Republic of the Philippines

SULTAN KUDARAT STATE UNIVERSITY

College of Health Sciences
ACCESS Campus, EJC Montilla, Tacurong City

A CASE STUDY ON
PATIENT WITH ABNORMAL UTERINE
BLEEDING SECONDARY TO MYOMA UTERI
OR UTERINE FIBRIOIDS

A CASE SUBMITTED FROM THE OBSTETRICS WARD EXPOSURE OF BACHELOR

OF SCIENCE IN NURSING LEVEL IV – SECTION C (GROUP 3)

SUBMITTED BY:

JENNIFER ALAMON
HAZEL RIANNE BASE
CRISSAFEL DEL ROSARIO
HANS GABRIEL DELES
FAIRRY ANN GATCHALIAN
ALEA LADRIDO
SAMERA MANGUDA
CHARMINE PALOMO
RIDA PILLO
PRENZ JOMAR TAGUIBAO
 TABLE OF CONTENTS
Background of the Study 1
Definition of the Diagnosis 2
Nursing Health History 4
Pathophysiology 5
Medical Management 6
Drug Studies 8
List of Nursing Problems (NANDA) 17
Health Teaching 29
FDAR 32
Bibliography 33
 BACKGROUND OF THE STUDY

Patient Lawangin Mison Digan, a single individual, was born on December 5, 1974,

making her a 49-year-old resident of Midtungok, SNA, Sultan Kudarat. She sought

medical attention due to concerns related to abnormal uterine bleeding, a condition

attributed to myoma uteri. Myoma uteri, commonly known as uterine fibroids, are benign

growths that develop within the muscular wall of the uterus. In Patient Digan's case, these

fibroids were causing irregular and excessive bleeding.

During the initial assessment, Patient Digan provided crucial information, stating

that she had not engaged in recent sexual activity and was not currently using oral

contraceptives. This information is vital for the healthcare provider to understand potential

contributing factors and formulate an appropriate treatment plan.

Abnormal uterine bleeding secondary to myoma uteri manifests in various ways,

leading to disruptions in the normal menstrual cycle. This may include heavy or prolonged

bleeding during menstrual periods, irregular bleeding between periods, and unpredictable

spotting. These symptoms can significantly impact a woman's quality of life, leading to

discomfort, fatigue, and emotional distress.

In addition to the patient's personal history, a detailed examination of her family

history was conducted, revealing no significant contributions to her current condition. This

information aids in ruling out hereditary factors that might be associated with uterine

fibroids.

1
 DEFINITION OF THE DIAGNOSIS

Uterine fibroids are common benign neoplasms, with a higher prevalence in older

women and in those of African descent. Many are discovered incidentally on clinical

examination or imaging in asymptomatic women. Fibroids can cause abnormal uterine

bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary

retention, low back pain, constipation, and dyspareunia. Ultrasonography is the preferred

initial imaging modality. Expectant management is recommended for asymptomatic

patients because most fibroids decrease in size during menopause. Management should

be tailored to the size and location of fibroids; the patient's age, symptoms, desire to

maintain fertility, and access to treatment; and the experience of the physician. Medical

therapy to reduce heavy menstrual bleeding includes hormonal contraceptives,

tranexamic acid, and nonsteroidal anti-inflammatory drugs. Gonadotropin-releasing

hormone agonists or selective progesterone receptor modulators are an option for

patients who need symptom relief preoperatively or who are approaching menopause.

Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and

magnetic resonance–guided focused ultrasound surgery.

A uterine fibroid is a non-cancerous growth in the uterus (womb). It can grow on

the inside of the uterus, within the muscle wall of the uterus or on the outer surface of the

uterus. Uterine fibroids are also known as myomas.

Uterine fibroids have different growth patterns. Some grow slowly, while others

grow rapidly. Some do not grow in size at all, while some uterine fibroids go through

growth spurts.

2
 There are also uterine fibroids that resolve on their own. For example, fibroids that

developed during pregnancy may shrink or completely disappear as the uterus returns to

its normal size after pregnancy.

Uterine fibroids are classified according to their location in the uterus:

• Intracavitary. This type of uterine fibroid is almost completely within the womb cavity.

It extends into the uterine cavity.

• Intramural or intramyometrial. This is the most common type of uterine fibroid. It is

located completely within the womb muscle.

