Davao Doctors College, Inc.

General Malvar St.,

Davao City
Nursing program

Nursing Management of a patient with Problems in Reproductive

UTERINE MYOMA

A Case Study Presented to the Nursing Clinical Instructor of

Davao Doctors College, Inc.

In Partial Fulfillment of the Requirements

In teo day of hospital exposure at Davao Doctors Hospital

Pacilan, Troy James S., Ronquillo, Coby Jay D., Sayon, Maria Andrinna T.,
Taha, Sheanna A., Tiquio, Stella Joy Y., Trinidad, Dana Marie L.,
Venteroso, Kaye P., Zainal, Hadeel Q.

November 2023
 Table of Contents

I. Objectives............................................................................................................................3
II. Introduction........................................................................................................................5
III. Patient Profile.....................................................................................................................6
Biographic Data......................................................................................................................... 6
Clinical Data.............................................................................................................................. 7
Past Health History.................................................................................................................... 7
Present Health History............................................................................................................... 7
Family Background....................................................................................................................7
Genogram...................................................................................................................................8
IV. Health Assessment............................................................................................................. 9
Comprehensive Health Status.................................................................................................. 11
V. Review of Anatomy and Physiology............................................................................... 22
VI. Pathophysiology............................................................................................................... 26
Definition................................................................................................................................. 26
Etiology....................................................................................................................................26
Symptomatology...................................................................................................................... 28
VII. Course in the Ward/Treatment/ Intervention............................................................... 33
Doctor’s Progress notes........................................................................................................... 33
Laboratory/Diagnostic Examination........................................................................................38
Surgical Management.............................................................................................................. 48
VIII. Nursing Management...................................................................................................... 67
IX. Discharge Planning.......................................................................................................... 80
REFERENCES.............................................................................................................................83
 Objectives

At the end of the 3-day hospital exposure at Davao Doctors Hospital’s 3D Medical Ward,

the level III nursing students from Group 44 of BSN 13K aim to create a comprehensive care

analysis in caring for patients with problems in Uterine myoma that will subject to learn in the

development of an overall health plan by fostering individual health after appropriate teachings,

management, and interventions. Furthermore, it would improve our individual knowledge and

skills in implementing a proper and effective nursing approach. Thus, the group will provide a

relevant, practical, credible, and evidence-based case study about the situation and interventions

in this scope, assisting in skill development and ensuring that patients receive the best possible

care.

Specific Objectives

Within the span of the case analysis, the following specific objectives will guide us to

accomplish our general objective. Specifically, the group aims to attain the following objectives:

• Assess the patient by collecting comprehensive information on his/her biographical profile,

clinical condition including chief complaint and clinical diagnosis, previous hospitalizations,

narrative description of present health problems, and information on risk factors related to

heredo-familial association of Uterine myoma.

• Establish baseline data on the patient’s present health condition by identifying normal and

abnormal data through the conduct of a comprehensive head-to-toe assessment.

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• Understand the anatomy and physiology of the affected organ/system related to the

development of Uterine myoma.

• Discuss the definition of the clinical diagnosis and the rationale behind the disease’

causative/risk factors, the manifestation of its symptoms, and the pathogenesis of Uterine

myoma.

• Discuss the indications of the doctor’s orders that may include specific instructions of nursing

care, medication orders, and laboratory/diagnostic examination orders, and to understand their

relevance on the progress of the patient’s condition.

• Plan specific, measurable, attainable, realistic, and time-bounded objectives of nursing care

rendered to a patient with Uterine myoma.

• Plan relevant, practical, credible, and evidence-based nursing interventions related to Uterine

myoma.

• Implement nursing interventions for the patient and the responsible party.

• Render appropriate health teachings to the patient and the responsible party.

• Evaluate outcomes of nursing care rendered towards the patient and ensure proper

documentation.

• Develop a discharge plan based on the patient’s needs and doctor’s discharge instructions.

4
 Introduction

Uterine myomas are monoclonal tumors that are also referred to as uterine leiomyomas or
uterine fibroids, the myometrial smooth muscle cells. They are categorized based on their size,
form, and nature, and are the most prevalent benign uterine neoplasm position inside the uterus
(Porcaro et al., 2020). Leiomyomas are extremely common in women who are perimenopausal,
with a 50% frequency at 50 years old, although leiomyosarcomas are quite uncommon,
constituting about 2-3% of all uterine cancers. USMTs are classified by pathologists as benign,
malignant, or of unknown likelihood of malignancy based on a mix of histological
characteristics, including mitotic rate, and presence or absence of tumor cell necrosis (Russo et
al., 2022). It is still difficult to differentiate between sarcomas and myomas. Clinically, pelvic
pain, palpable pelvic masses, and uterine bleeding are common symptoms shared by patients
with uterine sarcomas and myomas (Cabezas et al., 2023).

In recent years, there has been an increase in the age-standardized incidence of uterine
fibroids. Age-standardized DALY rates, on the other hand, have shown a downward trend. The
countries with the highest prevalence of uterine fibroids are Brazil, India, Tropical Latin
America, and Eastern Europe. Globally, women between the ages of 35 and 39 are more likely to
develop uterine fibroids, as evidenced by the higher incidence rates observed in these age groups
(Li et al., 2023). Nonetheless, there are a number of obstacles in the way of comprehending the
global epidemiology of uterine fibroids. The first problem is that most women who have uterine
fibroids don't have any symptoms, and the fibroids are unintentionally found during a standard
gynecologic exam or procedure (Lou et al., 2023). Despite the fact that uterine myomas are a
major worldwide health concern, the morbidity they bring about is highlighted by hysterectomy,
which is the uterine myoma's primary course of treatment, a significant surgical procedure that
ends the possibility of procreation and has multiple negative effects on overall health (Tinelli et
al. 2021).

The prevalence of endometrial cancer among Filipino women with myoma uteri
associated with AUB equates to 11% (n=31). The greatest incidence was identified in types 2
and 3 fibroid, which were linked to endometrial cancer at 68.75% and 48.89% (Tanchuling,
2021). Myomectomy, which eliminates the fibroids while protecting the uterine tissue, is the

5
most popular therapy for uterine fibroids in the Philippines. Women who want to keep their
uterus are the ideal candidates for this treatment, especially if they plan to get pregnant in the
future. Risk factors linked to non-puerperal uterine myoma is a condition associated with uterus
inversion (most frequently submucosal) or cancer.

The degree of symptoms, the location and size of the fibroids, and the patient's desire for
future fertility all influence the course of treatment for uterine myomas. Options include
medication for symptom management, vigilance during asymptomatic cases, and, in extreme
cases, surgery such as myomectomy or hysterectomy. For those who want to keep their uterus
intact, non-surgical techniques like focused ultrasound surgery or uterine artery embolization
provide less intrusive options. Treatment decisions are frequently individualized, taking into
consideration each patient's unique health circumstances as well as how the fibroids affect their
quality of life.

Patient Profile

Biographic Data

Name Wong Seo Keng Lee

Age 74

Gender Female

Birthday September 14, 1949

Weight 48.2 kg

Height 152 cm

Civil Status Married

Nationality Filipino- Chinese

Religion Catholic

Room 3310

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 Clinical Data

Chief Complaint Inguinal Pain

Clinical Impression Ovarian New Growth Probably Benign; Uterine Myoma: Endometrial Polyp

Date of Admission October 25, 2023

Time of Admission 11:00 PM

Attending Physician Dr. Que

Hospital Davao Doctors Hospital

Past Health History

Wong Seo Keng Lee was diagnosed with Diabetes Mellitus Type 2, 20 years ago;
managed and controlled.She has no known allergies to food, medications, or the environment.
She has undergone CT scans and ultrasounds.

Present Health History

A patient was taken to the emergency department due Inguinal pain. The patient has
postoperative diagnosis of Pelvic Abscess with Pyosalpinx; Fibroma, Left ovary, Multiple
myoma (figo type 4) by frozen section biopsy; pelvic adhesive disease, In adherent bladder
injury , DM type 2 controlled. Her abdomen was examined, showing a feeling of fullness and a
firm palpable uterine mass, a distended abdomen and other irregularities. She has an
unproductive cough.

Family Background

The patient's father, who is Chinese, died due to diabetes mellitus and hypertension. Her
mother, who is a Filipina was known to have hypertension and died due to unknown diseases.
Her sister is also diabetic She has 1 sister and 1 brother, who are still alive at present.

