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I.

INTRODUCTION

Uterine fibroids or uterine myomas, are benign tumors of the uterine smooth
muscle and extracellular matrix and are extremely common in women of reproductive
age. They are noncancerous tumors that grow within or along the walls of the uterus.
They are primarily made up of smooth muscle cells and range dramatically in size. The
cause of uterine fibroids is not known. However, research suggests each tumor develops
from an abnormal muscle cell in the uterus and multiplies rapidly when encountering the
estrogen hormone, which promotes the tumor's growth. Studies also suggest genetics and
prolonged exposure to estrogen may increase the risk of developing fibroids. (Ferri, F.,
2019)

Several factors may affect a woman’s risk for having uterine fibroids, including
the following:

 Age (older women are at higher risk than younger women) - Although it can
develop fibroids at any reproductive age, they're most likely when a woman is in
her 40s to mid-50s.
 Ethnic origin - African-American women are more likely to develop fibroids
compared to other ethnicities.
 Obesity - Women who are overweight are at higher risk for fibroids. For very
heavy women, the risk is two to three times greater than average.
 Family history of uterine fibroids - Having a family member with fibroids
increases a woman’s risk. If a woman's mother had fibroids, her risk of having
them is about three times higher than average.
 No history of pregnancy – Never having given birth to a child or nulliparity is a
risk factor. Increasing parity, on the other hand) is protective against fibroids.
 Eating habits - Eating a lot of red meat (e.g., beef) and ham is linked with a higher
risk of fibroids. Eating plenty of green vegetables seems to protect women from
developing fibroids.

The following are factors that may lower the risk of fibroids:

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 Pregnancy (the risk decreases with an increasing number of pregnancies)
 Long-term use of oral or injectable contraceptives

Although they are noncancerous and extremely common, not all fibroids cause
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 signs and symptoms of uterine
fibroids include:

 heavy menstrual bleeding or menstrual periods lasting more than a week - Uterine
fibroids may put pressure against the uterine lining, which can cause more
bleeding than usual. The uterus may not contract properly, which means it can't
stop the bleeding. Fibroids may stimulate the growth of blood vessels, which
contributes to heavier or irregular periods and spotting between periods.
 pelvic pressure or pain - Pressure on the uterine lining may also cause abdominal
or pelvic pain.
 frequent urination - Furthermore, if fibroids begin to grow larger, or if there are
numerous tumors, they may expand the uterus. This can cause the uterus to
compress the bladder, reducing its capacity to hold enough urine. This, of course,
often results in frequent urination.
 difficulty emptying the bladder - an enlarged uterus can put pressure on the area
where the bladder is connected to the urethra. This can lead to difficulty fully
emptying the bladder.
 Constipation - The uterus lies directly in front of the distal end (last section) of the
colon which controls bowel movements. Fibroids that develop in the back of the
uterus can press on the colon from the outside, which can lead to significant
constipation.
 backache - Rarely, fibroids press against the muscles and nerves of the lower back
and cause back pain.
 Leg pain - This can happen when fibroids become so large that they begin to press
on nerves and blood vessels that extend to the legs, causing immense pain and
discomfort in the legs.

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If the woman is experiencing symptoms from her fibroids — including anemia
from the excess bleeding, moderate to severe pain, infertility issues or urinary tract and
bowel problems — treatment is usually needed to help. The treatment plan will depend
on a few factors, including: the amount of fibroids patient has, the size of fibroids, the
location of the fibroids, the symptoms she is experiencing related to the fibroids, the
desire for pregnancy and the desire for uterine preservation.

The decision to perform surgery for uterine leiomyomata is complex and varies
from patient to patient based on their medical comorbidities, surgical history, clinical
scenario and patient preference. In general, consideration for a hysterectomy is performed
in patients with:

 Excessive uterine bleeding.


 Profuse bleeding causing lifestyle derangements that is refractory to
medical management
 Uterine bleeding that results in anemia
 Pelvic discomfort caused by myoma
 Acute and severe
 Chronic lower abdominal pain or low back or pelvic pressure with
evidence of sizeable leiomyoma on imaging studies
 Leiomyomata that are palpable abdominally

Uterine fibroids are generally harmless and often go away on their own. When
symptoms occur, however, untreated fibroids can interfere with a person’s quality of life
and may lead to complications such as anemia. Anemia is a condition when the body
doesn’t have enough healthy red blood cells to function properly. This can happen when
uterine fibroids cause heavy bleeding.

