A CASE REPORT:

43-YEAR-OLD WOMAN
DIAGNOSED WITH
MULTIPLE UTERINE
MYOMA

Presented by:
Group 1
 TO UNDERSTAND THE PATHOPHYSIOLOGY OF UTERINE MYOMA
TO IDENTIFY THE PREVALENCE AND INCIDENCE OF MYOMA
TO BECOME ACQUAINTED WITH THE PREDISPOSING FACTORS OF MYOMA
TO KNOW THE ASSOCIATED SIGNS AND SYMPTOMS
TO PRESENT THE MEDICAL AND NURSING MANAGEMENT FOR MYOMA
TO APPLY THE PRINCIPLES OF THE NURSING PROCESS

TO CARRY OUT THE STAGES OF THE NURSING PROCESS (ASSESSMENT, DIAGNOSIS, PLANNING,
AND IMPLEMENTATION).T

TO DIAGNOSE NURSING PROBLEMS AND DEVELOP THE CORRESPONDING NURSING CARE PLANS
WITH FOCUS ON THE PLANNING PROCESS

OBJECTIVES
THEORETICAL
FRAMEWORK
● ROY’S ADAPTATION MODEL
 ROY’S
ADAPTATION
MODEL
The major concepts of the RAM include: an individual as adaptive system, the
environment, health, and the goal of nursing. As an adaptive system, an individual is
defined as a whole with parts that function as a unity for a purpose. The
environment is defined as all conditions, circumstances, and influences that
surround and affect the development and behavior of humans as adaptive systems
with particular consideration of human and earth resources. Health is a state and
process of being and becoming integrated and whole. The goal of nursing is to
enhance life processes to promote adaptation, with adaptation being the process
and outcome of thinking and feeling individuals who use conscious awareness
and choice to create human and environmental integration.

MAJOR CONCEPTS
 A. Client had undergone abdominal
myomectomy. Postmyomectomy
care requires adaptive responses (e.g.
Nutritional diet adjustment/wound
care/coping mechanisms)

RATIONA B. RAM justifies the manipulation of

LE: USE
the client’s
environment/surroundings for the
purpose of enhancing adaptive

OF RAM processes and abilities

C. Nursing management focuses on
promoting adaptation in all the
client’s adaptive systems
(Physiological/physical, role
function, coping processes, self-
concept/group identity, and
interdependence)
NURSING
HEALTH
HISTORY
PERSONAL
DATA Name : DJA

Age : 43

B-day: 3/1/76

Status : Single

Religion : Born Again

Occupation : Hair stylist

PERSONAL
DATA
Attending Physician : Dr.
QUIAMBAO

Date of Admission : January

24,2020 at 7:34 pm

How Admitted : Ambulatory

Chief Complaint : Enlarging

Abdominal Girth

Diagnosis : Multiple myoma

HISTORY OF
PRESENT
ILLNESS
>G1P1 with a chief complaint of abdominal girth 2
years prior to consultation

>Incidental finding of myoma via ultrasound. There

were no subjective complaints (e.g. hypogastric pain
or abnormal uterine bleeding).

>Client, however, experienced heavy menstrual flow.

>Few months prior to consultation, client noticed

enlarging abdominal girth.

>Myomas were confirmed via whole abdomen

ultrasound
PAST
MEDICAL
HISTORY
>Client has a history of hypertension (on
both paternal and maternal sides)

>She is on Losartan (50 mg/OD) medication

after being diagnosed as hypertensive in
2019

>Client reports instances of dysmenorrhea

>In 2007, client experienced induced

abortion at 7 months AOG

>GI: Intrauterine fetal

demise/preterm/normal spontaneous vaginal
delivery
FAMILY
MEDICAL
HISTORY
>Client’s mother and father are
both hypertensive

>Client’s mother had undergone

thyroidectomy 5 years ago

>A history of DM on both

maternal and paternal sides (an
aunt and a cousin)

>No history of CVD

GENOGRAM
PERSONAL
AND SOCIAL
HISTORY
Client works as a senior hairstylist

Her job finds her in various places of the

country (She claims to have stayed in Baguio for
9 months) (e.g. Laguna, Cavite, and Pampanga)

She lives with parents in Fairview

Client has 4 siblings (1 male and 3 females). All

hold blue-collared jobs.