7
Unfortunately, the patient does not have any information related to her grandparents because they
died when she was just a toddler and do not remember asking her parents about her
grandparents’ medical conditions.

Genogram

8
 Health Assessment

General Survey:

Patient Wong, a 74-year-old female with a history of Type 2 Diabetes, presents to the
emergency department with inguinal pain. The provisional diagnosis is a likely benign new
growth, possibly Uterine Myoma. Her diabetes is currently controlled, and she has no known
allergies. Family history indicates a common occurrence of hypertension and diabetes.
Predisposing factors for her condition include gender and age, while precipitating factors involve
hormones, diabetes, and lifestyle choices. This overview provides insight into Patient Wong's
medical history and the contributing factors to her current health issue.

The client is alert, responsive, and able to actively engage in conversation. Vital signs are
normal, with no physical deformities, bad breath, or body odor. The lips and oral mucosa are dry,
and the client reports shortness of breath but no chest pain or postoperative pain. Overall, the
patient appears comfortable, with the main concern being shortness of breath.

Physical Examination
Body System Normal Findings Patient Findings

EENT (-) alar flaring Nasal flaring was not evident.

(+)moist lip and tongue
(-) night sweat
(-) sunken eyeballs
Ears are approximately the same
size and shape. Lymph nodes in
neck, groin and armpits were not
swollen.

SKIN (-) Cyanosis Skin is fair-color complexion,

(-) Fever smooth and even texture, good
skin turgor, absence of lesions
and no edema was noted

ABDOMINAL Abdomen is soft, no losses The patient's skin is normal,

smooth and intact.

NEUROLOGIC (+) comfortably rest Patient is alert, conscious and

(+) Active and awake coherent; aware of the
environment, time and date.

PULMONARY CHEST (-) Wheezing The patient has an unproductive

(-) retraction cough with absence of abnormal
lung sounds.

GASTROINTESTINAL (+) soft The patient's skin is normal,

(+) hypoactive smooth and intact. The patient's

9
 surgical wound located on the
lower abdomen was soft and non
tender.

CVS (+) good intake No murmurs heard upon

(+) good activity auscultation,

10
 Comprehensive Health Status
I. Mental Status

Guidelines Normal Value Day 1 Day 2

a.State of mental State of wakefulness, Patient is awake, aware of Patient is awake, aware of
consciousness awareness, and alertness the situation, and alert. the situation, and alert.
(Weber and Kelley, 2017).

b. Orientation Oriented to place and time,
situation, self, and others
(Weber and Kelley, 2017).
Patient is oriented to time
and place, can comprehend,
and explain her situation, and
can identify self and others
around her.
Patient is oriented to time
and place, can comprehend,
and explain her situation, and
can identify herself and
others around her.

c. Attention Span Pay attention to conversation Patient can listen and direct Patient can listen and direct
for more than a few minutes her focus to the conversation her focus to the conversation
(Weber and Kelley, 2017). for more than a few minutes. for more than a few minutes.

d. Ability to Understand Expresses full and Patient expresses full and Patient expresses full and
free-flowing thoughts during free-flowing thoughts during free-flowing thoughts during
interviews (Weber and the interview. the interview.
Kelley, 2017).

Assessment Analysis: The patient's mental state has remained stable over the course of the group's three days of care, as
shown by her vigilance and attentiveness throughout interviews where she could also share her opinions about her condition
and provide important details, particularly regarding her medical history, way of life, and habits, replies that serve as the
foundation for this thorough evaluation. These all suggest that the patient's both cerebral oxygenation and perfusion are
within ideal bounds.

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II. Special Sense Status
Guidelines Normal Value
a. Auditory Perception Able to hear and correctly
repeat two syllable words as
whispered from 2 feet away
(Weber and Kelley, 2017).
b. Visual Perception • 20/20 distant visual acuity
with or without corrective
lenses.
• 14/14 near visual acuity
with or without corrective
lenses.
• Full visual fields
• Proper eye muscle
coordination
• PERRLA (Weber and
Kelley, 2017).
c. Speech Perception Articulation of words is
evident at a moderate volume thoughts articulately with
pace, there is no presence of moderate pace and volume.
stuttering, and the expression
of thoughts is well
coordinated (Weber and
Kelley, 2017).
Day 1
The patient can hear and
repeat two-syllable words as
whispered in both ears from
2 feet away.
• Patient can identify the
number of fingers in all
angles of the peripheral
vision.
• Patient can follow object
movement in all six cardinal
fields.
• Patient’s pupils are equal,
round, reactive light and
accommodation.
• Patient can express
Day 2
Patient can hear and repeat
two-syllable words as
whispered in both ears from
2 feet away.
• Patient can identify the
number of fingers in all
angles of the peripheral
vision.
• Patient can follow object
movement in all six cardinal
fields.
• Patient’s pupils are equal,
round, reactive light and
accommodation
• Patient can express
thoughts articulately with
moderate pace and volume.
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 d. Tactile Perception Sensitive to stimuli by
correctly identifying sharp
and dull stimuli and light
touch to the skin (Weber and
Kelley, 2017).
Patient is not sensitive to Patient is not sensitive to
stimuli in the face, and upper stimuli in the face, and upper
and lower extremities. and lower extremities.

Assessment Analysis: In addition to Patient SS’s normal mentation, she also had no alteration in her sensory functions as
evidenced by her responsiveness to visual, tactile, and auditory stimuli. Furthermore, she was also articulate in her
responses. This indicates optimal cerebral perfusion and oxygenation, and that the patient’s brain was not affected by her
respiratory problem

III. Motor Ability

Guidelines Normal Value Day 1 Day 2

a. Current Mobility status
• Ability to move freely,
easily, rhythmically, and
purposely in the
environment.
• Able to move about in bed.
• Able to sit without support.
• Able to stand and walk.
(Weber and Kelley, 2017).
Patient can move about in
bed without assistance and
can sit with support. She can
also ambulate but requires
assistance due to the
presence of IV insertion and
surgical wound.
Patient can move about in
bed without assistance and
can sit with support. She can
also stand and walk but
requires assistance due to the
presence of IV insertion and
surgical wound.

b. Posture and Gait
Erect posture with good
balance and normal walking
gait. • Feet are flat on the
floor while walking and
should rest well on the
surface when sitting.
• Patient has stooped posture
with the head and neck
forward.
• Patient can walk steadily
with feet flat on the floor,
and feet rest well on the
• Patient has stooped posture
with the head and neck
forward.
• Patient can walk steadily
with feet flat on the floor,
and feet rest well on the

13
 small chair when sitting with small chair when sitting with
support support

c. Range of Motion
Able to move joints of the
upper and lower extremities
without difficulty (Weber and
Kelley, 2017)
Patient has active range of
motion in the upper
extremities, including the
shoulder, elbow, forearm,
and wrists.
Patient has an active range of
motion in the upper
extremities, including the
shoulder, elbow, forearm,
and wrists.

• Patient has an active range

of motion in the lower
extremities • Patient has an active range
of motion in the lower
extremities.

d. Muscle and Nerve status Firm developed. Firm muscle strength with Firm muscle strength with
• Strength equal bilaterally. coordinated coordinated
(Weber and Kelley, 2017)

e. Loss of extremities None (Weber and Kelley, None None

2017).

Assessment Analysis: The patient exhibited good motor function, was able to get in and out of bed, and was willing to walk
around. Though she is limited because of her IV pole and surgical wound. She walked with a stooped gait, suggesting that
she was getting older. Both feet planted firmly on the ground, active range of motion in the upper and lower limbs, and
muscles that are strongly coordinated.

