she
movement, experiences fatigue at
dizziness
times. There is possibility
that she might fall
unconsciously to
Nursing Diagnosis: dangerous areas or fall
from high risk places.
Risk for fall related to
body weakness
Objective Nursing Intervention Rationale Evaluation
STO: Dx: Dx: STO:
Within 30- 45 minutes  Assessed general status  This is to determine the GOAL MET
nursing intervention of the patient. patient’s condition that
patient will: may cause injury. Within 30-45 minutes of
nursing intervention
 Determined whether  Exposure to community
A. Remain free of patient has:
exposure to community violence has been
injuries.
violence is contributing associated with increase in
B. Be able to explain A. Remained free
to risk for injury. aggressive behavior and of injuries.
methods to depression.
prevent injury. B. Been able to
C. Be able to identify explain methods
 Assessed mood coping  Mood coping abilities and to prevent
factors that abilities, personality style style if personality aid to injury.
increase risk for that may result in determine the patient’s
injuries. C. Been able to
carelessness. level of cooperation. identify factors
LTO: Tx: Tx: that increase risk
for injuries.
Within 24-48 hours of  Thoroughly conform  The patient must get used
nursing intervention patient to surroundings. to the layout of the LTO:
patient will: Put call light within reach environment to avoid GOAL MET
A. Be able to relate and teach how to call accidents. Items that are
intent to practice for assistance; respond to too far from the patient Within 3 days of nursing
call light immediately. may cause hazard. intervention patient
selected
prevention  Avoided use of restraints.  If patients are restrained, has:
measures. Obtained physicians they can sustain injuries,
order if restraints are including strangulation, A. Been able to
B. Be able to
71
increase daily needed.
activities.
 Aid patients sit in a stable
chair with armrests. Limit
use of wheelchairs and
gerichairs except for
transportation as
needed.
Edx:
 Educated patient about
safety ambulation at
home, including the use
of safety ambulation at
home, including the use
of safety measures such
as handrails in bathroom.
 Informed patient’s s/o to
be with the patient to
prevent him or her from
accidentally falling or
pulling out tubes.
asphyxiation, or head relate intent to
injury from leading with practice
their heads to get out of selected
the bed. prevention
measures.
 Patients are likely to fall B. Been able to
when left in a wheelchair increase daily
or gerichair because they activities.
may stand up without
locking the wheels or
removing the footrests.
Edx:
 Patient’s knowledge about
his or her condition is vital
to safety and recovery.
 This is to prevent the
patient from accidentally
falling or pulling out tubes.
72
C. Discharged Plan
Health Teaching
Diet/Nutrition 1. Drink the required amount of fluids or certain
food as prescribed by the physician and also to
improve digestion.
2. Advise the patient to eat foods high in protein
and iron such as chicken, tofu, beans, fish,
peanut butter, nuts, steak, pork, eggs and
cheese. Protein helps build healthy tissue and
heal wounds from the operation. Iron helps
increase red blood cells.
3. Advise the patient to eat foods high in vitamin C
such as broccoli, tomatoes, peppers, oranges,
and strawberries which helps the body use iron
more efficiently. It is also an antioxidant and
helps boost immunity.
Activity 1. Instruct the patient to avoid heavy lifting heavy
objects for a certain amount of time after
surgery. This will help prevent injury to the surgery
wound.
2. Instruct the patient to ask or call health care
providers regarding the proper way of cleaning
the surgery wound.

Medication 1. Explain to the patient the nature of drugs

prescribed.
2. Explain to the patient to give medicine to
decrease pain and to not wait until the pain
becomes severe.
3. Explain to the patient the importance of giving
medicine on the prescribe time and day.
4. Advise the patient to contact healthcare
provider if medicines are not helping or if there
are any unusual side effects.

Other 1. If the patient notices any problems or unusual

symptoms, get medical treatment right away.
2. Remind the patient on follow-up check-up at
BGHMC OB Gyne Outpatient Department.