Client is a practicing born again Christian

Claims to enjoy socialization with friends and

loved ones

She is a non-smoker and a non-alcoholic drinker

OBSTETRIC AND
GYNECOLOGICAL
HISTORY
Client had her menarche at 10 y/o

Since 2007, her menstruation had been irregular.

Most of her menses were prolonged lasting >7 days.

She claims to consume 2 or more large diapers in a

day during menstruation.

Prior to hospitalization, experiences dysmenorrhea

and menorrhagia.

Reports dull throbbing pain over pelvis

GORDON’S
FUNCTIONAL
HEALTH PATTERNS
ASSESSMENT
 Before Hospitalization During Hospitalization Analysis &
Interpretation
Client is aware of Client has become more Client’s stay in the
condition. She knows that health conscious. hospital increased her
her increasing abdominal Undergoing abdominal knowledge about her
girth and menorrhagia are myomectomy has made condition
not normal. She is however her more determined to (cause/predisposing
unaware of the cause(s) or pursue a healthy and factors of
Health predisposing factors of productive lifestyle. myomectomy/preventi
Perception condition. Seeks medical She now knows that on or reducing risk for
Health consultation belatedly. achieving health requires fibroids). Health-
Maintenance To maintain her health, effort and willingness to seeking behaviour was
patient does some daily embrace positive changes. noted (aftercare for
exercises (e.g. walking, However, client has abdominal
doing household chores). limited understanding myomectomy)
Patient avoids smoking and about the aftercare for
drinking. myomectomy (e.g. wound
care/recovery time)
 Before During Analysis &
Hospitalization Hospitalization Interpretation
Client eats a variety After abdominal Client demonstrates
of food (e.g. meat, myomectomy, client increased nutritional
vegetables, and is advised to awareness after
fruits) and expresses avoid dairy products, abdominal
Nutritional- red meat, saturated
Metabolic no food preference. myomectomy.
She claims to eat fats, high salt intake, However, client’s
Pattern and caffeinated
whatever is understanding is still
available. Client is drinks. Although limited. Needs to be
not diet conscious. client is aware of educated about the
diet restrictions, she linkage between
does not fully nutritional diet and
understand the the development of
rationale behind fibroids. Deficient
them. knowledge is noted.
 Before During Analysis &
Hospitalization Hospitalization Interpretation

Voids 6-7 X in a Experiences some Pain medications

24- hour period. constipation. most likely caused
Defecates at least Unable to void for the constipation
Elimination Pattern once per day. two days. Voiding
Client does not pattern remains
have any diseases similar to period
of the digestive, before
urinary, and hospitalization. On
integumentary the day of
systems. assessment, client
successfully
defecated.
 Before During Analysis &
Hospitalization Hospitalization Interpretation

Forms of exercise Activity is limited Client

include walking and because of demonstrates
performing abdominal activity intolerance
household chores. myomectomy. (level 3).
Activity-Exercise She performs Minimal/guarded
Pattern household chores movement noted.
on a daily basis. Needs assistance
Does not have any from family
disease that affects members when
her cardio- trying to ambulate
respiratory system to the bathroom.
or musculoskeletal
system.
 Before During Analysis &
Hospitalization Hospitalization Interpretation

Sleeps for 7-9 Despite Clientś reduced

hours each day. myomectomy, sleep hours and
Does not have any client sleeps for no tiredness or fatigue
sleeping disorders less than 6 hours. is expected
Sleep-Rest Pattern Although on initial following
observation (Post myomectomy.
Op Day 2), client Despite falling
looks tired and within Post Op
appears norms, appropriate
uncomfortable. care should be
undertaken to
alleviate fatigue
and impaired
comfort.
 Before Analysis &
Hospitalization During Hospitalization Interpretation

Orientated to Following abdominal Impaired comfort

time, place, and myomectomy (Post Op is expected
person. No Day 2), client following
Cognitive/ sensory deficits. experiences pain (4/10) Appropriate care
Perceptual Pattern Could express and discomfort over the should be
herself clearly and surgical site. Client is extended to
logically. No still orientated to time, alleviate pain
diseases affecting place, and person. Could sensation.
mental or sensory give clear and logical
functions. answers to questions.
No sensation of Client communicates
pain. with strong and audible
voice.
 Before During Analysis &
Hospitalization Hospitalization Interpretation