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IV. Body Temperature
Guidelines Normal Value
a. Temperature 36.2°C – 37.5°C (Berman et
al., 2022)
Assessment Analysis: Fever is the body’s normal response to infection and/or injury. However, the absence of fever does not
always indicate the absence of infection and/or injury.
V. Respiratory Status
Guidelines Normal Value
a. Respiratory rate 12 cpm – 20 cpm (Berman et
al., 2022)
b. Characteristic • Respiration is relaxed,
effortless, and quiet.
• Consist of regular and
rhythmical rising and falling
of the chest wall.
• Absence of sternal and
intercostal spaces’
retractions. (Weber and
Kelley, 2017)
c. Oxygenation status • 95% O2 saturation
• CRT < 2 seconds (Berman
Day 1
36.4 C
Day 1
28 cpm
Patient’s breathing pattern is
fast with a 28 cpm
respiratory rate during shift,
spontaneous Depth of
respiration is fast with
observed retractions of the
intercostal spaces. Use of
accessory muscles was seen.
96% - 99% • CRT <2
seconds
Day 2
36.6 C
Day 2
23 cpm
Patient’s breathing pattern is
near normal with a 23 cpm
respiratory rate during shift,
spontaneous Depth of
respiration is normal with
observed retractions of the
intercostal spaces. Use of
accessory muscles was not
seen.
96% - 99% • CRT <2
seconds
15
 et al., 2022)

d. Use of respiratory aids No use of respiratory aid None None

(Weber and Kelley, 2017).

e. Interference with No interference with None None

respiration respiration (Weber and
Kelley, 2017).

f. Abnormal respiratory No abnormal respiratory None None

opening opening (Weber and Kelley,
2017).

Assessment Analysis: Over the course of two consecutive days, the patient exhibited distinct respiratory patterns that
necessitate a focused health assessment. On Day 1, the respiratory rate was elevated at 28 cpm, accompanied by fast and
effortful breathing, evident retractions of intercostal spaces, and the use of accessory muscles. These indicators suggest a
state of respiratory distress, warranting immediate attention and further investigation into the underlying cause. In contrast,
on Day 2, the respiratory rate improved to 23 cpm, and while the breathing pattern appeared more normalized, the
persistence of intercostal space retractions suggests ongoing respiratory effort. Although the oxygenation status remained
within the normal range, the observed respiratory changes underscore the importance of continued monitoring and a
comprehensive assessment to identify and address potential respiratory issues. The dynamic nature of the patient's
respiratory presentation highlights the need for vigilant observation and timely interventions to optimize respiratory function
and overall patient well-being.

16
VI. Circulatory Status

Guidelines Normal Value Day 1 Day 2

a. Characteristic of Regular, strong, and palpable Patient’s arterial pulse is Patient’s arterial pulse is
arterial pulse (Weber and Kelley, 2017). palpable with regular rhythm palpable with regular rhythm
and an amplitude of 2+ and an amplitude of 2+

b. Apical-radial Pulse 60-100 bpm (Berman et al., 100 bpm 97 bpm

2022)

c. Blood pressure < 120/80 mmHg (Berman et 140/80 mmHg (Increased but 130/80 mmHg (Increased but
al., 2022) controlled) controlled)

d. Pulse pressure 40-60 mmHg (Berman et al., 50 mmHg 50 mmHg - 70 mmHg

2022)

e. Mean arterial pressure 70 – 100 mmHg (Berman et 96 mmHg 96 mmHg - 103 mmHg
al., 2022)

f. Intravenous fluid None (Weber and Kelley, PNSS 1L @80 cc/hr PNSS 1L @80 cc/hr
2017).

g. Capillary blood Glucose 72 mg/dL – 108 mg/dL No data No data

h. Serum electrolytes • Serum Na+: 135-145 No data No data

mEq/L

• Serum K+: 3.5-5.0 mEq/L

Assessment Analysis: 2 -day assessment data showed elevation in the patient's blood pressure which indicates circulatory
compromise possibly related to prior diagnosis of hypertensive disease, as well as the presence of diabetes mellitus type 2

17
 and chronic kidney disease that can both affect the body's hemodynamics, particularly the blood pressure.
VII. Elimination Status
Guidelines Normal Value
a. Bowel Defecates at least once a day.
• Stool that is brown in color
with soft to firm texture and
is easy to pass. (Weber and
Kelley, 2017)
b. Bladder • Urinates freely at a rate of
at least 30 ml/hr (Weber and
Kelley, 2017).
c. Abnormalities No abnormality present
(Weber and Kelley, 2017).
Assessment Analysis: Patient defecates regularly with soft to solid stool consistency. However, she was frequently urinating
Day 1
Patient defecates once within
the day with a soft brown
stool. No verbalized
difficulty in passing.
• Intake ~ 700 mL
• Output ~ 500 mL
• Color: Pale
Patient is taking an adequate
amount of fluids at a rate of
80 mL/hour and a urine
output of 63 mL/hour.
• (+) still with left flank pain.
• (+) still with increased
urinary frequency.
• (+) still with increased
urgency.
• (+) minimal dysuria
• (+) incontinence
Day 2
Patient defecates once within
the day with a soft brown
stool. No verbalized
difficulty in passing.
• Intake ~ 700 mL
• Output ~ 500 mL
• Color: Pale
Patient is taking an adequate
amount of fluids at a rate of
80mL/hour and a urine
output of 63 mL/hour.
• No left flank pains.
• No frequency.
• No urgency.
• No dysuria.
• No incontinence.
18
 which reflects her higher-than-normal hourly urine output. In fact, during the 2nd day of nursing care, the patient was
manifesting urinary incontinence which prompted the use of a diaper. This symptom is also consistent with her laboratory
data which showed electrolyte imbalances, particularly hypernatremia, hyperkalemia, and hypermagnesemia.

VIII. State of Skin and Appendage

Guidelines Normal Value Day 1 Day 2

a. Skin • Intact skin with no Patient skin is generally Patient skin is generally
reddened areas.
intact with no reddened intact with no reddened
• Absence of lesions,
bruising, and rashes. areas, lesions, bruising, areas, lesions, bruising,
• Absence of normal skin
rashes, and no abnormal rashes, and no abnormal
colors such as pallor,
cyanosis, and jaundice. discolorations. Skin is discolorations. Skin is
• Skin is mobile and has
mobile and quickly returns to mobile and quickly returns to
turgor
• Skin rebounds and does normal and extremities show normal and extremities show
not remain indented when
no indentations when no indentations when
pressure is released. (Weber
and Kelley, 2017) palpated. palpated.

b. Hair • Evenly distributed hair with Patient has evenly distributed Patient has evenly distributed
natural hair color.
hair with a black-brown hair with a black-brown
• Scalp is clean and dry with combination of colors. Scalp combination of colors. Scalp
some sparse dandruff
is clean with no parasites. is clean with no parasites.
present. (Weber and Kelley,
2017)

c. Nails • Nails are well trimmed and Patient nails are long, clean, Patient nails are long, clean,

19
 clean.
• Fingernails are generally
pink in one. (Weber and
Kelley, 2017).
Assessment Analysis: Patient SS did not show signs of dehydration as evidenced by her skin’s presence of mobility and
turgor. In addition, there are no edema and cyanosis which indicate optimal blood flow and oxygenation.
IX. State of Physical Rest and Comfort
Guidelines Normal Value
a. Sleep/ rest Sleeps 6-8 hours a day
(Weber and Kelley, 2017)
b. Presence of Pain and No presence of pain and
discomfort discomfort (Weber and
Kelley, 2017).
c. Use of supportive aids None (Weber and Kelley,
2017).
and generally have a pink
tone. CRT is less than 2
seconds.
Day 1
Patient is asleep during the
afternoon and has 7-8 hours
of sleep at night.
Patient reported ongoing left
flank pain but described it as
much better compared to
previous days with a pain
scale of 6/10. There were
reports of minimal dysuria as
well.
None
and generally have a pink
tone. CRT is less than 2
seconds.
Day 2
Patient is asleep during the
afternoon and has 7-8 hours
of sleep at night.
Patient reported ongoing left
flank pain but described it as
much better compared to
previous days with a pain
scale of 6/10. There were
reports of minimal dysuria as
well.
None
20
 Assessment Analysis: Alteration in comfort was determined as evidenced by the patient’s verbalization of pain in her right
arm and hand, indicating pain when cuffed too tight when obtaining blood pressure, and due to the re-insertion of
intravenous fluid

X. Emotional Status

Guidelines Normal Value Day 1 Day 2

a. Emotional reactions
Expresses good feelings
about self, others, and life;
verbalizes positive coping
mechanisms (Weber and
Kelley, 2017).
Patient is very talkative, she Patient expresses a positive
communicates well with staff outlook as she was seen
and assures she does not feel communicating with the staff
anything bad. with good feelings. She is
also able to share humor and
a good laugh.

b. Ability to relate to others Expresses good feelings Patient expresses being able Patient expresses being able
about being able to relate to to relate with patients who to relate with patients who
others (Weber and Kelley, undergo the same problem as undergo the same problem as
2017). her. her.