Some uterine fibroids may also interfere with the probability of becoming
pregnant, and may increase the chance of miscarriage, but more research is needed here.
In these cases, treatment can help people become and stay pregnant.

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Rarely, uterine fibroids can become very large, twisted, or infected. These
situations can create symptoms that are intense, and may require immediate medical
treatment.

Myomas affect, with some variability, all ethnic groups and approximately 50%
of all women during their lifetime. While some remain asymptomatic, myomas can cause
significant and sometimes life-threatening uterine bleeding, pain, infertility, and, in
extreme cases, ureteral obstruction and death.

A study conducted in 2016 by Chibber, S. et. Al., suggests that there are
significant ethnic differences in fibroid prevalence and related uterine anatomy even in
asymptomatic women. The research found that when compared to other groups, fibroid
prevalence and size remained the highest among African American women. Rates in East
Asian women and South Asian women were similar to those found in Caucasian women.
Rates and sizes were lowest among Hispanic women, which could indicate later age of
onset and/or a different pathophysiology. Comparisons of uterine anatomy also showed
that African American women had significantly larger ovarian volumes and thicker
endometrium. Collectively, these results warrant an exploration of ethnic-specific
consideration when developing treatment options for patients with fibroids.

In relation to that, a research conducted by (Murji, A. et. Al., 2020) concluded


that Black and East Asian women have an increased clinical manifestation of uterine
fibroids compared to White women and prefer uterine preservation. There is a
discrepancy between disease burden and patient-reported outcomes that may reflect
ethnocultural differences in disease experience.

It’s extremely rare for a fibroid to go through changes that transform it into a
cancerous or a malignant tumor. In fact, one out of 350 people with fibroids will develop
malignancy. There’s no test that’s 100% predictive in detecting rare fibroid-related
cancers. However, people who have rapid growth of uterine fibroids, or fibroids that
grow during menopause, should be evaluated immediately.

In 2019, a study was conducted by the Philippine Obstetrical and Gynecological


Society wherein 135 accredited hospitals all over the Philippines submitted their census

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on the number of obstetric and gynecologic cases from January 2019 to December 2019.
A total of 365,947 cases were reported, 11% (39,921) were gynecologic cases.

Among the 39,921 gynecologic cases reported, Leiomyoma (24%), Abnormal


Uterine Bleeding-Polyp (AUB-P) (22%), and Abnormal Uterine Bleeding-Malignancy
(AUB-M) (12.87%) were the top gynecologic diagnosis.

II. BIOGRAPHICAL DATA

Name: Ma. Bering

Age: 50

Ward: OB Gyne

Sex: Female

Birthdate: August 18, 1972

Birthplace: Bangued, Abra,Philippines

Address: Zone 7, Bangued, Abra, Philippines

Nationality: Filipino

Religion: Roman Catholic

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Occupation: Housewife

Case Number: 025264

Date of Admission: February 17, 2023

Time of Admission: 8:45 am

Admitting Diagnosis: G1 P1(1001) Myoma Uteri

Final Diagnosis: G1 P1(1001) Myoma Uteri

Admitting Physician: Dr. Berna

Attending Physician: Dr. Berna

III. NURSING HISTORY


A. Past history

The patient stated that she had experienced mumps, measles, common coughs, colds,
and flu when she was a kid and was treated without the supervision of a physician. She
also stated that she experienced an allergy to chicken and had a kidney stone during her
high school days. She also experienced difficulty breathing that she described felt as if
riding a Ferris wheel or roller coaster. In her adulthood, she was hospitalized during her
pregnancy with her son, who underwent normal spontaneous delivery.

B. Present history

On April 20, 2020, she went for a check-up because she was experiencing menstrual
periods 3 times a month and was concerned that it was no longer normal. On her first
doctor they thought it's just a sign for menopausal. Then, she went to the medical center
in Calaba and the medical center in Dagupan, Pangasinan, and their diagnosis was
myoma.

On February 17, 2023, she went to the Abra Provincial Hospital to get more information
and confirmation about her case. After a routine assessment, her admitting doctor, Dr.

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Gross, ordered a complete blood count (CBC) test. She underwent laboratory work and
an ultrasound, which revealed a G1-P1 (1001 type) myoma uteri.

C. Obstetric History

GTPALM scoring

G– 1, T – 1, P – 0, A – 0, L – 1

 Menstrual History
a. Past Menstrual Cycle
o Regularity
- Patient stated she had a regular menstruation since her first period
o Amount of bleeding
 Number of days
- The patient reported of having three to four days of
menstrual bleeding per 28 days of menstrual cycle.
 Volume
- The patient reported having a normal flow, and consuming
at least 7-8 pads per menstrual period.
o Associated pain.
- The patient reported having menstrual cramps during menstruation.