• Pedunculated. Pedunculated fibroids are located on the outer and inner wall of the

womb. They are attached to the womb surface by a stalk. When sudden movements

cause these fibroids to rotate, you may feel sudden and intense pain.

• Submucous. This type of uterine fibroid is located partially in the womb cavity, starting

from its wall. This is the least common type of uterine fibroid. It can cause heavy

bleeding and is most closely related to a fertility problem.

• Subserous. Subserosal uterine fibroids protrude outside the womb, with the base on

the outer surface of the womb. These fibroids may cause pressure, but they do not

usually cause bleeding.

3
 NURSING HEALTH HISTORY

I. PATIENT’S BIOGRAPHICAL INFORMATION

Name: Lawangin Mison Digan

Address: Midtungok, Senator Ninoy Aquino, Sultan Kudarat

Age: 49 years old

Birthday: Decembar 5, 1974

Gender: Female

Nationality: Filipino

Religion: Roman Catholic

Marital Status:

II. NURSING HEALTH HISTORY

A. CHIEF COMPLAINT

Abdominal Pain and Uterine Bleeding

B. HISTORY OF PRESENT ILLNESS

The patient is 49 years old with myoma uteri as described enlarged anteverted uterus

with secretory phase endoretus

4
 PATHOPHYSIOLOGY

LOW PARITY EARLY MENARCHE AGE 40 – 50

INCREASED ESTROGEN EXPOSURE IN LIFETIME

ESTROGEN STIMULATES PROLIFERATION OF UTERINE SMOOTH

MUSCLE CELLS

BENIGN PROLIFERATION OF MONOCIONAL MYOMETRIAL (UTERINE

WALL/MUSCLE) CELLS INTO DISCRETE MASSES

UTERINE FIBROIDS (LEIOMYOMAS)

BENIGN TUMORS ORGINATING IN AND CONSISTING OF UTERINE
MUSCLE TISSUE

FIBROIDS CAN BE LOCATED IN DIFFERENT AREAS OF THE UTERUS

INCREASED ENDOMETRIAL SURFACE AREA

INCREASED ENDOMETRIUM TO PROLIFERATE AND LOSE DURING

MENSTRUATION

MENORRHAGIA REPEAT SHEDDING OVER TIME

DYSMENORRHEA IRON DEFICIENCY ANEMIA

ETIOLOGY MECHANISM COMPLICATIONS

MECHANISM

5
 MEDICAL MANAGEMENT

Fibroids are the most common benign tumors of the female reproductive tract. In

fact, 25% of women older than age 35 have uterine leiomyomas. Most are asymptomatic.

When present, symptoms may include heavy menstrual bleeding, intermenstrual or

postmenopausal bleeding, infertility, back pain, pressure, or urinary issues, and

hydronephrosis due to ureteral compression. The symptoms are related to the size, type,

number, and location of the tumor(s). Management of women with symptomatic uterine

myomata depends on several factors including age; reproductive plans; size, location,

and number of leiomyomas and type and severity of symptoms. Asymptomatic women do

not require any treatment and prophylactic surgery to prevent potential complications is

not recommended. Many modalities are available for treatment of women with

symptomatic myomata, including expectant management (especially for those close to

menopause), medical treatment, and surgery. This review is confined to medical

management of uterine myomata.

Medical treatment is particularly useful for women in whom surgery is

contraindicated or who are at high surgical risk, and for those who do not wish to undergo

procedures including uterine artery embolization. The purpose is to alleviate symptoms

and improve quality of life. Medical management is also used preoperatively to improve

the hematologic status of patients before surgery and to reduce myomata volume,

enabling use of a minimally invasive surgical technique.

6
SYMPTOMATIC TREATMENT

• Oral contraceptive pills (OCPs): The influence of OCP on myomata is poorly

understood and data on its effect on the size of myomata are conflicting. Yet, by

inhibiting ovulation, both OCPs and pregnancy may have a protective effect

against the recurrence of fibroids after myomectomy.

• Tranexamic acid (TA): This antifibrinolytic lysine derivative reduces the amount

of bleeding by preventing fibrin degradation. FDA-approved for treatment of

menorrhagia in 2009, TA decreases menstrual bleeding within 2–3 hours of

administration.

• Progesterone: Because it promotes endometrial atrophy and suppresses

gonadotropin secretion, oral progesterone is often used to treat abnormal uterine

bleeding. On the other hand, the levonorgestrel-releasing intrauterine system

(LNG-IUS) seems to be effective and has fewer adverse effects compared to other

progestin preparations. It does not reduce myomata volume, but after an initial

period of irregular spotting, it causes amenorrhea in most cases and improves

anemia.