Client claims to Positive self- Client does not

Self-Perception/ have a positive self- perception/self- have any impaired
Self-Concept perception prior to esteem/self- self-perception/
Pattern hospitalization. concept intact Self-concept
Self-concept is following pattern
intact. Does not myomectomy.
aspire to be anyone Support system
other than herself. makes this possible
 Before During Analysis &
Hospitalization Hospitalization Interpretation

Assumes various Experiences role Client does not

roles as daughter, reversal during demonstrate any
Role Relationship aunt, sibling in the
Pattern hospitalization. resistance or
home. Positive role Instead of being the negative response
model for these provider of care, she to the role reversal.
roles is her mother. finds herself as the Acknowledges
Values relationships recipient of care. change of role well
with parents,
siblings, and
nephews/nieces.
 Before During Analysis &
Hospitalization Hospitalization Interpretation

Fibroids detected Multiple No noted

prior to myomectomy was impairments in
Sexuality/ hospitalization. performed. sexuality/reproducti
Reproductive Experiences ve pattern
Pattern menorrhagia and a
slight pain
sensation, which
she characterized as
a vague discomfort
instead of a sharp
pain.
 Before During Analysis &
Hospitalization Hospitalization Interpretation
Copes with Same coping No noted
Coping/Stress problems through patterns and impairments in
Pattern prayers and mechanisms coping/stress
attending Born pattern.
Again masses.
Gains support from
family.
 Before During Analysis &
Hospitalization Hospitalization Interpretation
Observes the Observes the No noted
Protestant faith. Protestant faith. impairments in
Values & Beliefs Practices Christian Practices Christian values & beliefs
Pattern beliefs and values. beliefs and values. pattern
Adopts spiritual Adopts spiritual
values. values.
PHYSICAL
ASSESSMENT
 January 28, 2020 1:00PM
● Upon assessment, the patient was
lying in bed accompanied by a
relative, conscious and coherent, able
to respond properly and breathing on
room air. She demonstrated limited
and guarded movements. She was
well-groomed and dressed
appropriately, wearing house clothes.
Her hair was dyed brown. She is big-
boned and appeared tomboyish. She
weighs 82 kg and has a height of 147
cm. Her BMI is 37.9 kg/m2, which is
considered Obese Class II.
GENERAL ●  Patient had no observed
contraptions.
SURVEY
 VITAL SIGNS

Blood Pressure 130/80 mmHg Stage 1 Hypertension

Pulse Rate 93/min Falls within the normal
range of 60-100 bpm
Respiratory Rate 20/min Falls within the normal
range of 12-20 bpm
Temperature 36.6 °C Falls within the normal
range of 36.1 to 37.1
Celsius
O2 saturation 99% Falls within the normal
range of 95-99%
 BODY PARTS TECHNIQUE NORMAL ACTUAL ANALYSIS/
USED FINDINGS FINDINGS INTERPRETATI
ON
Head & Inspection & -Round with no No No noted
Skull/Neck Palpation prominences achromotrichia abnormal
found in the or grey hair/no features on
frontal and visible lesions or head & skull
occipital area – prominences