73
XVI. Learning Insights
A. AL-HAJJ, Meteab A.
I enhanced my nursing skills on how to deal with different patients that
have different diseases. This case presentation helped me to understand the
major factors that could affect the patient. I learned that rather than aiming
for perfection at all tasks, real learning occurs from trial and error. I obtained a
real behind the scenes view of how an organization is run and maintained to
ensure transparency and that the client’s needs are met. This involved at
times juggling multiple tasks and dealing with the frustrations that come with
them. During this stage I found myself attempting to move between different
tasks in the name of multi-tasking. And I have learned the importance of
building rapport with the patient which helped a lot because building rapport
will not only gain the trust of the patient, but also learning things about her
such as her childhood history, medical history, developmental history, outlook
in life and others which are important details for our case study. Not only that I
have learned things about her for our case study, but I have also learned
from her experiences in life which gives me an inspiration to continue caring
for other people especially the poor ones.

B. AL-QUHAIT, Abdulaziz S.
As for our case study, I have learned that we student nurses have
these primary goals in rendering our care to our patient which is to reduce
morbidity, prolong life, improve the quality of life, preserve or restore immune
function and suppress the viral load and prevent new cases of diseases . I
also have learned that every factors in our environment have an effect in our
life. We may ignore it but the thing is we can't see how it affects us. Having
our hospital duty made me realized that we student nurses have a big role in
the life of every individual. We have the chance to make a big difference.

C. AQUINO, Allyza Ashley V.

In this case presentation, we were able to enhance our skills both
individually and working with others. Through this case presentation, we were
able to learn more and enhance our knowledge when it comes to different
diagnosis specifically Leiomyoma Uteri. As a student nurse, we were able to
gain more information about the disease and will lead us to some certain
new facts about the said condition such as cause of disease,
pathophysiology, manifestation, related factors as well as the proper nursing
care management and medical regimens to be rendered. We were able to
learn how to properly manage our chosen patient with the said diagnosis.
Our communication, patience, and teamwork were enhanced throughout
the making of this research paper. The skills and management that we did
with our patient is very helpful especially when it comes to our future
profession. We were able to apply the theories and skills that were taught to
us in school. I believe that there are more experiences like this that would be
very helpful for student nurses like me.

D. BARTOLOME, Gian Gabriel F.

I have learned that any obstacles that we encounter can be done as
long as we help each other out, and support each other. That teamwork is
working collaboratively with a group of people in order to achieve a
common goal. Teamwork means that people will try to cooperate, using their
individual skills and providing constructive feedback, despite any personal
conflict between individuals, as what Henry Ford has said, “Coming together
is a beginning, staying together is a process, and working together is a
success.”

74
E. BORCE, Hazel Mae M.
I have learned that without teamwork we will not be successful in the
completion of our case presentation. It is a challenging requirement but we
didn’t give up since everybody has one goal “Overcome” this case
presentation and fully understand the importance of it.

F. DAIT, Creiamee D.
What I learned when doing the case presentation we somehow need
to speak to one another on what we know or on how we can give ideas on
the case and to help one another so that our work will be finish.

G. EMBES, Cheizl Joy S.

I have learned that to work as a team is a very effective way to pursue
such work. As student nurses, it is important for us to possess qualities as an
individual for a group or team be effective to provide care for our patients
and to deliver service properly. Such as cooperation, effort, initiative and
honesty. Without it we may not be able to create excellence in our tasks.

H. FRONDA, Ihnel Louis C.

The patient had undergone a Total Abdominal Hysterectomy with
Bilateral Salpingo-oophorectomy (TAHBSO) due to Leiomyoma Uteri which
means that she is unable to bear a child of her own due to the surgical
procedure. As a health care provider, I would not only focus on the physical
health of the patient but I will also consider the patient’s mental and
emotional health because witnessing her to go through such an
unanticipated depressing situation is heartrending. I may not have the right to
assume the patient’s personal feelings regarding her hospitalization and all
the procedures that she had gone through but as a human being, I
empathize with the patient because losing parts of a body that are very
important for a woman like her is devastating.
In a situation like this, I have learned that as a health care provider, I
must evaluate the patient’s behavior regarding the actual loss of her
reproductive parts and I must be able to be with the patient and assist the
patient with all that the she needs while maintaining a non-judgmental
attitude towards her. Furthermore, it is very important to listen, acknowledge
and accept the patient’s feelings regarding the loss of her reproductive parts;
and to ask the patient open-ended ended questions only regarding her
feelings.
As a student nurse, I have realized and learned from the patient’s case
that Nursing gives a holistic care to all patients. We must treat our patients as
a whole, not just the illness itself because unfortunately, in most cases, when
we are having duties in the different areas of the hospital and in the
community, we only focus on the illness itself. Therefore, I am looking forward
to have Nursing Psychology classes this coming school year to be able to
expand my knowledge and skills regarding the different approaches that are
suitable to different situations that I may encounter in the hospital, in the
community and in my own personal life.