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IV. ANATOMY AND PHYSIOLOGY

UTERUS

The corpus is further


divided into the lower uterine
segment and the fundus. The
cervix is a narrow cylindrical
passage which connects at its
lower end with the vagina. At
its upper end, the cervix
widens to form the lower
uterine segment (isthmus); the lower uterine segment in turn widens into the uterine
fundus.

The corpus is the body of the uterus which grows during pregnancy to carry a
fetus.

Extending from the top of the uterus on either side are the fallopian tubes
(oviducts); these tubes are continuous with the uterine cavity and allow the passage of an
ova (egg) from the ovaries to the uterus where the egg may implant if fertilized.

The thick wall of the uterus is


formed of three layers: endometrium,
myometrium, and serosa. The
endometrium (uterine mucosa) is the
innermost layer that lines the cavity of the
uterus.

Throughout the menstrual cycle,


the endometrium grows progressively thicker with a rich blood supply to prepare the
uterus for potential implantation of an embryo. In the absence of implantation, a portion
of this layer is shed during menstruation.

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The myometrium is the middle and thickest layer of the uterus and is composed of
smooth (involuntary) muscle. The myometrium contracts during menstruation to help
expel the sloughed endometrial lining and during childbirth to propel the fetus out of the
uterus. The outermost layer, or serosa, is a thin fibrous layer contiguous with extrauterine
connective tissue structures such as ligaments that give mechanical support to the uterus
within the pelvic cavity. Non-pregnant uterine size varies with age and number of
pregnancies, but is approximately three and a half inches long and weighs about one sixth
of a pound.

UTERINE FIBROIDS

Uterine leiomyomas, commonly


known as fibroids, are well-
circumscribed, non-cancerous tumors
arising from the myometrium (smooth
muscle layer) of the uterus. In addition
to smooth muscle, leiomyomas are also
composed of extracellular matrix (i.e.,
collagen, proteoglycan, fibronectin).
Other names for these tumors include
fibromyomas, fibromas, myofibromas,
and myomas.

Leiomyomas are the most common solid pelvic tumor in women, causing
symptoms in approximately 25% of reproductive age women. However, with careful
pathologic inspection of the uterus, the overall prevalence of leiomyomas increases to
over 70%, because leiomyomas can be present but not symptomatic in many women. The
average affected uterus has six to seven fibroids.

Leiomyomas are usually detected in women in their 30's and 40's and will shrink
after menopause in the absence of post-menopausal estrogen replacement therapy. They
are two to five times more prevalent in black women than white women. Risk for

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developing leiomyomas is also higher in women who are heavy for their height and is
lower in women who are smokers and in women who have given birth. Although the high
estrogen levels in oral contraceptive pills have led some clinicians to advise women with
leiomyomas to avoid using them, there is good epidemiologic evidence to suggest that
oral contraceptive use decreases the risk of leiomyomas.

Leiomyomas are classified by their location in the uterus. Subserosal leiomyomas


are located just under the uterine serosa and may be pedunculated (attached to the
corpus by a narrow stalk) or sessile (broad-based). Intramural leiomyomas are found
predominantly within the thick myometrium but may distort the uterine cavity or cause
an irregular external uterine contour. Submucous leiomyomas are located just under the
uterine mucosa (endometrium) and, like subserosal leiomyomas, may be either
pedunculated or sessile. Tumors in subserosal and intramural locations comprise the
majority (95%) of all leiomyomas; submucous leiomyomas make up the remaining 5%.

Although this classification scheme is widely used by clinicians, it suffers from


the limitation that few leiomyomas are actually a single "pure" type. Most leiomyomas
span more than one anatomic location and, therefore, are hybrids (e.g., a predominantly
intramural leiomyoma with a submucous component). Other types of leiomyomas include
"parasitic" myomas, which receive their blood supply from structures other than the
uterus (e.g., the omentum), and seedling myomas, which have a diameter of less than or
equal to four millimeters.

Transformation of uterine leiomyomas (benign) to


uterine leiomyosarcomas (malignant smooth muscle tumors of the uterus) is extremely
rare, and, in fact, many researchers and clinicians believe this type of transformation
never occurs. However, without pathologic examination of the uterus, this determination
is not possible. Uterine leiomyosarcomas are found in approximately 0.1% of women
with leiomyomas and are reported to be more frequently associated with large or rapidly
growing fibroids. Therefore, surgical intervention may be undertaken in women with
these types of tumors to rule out leiomyosarcoma, a rare but medically important lesion.