No tenderness >ROMs not No noted

Smooth, limited abnormal
controlled findings
movements; -
ROM from
upright position
-Flexion – 45
deg -Extension
– 55 deg -
Lateral
 BODY TECHNIQUE NORMAL FINDINGS ACTUAL ANALYSIS/
PARTS USED FINDINGS INTERPRETATI
ON
Eyes, ears, Inspection -Moist, pink, evenly Eyes & ears are No abnormal
and Nose and palpation spaced and curled -Lower symmetrical; no findings
margins at bottom edge lesions/discolor
of iris -Upper margins ation on eyes,
cover approximately ears, & nose;
2mm of iris sense of
-Symmetrical blinking smell/hearing
(Ears) intact; eyes are
-Ears equally size and moist and pink
similar appearance,
alignment of pinna with
corner of eye and within
10 deg angle of vertical
position
 BODY TECHNIQUE NORMAL FINDINGS ACTUAL ANALYSIS/
PARTS USED FINDINGS INTERPRETA
TION
Eyes, Inspection -Skin and smooth without Eyes & ears No abnormal
ears, and and palpation nodules Patient does not are findings
Nose present any abnormal findings symmetrical;
except mild hearing loss (LE) 17 no
-Non tender, painless, warm - lesions/discol
Cerumen: odorless Flakey, waxy,
soft, hard (Nose) oration on
-Air is felt being exhaled -Non- eyes, ears, &
tender/ painless -Symmetrical nose; sense of
appearance -Smooth and color smell/hearing
same as face intact; eyes
-No changes in nares with are moist and
respiration pink
-Septum at midline
-Pink and moist with no lesions
 ANALYSIS/
BODY PARTS TECHNIQUE NORMAL ACTUAL INTERPRETATI
USED FINDINGS FINDINGS ON
Skin, hair, and Inspection & No skin IV removed on Except for the
nails Palpation discoloration, no the day of abdominal
presence of assessment/no incision, no
dandruff in the alopecia; other
hair. No capillary refill abnormalities
alopecia noted. (normal)/Abdom noted
Capillary refill inal incision
(normal): <2 (Inverted T)
seconds
 BODY TECHNIQUE ACTUAL ANALYSIS /
PARTS USED NORMAL FINDINGS FINDINGS INTERPRETA
TION
Lungs / Inspection, No adventitious sounds heard No No abnormal
Chest Auscultation, (fine and coarse crackles adventitious findings
& Percussion (crackles are also called rales), sound heard/ noted
wheezes (sometimes called symmetrical
rhonchi), pleural rubs and chest/no
stridor) labored
Symmetrical Chest -Unlabored breathing
breathing -3 inches with deep
inspiration -Midline -No pain/
tenderness -Vibration
decreases over periphery of
lungs & increased over major
airways – vocal fremitus: client
says “99”
 ANALYSIS/
BODY PARTS TECHNIQUE NORMAL ACTUAL INTERPRETATI
USED FINDINGS FINDINGS ON
Mouth Inspection -Symmetrical. - Slightly dry lips Dry lips can be
No lesions, No lesions or attributed to
swelling, or swelling decreased oral
drooping -Pink, No drooping fluid intake (OFI)
freckle-like
pigmentation -
Moist, smooth
with no lesions -
32 adult teeth,
stable fixation,
pearly white and
shiny
 BODY TECHNIQUE ACTUAL ANALYSIS/
PARTS USED NORMAL FINDINGS FINDINGS INTERPRETATIO
N

Cardio / Inspection, -S1 precedes short systolic No No abnormal

Chest Auscultation, pause then followed by s2 abnormal findings noted
& Percussion that precedes the long sounds
diastolic pause 60-100 bpm - upon
Regular rhythm -Identical - auscultation
Softer with inspiration - (Murmur)
Crisp, distinct and loudest at
aortic/ pulmonic area -Silent
pause between end of s1
and beginning of s2 with
nothing in between -Silent
pause heard at the end of s2
and beginning of s1
 ANALYSIS/
BODY PARTS TECHNIQUE NORMAL ACTUAL INTERPRETATI
USED FINDINGS FINDINGS ON

Abdomino- Inspection, No Surgical incision: Active lower

wound/tenderness. (Inverted T extremity ROMs are
pelvic auscultation, procedure) limited due to
Absence of dark
percussiom, bluish striae, redness abdominal incision r/t
palpation inflammation, rashes Stretch marks were myomectomy
or lesions, engorged noted.
veins.
>Surgical incision
Pain/discomfort over over abdomino-pelvic
Absence of venous at the incision site area noted (inverted
pattern. No deviation T-shaped incision)
from midline with
mass. Pinkish
umbilicus.
 ANALYSIS/
BODY PARTS TECHNIQUE NORMAL ACTUAL INTERPRETATI
USED FINDINGS FINDINGS ON
Muscle/ Inspection & Weight evenly Difficulty Ambulation or
Tendons Palpation distributed - ambulating/ still standing
Able to stand on unsteady capability still
right/ left heel compromised
with toes because of
pointing straight surgical
ahead -Full procedure
ROM, bilaterally
symmetrical
CLINICAL
RESEARCH /
DISEASE
DEFINITION
(FIBROIDS)
ANATOMY AND
PHYSIOLOGY
The Uterus
● a hollow, muscular organ that is shaped like an inverted pear
● or womb, is the part of the female reproductive system in which a
baby grows
● it is above the vagina, between the bladder and rectum
● the female reproductive system is made up of internal organs,
including the vagina, uterus, ovaries and fallopian tubes. It also
includes the external genital organs
ANATOMY AND
PHYSIOLOGY
Function
● receives a fertilized egg and protects the fetus (baby) while it grows
and develops
● contracts to push the baby out of the body during birth
● every month, the lining of the uterus grows and thickens in
preparation for pregnancy
● if the woman doesn’t get pregnant, the lining is shed through the
cervix into the vagina and out of the body
ANATOMY AND
PHYSIOLOGY
Structure