Assessment Analysis: Patient ES was coping well to her condition as she was able to express both frustrations and a positive
outlook. She also understood the need for her treatment and she vowed to maintain her smoke-free lifestyle and improve on
things she could still improve, such as rest, diet, and exercise.

21
 Review of Anatomy and Physiology

The female reproductive system functions to produce gametes and reproductive

hormones, just like the male reproductive system; however, it also has the additional task of
supporting the developing fetus and delivering it to the outside world. Unlike its male
counterpart, the female reproductive system is located primarily inside the pelvic cavity. Recall
that the ovaries are the female gonads. The gamete they produce is called an oocyte.

The external female reproductive structures are referred to collectively as the vulva. The
mons pubis is a pad of fat that is located at the anterior, over the pubic bone. After puberty, it
becomes covered in pubic hair. The
labia majora (labia = “lips”; majora
= “larger”) are folds of hair-covered
skin that begin just posterior to the
mons pubis. The thinner and more
pigmented labia minora (labia =
“lips”; minora = “smaller”) extend
medial to the labia majora. Although
they naturally vary in shape and size
from woman to woman, the labia
minora serve to protect the female
urethra and the entrance to the female reproductive tract. The superior, anterior portions of the
labia minora come together to encircle the clitoris (or glans clitoris), an organ that originates
from the same cells as the glans penis and has abundant nerves that make it important in sexual
sensation and orgasm. The hymen is a thin membrane that sometimes partially covers the
entrance to the vagina. An intact hymen cannot be used as an indication of “virginity”; even at
birth, this is only a partial membrane, as menstrual fluid and other secretions must be able to exit
the body, regardless of penile–vaginal intercourse. The vaginal opening is located between the
opening of the urethra and the anus. It is flanked by outlets to the Bartholin’s glands (or greater
vestibular glands).

22
Vagina

The vagina is a muscular canal (approximately 10 cm long) that serves as the entrance to
the reproductive tract. It also
serves as the exit from the uterus
during menses and childbirth. The
outer walls of the anterior and
posterior vagina are formed into
longitudinal columns, or ridges,
and the superior portion of the
vagina—called the fornix—meets
the protruding uterine cervix. The
walls of the vagina are lined with
an outer, fibrous adventitia; a middle layer of smooth muscle; and an inner mucous membrane
with transverse folds called rugae. Together, the middle and inner layers allow the expansion of
the vagina to accommodate intercourse and childbirth. The thin, perforated hymen can partially
surround the opening to the vaginal orifice. The hymen can be ruptured with strenuous physical
exercise, penile–vaginal intercourse, and childbirth. The Bartholin’s glands and the lesser
vestibular glands (located near the clitoris) secrete mucus, which keeps the vestibular area moist.

Ovaries

The ovaries are the female gonads. Paired ovals, they are each about 2 to 3 cm in length,
about the size of an almond. The ovaries are located within the pelvic cavity, and are supported
by the mesovarium, an extension of the peritoneum that connects the ovaries to the broad
ligament. Extending from the mesovarium itself is the suspensory ligament that contains the
ovarian blood and lymph vessels. Finally, the ovary itself is attached to the uterus via the ovarian
ligament.

The Ovarian Cycle

The ovarian cycle is a set of predictable

changes in a female’s oocytes and ovarian

23
follicles. During a woman’s reproductive years, it is a roughly 28-day cycle that can be
correlated with, but is not the same as, the menstrual cycle (discussed shortly). The cycle
includes two interrelated processes: oogenesis (the production of female gametes) and
folliculogenesis (the growth and development of ovarian follicles).

Oogenesis

Gametogenesis in females is called oogenesis. The process begins with the ovarian stem
cells, or oogonia. Oogonia are formed during fetal development, and divide via mitosis, much
like spermatogonia in the testis. Unlike spermatogonia, however, oogonia form primary oocytes
in the fetal ovary prior to birth. These primary oocytes are then arrested in this stage of meiosis I,
only to resume it years later, beginning at puberty and continuing until the woman is near
menopause (the cessation of a woman’s reproductive functions). The number of primary oocytes
present in the ovaries declines from one to two million in an infant, to approximately 400,000 at
puberty, to zero by the end of menopause.

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 matrices (i.e.,
collagen, proteoglycan, fibronectin). Other names for these tumors include fibromyomas,
fibromas, myelofibrosis, and myomas.

The human uterus is a pear-shaped organ composed of two distinct anatomic regions: the
cervix and the corpus.

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

24
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.

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.

25
 Pathophysiology

Definition

Mutchler (2023) defined myoma as a common noncancerous growth that develops

in or around the uterus. It is sometimes referred to as a leiomyoma or uterine fibroid.
Depending on their size, myomas can cause symptoms including heavy menstrual flow
and stomach discomfort, while other people never experience any symptoms. Although
the exact etiology of myomas is unknown, age, obesity, and a family history of the
condition are risk factors. By the time they are 50 years old, about half of all uterine users
will have a myoma.

Etiology

Present Justification

Predisposing Factors

Genetics Genetic factors play a crucial role in the

development of myomas. The occurrence of
multiple myomas within the same uterus
suggests that hereditary factors significantly
contribute to myoma development, making
certain women more susceptible than
others. The concept of "myoma families"
underscores the influence of genetics in the
prevalence of myomas.(Gupta, S. et. al,
2008)

Gender / Uterine myoma affects many women 80%

of women have fibroids by 50 according to
the National Institutes of health. Uterine
fibroids grows at the uterus that often

26
 appear during childbaring years

Age / Myomas risk increase with age 20-25% are

diagnosed in women of reproductive age in
and women older than 40 years old at
30-40% (Okolo, 2008)

Ethnicity/Race Uterine fibroids reported rates are

80-70%higher among black and white
women (Pavone, 2018) And it is rarest in
women of Asian race

Precipitating Factors

Lifestyle / Various lifestyle elements, including dietary

choices, caffeine and alcohol intake,
smoking habits, physical activity levels, and
stress, may influence the development and
growth of myomas.(He, Y., et. al., 2013)

Hormones / Both estrogen and progesterone are

significant in the onset and growth of
myoma. Estrogen is thought to stimulate
myoma growth and recent research suggests
that progesterone might also play a
significant role in myoma growth, as it
collaborates with estrogen to stimulate
myoma development (Wise, LA, 2013)).

Obesity Obesity increases the risk of uterine

myomas through various mechanisms. It is
associated with hormonal imbalances,
particularly elevated estrogen levels stored

27
 in fat cells. Insulin resistance, inflammation,
changes in cellular environments, and
disruptions in reproductive hormones also
contribute to the link between obesity and
uterine myoma development.

Diabetes Mellitus / Numerous epidemiological studies have

identified a heightened risk of myomas in
women with diabetes mellitus. Additionally,
it has been observed that elevated insulin
levels play a protective role against the
development of large myomas. (Wise,LA.,
et.al.,2013)

Symptomatology

Signs/Symptoms Present Justification

Nausea Complications are possible, however most

fibroids don't create issues. Spinally connected
fibroids to the uterus have the potential to twist
and produce discomfort, nausea, or fever. Pain
can also be caused by fibroids that begin to
break down or develop quickly. They may
occasionally be connected to cancer (Uterine
Fibroids, 2022).

Vomiting Vomiting can also result from the pain of

secondary dysmenorrhea brought on by fibroids,
which is comparable to menstrual cramps. This
type of pain can either be subtle and throbbing
or intense and scorching (Schultz, 2022).

28
Abdominal pain / Unusual growths that form on or inside the
uterus are called fibroids. These tumors can
occasionally grow to be rather big, causing
excruciating abdominal pain and heavy
menstruation. Most of the time, they have no
symptoms at all. Most of the time, the growths
are benign, or noncancerous. Unknown is the
cause of fibroids (Macon, 2023).

Distended abdomen Given that uterine fibroids are situated in the

abdominal region, it is logical to anticipate that
symptoms may manifest in the stomach area.
Large fibroids may push on the rectum, bladder,
or stomach cavity, resulting in bloating
distention, stomach discomfort, and swelling in
the abdomen (Schultz, 2022).

Back pain / Back pain may be caused by fibroids. Many

people have benign tumors called fibroids that
they are unaware of. Fibroids are not fatal, but
they can have a negative impact on a person's
quality of life. Subserosal fibroids, which
develop on the exterior walls of the uterus, are
the majority of fibroids-related back pain
sufferers (Weber, 2023).