7
DRUG STUDY
 Mechanism of Nursing
Drug Name Classification Indication Contraindication Adverse reaction
action considerations
Brand name: Tranexamic Tranexamic acid is Taken orally, Hypersensitivity. CNS: Perform eye
acid is an an antifibrinolytic tranexamic acid is Active convulsions, examinations (e.g.
antifibrinolytic agent that inhibits indicated for the thromboembolic severe visual acuity,
Generic name: used to reduce the breakdown of treatment of disease (e.g. hypersensitivity intraocular pressure,
Tranexamic Acid or prevent fibrin clots. It blocks hereditary pulmonary embolism, reactions, cerebral visual fields, slit lamp)
hemorrhagic the lysine binding angioedema, cyclic DVT, cerebral oedema and and monitor LFTs
Dosage: episodes, sites of plasminogen heavy menstrual thrombosis), history or infarction, regularly during
12/29/23 especially in and impairs the bleeding in risk of dizziness continuous long-term
1g the context of endogenous premenopausal thromboembolism treatment. Monitor for
hyperfibrinolytic fibrinolytic process, females, and other (including retinal vein CV: venous and signs and symptoms of
Frequency: disorders. thus preserving and instances of or artery occlusion); arterial thrombosis hypersensitivity
q8 stabilizing the fibrin significant bleeding fibrinolytic conditions or reactions, convulsions,
matrix structure. in the context of after consumption thromboembolism, thrombotic events, and
Route: Additionally, it hyperfibrinolysis. In coagulopathy (unless Anaemia ureteral obstruction.
IVTT reduces this case, predominant For menorrhagia:
inflammation tranexamic acid is activation of the EENT: Visual Exclude structural or
associated with given due to the fibrinolytic system with defects, retinal histological causes or
hereditary excessive uterine acute severe venous and fibroids distorting the
angioedema by bleeding of the bleeding), history of arterial occlusions, uterine cavity before
inhibiting the patient. Given convulsions; acquired ligneous initiating treatment.
proteolytic activity of intravenously, disturbances of color conjunctivitis,
plasmin which tranexamic acid is vision. Severe renal Nasal and sinus
decreases the indicated for short- impairment. symptoms
activation of term use (2-8 days) Concomitant use with
complement and in patients with combined hormonal Musculoskeletal:
consumption of C1 hemophilia to contraceptives. Musculoskeletal
esterase inhibitor prevent or reduce pain, back pain,
(C1-INH). bleeding following muscle cramps or
tooth extraction. spasm, arthralgia

9
 MECHANISM OF ADVERSE
DRUG NAME INDICATION CONTRAINDICATION NURSING RESPONSIBILITY
ACTION EFFECT
Generic Name: Bevates the serum iron General: Contraindicated with CNS: CNS Before:
Ferrous Sulfate concentration, and is ➢ Prevention allergy to any ingredient; toxicity, ➢ Check the doctor’s order
then converted to Hgb and treatment sulphite allergy; acidosis, ➢ assess for allergy to any
Brand Name: or trapped in the of iron- hemochromatosis, coma and ingredient,
Femiron, reticuloendothelial cells defficiency hemosiderosis, death with sulfite;hemochromatosis,
Hemocyte, Ircon tor storage and anemias haemolytic anemias. overdose. hemosiderosis, haemolytic
eventual conversion to ➢ Dietary anemias
Patent's dose: a usable form ofiron suppplement Precaution: use GI: GI upset, ➢ assess for skin lesions, color;
Itab BID for iron cautiously with normal anorexia, gums, teeth (color): bowel
Onset: 4 days Peak: ➢ Unlabeled iron balance: peptic nausea, sounds
Route:PO 7-10 days Duration: 2- use: ulcer, regional enteritis, vomiting, ➢ monitor blood studies
4 mo. Metabolism: supplemental ulcerative colitis constipation, ➢ contirm that client does have
Recycled for use, not use during diarrhea, dark iron
known Distribution: epoetin Interactions: stools, defciency anemia
crosses placenta therapy to temporary
enters breast milk ensure proper drug-drug: decreased staining of During:
hematologic nti-infective response to teeth (liquid ➢ Verify patient’s identity
response to ciprofoxacin, norfoxacin, preparations) ➢ Administer the right drug in the
epoetin. ofoxacin; decreased right dose and route at the right
absorption with time
Patient’s actual antacids,cimetidine; ➢ Do not crush, chew or cut
indication: decreased effects of tablets and capsules
Ferrous sulfate is levodopa if taken with ➢ Give drug with meals (avoiding
given to the iron: increased serum milk, eggs, coffee, and tea)
patient for the iron levels with ➢ Administer liquid preparation in
prevention and chloramphenicol water or juice to mask the taste
treatment of iron- and prvent staining of teeth;
defficiency anemia drug-food: decreased have patient drink solution with
brought about by absorption with straw
the illness. antacids, eggs or milk,
cofee and tea; avoid ➢ Do not take this drug with
concurrent antacids nor tetracyclines
administration of any of unless prescribed
these