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V. PATHOPHYSIOLOGY

Predisposing factor: Precipitating factor:


Age (40) Eating habits
Obesity
↑Adipose tissue
↑Estrogen Production
Estrogen stimulates Conversion of androgens
proliferation of uterine into estrogen
smooth muscles

Benign proliferation of
monoclonal myometrial cells
into discrete masses

MYOMA UTERI

↑Endometrial Surface ↑ Stimulation ↑ Pressure on


Area: 10.03 cm growth of Blood Endometrium
Vessels

Frequent Urination
Uterine Bleeding

Constipation

Difficulty emptying
Anemia bladder

Pelvic pressure or
pain

↑Chance of
miscarriage

↓Fertility

LEGEND
DIAGNOSIS CLINICAL MANIFESTATION COMPLICATIONS 12
For women at the reproductive age, there is increased estrogen production.
Estrogen stimulates proliferation of uterine smooth muscles. Factors like abnormal
weight (overweight), increased adipose tissue, and the conversion of androgens into
estrogen can cause benign proliferation of monoclonal myometrial cells into discrete
masses called myomas.

Submucosal myomas put pressure on the uterine lining causing an increase in the
endometrial surface area which can cause abnormal bleeding.

Fibroids can also stimulate the growth of blood vessels which contribute to heavy
menstrual bleeding and spotting between periods. Anemia can be caused by uterine
bleeding and is one of the complications of untreated fibroids.

Fibroids putting pressure on the uterine lining can also affect surrounding organs
like the bladder and the colon which lead to frequent urination, difficulty voiding the
bladder and constipation.

Myomas can also press against nerves and blood vessels of the lower back which
can cause back pain and leg pain.

When left untreated, complications like infertility, higher chances of miscarriages,


anemia can occur.

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VI. Laboratory and Diagnostic Tests

Parameter Result Ref. Range


WBC 5.3 x 10^3/uL 4.0 - 10.0
Lymph # 2.4 x 10^3/uL 0.8 - 4.0
Mid # 0.7 x 10^3/uL 0.1 - 1.5
Gran # 4.5 x 10^3/uL 2.0 - 7.0
Lymph % 30.1 % 20.0 - 40.0
Mid % 11.8 % 3.0 - 15.0
Gran % 42.6 % 50.0 - 70.0
HGB L 8.6 g/dl 11.0 - 15.0
RBC 4.22 μ 10^6/uL 3.50 - 5.00
HCT L 25.4 % 37.0 - 47.0
MCV L 71.9 fL 80.0 - 100.0
MCH L 18.3 pg 27.0 - 34.0
MCHC L 29.8 g/dL 32.0 - 36.0
RDW - CV H 20.0 % 11.0 - 16.0
RDW - SD 44.6 fL 35.0 - 56.0
PLT H 367 x 10^3/uL 100 - 300
MPV 9.3 fL 6.5 - 12.0
PDW 16.5 9.0 - 17.0
PCT 0. 276 % 0.108 - 0.282

SIGNIFICANCE

 Low level of HGB indicates excessive blood loss due to uterine bleeding that
causes anemia
 Low levels of RBC indicate excessive blood loss due to uterine bleeding that
causes anemia
 Low levels of HCT indicates low level of RBC due to excessive blood loss due to
uterine bleeding that causes anemia
 Low levels of MCH indicates smaller RBC size, and low levels of HGB due to
uterine bleeding that causes anemia
 low levels of MCHC indicates smaller RBC size, and low levels og HGB due to
uterine bleeding that causes anemia
 Low levels of MCV indicates a smaller size of RBC due to low HGB due to
excessive blood loss due to uterine bleeding that causes anemia
 High levels of RDW-CV indicate: most of the RBC are different in size.
 High PLT indicates presence of uterine bleeding that causes anemia

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Test Concentration Unit Result Remark Reference
CHOLESTEROL 235.7 mg/dL ^ RFH <=200.0
TRIGLYCERIDE 106.9 mg/dL Normal <=150.0
GLUCOSE 100.44 mg/dL ^ RFH 71.00-
HEXOKINASE 99.00
HDL 46.2 mg/dL Normal 40.0-60.0
CREATININE 0.8 mg/dL Normal 0.6-1.1
SOX
BLOOD UREA 18.4 mg/dL Normal 6.0-24.0
NITROGEN
LDL 140.91 mg/dL ^ RFH <=135.00

SIGNIFICANCE
 Your total cholesterol and HDL (good) cholesterol are among numerous factors
your doctor can use to predict your lifetime or 10-year risk for a heart attack or
stroke. Your doctor will also consider other risk factors, such as age, family
history, smoking status, diabetes and high blood pressure.
 the elevated hexokinase activity resulted in enhanced glycolysis and increased
glycogen storage in the heart, indicating that glucose phosphorylation is an
important step determining cardiac glucose utilization.
 LDL (low-density lipoprotein) cholesterol, sometimes called “bad” cholesterol,
makes up most of the body's cholesterol. High levels of LDL cholesterol raise the
risk for heart disease and stroke.