29
Hypertension / Roughly 25% of premenopausal women have
uterine leiomyomata, sometimes referred to as
fibroids or myomas; the risk factors for this
condition are not well established. Similar to
atherosclerosis, elevated diastolic blood pressure
may raise the risk of fibroid through uterine
smooth muscle damage (Boynton-Jarrett et al.,
2005).

Inguinal Pain or Pelvic / A woman may suffer from severe pelvic pain or
Pain abdominal swelling, discomfort during sex,
heavy menstrual bleeding, difficulties urinating
or defecating, anemia from blood loss, infertility,
miscarriages, and other pregnancy complications
if her uterine fibroids grow too big, too many, or
begin pressing against another organ (Uterine
myoma, 2022).

30
Schematic Diagram

31
Narrative

Patient Wong, a 74-year-old female, was brought to the emergency department with a
chief complaint of inguinal pain. The clinical impression suggests a new growth, likely benign,
with a provisional diagnosis of Uterine Myoma. She has a history of Type 2 Diabetes, which is
currently under control. Patient Wong has no known allergies to food or medication. The family
history reveals a common occurrence of hypertension and diabetes. Presently, the predisposing
factors for her condition are gender and age. Additionally, precipitating factors include
hormones, diabetes and lifestyle choices. This comprehensive overview provides a clearer
understanding of Patient Wong's medical background and the factors contributing to her current
health situation.

Uterine myomas, or fibroids, are non-cancerous growths originating from a single muscle
cell in the uterine wall, typically emerging during childbearing years. The exact cause of their
formation is unclear, but genetic and hormonal factors, particularly estrogen and progesterone,
contribute to their growth. These tumors can vary in size, number, and location within the uterus,
influencing the severity of symptoms. As myomas grow, they may distort the uterine
architecture, leading to symptoms such as pelvic pain, heavy menstrual bleeding, and pressure.
While some women remain asymptomatic, others may experience complications impacting
fertility and pregnancy. Hormonal fluctuations, especially during pregnancy, can affect the size
of myomas. Diagnosis involves clinical evaluation and imaging studies, with treatment options
ranging from watchful waiting to medication, myomectomy, or, in severe cases, hysterectomy.
Understanding the disease process is crucial for tailoring effective management strategies that
consider the individual's symptoms and reproductive goals.

32
 Course in the Ward/Treatment/ Intervention

Doctor’s Progress notes

Date Physician’s Order Rationale

November Diabetic diet

The plan helps you control your
03, 2023
blood sugar, also called blood
@ 8:15
glucose, manage your weight
am
and control heart disease risk
factors. These factors include
high blood pressure and high
blood fats. When you eat extra
calories and carbohydrates, your
blood sugar levels rise.

VSq4 Vital Signs (VS) Monitoring

Q4H (Every 4 Hours) Frequent
VS checks serve as a safety net
for patient care. It helps prevent
potentially life-threatening
situations

I & O qshift Monitoring a patient's intake and

output is essential for assessing
their fluid balance. It helps
healthcare providers determine
whether the patient is retaining
or losing fluids.

33
 Maintain insulin and antibiotic
Combining insulin with
medications like beta blockers,
certain antibiotics, and other
diabetes medications can
increase the risk of low blood
glucose.

Soaked dressing
Use this solution to remove all
the pus and loose scabs.

With foley catheter

It allows pee to drain from your
bladder into a collection bag.
The other pathway connects to a
balloon at the tip of the tube in
your bladder.

November Soft non tender abdomen

Assessing the patient's abdomen
03, 2023
can provide critical information
@ 10:40
about his internal organs.
am

Diagnostics and Laboratories:

PCR Test To detects the genetic material

-Negative (nucleic acid) of the virus during

34
 an active infection. It is also
called a PCR (polymerase chain
reaction) test or nucleic acid test,
and is sometimes inaccurately
called an antigen test.

Blood chemistry
To show how well certain organs
are working and can help find
abnormalities.

Complete blood count CBC aids in the detection of

certain illnesses including
ailments like anemia.

Creatinine, BUN BUN and creatinine are waste

products that need to be
Kidneys filter substances. This
examination will show
crucial details on the health of
the kidneys are at work. SLE
may result in nephritis because
accumulation of immunological
complexes and antibodies that
harms the nephrons, eliminating
toxins found in blood.

Chest X Ray Using the chest X-ray PA view,

one may see encompassing every
organ in the thoracic cavity. Such

35
 will assist in determining
whether there is fluid or
inflammation in the patient's
heart enlargement, lungs, or
peculiarities.

Sodium, Potassium Potassium and sodium can reveal

the fluid in the body.
levels and the equilibrium of its
acid-base, this can also
assist in evaluating the kidneys.

November Increase Bisoprolol

If this dose is not working well
04, 2023
enough to reduce your blood
@ 8:00
pressure or control your angina,
am
The doctor may increase it to
20mg.

Medication:

Bisoprolol 2.5mg 1 tab PO daily Is used to treat high blood

pressure (hypertension) (Mayo
Clinic, n.d).

Potassium Chloride (kalium) used to treat or prevent low

750mg 1 tab 3x daily for 3 days amounts of potassium in the
blood.(Drugs & Medications.

36
 n.d.).

Insulin 6L 10 units SQ OD HS Used to help control blood sugar

levels in people with diabetes
(Type 2 Diabetes: Signs,
Symptoms, Treatments. n.d.).

Calcium Carbonate to 1 tab OD PO Calcium carbonate is for the

relief of heartburn and acid
indigestion Team, C. B. M. n.d.)

Mirabregon 1 tab PO daily is indicated for the treatment of

OAB (overactive bladder) in
adult patients with symptoms of
urge urinary incontinence,
urgency, and urinary frequency
(DrugBank Online, n.d.)

Inbumin 200mg 1 tab PO daily Food supplement/Helps to

maintain general health (Team,
C. B. M. n.d.).

Celocoxib 200mg/tab 1 tab PO 2x Uses as treatment of acute pain

a day (Mayo Clinic, n.d).

Metronidazole 500mg IVTT

to treat serious bacterial

37
 infections in different areas of
the body.

Laboratory/Diagnostic Examination

PROCEDURE PURPOSE NORMAL RESULTS NURSING

RANGE MANAGEMENT

CHEST To assist in the FINDINGS: Pre-Procedure:

Impression:
(ADULT) Xray examination of Inform the patient that
Resolving
cardiac, pneumonia this procedure can aid in
and
respiratory, and pulmonary the diagnosis of disease

congestion
skeletal structure in the heart and lungs.

within the lung Allow the patient to wear

cavity, as well as comfortable, loosefitting

to clothing to the

identify a variety exam. During the

of
procedure, they may be
disorders such as
given a gown to wear.
pneumonia and
Take away all metallic
heart failure.

38
objects. Items such as

jewelry, pins, buttons,

and so on can be

used because

this may hinder the

visualization of the

chest. Make sure to take

them off before the

exam.

There is no need to

prepare. Unless

otherwise directed by a

health care provider, no

fasting or medication

restriction is required.

Intra Procedure:

Assess the patient's

capacity to hold her

breath. After inhaling,

39
holding one's breath

allows the lungs and

heart to be seen more

clearly in the X-ray.

Verify that the patient

will be able to cooperate

fully and follow

instructions.

Because movement

produces unreliable

results, keep the patient

still through

Post Procedure:Provide
comfort.

Reposition the patient

properly if the test is

performed at the

bedside.

Explain the outcomes.

40
 Provide education if the

test results have clinical

implications
To detects the
PCR TEST Negative
genetic material
(nucleic acid) of Monitor vital signs
the virus during particularly
an active temperature and
infection. It is respiratory rate, as
also called a fever and dyspnea are
PCR common symptoms of
(polymerase COVID-19.
chain reaction)
test or nucleic Monitor O2 saturation

acid test, and is normal O2 saturation

sometimes as measured with

inaccurately pulse oximeter should

called an antigen be 94 or higher.

test.
Maintaining
respiratory isolation
isolation rooms should
be well-marked with
limited access.

Enforce strict hand

hygiene to reduce or
prevent transmission
of coronavirus.

41
 Provide information

educate the patient and

patient’s family members
of the transmission of
COVID-19.