3 Parts:

● Fundus is the top of the uterus;

● Body is the main part of the uterus and includes the uterine
cavity;
● Cervix is the lower, narrow part of the uterus.
ANATOMY AND
PHYSIOLOGY
Structure

3 layers:

● Endometrium, it is made up of glandular cells that make

secretions;
● Myometrium, it is made up mostly of smooth muscle;
● Perimetrium, the serous layer secretes a lubricating fluid that
helps to reduce friction, it is also part of the peritoneum that
covers some of the organs of the pelvis.
ETIOLOGY
● Fibroids are abnormal growths that develop in or on a woman’s
uterus
● Sometimes these tumors become quite large and cause severe
abdominal pain and heavy periods
● In other cases, they cause no signs or symptoms at all
● The growths are typically benign, or noncancerous
● The cause of fibroids is unknown
● Fibroids are also known by the following names: leiomyomas,
myomas, uterine myomas, fibromas
TYPES OF FIBROIDS
The type of fibroid a woman develops depends
on its location in or on the uterus.

Intramural fibroids

● the most common type of fibroid

● these types appear within the muscular wall
of the uterus.
● may grow larger and can stretch your womb
TYPES OF FIBROIDS
The type of fibroid a woman develops depends
on its location in or on the uterus.

Subserosal fibroids

● form on the outside of your uterus, which is

called the serosa
● may grow large enough to make your womb
appear bigger on one side
TYPES OF FIBROIDS
The type of fibroid a woman develops depends
on its location in or on the uterus.

Pedunculated fibroids

● subserosal tumors can develop a stem, a

slender base that supports the tumor. When
they do, they’re known as pedunculated
fibroids
● with a stalk or stem
TYPES OF FIBROIDS
The type of fibroid a woman develops depends
on its location in or on the uterus.

Submucosal fibroids.

● these types of tumors develop in the middle

muscle layer, or myometrium, of your
uterus
● bulge into the uterine cavity
● not common as the other types

.
CAUSES
Genetic changes

● Many fibroids contain changes in genes that differ from those in

normal uterine muscle cells.

Hormones

● Estrogen and progesterone appears to promote the growth of

fibroids
● Fibroids contain more estrogen and progesterone receptors than
normal uterine muscle cells do
● Fibroids tend to shrink after menopause due to a decrease in
hormone production.
CAUSES
Family history

● Fibroids may run in the family. If your mother, sister, or

grandmother has a history of this condition, you may develop it as
well.

Pregnancy

● Pregnancy increases the production of estrogen and progesterone in

your body
● Fibroids may develop and grow rapidly while you’re pregnant
PREVALENCE
● Myomas are diagnosed in 20-25% of women of reproductive age,
and 30-40% of women older than 40 years.
● National Institutes of Health (NIH), about up to 80 percent of
women have them by the age of 50. However, most women don’t
have any symptoms and may never know they have fibroids.
● The clinical incidence of myomas, in terms of a symptomatic
disease requiring treatment, is the most frequent in perimenopause,
whereas after menopause it rapidly decreases.
RISKS
Race

● Although any woman of reproductive age can develop fibroids,

black women are more likely to have fibroids than are women of
other racial groups
● In addition, black women have fibroids at younger ages, and
they're also likely to have more or larger fibroids, along with more-
severe symptoms.
RISKS
Heredity

● If your mother or sister had fibroids, you're at increased risk of

developing them.