15
VII. DRUG STUDY
DRUG STUDY
Mechanism of
Generic Name Indication Nursing Implications Rationale
Action
Tramadol Tramadol modulates Tramadol is used to 1. Check the medication ordered.  To ensure that the
the descending pain relieve moderate to medication was
pathways within the moderately severe 2. Read the medication ordered.
Brand Name information.
central nervous pain. Tramadol  To have adequate knowledge
Ultracet
system through the extended-release about the drug.
binding of parent and tablets and capsules 3. Assess for hypersensitivity
Classification M1 metabolite to μ- are only used by to the drug.  To decrease the incidence
Opiate opioid receptors and people who are 4. Check the dose, time, and of untoward reactions.
(narcotic)analgesic the weak inhibition of expected to need route.  To ensure the desired
the reuptake of medication to relieve dose, frequency, and right
norepinephrine and pain around-the-clock. 5. Perform hand hygiene. route.
serotonin.
D.R.F.F.T  To prevent
6. Prepare medications for one contamination/spread of
Dosage:100mg patient at a time. microorganisms.
Route: IV  To prevents errors in
Frequency: q8 7. Identify the patient. medication administration.
Form: Vial  To ensures the right patient
Timing: 9:00 am, 5:00 pm, 1:00 am 8. Perform necessary receives the medications and
Precautions Contraindications assessment prior to helps prevent errors.
Use cautiously with the following Contraindicated with the medication administration.  To establish specific
conditions: following conditions: 9. Explain the purpose and parameters prior to
This medicine may cause adrenal Tramadol is contraindicated action of medication to the administration.
gland problems. Check with your in patients who have had a patient.  To reduce anxiety, to gain
doctor right away if you have hypersensitivity reaction to any compliance, and to know
darkening of the skin, diarrhea, opioid.  10. Assist the patient to an what to expect.
dizziness, fainting, loss of appetite, upright position. (Note:  To protects the patient
mental depression, nausea, skin depending on the route of from aspiration
rash, unusual tiredness or administration).
11. Store the medicine at room  To preserve the medicine.
weakness, or vomiting.
temperature away from
moisture and heat.
12. Document the administration  Timely documentation helps
of the medication immediately to ensure patient safety.
after administration.
Side Effects Adverse Reactions (Note: depending on the route of
.  shallow administration).
 Headaches breathing,
 Feeling sleepy  difficulty or
 Feeling or being sick noisy breathing,
 Dry mouth  confusion,
 Sweating  more than usual
 Low energy sleepiness

DRUG STUDY

16
Generic Name Mechanism of Indication Nursing Implications Rationale
Action
Tranexamic Acid The binding of Decrease heavy 1. Check the medication ordered.  To ensure that the
plasminogen to fibrin menstrual bleeding and medication was ordered.
induces fibrinolysis - by cause necrosis of the 2. Read the medication  To have adequate knowledge
Brand Name occupying the necessary fibroids. information. about the drug.
Cyklokapron binding sites tranexamic
acid prevents this 3. Assess for hypersensitivity to  To decrease the incidence of
dissolution of fibrin,
Classification the drug. untoward reactions.
thereby stabilizing the clot  To ensure the desired dose,
Antifibrinolytics 4. Check the dose, time, and
and preventing frequency, and right route.
hemorrhage. route.
D.R.F.F.T 5. Perform hand hygiene.
 To prevent
Dosage:1gram contamination/spread of
microorganisms.
Route: IV 6. Prepare medications for one
 To prevents errors in
Frequency: q 8 patient at a time. medication administration.
Form: Ampule  To ensures the right patient
7. Identify the patient.
Timing: 7am, 3pm, 11pm receives the medications and
Precautions Contraindications 
helps prevent errors.
Before taking tranexamic acid, tell Tranexamic acid can cause 8. Perform necessary assessment To establish specific
your doctor or pharmacist if you are fibroid necrosis and prior to medication parameters prior to
allergic to it; or if you have any infarction, resulting in pain administration.
administration. 
other allergies. This product nay and providing a site for To reduce anxiety, to gain
9. Explain the purpose and action
contain inactive ingredients, which infection. Tranexamic acid compliance, and to know
of medication to the patient. what to expect.
can cause allergic reactions or other has been associated with 
problems. deep vein thrombosis and 10.Assist the patient to an upright
To protects the patient from
is therefore contraindicated aspiration
position. (Note: depending on
in women who have or are
the route of administration).
at risk of developing 
thromboembolic disease. 11.Administer the medications: To facilitate swallowing of
a. Offer water. solid drugs.