BLOOD SUGAR The primary 4% - 5.6% 4.5 % ● Determine the patient's

TEST purpose of this clinical status by

examination is analyzing their vital

to
signs, the drugs they
diagnose and
are currently taking,
monitor
and any symptoms that
diabetes, a
are associated with blood
disorder that is
sugar
defined by
abnormalities.
abnormally high
● It is important to ensure
amounts of
glucose that the patient is well

in the blood. In -

patients with educated about the

leukemia, the objective of the blood

major
sugar test and to
objective of a
blood acquire informed

42
sugar test is to permission from them if

evaluate and this is necessary.

monitor the ● Ensure that the patient

patients'
is aware of the
blood glucose
objective of the blood
levels,
sugar test as well as
particularly in
the specific test(s) that
cases when the
will be performed, such
patients have
as the blood sugar
Certain risk
factors reading taken after the

or treatment patient has fasted, the

-related blood sugar reading

problems taken at random, or the

oral glucose tolerance

test.

● Obtain a blood sample

for the blood sugar test

by puncturing a vein or

drawing blood from the

43
 fingertip, taking care to

follow all appropriate

aseptic procedures.

RENAL Evaluate how BUN BUN KIDNEY URINE

FUNCTION well your TEST
0.6-1.1(10- 4.2mg/dL
TEST kidneys are
50) mg/dL complete 24-hour urine
working.
tests at home. For a
Most of these
24-hour urine test, your
tests measure
CREATINI provider will give you
glomerular
CREATINI a container to collect
filtration rate NE
NE urine.
(GFR). GFR
0.6-1.6
assesses how 70 mg/dL
(61.9-114.
efficiently
9)mg/dL
your kidneys KIDNEY BLOOD

clear waste TEST

from your
system.
visit your provider’s
office or laboratory to
give a blood sample. A
technician uses a small
needle and test tube to
collect a blood sample.

SODIUM SODIUM

44
ELECTROLYT used to find 135-145 142 mEq/L - Administer PO
ES out if your mEq/L and IV electrolyte
body has a supplements as
fluid POTASSIU ordered for
imbalance or POTASSI M deficiencies.
an imbalance UM
5.0 mEq/L - Limit dietary
in acid and
5.2 mEq/L intake of specific
base levels.
electrolyte
Electrolytes
excesses.
are usually CALCIUM
measured CALCIUM
together.
9-11 - Administer
mg/dL electrolyte-binding
medications, such
as Kayexalate for
hyperkalemia, as
prescribed.

- Administer IV
fluids to promote
renal excretion of
excess electrolyte
levels, as
prescribed.

HGB HGB

45
Complete Complete 120-140 101 g/L - Explain the test
Blood Count blood count g/L procedure to the
(CBC) (CBC) is used PT.
to assess the HEMATO
HEMATO - Explain that
overall health CRIT
CRIT slight discomfort
and to detect
0.31 may be felt when
a variety of 0.37-0.45
skin is punctured
illnesses of
ERYTHRO
the PT. ERYTHRO
CYTES - When the needle
CYTES
is removed. Apply
3.51 manual pressure
4.5-5.0
and dressings to the
punctured hole.
LEUKOC
LEUKOC
YTES - Monitor the
YTES
puncture site.
15.03
5.0-10.0
- Instruct to
resume normal
NEUTROP activity of healthy
NEUTROP
HILS diet.
HILS
0.67
0.55-0.65

LYMPHO
LYMPHO
CYTES
CYTES
0.15
0.35-0.45

46
EOSINOP EOSINOP
HILS HILS

0.02-0.04 0.05

47
Surgical Management

Surgical Purpose Nursing Management

Procedure

Exploratory
laparotomy Exploratory laparotomy is surgery to The nurse assists the patient to use
open up the belly area (abdomen). noninvasive pain relief measures and
This surgery is done to find the cause prescribed analgesia for pain relief or
of problems (such as pain or monitors patient-controlled analgesia for
bleeding) that testing could not effectiveness.
diagnose. It's also used when an
Fluid balance is monitored, and
abdominal injury needs emergency
prescribed fluid and electrolyte
medical care. This surgery uses one
replacement therapy is administered
large cut (incision).

Total abdominal
hysterectomy A surgery to remove the uterus and Postoperative pain management, diet
Bilateral cervix. “Abdominal” is the surgical advancement, bladder and bowel care,
Salpingo
technique that will be used. This mobility and physical therapy, breathing
means the surgery will be done exercises, wound care, personal hygiene,
through an incision in your abdomen. and monitoring of vaginal bleeding.
A bilateral salpingo-oophorectomy is
surgery to remove both of your
ovaries and fallopian tubes.

Cystorrhaphy
Suture of a laceration, injury, or Monitor and record vital signs, Assess the
rupture in the urinary bladder. patient’s ability to void at least 24 hours
after the procedure, Observe the color of
urine, Encourage increased fluid intake as

48
 indicated, Encourage deep breathing
exercises, Provide warm sitz baths and
administer mild analgesics as ordered,
and Watch out for signs of serious
complications (sepsis, bladder
perforation, hematuria)

Adhesiolysis
Destroys scar tissue that's causing Follow your doctor's instructions. These
abdominal and chronic pelvic pain. may include having only a clear liquid
The scar tissue typically forms after diet for a short time to avoid a complete
surgery as part of the healing process, blockage.
but can also develop after an infection
Be safe with medicines. Take them
or a condition that causes
exactly as prescribed. Call your doctor or
inflammation, such as endometriosis.
nurse advice line if you think you are
having a problem with your medicine.

Put a heating pad set low on your belly to

relieve mild cramps and pain. Put a thin
cloth between the heating pad and your
skin. Do not go to sleep with a heating
pad on your skin.

Frozen section
biopsy A biopsy of the tissue is done to During the frozen section procedure, the
check whether the cancer is malignant surgeon removes a portion of the tissue
or benign. In the case of breast mass. This biopsy is then given to a
cancer, frozen section biopsy is a very pathologist (a doctor who examines
common procedure to check whether tissues and uses laboratory tests to make a
the tissue is malignant or benign diagnosis). The pathologist freezes the
(cancerous OR non-cancerous). It is tissue in a cryostat machine, cuts it with a

49
also called an intraoperative frozen microtome, and then stains it with various
section. dyes so that it can be examined under the
microscope. The procedure usually takes
only minutes.

50
Pharmacologic Management

DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING

MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

BRAND NAME: CLASSIFICATION: Calcium carbonate is Calcium carbonate is SIDE EFFECTS: -Assess for possible
Cal-Carb Forte, Antacids for the relief of contraindicated to -Loss of appetite contraindications and
Cal-Gest, Maalox, heartburn and acid patients with: -Constipation cautions: any history of
Maalox Children’s, MECHANISM OF indigestion. May also - Nausea allergy to antacids to
Oystercal, Titralac, ACTION: be used as a nutritional -Hypersensitivity -Vomiting prevent hypersensitivity
Tums, Tums Calcium carbonate is supplement or to treat -High calcium levels in -Headache reactions.
smoothies used as a hypocalcemia. the urine -High calcium levels
supplementary source -Kidney stones (renal -Low phosphate levels - Assess blood pressure
of Ca to help prevent calculi) and pulse rate before
or decrease the rate of -Low phosphate levels ADVERSE administration of the
GENERIC: Calcium bone loss in -High calcium levels EFFECTS: drug.
Carbonate osteoporosis. It also -Suspected digoxin - Confusion
acts as an antacid by toxicity -Irregular heart rhythms - Assess the patient for
neutralizing gastric -Muscle twitching any signs of acid-base
acidity resulting in -Bone pain or electrolyte imbalance
DOSAGE: 1 Tab
increased gastric and -Abdominal pain to ensure early
duodenal pH. -Anorexia detection and prompt
Additionally, it is also -Irritability interventions.
used in the treatment -Hypokalemia
ROUTE: PO (Orally)
of hyperphosphatemia - Have the patient chew

51
 in patients with tablets thoroughly and
chronic kidney follow with water to
disease by binding ensure that therapeutic
FREQUENCY: Daily with phosphate in the levels reach the
gastrointestinal tract stomach to decrease
to form insoluble acidity.
complex thus
reducing phosphate - Take with or without
absorption. food. Food increases
the absorption of
REFERENCES: calcium carbonate,
Team, C. B. M. (n.d.). which may be
Calcium carbonate: advantageous in its use
Indication, Dosage, as a calcium
Side Effect, supplement
Precaution | MIMS
Philippines.
https://www.mims.co
m/philippines/drug/inf
o/calcium%20carbona
te?mtype=generic