10
 After :
➢ Warn patient that stool maybe
dark or green
➢ Arrange periodic monitoring of
Hct of Hgb levels
➢ Keep this drug out of reach of
children(may cause fetal
poisoning)
➢ Report severe GI upset,
lethargy, rapid respiration and
constipation
➢ Document and record

11
 MECHANISM OF
DRUG ADVERSE
ACTION INDICATION CONTRAINDICATION NURSING RESPONSIBILITY
NAME EFFECT
Generic Inhibits proton GERD/maintenan - Contraindicated in - CNS: dizziness, • Give omeprazole before
Name: pump activity by ce of healing in patients’ hypersensitivity to drowsiness, meals, preferably in the
Omeprazole binding to erosive drug or its components fatigue, headache, morning for once-daily
hydrogen esophagitis. and in patients receiving weakness. dosing.
Brand Name: potassium Duodenal ulcers rilpivirine containing - CV: chest pain. • If needed, also give an
Losac, triphosphate, (Short-term products. GI: abdominal pain, antacid, as prescribed.
Prilosec, located as treatment). - Use cautiously in patients acid regurgitation, • Assess patient routinely for
Zegerid secretory surface Helicobacter with hyperkalemia and constipation, gastric or abdominal pain
of gastric parietal pylori infection respiratory alkalosis and diarrhea, and frank or occult blood in
Ordered: cells, to suppress and dou-denal 8n patients on a low flatulence, nausea, the stool, emesis, or gastric
Dosage gastric acid ulcer disease, to sodium diet. vomiting. - aspirate.
40 mg secretion. eradicate H. - Risk for fundic gland Musculoskeletal: • If needed, open capsule and
Pylori with polyps increases with long back pain, sprinkleenteric-
Frequency: Therapeutic clarithromycin term use especially weakness. coatedgranules on
Once a day Effects: (dual therapy). beyond 1 year. Respiratory: cough, applesauce or yogurt or mix
Diminished active benign - Use PPIs may increase URI. Derm: itching, with water or acidic fruit
Route: accumulation of gastric ulcer. risk of CDAD. rash, Misc: allergic juice, such as apple or
IVTT acid in the gastric Pathologic hyper - Pregnancy, lactation, or reactions. cranberry juice.
Classification lumen with secretory children <2 yr (safety not • Give immediately. Give drug
Therapeutic: lessened gastro conditions, established). via NG tube, when needed
antiulcer esophageal including by mixing granules in acidic
agents reflux. Healing of Zollinger-Ellison juice, because enteric
duodenal reflux. syndrome. coating dissolves in alkaline
Reduction of risk pH, or using the delayed-
of GI bleeding in release oral suspension form
critically ill by mixing with water.
patients. OTC: • Know that because drug can
Heartburn interfere with absorption of
occurring vitaminB12, monitor patient
≥twice/wk. for macrocytic anemia.
Frequent • Monitor patient for patients
heartburn (2 or signs and symptoms of low
magnesium levels, such as

12
more days a normal HR, palpation,
week) muscle spasms, tremors or
Dyspepsia seizure.
Patient Teaching:
• Tell patients to swallow
tablets whole and not to
open, crush, or chew them.
• Give patients instructions on
how to take oral suspension.
• Instruct patients to take
drugs at least 30 to 60
minutes before meals.
• Cautions patients to avoid
hazardous activity if
dizziness occurs.
• Advise patients that Prilosec
OTC isn’t intended to treat
infrequent heartburn (one
episode of heartburn a week
less). Or for those who want
immediate relief of
heartburn.
• Teach patients to recognize
and report signs and
symptoms of low magnesium
levels.
• Instruct patient to take
medication as directed for
the full course of therapy,
even if feeling better. Take
missed doses as soon
remembered but not if
almost time for next dose.
Do not double doses.