To encourage the patient’s
b. Ask the patient preference participation in taking the
Side Effects Adverse Reactions
in taking the medications  medications.
 diarrhea  seizures, by hand or in a cup. To ensure that the drug is
 dizziness  pulmonary embolism, c. Remain with the patient swallowed.
until each medication is 
 nausea and vomiting,  deep vein thrombosis, To preserve the medicine.
swallowed.
 muscle pain.  anaphylaxis, 
12.Store the medicine at room Timely documentation helps
 headaches, temperature away from to ensure patient safety.
 backache, moisture and heat.
 abdominal pain, 13.Document the administration
of the medication immediately
 nausea, after administration.
 vomiting, (Note: depending on the route of
administration).
 diarrhea,
 fatigue,

DRUG STUDY

17
Mechanism of
Generic Name Indication Nursing Implications Rationale
Action
Ketorolac Anti-inflammatory Short-term 1. Check the medication ordered.  To ensure that the
and analgesic management of medication was
2. Read the medication ordered.
Brand Name activity; inhibits moderating severe information.  To have adequate knowledge
Toradol prostaglandins and acute pain for about the drug.
leukotriene single dose 3. Assess for hypersensitivity
Classification synthesis treatment to the drug.  To decrease the incidence
4. Check the dose, time, and of untoward reactions.
Anti-pyretic route.  To ensure the desired
NSAID dose, frequency, and right
D.R.F.F.T 5. Perform hand hygiene. route.
Dosage: 30 mg (3 dose)
 To prevent
Route: IV 6. Prepare medications for one contamination/spread of
Frequency: q6 patient at a time. microorganisms.
Form: Ampule  To prevents errors in
7. Identify the patient. medication administration.
Timing: 9 am, 3 am
Precautions Contraindications  To ensures the right patient
Use cautiously with the following Contraindicated with the 8. Perform necessary receives the medications and
conditions: following conditions: assessment prior to helps prevent errors.
Be aware that patient may Contraindicated medication administration.  To establish specific
9. Explain the purpose and parameters prior to
be at risk for CV events, GI with significant action of medication to the administration.
bleeding, renal toxicity, renal impairment, patient.  To reduce anxiety, to gain
monitor accordingly. aspirin allergy, compliance, and to know
recent GI bleed or 10. Assist the patient to an what to expect.
upright position. (Note:  To protects the patient
perforation Use from aspiration
depending on the route of
cautiously with administration).
impaired hearing; 11. Store the medicine at room  To preserve the medicine.
allergies; hepatic temperature away from
conditions. moisture and heat.
12. Document the administration  Timely documentation helps
Side Effects Adverse Reactions of the medication immediately to ensure patient safety.
 Headache  CV: edema after administration.
 Dizziness  EENT: tinnitus (Note: depending on the route of
administration).
 Diarrhea  GI: dyspepsia, GI
 Sweating pain, peptic
 Somnolence ulceration,
 Constipation stomatitis, GI
hemorrhage
 GU: renal
impairment
 Other: pain at
injection site

VIII. NURSING CARE PLANS

18
NURSING CARE PLAN
Assessment

Objective Data:
-VS taken as follows: - Grimacing
Temperaure – 35.1 °C - Pain Scale: 8/10
BP – 150/80 mmHg
PR – 59 bpm
RR – 27 BPM
SpO2 – 98 %

Nursing Diagnosis

Acute pain related to postoperative surgical incisions as evidenced by subjective and objective cues

Planning

After 4 hours of nursing intervention, patient will be able report pain is relieved/controlled.