52
DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING
MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

Brand name: - A13A - TONICS ; Food supplement/Helps Contraindicated for - Diarrhea - Use the drug only
Inbumin Used as tonics. to maintain general individuals with history - indigestion as suggested
health of allergy to the product - avoid overdose.
- nausea
Generic name: of snakehead fish Take with food or
Striatin (Channa striata). - stomach after meals if GI
For Adult use only. Not discomfort upset occurs.
Dosage: intended for children, - vomiting - Do not exceed the
200mg 1tab pregnant and lactating prescribed dosage
women.
Route: PO

Frequency:
Daily/OD

53
DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING
MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

Brand Name: Classification: Suspected/ Expected: Perform a skin test or

Known hypersensitivity
-Noritate PHARMACOTHERA proven anaerobic No infants showed any do a blood test (if not
to metronidazole.
-Vandazole PEUTIC: infection, side effects that might yet done) to know if the
Flagyl Nitroimidazole especially Bacteroides have been caused by patient is allergic to any
Infants with biliary tract
Flagyl ER derivative. fragilis. metronidazole and no drug (metronidazole).
obstruction.
- Flagyl 375 CLINICAL: Necrotizing case of anaerobic sepsis
- Metro Cream Antibacterial, enterocolitis. Caution in preterm was identified by -Monitor I&O
-Metro Gel antiprotozoal Peritonitis infants especially cultured -Assess for urinary
- Nida Gel Mechanism of action: extreme immaturity. problems of the pt after
taking the medication.
Caution in infants with Venous irritation, and
Generic Name: Disrupts DNA, - Assess for rash, and
jaundice, liver soft tissue injury at the
Metronidazole inhibiting urticaria of the pt.
dysfunction, and biliary IV injection site.
nucleic acid synthesis.
tract disease
Drug Therapeutic Effect: -Observe for signs of
Gastrointestinal
Class: Produces bactericidal, adverse effects.
disturbance (nausea,
IVTT antiprotozoal,
vomiting
amebicidal, -Always check for
Dosage: trichomonacidal effects. Peripheral neuropathy, dosing intervals it may
Produces anti- encephalopathy (usually lead to extreme
500mg during intensive and
inflammatory, immaturity, severe
immunosuppressive prolonged therapy) jaundice, and hepatic
effects when applied dysfunction

54
Topically Disrupts
DNA, inhibiting nucleic
acid synthesis.

Therapeutic Effect:
Produces bactericidal,
antiprotozoal,
amoebicidal,
trichomonacidal effects.
Produces
anti-inflammatory,
immunosuppressive
effects when applied
topically.

55
DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING
MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

BRAND NAME: CLASSIFICATION: Uses as treatment of Patient with Frequent side effect - Check first if you have
Celebrex NSAID/ acute pain hypersensitivity to (16-5%) the right medication,
Anti-inflammatory celecoxib, Diarrhea, dyspepsia, dose, route and right
sulfonamides, aspirin headache, upper patient
GENERIC NAME: MOA: It inhibits and other NSAID. respiratory tract -Assess patient if she
Celecoxib cyclooxygenase-2 the infection has any allergies to any
enzyme responsible Patients experiencing NSAID, aspirin and
DOSAGE: 200 mg/ 1 for prostaglandins asthma, uriticaria or any Occasional(less than sulfonamides
tab synthesis. allergic reaction 5%) -Asses the onset, type,
Abdominal pain, location and duration of
ROUTE: Per orem Use as treatment for flatulence, nausea, back the pain
perioperative pain in pain, peripheral edema, Assess patient
coronary artery bypass dizziness, insomia and therapeutic response;
FREQUENCY: 2x a graft (CABG) rash verbalize decrease or
day relief of pain
Adverse Effect Observe any presence
GI: Bleeding in GI of bleeding, bruising
Cardio: MI, CVA and weight gain
Instruct this medication
can be taken without
regard to food

56
If GI upset happen take
medication with food
Instruct patient to avoid
alcohol, aspirin(This
increase risk for GI
bleeding)
Encourage patient and
familt to report
immediately patient
report chest pain, jaw
pain, sweating,
confusion, difficulty in
speaking only one side(
Possible of heart attack
or stroke)

57
DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING
MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

BRAND NAME: Regulation of Indicated to During episodes of Injection site Assess the
Apidra glucose improve glycemic hypoglycemia. in reactions patient's medical

control in adults and patients with known (pain, history, including

metabolism is the
GENERIC: children with hypersensitivity to any allergies,
primary activity of redness, or
insulin glulisine diabetes mellitus insulin glulisine or previous insulin
insulins and irritatio).
to any of the use, and
insulin analogs,
CLASSIFICATI dizziness
excipients in comorbidities.
including insulin
ON: recombinant Sweating Regularly monitor and
glulisine. Insulins APIDRA
insulin analog assess blood glucose
lower blood
Fluid retention - levels to determine
glucose by
DOSAGE: 6 units
weight gain, appropriate insulin
stimulating
swelling in your dosages.
ROUTE: peripheral glucose
Be aware that certain
subcutaneous hands or feet,
uptake by skeletal
insulin types should
muscle and fat feeling short of
not be mixed in the
FREQUENCY:
breath same syringe (e.g.,
three times a day
• low potassium long-acting insulins
(should be
with short-acting
administered - leg cramps,
insulins).
before meals constipation,
Accurately document
irregular
the type, dosage, time,
heartbeats, and site of insulin

58
fluttering in administration.
PATIENT
your chest,
EDUCATION
increased thirst
Explain to the PT’s the
or urination,
importance of taking
numbness or insulin at the prescribed
tingling, muscle, dosage and at the
weakness or limp scheduled times
feeling and,discuss the
relationship
between
insulin, meals,
and physical
activity.

Educate patients about

the symptoms of low
blood sugar
(hypoglycemia) and
how to treat it. Provide
information on what to
do in case of an
emergency, such as
severe hypoglycemia or
inability to take insulin.

59
DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING
MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

BRAND NAME: Mirabegron is a potent is indicated for the Hypersensitivity to the Bladder pain. Assess patients for
Betmiga and selective agonist of treatment of OAB active substance or to bloody or cloudy urine. urinary urgency,
GENERIC: beta-3 adrenergic (overactive bladder) in any of the excipients. blurred vision.difficult, frequency, and urge
Mirabregon receptors. The adult patients with Patients with severe burning, or painful incontinence
activation of beta-3 symptoms of urge uncontrolled urination. periodically during
CLASSIFICATION: receptors relaxes urinary incontinence, hypertension. dizziness. therapy.
beta-3 adrenergic detrusor smooth muscle urgency, and urinary requent urge to urinate.
agonists. during the storage phase frequency. headache. Monitor BP prior to
of the urinary bladder lower back or side pain starting and periodically
DOSAGE: 25mg fill-void cycle, which during therapy; may
CV: BP, tachycardia
increases the bladder's cause BP.
ROUTE: Oral storage capacity thereby EENT: nasopharyngitis Monitor for signs and
alleviating feelings of
GI: constipation, symptoms of
FREQUENCY: urgency and frequency.
diarrhea, nausea angioedema (swelling
Once a day
of face, lips, tongue
GU: urinary tract and/or larynx).
infection Discontinue mirabegron
and treat
Neuro: dizziness,
symptomatically.
headache

Misc: ANGIOEDEMA
Instruct the patient to
take mirabegron as

60
directed. If a dose is
missed, take as soon as
remembered unless >12
hrs since missed dose.
If >12 hrs since missed
dose, omit dose and
take next dose at
scheduled time. Advise
patients to read the
Patient Information
sheet prior to starting
and with each Rx refill,
in case of changes.

Inform patients that

mirabegron may cause
an increase in BP.
Advise patients to have
BP checked
periodically during
therapy.

May cause dizziness.

Caution patient to avoid
driving or other
activities requiring

61
alertness until response
to medication is known.

Advise patient to notify

health care professional
if difficulty emptying
bladder occurs.
Advise patient to notify
health care professional
of all Rx or OTC
medications, vitamins,
or herbal products being
taken and to consult
with health care
professional before
taking other
medications.