13
 Mechanism of Nursing
Drug Name Classification Indication Contraindication Adverse reaction
action considerations
Brand name: Replaces iron stores Indicated to Contraindicated in CNS: Dizziness 1. Regular
N/A Therapeutic in the body, it helps prevent iron- patients with monitoring of
class: replenish iron levels, deficiency anemia, Hypersensitivity, CV: Hypotension haemoglobin levels.
Generic name: enabling the body to rather than solely severe allergic 2. Monitor vital
Iron Sucrose Electrolytes produce enough as a preventive reaction, liver disease. Metabolic: sign and after the
replacements
haemoglobin and measure. Alteration in infusion to check for
Dosage: Pharmacologic
red blood cells Serum any adverse reaction.
2 grams class: Use cautiously in Electrolytes 3. Monitoring
Minerals . patients with Chronic periodic blood tests to
Route: Kidney Disease. Skin: Erythema assess iron levels.
IVTT or Skin 4. Observation for
discoloration any local reactions or
Frequency: issues at the injection
N/A Other: Nausea or site.
Vomiting

14
 Mechanism of Nursing
Drug Name Classification Indication Contraindication Adverse reaction
action considerations
Generic name: Therapeutic Action: Ibuprofen Ibuprofen is used Asthma: that is CNS: dizziness, Administer drug with
Ibuprofen class: Non- exerts its anti- to relieve pain aspirin or NSAID fatigue, food or after meals if
inflammatory and from various sensitive, known headache, GI upset occurs,
steroidal Anti- conditions such as
analgesic effects hypersensitivity to nervousness Arrange for periodic
Brand name: Inflammatory headache, dental aspirin and other
through inhibition GI: dyspepsia, ophthalmologic
N/A Drugs pain, menstrual NSAIDs, active
of both COX cramps, muscle
heartburn, examination during
gastrointestinal
isoforms. In aches, or arthritis. bleeding or peptic
nausea, loss of long-term therapy,
Pharmacologic addition, It is also used to appetite, Discontinue drug if
ulceration, known
class: Non- ibuprofen reduce fever and hypersensitivity or stomach pain, eye changes,
steroidal Anti- scavenges HO•, to relieve minor idiosyncratic reaction diarrhoea symptoms of hepatic
Inflammatory •NO, and ONOO− aches and pain to ibuprofen (or any of hypersensitivity impairment, or renal
Drugs radicals and can due to the the other ingredients reactions - skin impairment occur, Be
potentiate or common cold or in the product) rashes and aware that patient
inhibit nitric oxide flu. Ibuprofen is a itching. Rarely may be at increased
formation through nonsteroidal anti- exfoliative risk of CV event, GI
inflammatory drug
its effects on nitric dermatitis and bleeding, monitor
(NSAID).
oxide synthase epidermal accordingly, Institute
(NOS) isoforms. necrolysis have emergency
Therapeutic been reported procedures if
Effects: It works with ibuprofen overdose occurs:
by blocking your cardiovascular - Gastric lavage,
body's production fluid retention induction of emesis,
of certain natural and in some and supportive
substances that cases oedema. therapy.
cause These effects are
inflammation. This rare at non-
effect helps to prescription
decrease swelling, doses.
pain, or fever.If
you are treating a
chronic condition

15
such as arthritis,
ask your doctor
about non-drug
treatments and/or
using other
medications to
treat your pain.

16
NURSING CARE PLANS
 NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
December 29, 2023

Subjective cues: A. Identify the

“Hindi ako makahulag type of
sang mayad.” discomfort the
Objective cues : client is
After 8 hours
Restlessness experiencing. A. Help the client
of intervention “GOAL MET”
Sighing B. Review identify the focus of
the patient will After 8 hours of
Moaning knowledge discomfort.
be able to: nursing
base and note B. Brings these
intervention
coping skills client’s to
A. Engage in patient was able
that have been awareness and
behavior or to:
used promotes use in the
lifestyle A. Responses
previously to current situation.
Impaired Comfort changes to to interventions,
promote well- C. To provide
related to increase level teaching, and
being. nonpharmacological
abdominal of ease actions
C. Provide age- pain management.
cramping B. Verbalize performed.
approppriate D. Timely
sense of B. Progress
comfort recognition and
comfort or toward desired
measures. intervention can
contentment outcomes.
D. Discuss promote wellness.
C. Participate C. Modifications
potential
in desirable to plan care.
complications
and realistic
and the
health-seeking
possible need
behavior
for medical
follow-up or
alternattive
therapies.