I. MOICO, Nhica Shane C.

I learnt so much in our case presentation especially in different kinds of
drugs used for the surgery and how our case can truly affect the patient's
health in a deeper level.

J. OYANG-O, Sanclairy Zayde Y.

What I have learned from this case was that a leiomyoma, also known
as fibroids, is a benign smooth muscle tumor that very rarely becomes cancer

75
 (0.1%). They can occur in any organ, but the most common forms occur in
the uterus, small bowel, and the esophagus, and in our patients case it
occurred on her uterus and she had to undergo TAHBSO, A total abdominal
hysterectomy (TAH) is the removal of your uterus (womb) and the cervix
through an abdominal incision. Bilateral salpingo-oophorectomy (BSO), is the
removal of both your fallopian tubes and ovaries, which successfully removed
the fibroids which were in her uterus. Having this patient made me think that
people who are undergoing hysterectomy needs lots of emotional support
because having to undergo hysterectomy is a tough choice most specially in
women who are hoping to become mothers but are not able to because
they have to undergo hysterectomy, so having someone to support them
would be an utmost help.

K. PIAMONTE, Yrvynn C.
Honestly, I was not the one who directly handled the patient, but i was
able to learn a lot from our case by researching and reading materials
regarding leiomyoma uteri. I was able to learn about the risk factors
associated with this type of leiomyoma and understand how these factors
eventually lead to complication just like what happened to the patient in this
case. I think that I will be able to incorporate the proper nursing interventions
that I learned from this case if ever I get to encounter this again.

L. RAMOS, Cresha L.
I have learned that teamwork and establishing of effective rapport
between your group mates as well as with health professionals is necessary for
the delivery of quality patient care. However, a lack of understanding of the
roles, responsibilities and skills of other team members can be an obstacle to
effective communication. Moreover, developing of multitasking skills
emotionally, mentally and physically is also very important for we are
expected to portray a variety of roles. Be it as an educator, communicator,
caregiver, counselor, advocate or as a leader.

M. TABLAC, Viriel Tiffany C.

As for our case study, I have learned that we need to have
determination and perseverance in doing our responsibilities. We must have
teamwork, cooperation and justice for us to be able to do an effective
nursing care to our patients. With this, I have also showed my skills and
potentials in assessing our patient. I have given the chance to build rapport in
order for me to gain information about Leiomyoma Uteri which was
experienced by our patient. Yet, I have expanded my learnings through our
case study, it helped me to be wiser and braver in doing my responsibilities as
a student nurse.

N. TOLIBAS, Eurika P.
I have learned a lot about the case that we have in our case study
which is the Uterine Leiomyoma. Along the way in handling the patient and in
gathering the datas, it gave me a broad knowledge on how to prevent and
manage this illness that threatens woman's health and the ability to bear
child. I have learned the contributing factors of acquiring this disease, that is
why, as a woman, a family and a friend, I could share to all women around
me the things that I have learned about this case which may help them be
aware and prevent this disease.

76
XVII. List of References

Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA.
(2000). “Endometrial polyps: prevalence, detection, and malignant potential
in women with abnormal uterine bleeding.”. Eur J Gynaecol Oncol. 21 (2):
180–183. PMID 10843481

Baxley, E. G. (2008). Pregnancy Interventions. Family Medicine Obstetrics. 102–129.

Cotran R.S., Kumar V., Collins T. (1999). Robbins pathologic basis of disease (6th ed.,
p. 713). : W.B. Saunders.

