Interpretation:

The diagram shows the disease process or the pathophysiology of Ovarian

New Growth or Ovarian Cyst. Benign follicular cysts are also known as benign

ovarian cysts or functional cysts. They're basically fluid-filled pockets of tissue that

form on or in your ovaries. Ovarian New Growth has no known cause, although

studies have connected it to Hormonal Imbalance during hormonal stimulation.

Luteinizing hormone, follicle stimulating hormone, estrogen and progesterone work

together to tell your body to create one egg per month when they are in balance.

However, if there is an imbalance, your ovary may not get the signal it requires to

release the egg, keeping the follicle frozen and poised to grow into an ovarian cyst.

In the first instance, client D.M is exposed to various factors that greatly

influenced the formation of ovarian new growth in her ovaries. Predisposing factor

includes the fact that she is a woman with ovaries making her susceptible to this

disease. Ovarian cysts can affect women of any age; specifically prevalent in women

of reproductive age (15-49 years old) and menopausal age (45-55 years old). They

are also more likely in menstruating females owing to endogenous hormone

synthesis, and client D.M is a 47-year-old woman, making her more vulnerable to

this case. Moreover, women who are classified as obese are more likely to have

ovarian cysts as obesity contributes to hormonal imbalances wherein, an increase in

serum estradiol levels due to obesity might alter the feedback regulation at the

hypothalamus-pituitary axis and contribute to ovarian cyst formation (Ande et. al,

2017), and during the physical examination, client D.M weighs 78kgs and 155 cm tall

resulting in a Body Mass Index (BMI) of 32.5, which falls under the classification of

obese class I for the Asian population.

 On the other hand, the precipitating factors include stress and client D.M is

under stress due to extreme pain that she was experiencing, and stress is also

included as a factor, as increased cortisol (the stress hormone) and -amylase (a

measure of sympathetic nervous system activity) were found in women with

hormonal abnormalities in clinical studies (Woldemeskel, 2017). According to Mayo

Clinic, a long-standing condition like Endometriosis is a factor that contributes to the

emergence of Ovarian new growth. Endometrial cells from the uterus expand outside

the uterus, and some tissue might adhere to the ovary and produce a growth, and in

the case of the client, one of the identified problems by the transvaginal ultrasound

was her existing endometriosis. Another factor is that the client has a history of

Sexually Transmitted Diseases and having a history of STD or Severe Pelvic

Infection, as the infection spreads to the ovaries, or if there is an infection in the

pelvic area, such as gonorrhea or chlamydia, infected ovarian cysts are more likely

to develop. These sexually transmitted diseases' bacteria move from the cervix to

the uterus, where they can create cysts.

During hormonal stimulation, the body signals the hypothalamic neurons to

stimulate the hypothalamus to secrete Gonadotropin-releasing hormone (GnRH)

into the portal circulation, where GnRH receptors on the anterior pituitary are

activated with subsequent secretion of follicle-stimulating hormone (FSH) and

luteinizing hormone (LH). However, in cases with hormonal imbalance, an excessive

concentration of Follicle stimulating hormone (FSH) is released. Consequently,

causes hyperstimulation of the ovaries. Due to the excessive FHS level, the Graafian

follicle will fail to mature, not permitting the follicle to get out in the lining of the

ovaries. Thus, it continues to grow inside the ovaries that contributes now to the

manifestation of an ovarian new growth. As the cyst continues to grow, it causes

compression of nerves endings, leading the existence of lower quadrant pain. Under

the medical management, the medication prescribed by the doctor to alleviate the

pain is Etoricoxib 90 mg once a day. It is associated with adverse effects like

dizziness, headache, drowsiness, constipation, increased blood pressure, and chest

pain. Its nursing management include monitoring of vital signs, especially the blood

pressure, positioning client in a comfortable position by avoiding lying on the painful

side, applying heat pad on lower abdomen to minimize pain, and encourage resting

period. On the other hand, dyspareunia is experienced by the client also due to the

pressure exerted during sexual intercourse.

Furthermore, the diagnostic test done to the client is transvaginal ultrasound

as part of the medical management. Nursing responsibilities includes instructing

client to drink water prior to examination, explain the procedure, provide privacy, use

hypoallergenic latex gloves, and position client in a dorsal recumbent position with

knees flexed. The result of the diagnostic test shows that the left ovary was

cystically, enlarged adherent to the uterus with ground glass echogenicity measuring

8.5cm x 7.56cm x 5.60cm. The right ovary was multiloculated with ground glass

appearance closely adherent to the uterus surrounding bowl, measuring 3.5cm x

4.8cm x 3.04 cm. Thus, confirming the case of ovarian cyst.

If an ovarian cyst is treated, it prevents the tendency of it to become malignant

and the occurrence of other complications. For treatment, the client received a

surgical process called Total Abdominal Hysterectomy and Bilateral Salphingo

Oophorectomy (TAH-BSO), wherein the uterus, fallopian tubes, ovaries, and cervix

are removed by creating an incision in the abdomen. Hysterectomy is considered

among surgeon when a woman is undergoing bilateral ovary removal because of a

suspicious mass because it increases life expectancy, avoid a later second surgery,
and save health care costs; hence, preventing the occurrence of cancer. The nursing

management under this procedure includes assessment of patient’s vital signs to

monitor any deviations from normal. It is vital to obtain consent from the client since

they will undergo an invasive procedure and to orient client about the whole process

assess their knowledge about it. Since TAH-BSO is an invasive procedure, it is

important to put client in NPO status to prior to surgery to prevent aspiration and all

blood thinners must be stopped as it puts client at risk of heavy bleeding. Also, blood

typing is needed to prepare the right blood type for packet red blood cells that will be

used for possible blood transfusions. For the intraoperative care, the patient must be

positioned in a supine position. As part of the postoperative care, assessment for

hemorrhage and other complications is a must for early prevention. Assessing the

incision site is also important. Encourage client to do self-care and early ambulation

but refrain them from doing strenuous activities and lifting heavy objects. Rest is also

prioritized after surgery and wait for six (6) weeks before doing sexual activities or if

the doctor says so. Contrary to this, the growing cyst may cause ovarian torsion and

may rupture if it is left untreated. Ovarian torsion takes place as the ovary continues

to grow causing it to move and twist, and pain will be experienced caused by the

twisting motion. Moreover, if the cyst continues to metastasize, it can eventually

rupture causing pain and hemorrhage and this event greatly influences the process

of homeostasis. Failing to meet homeostasis due to hemorrhage leads to

hypovolemia wherein there is a decrease in blood volume which then leads to

hypoxia where oxygen supply is inefficient. In rare cases, infection, especially of the

cyst already contains abscess, may cause the occurrence of sepsis and the bacteria

will eventually accumulate the brain and cause death.