18
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

December 29, Activity After 7 hours of A. Assess client’s A. Influences December 29,
2023 (10:00am) Intolerance nursing intervention ability to perform choice of 2023 (05:00pm)
Subjective Data: related to the client will be able normal task and interventions and “Goal Met”
"Nakapoy gid ko Myoma as to: ADLs. Noting reports needed assistance. After 7 hours of
sige higda, grabi evidenced 1. Report a of weakness, fatigue B. May indicate nursing
pa gid kainit, by fatigue measurable and difficulty neurological intervention the
gusto ko na and increase in activity accomplishing tasks. changes client was able to:
magpauli.” generalized intolerance including B. Note changes in associated with 1. Report a
weakness performance in balance, gait vitamin B12 measurable
ADLs. disturbance, and deficiency, increase in activity
Objective Data: 2. Demonstrate muscle weakness. affecting client’s intolerance
Fatigue reduced C. Monitor BP, pulse safety and including
Facial Grimace physiological signs and respirations increasing risk of performance in
seen upon of intolerance – during and after injury. ADLs.
moving pulse, BP, and activity. Note adverse C. 2. Demonstrate
Irritability respirations, within response to Cardiopulmonary reduced
Blood Pressure- clients’ normal increased levels of manifestations physiological
110/70mm/Hg, range. activity – increased result from signs of
Respiratory heart rate and BP, attempts by the intolerance –
Rate- 29bpm, dysthymias, heart and lungs to pulse, BP, and
Pulse Rate- dizziness, dyspnea, supply adequate respirations,
86bpm, tachypnea, and amounts of oxygen within clients’
Temperature- 37 cyanosis of mucus to the tissues. normal range.
°C, Spo2- 99% membranes and D. Activity may E. Understanding
nailbeds need to be the specific nature
D. Recommend minimize to reduce of the discomfort is
frequent rest periods strain on the heart crucial for
or bedrest, as and lungs. developing an
indicated. effective

19
 E. Determined intervention plan.
type of discomfort Different types of
the client is discomfort may
experiencing, such require distinct
as physical pain, approaches,
feeling of whether it be
discontent, lack of addressing
ease with self, physical pain
environment, or through medical
sociocultural interventions,
settings, or inability addressing
to rise above one’s discontent through
problem or pain. counseling, or
addressing issues
related to self,
environment, or
sociocultural
settings through a
holistic and
personalized
approach.

20
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

December 29, Fatigue After 6 hours of A.Identify the A.Recognizing “Goal Met”
2023 (09:00am) related to nursing intervention presence of physical underlying health After 6 hours of
poor the patient will be and/or phycological issues can guide nursing
Assessment physical able to: conditions. appropriate intervention the
Subjective condition interventions, whether patient was be
Data: A. Report improved they involve medical able to:
"Nakapoy naku sense of energy. treatments, lifestyle
segi hulag- B.Perform ADLs adjustments, or A. Reported
hulag kag Wala and participate in psychological improved sense
naku gana desired activities at support.By pinpointing of energy.
miskan level of ability. contributing factors, a B.Performed
magpungko C.Participate in more targeted and ADLs and
para magkaon." recommended effective approach to participated in
Objective Data: treatment program. managing fatigue can desired
Drowsiness, be developed, activities at level
Lethargy, improving overall well- of ability.
Disinterest in being. C.Participated
sorroundings, B.Note recent B.Lifestyle changes, in
lack of energy lifestyle such as shifts in work or recommended
changes,including sleep patterns, may treatment
conflicts,maturational contribute to fatigue. program.
issues and Conflicts and stressors
developmental can lead to emotional
issues. exhaustion.
Maturational and
developmental issues,
such as aging or major
life transitions, may
affect energy levels.