Nursing Interventions Rationale


 Assessed level of pain and monitored VS  Serves as baseline data
 Obtained client assessment to pain  To rate out worsening of underlying
including location, characteristics, condition/development of complications.
onset/duration, intensity, precipitating,
and aggravating factors.
 Evaluated client’s response to analgesic  Increasing or decreasing dosage, stepped program
and assisted in transitioning or altering helps in self-management of pain.
drug regimen, based on individual needs
and protocols.
 Acknowledged the pain experience and
 Reduces defensive responses, promotes trust, and
convey acceptance of client’s response to
enhances cooperative with regimen.
pain.
 Encouraged adequate rest periods.
 To prevent fatigue that can impair ability to manage
or cope with pain.
 Discussed with SO(s) ways in which they
 Family members/SOs was provided assistance by
can assist client with pain management.
transporting client to prevent walking long
distances, or by taking on client’s strenuous chores,
supporting timely pain control, encouraging eating
nutritious meals to enhance wellness, and providing
gentle massage to reduce muscle tension.
 To maintain acceptable level of pain.
 Administered analgesics, such as
Ketorolac and Cefuroxime as indicated.

Evaluation

After 4 hours of rendering nursing intervention, patient did not report decreased pain.
 Goal unmet

NURSING CARE PLAN


Assessment

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Objective Data:
 VS at home. - with surgical incision at the lower abdominal area
T- 36.4 C - with dry intact dressing at the surgical site
BP- 100/70 mmHg
PR- 55 bpm
RR- 18 BPM
SpO2- 97%

Nursing Diagnosis

Impaired Skin Integrity related to surgical procedure

Planning
Within 2 hours of nursing intervention, the patient will be able to manifest dry and intact wound dressing.

Nursing Interventions Rationale


 Assessed operative site for redness,  To check integrity monitor progress of healing
swelling, lose sutures, or soaked dressing
 Monitored VS  Serves as baseline data
 Encouraged patient to verbalize her any  To allow continuous monitoring and assessment of
untoward feelings especially pain, patient condition
discomfort as well as changes noted in
operative site
 Encouraged patient to engage ambulation  To promote circulation to the surgical site for
and have her SO assist her in such activities timely healing
 Instructed patient and SO to refrain from
touching/scratching operative site  To avoid accumulation of moisture at the operative
 Provided regular dressing care site this may lead to skin breakdown
 To prevent harbor in operative site

Evaluation

After 2 hours of nursing intervention, the patient has able to manifest dry and intact wound dressing.

NURSING CARE PLAN


Assessment

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Objective Data:
-VS at home. - Grimacing
Temperaure – 36.4 °C - (+) surgical incision intact dressing
BP – 100/70 mmHg
PR – 55 bpm
RR – 18 BPM
SpO2 – 97 %

Nursing Diagnosis
Risk for infection related to post-operative surgical incision.
Planning
After 1 hour of nursing interventions, patient will have knowledge in identifying the risk factors
of infection, and be free from any signs and symptoms of related to infection.
Nursing Interventions Rationale
 Assessed for presence of host-specific factors
that affect immunity:
1. Extremes of age  Elderly and newborn are more susceptible to disease and
infection than the general population
2. Presence of underlying disease  The client may have a disease that directly impacts the
immune system or may be weakened by prolonged
diseases conditions
3. Lifestyle  Personal habits or living situations such as persons
sharing close quarters and/or equipment
4. Nutritional status  Malnutrition weakens the immune system; elevated
serum glucose levels provide growth media for
pathogens
5. Trauma  Loss of skin and tissue integrity, invasive diagnostic
procedure or surgery, premature rupture of amniotic
membrane, urinary catheterizations, sharps, and
needlesticks are common paths of pathogen entry
 That could be signs of developing localized infection
 Changes in skin color and warmth at insertion
 That could be signs of developing systemic infection
sites of invasive lines, sutures, surgical incisions,
and wounds  To help the patient identify the present risk factors that
may add up to the infections.
 Changes in mental status, skin warmth and color,
heart, and respiratory rate  To help the client modify/changed avoid some of the
environmental factors present which could reduce the
 Note risk factors for occurrence of infection in
incidence of infection.
incision.
 Antibiotics will help kill and stop the proliferation and
 Shared health teachings especially in
growth of the bacteria which could cause infection.
identification of environmental risk factors that
could add up on infection.
 Taking antibiotics such as Cloxacillin, as ordered
by the physician.
Evaluation
After 1 hour of nursing intervention, patient was able to gain knowledge and was able to identify the risk factor of
infection, and freed from any signs and symptoms of related to infection.

IX. DISCHARGE PLAN AND HEALTH TEACHINGS

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Patient may resume a normal diet after returning home. Limit activity for 2 weeks
following surgery. Climbing stairs, walking, and light housework may be resumed at
patient’s own pace. No lifting, pushing, or pulling anything greater than 10 pounds for 6
weeks following surgery. Patient may resume driving 2 weeks following surgery. No
sexual intercourse, tampons, or douching for 6 weeks following surgery. Patient may
shower any time after returning home.