Collins Dictionary of Medicine Robert M. Youngson 2004, 2005

Doenges, M.E; Mocrehouse, Murr, A.C (2016). Nurses Pocket Guide. 14th Edition . F.A
Davis Company , Philadelphia, Pennsylvania.

Herdman, T. H. (2012). NANDA International Nursing diagnoses: Definitions and

classification 2012-14. Chichester, U.K ; Ames, Iowa: Wiley-Blackwell.

Martin Guha, (2007) "The Gale Encyclopedia of Medicine (3rd edition)", Reference
Reviews, Vol. 21 Issue: 4,

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health,

Seventh Edition. 2003 by Saunders, an imprint of Elsevier, Inc.

Mosby's Medical Dictionary - Elsevier eBook on VitalSource, 10th Edition

Novak, E. R., Jones, H. W., & jones, G.S. (1981). Novaks textbook of gynecology.
Baltimore: Williams & Wilkins.

Phipps, W. J., Cassmeyer, V. L., Sands, J. K., et al. (1995). Medical-Surgical Nursing:
Concepts and clinical Practice (5th Ed.). Missouri: Mosby - Year Book, inc.

Salustiano, R. (2009). Dr. RPS Essential Procedures for Safe Maternity Care: A Guide
Book for Philippine Nurses and Midwives. Quezon City, Philippines: C & E
Publishing, Inc.

Ratcliffe, S. (2008). Family Medicine Obstetrics. Philadelphia, Pennsylvania: Mosby

Elsevier.

WA Newman Dorland Publisher: Philadelphia, PA : Saunders, 2007.

S.K. Laughlin, J.C. Schroeder, and D.D Baird, “New directions in the epidemiology of
uterine fibroids”, Seminars in Reproductive Medicine, vol. 28, no. 3, pp. 204-217, 2010.

S.D. Peddada, S.K. Laughlin, K. Miner et al., “Growth of uterine leiomyoma among
premenopausal black and white women” Proceedings of the National Academy
Sciences of the United States of America, vol. 105, no.50, pp. 19887-19892, 2008.

77
XVIII. Appendices

78
 Appendix A
Approval/Request Letter

Judith A. Layao
Area Head

Thru: Juliet V. Avena

Clinical Coordinator

Dear Ma’am,

Greetings!

We, the Level II Section 1 Group C, would like to reserve the case with a
diagnosis of Leiomyoma Uteri for our case presentation this second
semester of school year 2018-2019. This case was presented to us during
our clinical duty for this semester at Baguio General Hospital and Medical
Center, Gynecology Ward with the dates of February 28, March 1-2, 2019.
Our clinical instructor during our rotation was Ma’am Nora M. Mongolnon.

We have selected this case to further enhance our knowledge and

management regarding this problem that we have chosen.

Thank you very much for your kind consideration and God Bless!

Respectfully yours,
__________________ __________________
Meteab A. Al-Hajj Creiamee D. Dait

_____________________ ___________________
Abdulaziz S. Al-Quhait Cheizl Joy S. Embes

_______________________ ____________________
Allyza Ashley V. Aquino Ihnel Louis C. Fronda

_________________________ ____________________
Gian Gabriel F. Bartolome Nhica Shane C. Moico

____________________ ___________________________
Hazel Mae M. Borce Sanclairy Zayde Y. Oyang-o
____________________ ______________________
Yrvynn C. Piamonte Viriel Tiffany C. Tablac

_________________ _________________
Cresha sL. Ramos Eurika P. Tolibas

Noted by:

Ma’am Nora M. Mongolnon

Clinical Instructor

79
 Appendix B
Interview Guides

1. When did the bleeding occur?

2. How often do you change your pads in a day?
3. How many pads do you consume everyday?
4. When did you subject for a check-up?
5. Is there any history of leiomyoma in your family?
6. When were you diagnosed with leiomyoma?
7. What medications did you take prior to admission?
8. Do you have any present disease before your diagnosis with leiomyoma?
If there is, name it.
9. How long did the bleeding occur?
10. Did you ever thought of trying an alternative treatment such as herbal
medication besides from surgery?

80