21
 Acknowledging these
aspects provides a
comprehensive view,
enabling tailored
strategies for managing
fatigue based on
individual
circumstances.
C.Accept the reality C.Understanding the
of client reports of significant impact on
fatigue and do not the client's quality of life
underestimate effect ensures a more
on client's quality of empathetic and
life. effective approach to
addressing fatigue,
promoting a client-
centered care model.
D.Plann care to allow D.To maximize
individually adequate participation.
rest
periods.Schedule
activities for periods
when client has the
most energy.
E.Establish realistic E.Enhances
goals with the client commitment to
and encourage promoting optimal
forward movement. outcomes.
F.Assist F.Promotes sense of
client/significant control and improves
others to develop self-esteem.
plan for activity and

22
exercise within
individual activity.

23
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Subjective: Disturbed After 8 hours of • Assess • High
"Di ko katulog sleeping pattern nursing sleep pattern percentage of Goal met
maayo ma'am, related to interventions the disturbances sleep
gahod abe diri" environmental patient will able that are disturbances After 8 hours of
verbalized by the factors such as to. associated can affect the nursing
patients. interruptions for A. Verbalize with the recovery of interventions the
intervention and understanding of environment. the patient. patient was able
ambient noise sleep to.
Objectives: and impairment. • Observe and • To determine A. Verbalized
tiredness, temperature obtain usual understanding of
mood changes, as evidenced B. Identify feedbacks sleeping sleep
lack of energy by "Di ko individually regarding on pattern and to impairment.
katulog maayo appropriate the usual compare if
ma'am, gahod intervention to sleeping there are any B. Identified
abe diri" promote sleep. pattern, improvements individually
verbalized by bedtime on the appropriate
the patient. C. Adjust lifestyle routine and sleeping intervention to
to accommodate the usual pattern of the promote sleep.
chronobiological number of patient.
rhythms. hours of C. Adjust lifestyle
sleepand to accommodate
D. Report rest. • To avoid chronobiological
improvement in disturbances rhythms.
sleep or rest • Do as much during sleep,
pattern. are as and also to D. Reported
possible maximize the improvement in
E. Report without sleep and rest sleep or rest
increase sense waking up of the patient. pattern.
of well-being and the client
feeling rested. and do as E. Reported
much care increase sense

24
 as possible • For the of well-being and
while the patient to feeling rested.
patient is still have an
awake. understanding
of the
• Explain importance of
necessity of care being
disturbances done to her
for and to
monitoring minimize her
Vital signs complaints.
and other
care when • These factors
hospitalized. are known to
disrupt sleep
• Encourage patterns.
patient
limiting • To reduce
intake of stimulation so
coffee, the patient
chocolate can relax.
and other
substances
specially • To decrease
prior to tension,
bedtime. prepare for
rest
• Instruct
patient in
relaxation
techniques
and comfort.

25
 • Provide
calm, and
manage
controllable
sleep
disrupting
factors,(
noise, light
and room
temperature.

26
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
DECEMBER 30, Impaired After 6 hours of 1. Administer Pain medications, After 6 hours of
2023 comfort related nursing prescribed such as analgesics nursing intervention:
to pelvic pain intervention: pain or anti-
Objective: due to medications. inflammatory GOAL MET
Abnormal The patient will drugs, are
• Facial Uterine experience a prescribed to ⚫ The patient
grimace. bleeding reduction in address the reports a decrease
• Guarding secondary to pelvic pain as physiological in pelvic pain
the pelvic Mayoma Uteri. evidenced by a source of pain and intensity.
region. pain rating of 5 or provide relief. ⚫ The patient
• Limited lower on a scale demonstrates the
Mobility of 0 to 10 within use of effective
• Altered the next 6 hours. 2. Implement Heat therapy is pain management
posture comfort known to promote techniques.
measures. vasodilation, ⚫ The patient
Subjective: increase blood verbalizes an
flow, and alleviate understanding of
muscle tension. the importance of
“Nagadagdag adhering to
ang sakit kung 3. Collaborate Finding prescribed pain
mag galaw ako” in positioning comfortable management
as verbalized by and positions and strategies..
the patient. movement. gentle movement
help prevent
stiffness and
improve circulation.

4. Educate on Patient education

pain enhances the
management patient's
strategies. understanding of
their pain and the

27
 available
management
strategies.

5. Encourage Adequate rest and

rest and relaxation
relaxation. contribute to
muscle recovery
and can help
alleviate tension,
reducing the overall
perception of pain.

Adequate
hydration is
essential for overall
well-being and can
6.Encourage contribute to pain
fluid intake. management.