62
DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING
MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

BRAND NAME: CLASSIFICATION: This drug is being used Bisoprolol is SIDE EFFECTS Assess blood pressure
as a management of contraindicated to and pulse rate before
hypertension, alone or patients with: administration of the
in combination with drug.
Zebeta Antihypertensive Dizziness
diuretics, other
medications Bradycardia
Hypersensitivity to the
drug Administer with or
Nausea
without food, but be
Sinus bradycardia
GENERIC NAME: MECHANISM OF Vomiting consistent to minimize
ACTION: variations in absorption.
Second or third degree
Gastric pain
heart block
Bisoprolol Dry skin
Cardiogenic shock
This medication inhibits Instruct patient to move
Polyuria slowly when sitting up
stimulation of
Heart failure
beta1-receptors or standing, to avoid
Blurred vision
primarily in the heart, dizziness or

DOSAGE: which decreases cardiac light-headedness from

excitability, cardiac decrease in BP.
output, and myocardial ADVERSE EFFECTS
Assist with ambulation
oxygen demand.
2.5mg 1 tab Peripheral vascular if dizziness occurs after
Bisoprolol also

63
 decreases renin release insufficiency administration.
from kidneys, which
Sleep disturbances Caution patient to
helps reduce blood
avoid driving and other
pressure.
ROUTE: Hallucination
hazardous activities
until he knows how
Slurred speech
drug affects
P.O (orally) Anorexia concentration and
alertness.
REFERENCE:
Bronchial obstruction

Ischemic colitis

Sullivan, K. (2011).
FREQUENCY: Acute pancreatitis
2011 Nurse’s Drug
Handbook (10th
Edition). United States
Daily of America: Jones &
Bartlett Learning

64
DRUG NAME CLASSIFICATION/ INDICATION CONTRAINDICATI SIDE/ADVERSE NURSING
MECHANISM OF ONS EFFECT RESPONSIBILITY
ACTION

BRAND NAME: CLASSIFICATION: This medication is Potassium chloride is SIDE EFFECTS Monitor renal function,
indicated for treatment contraindicated to fluid intake and output,
Weakness
and/or prevention of patients with: potassium, creatinine,
hypokalemia to avoid and blood urea nitrogen
Kalium Electrolyte replacement Heaviness of legs
acid-base imbalance levels.
MECHANISM OF Restlessness
· Acute dehydration
ACTION:
Abdominal discomfort
Heat cramps
Assess vital signs and
This drug acts as the
GENERIC NAME: Vomiting ECG. Stay alert for
major cation in Hyperkalemia
arrhythmias.
intracellular fluid,
Nausea
Severe renal
activating many
impairment
Potassium Chloride enzymatic reactions · Irritation at IV site
essential for Administer with or just
Severe hemolytic
physiologic processes, Hypotension after a meal, with a
reactions· Severe tissue
including nerve impulse glass of water.
trauma Flatulence
transmission and
Tell patient to swallow
DOSAGE: cardiac and skeletal Untreated Addison’s
tablet whole without
muscle contraction. disease
ADVERSE EFFECTS crushing or chewing it.
Potassium also helps
maintain
750mg 1 tab Respiratory paralysis
electro-neutrality in

65
 cells by controlling Unusual fatigue · Instruct patient to
exchange of minimize GI upset by
Asthenia
intracellular and eating frequent, small
extracellular ions. It servings of food and
ROUTE: Flaccid paralysis
also helps maintain drinking plenty of
normal renal function Absent reflexes fluids.
and acid-base balance.
P.O (orally) Arrhythmias
REFERENCE:
Cardiac arrest Advise patient to report
nausea, vomiting,
Hyperkalemia confusion, numbness
Sullivan, K. (2011).
and tingling, unusual
FREQUENCY: 2011 Nurse’s Drug Rashes
fatigue or weakness, or
Handbook (10th
a heavy feeling in legs.
Edition). United States

TID for 3 days of America: Jones &

Bartlett Learnin

66
Nursing Management

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 Discharge Planning

● Ensure the patient understands any prescribed

medications, including dosage, frequency, and
potential side effects.
● Tell the patient to follow the prescription
exactly as the assigned physician has prescribed.
MEDICATIONS
● Provide written instructions and a schedule for
medications.
● Inform the patient to not forget to take
medication as prescribed, even if the patient has
been to the doctor or the hospital, to ensure that
the patient is receiving the proper care.

● Advise the patient on appropriate levels of

physical activity and restrictions based on their
surgical procedure.
EXERCISE ● Inform the patient to focus on gentle
cardiovascular exercises like sustained walking or
moderate jogging, and Yoga. But avoid bending
and stretching the stomach too much.
● Emphasize the importance of adequate rest
during the recovery period.

80
 ● Tell the patient to never stop the treatment of the
patient, not until they’re told so.
TREATMENT
● Instruct the patient about the treatment regimen

● Instruct the patient on proper wound care if

applicable (e.g., for laparoscopic incisions).
● Provide information on signs of infection and
HYGIENE when to contact healthcare providers.
● Educate the patient the importance of
maintaining good proper hygiene on a daily
basis for the safety of the patient.

● Provide the patient with a clear understanding of

the follow-up schedule and the importance of
attending these appointments.
● Advise the patient to take note of any question
or problems to be addressed so that they can
OUTPATIENT (CHECK UP easily remember it during visits.
● Instruct family to call or visit their healthcare
provider immediately if they find any
unusualities regarding the patient’s condition.
● Provide emergency contact information in case
the patient experiences unexpected
complications or concerns.

81
 ● Offer guidance on a healthy and balanced diet to
support recovery.
DIET
● Discuss any dietary restrictions or modifications
based on the patient's condition.

● Discuss the potential emotional and

psychological impact of uterine myomas.
● Provide information on support groups,
SPIRITUALITY counseling services, or resources for patients
seeking emotional support.

82
 REFERENCES

Porcaro, G., Santamaria, A., Giordano, D., & Angelozzi, P. (2020). Vitamin D plus
epigallocatechin gallate: a novel promising approach for uterine myomas.
European Review for Medical & Pharmacological Sciences, 24(6).

Russo, C., Camilli, S., Martire, F. G., Di Giovanni, A., Lazzeri, L., Malzoni, M., ... &
Exacoustos, C. (2022). Ultrasound features of highly vascularized uterine
myomas (uterine smooth muscle tumors) and correlation with histopathology.
Ultrasound in Obstetrics & Gynecology, 60(2), 269-276.
https://doi.org/10.1002/uog.24855

Cabezas, N., López-Picazo, A., Diaz, P., Valero, B., Rodriguez, M. J., Redondo, A.,&
Alcázar, J. L. (2023). How frequently benign uterine myomas appear suspicious
for sarcoma as assessed by transvaginal ultrasound?. Diagnostics, 13(3), 501.
https://doi.org/10.5114/aoms/171786

Li, B., Wang, F., Chen, L., & Tong, H. (2023). Global epidemiological characteristics of
uterine fibroids. Archives of Medical Science, 19(6), 1802-1810.
https://doi.org/10.5114/aoms/171786

Lou, Z., Huang, Y., Li, S. et al. Global, regional, and national time trends in incidence,
prevalence, years lived with disability for uterine fibroids, 1990–2019: an
age-period-cohort analysis for the global burden of disease 2019 study. BMC
Public Health 23, 916 (2023). https://doi.org/10.1186/s12889-023-15765-x

Tinelli, A., Vinciguerra, M., Malvasi, A., Andjić, M., Babović, I., & Sparić, R. (2021).
Uterine fibroids and diet. International journal of environmental research and
public health, 18(3), 1066. https://doi.org/10.3390/ijerph18031066

Tanchuling, J. (2021). 1158 Prevalence of endometrial carcinoma in women with myoma

uteri associated abnormal uterine bleeding (AUB) in a tertiary government
hospital. Endometrial Cancer. https://doi.org/10.1136/ijgc-2021-esgo.234

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Uterine fibroids treatment | St. Luke’s Medical Center. (2023, September 13).
https://www.stlukes.com.ph/health-library/health-articles/uterine-fibroids-treatme
nt

General Gynaecology. (2017). Journal of Obstetrics and Gynaecology Research, 43(S1),

87–101. https://doi.org/10.1111/jog.13390

Schull, P. D. (2013). Nurse’s Drug Handbook Seventh Edition. New York: McGraw-Hill
Education

Sullivan, K. (2011). 2011 Nurse’s Drug Handbook (10 Edition). United States of
America: Jones & Bartlett Learning

Fibroids (Uterine Myoma). (2022, October 30). Yale Medicine.

https://www.yalemedicine.org/conditions/fibroids

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