Patient must avoid heavy lifting (more than 3–4 kg) for 4–6 weeks, depending on the
advice of the surgeon. This will depend on the method of the surgery.

MEDICATIONS:

Advice the patient to follow and take the prescribed medication regimen needed
for effective treatment and fast recovery.

Patient may be prescribed antibiotics to help treat or prevent infection. Remind


patient to be sure to take all of the antibiotics even if he/she starts to feel better.

Patient may be prescribed pain medicine. Remind patient to not wait until the pain
becomes severe before taking the medicine. It may not work as well if he/she waits too
long to take it between doses.

EXERCISES:

 Instruct the patient to limit heavy exercise and plan regular naps and quiet
activities gradually increasing over the following weeks
 Instruct the patient to ambulate by walking around the house for a short period

TREATMENT:

 Encourage patient to eat nutritious foods such as fruits and vegetables


 Educate and perform the patient on how to aseptically clean the umbilical cord of
the baby

HYGIENE:

 Educate the patient about proper hygiene and its importance

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 Instruct the patient to keep incision clean and dry. It’s OK to wash the skin
around your incision with mild soap and water.
 Don’t use oils, or creams on your incision. Ask your healthcare provider before
using lotions on your incision

OUT-PATIENT:

 Advise the patient to come back for follow up checkup


 Instruct to notify the physician if any problem or complication arises
 Instruct patient to visit the healthcare provider again to be sure you are healing
well as well as to keep all follow-up appointments. Be sure to tell healthcare
provider if you have hot flashes, mood swings, or irritability. Medicine may help
ease these symptoms.

DIET:

 Follow any diet instructions given by your healthcare provider. You may need to
start with liquids and then slowly add solid foods back into your diet.
 Encourage the patient to eat nutritious foods like fresh fruits, vegetables, and
whole grains to provide the right energy it needs
 If you have constipation, your healthcare provider may tell you to add more fiber
to your diet. You may also be told to use a laxative or stool softener. These can
often be bought over the counter.
 To help your body recover from surgery, eat a well-balanced diet that includes a
variety of foods. Include proteins such as lean meat, fish, eggs, milk, yoghurt,
nuts, and legumes/beans
 Instruct the patient to Drink plenty of fluids

SPIRITUALLY:

 Instruct the patient always to pray and have faith in God in regard to her heal
 You may feel a sense of loss and sadness after having a hysterectomy. Talking to
other women who have had a hysterectomy may help by providing emotional
support and reassurance

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X. REFERENCES
Stewart EA, et al. (2019). Uterine leiomyomas (fibroids): Epidemiology, clinical
features, diagnosis and natural history.
https://www.uptodate.com/contents/search.
Stewart, E. A. (2015). Uterine fibroids. New England Journal of Medicine.
https://www.nejm.org/doi/full/10.1056/NEJMcp1411029?page=&sort=oldest
Cleveland Clinic. Uterine fibroids. https://my.clevelandclinic.org/health/diseases/9130-
uterine-fibroids
Dr. Nithin Jayan. (2018, July 06). Causes of Uterine Fibroids | Fibroids in Uterus.
Medindia. https://www.medindia.net/patients/patientinfo/fibroids-in-uterus-
causes.htm.
Weiss, K. (2020). The Link Between Uterine Fibroids and Heavy Menstrual Bleeding.
https://www.everydayhealth.com/womens-health/uterine-fibroids-heavy-
menstrual-bleeding/
USA Fibroid Centers. Fibroids Frequent Urination in Women.
https://www.usafibroidcenters.com/uterine-fibroid-symptoms/frequent-urination/
#:~:text=If%20fibroids%20begin%20to%20grow,often%20results%20in
%20frequent%20urination.
Lipman, J. (Sept. 2020). Ask Dr. John Lipman: “Can Fibroids Cause Constipation?”
Atlanta Fibroid Center. https://atlii.com/can-fibroids-cause-constipation/
Macauayon, A. et. Al. (2020). POGS 2019 Report of Obstetrical and Gynecological
Indicators of Healthcare. Philippine Obstetrical and Gynecological History.
http://pjog.org/article-detail.php?id=227
NIHR (2020, July 30) “New research reveals important discovery for women who have
fibroids”. https://www.nihr.ac.uk/news/new-research-reveals-important-
discovery-for- women-who have-fibroids/25163

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