28
 HEALTH TEACHING

Rest and Recovery:

• Prioritize rest and sleep whenever possible to aid physical and emotional recovery.

• Provide tips for improving sleep hygiene, including maintaining a consistent sleep

schedule, creating a comfortable sleep environment, and avoiding stimulants close

to bedtime.

• Adjust goals as needed based on the patient's evolving health status.

Pain Management:

• Use over-the-counter pain relievers or prescribed medications as directed for

discomfort or pain.

• Encourage regular communication about pain levels, triggers, and any changes in

the pain experience.

• Emphasize the importance of taking medications as prescribed and notifying

healthcare providers of any adverse effects.

Emotional Well-being:

• Seek help if experiencing persistent symptoms of depression or anxiety.

• Emphasize the importance of open communication with healthcare providers

regarding emotional well-being.

Support Systems:

• Lean on friends, family, or support groups for emotional support.

• Acknowledge the emotional impact of uterine bleeding and myoma uteri on the

patient's quality of life.

29
 • Provide information about support groups or counseling services available for

emotional support.

Partner and Family Support:

• Encourage partners to provide active support and help with caregiving.

Nutrition:

• Maintain a balanced diet to support recovery and healthy body.

• Highlight the role of nutrition in supporting the body's recovery process.

Physical Activity:

• Gradually reintroduce physical activity and exercise based on healthcare provider

guidance.

• Encourage modifications based on individual needs and abilities.

• Discuss the importance of modifying or stopping activities if they experience pain

or discomfort.

Medications:

• Take prescribed medications or supplements as directed.

• Explain how consistent adherence to the medication plan contributes to effective

pain management.

• Educate the patient about potential drug interactions, including interactions with

over-the-counter medications, herbal supplements, and other prescription drugs.

Warning Signs:

• Be alert to warning signs such as fever, severe pain, heavy bleeding, or infection,

and seek medical attention if necessary.

• Stress the importance of reporting any abnormal changes to healthcare providers.

30
 • Encourage the patient to track and monitor changes in their menstrual patterns,

including changes in flow, duration, or the presence of clots

Perineal Care:

• Keep the perineal area clean and dry to prevent infection.

• Use warm water and gentle soap for hygiene after using the toilet.

• Guide the patient on choosing gentle and hypoallergenic products for perineal care

to avoid irritation.

• Instruct on the importance of promptly changing soiled pads or undergarments to

maintain cleanliness and prevent skin irritation.

Questions and Concerns:

Encourage the patient to ask questions and express any concerns about their condition

or the recommended management plan.

31
 FOCUS, DATA, ACTION, & RESPONSE

DATE & TIME FOCUS DATA, ACTION, RESPONSE

Data: Patient received lying on bed awake
and coherent with IV Fluid 0.9% NaCl 1L
hooked at right antebrachial vein running at
30 gtts/min infusing well. Subjective Data:
“Nakapoy nako sige hulag-hulag kag wala na
ko gana mag pungko para mag kaon”
Objective Data: Drowsiness, Lethargy,
Disinterested in Surroundings, RR – 27 cpm.
Action: Identify the presence of physical
and/or psychological conditions, note recent
lifestyle changes, including conflicts,
December 29, ACTIVITY maturational issues and developmental
2023 | 09:00 am INTOLERANCE issues, establish realistic goals with the client
and encourage forward movement, assist the
client and significant others to develop plan
for activity and exercise within individual
ability. -----------------------------------------------
Response: The patient was able to
verbalized “medyo okay na ko”, patient was
able to sit on her own. The client and
significant others verbalized the willingness
to develop a tailored plan for activity and
exercise, aiming to enhance overall well-
being. Endorsed to NOD. ------------------------

32
 BIBLIOGRAPHY

Al-Asmari, N. (2020, November 13). Uterine fibroids: medical management options.

Contemporary OB/GYN. https://www.contemporaryobgyn.net/view/uterine-

fibroids-medical-management-options

Puchar, A., Feyeux, C., Luton, D., & Koskas, M. (2016). Therapeutic management of

uterine fibroid tumors. Minerva ginecologica, 68(4), 466–476.

Stewart, E. A., Laughlin-Tommaso, S. K., Catherino, W. H., Lalitkumar, S., Gupta, D., &

Vollenhoven, B. (2016). Uterine fibroids. Nature reviews. Disease primers, 2,

16043. https://doi.org/10.1038/nrdp.2016.43

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