Other factors
● Onset of menstruation at an early age
● Obesity
● Having a diet higher in red meat and lower in green vegetables,
fruit and dairy
● Drinking alcohol, including beer
SIGNS AND SYMPTOMS
● heavy menstrual bleeding
● menstrual periods lasting more than a week
● pelvic pressure or pain
● frequent urination
● difficulty emptying the bladder
● Constipation
● backache or leg pains
● rarely, acute pain when it outgrows its blood supply, and begins to
die
 TEST RESULT UNIT REFERENCE

Hemoglobin 108 g/L 120-150

Hematocrit 0.39 0.37-0.45

Erythrocytes 5.62 x10^12/L 4.00-5.00

RDW 20.9 % 11.5-14.5

MCV 69.2 fL 80-96

MCHC 27.8 g/dL 33-36

MCH 19.2 Pg 27-33

 TEST RESULT UNIT REFERENCE

WBC 6.2 x10^9/L 5.0-10.0

Segmenters 0.58 0.55-0.65

Lymphocytes 0.31 0.25-0.40

Monocytes 0.08 0.02-0.06

Eosinophils 0.03 0.01-0.05

Platelet 388 x10^9/L 150-440

DIAGNOSTIC
EXAMINATION
Ultrasound Scan
● One of the main tests carried out to diagnose fibroids is an
ultrasound scan.
● This is a painless scan that uses a probe to produce high frequency
sound waves to create an image of the inside of your body.
DIAGNOSTIC
EXAMINATION
Two types of ultrasound scan can be used to help diagnose fibroids:
● Abdominal ultrasound scan – where the ultrasound probe is
moved over the outside of your tummy (abdomen)
● Transvaginal ultrasound scan – where a small ultrasound probe is
inserted into your vagina

Images produced by these scans are transmitted to a monitor so your

doctor can see if there are any signs of fibroids.
PROCEDURES (SURGICAL
MANAGEMENT)
Abdominal Myomectomy

● Also known as an "open" myomectomy, an abdominal

myomectomy is a major surgical procedure
● It involves making an incision through the skin on the lower
abdomen, known as a "bikini cut," and removing the fibroids from
the wall of the uterus
● The uterine muscle is then sewn back together using several layers
of stitches.
 PROCEDURES
(MEDICAL
MANAGEMENT)
ABDOMINAL
MYOMECTOMY
 Indicatio Mechanism of Side / Adverse
Name of Drugs Contraindication Nursing Considerations
n Action Effects

Generic Name: Symptom Paracetamol may Contraindicated in Hematologic, Use the liquid for children
Acetaminophen atic relief cause analgesia patients hemolytic and patients who have
of pain by inhibiting CNS hypersensitivity to anemia, difficulty swallowing.
Brand Name: and fever prostaglandin drug leukopenia,
paracetamol synthesis. The neutropenia, In children don't exceed five
mechanism of Use cautiously in pancytopenia,t doses in 24 hrs.
Dosage/route/ morphine is patients with long hrombocytopen
freq: 500mg believed to involve term alcohol use ia Advise patient that drug is
1 tab decreased because only for short term use and
Oral permeability of the therapeutic doses Hepatic: liver consult the physician if given
4-6hrs cell membrane to cause damage, to children for longer than 5
sodium, which hepatotoxicity in jaundice days or adults of longer than
results in these patients. 10 days
diminished Metabolic:
transmission of Hematologic, hypoglycemia Warn patient that high doses
pain impulses hemolytic, anemia, or unsupervised long term
therefore neutropenia Skin: rash, use can cause liver damage
analgesia leukopenia, urticaria
pancytopenia
 Mechanism of Contraindicatio Side / Adverse Nursing
Name of Drugs Indication
Action n Effects Considerations

Generic: constipation Increases Nausea, caution is Monitor

Bisacodyl relief of peristalsis and vomiting or advised during frequency and
evacuation in motor activity of other symptoms 1st 3months of character of stool
Brand: Dulcolax hemorrhoids, the small of appendicitis, pregnancy as
prep for barium intestines by acute surgical well as Monitor
Dose/route/freq.: enema, pre and acting smooth abdomen, administration to occurrence of
1 Tablet 10mg post-op muscles. abdominal pain, children 4 yrs adverse rxn
Oral ulcerative
lesions of the Adverse rxn Swallow the
colon occasional tablet whole, do
abdominal not crush or chew
discomfort,
soreness in and
region
 Mechanism of Contraindicatio Side / Adverse Nursing
Name of Drugs Indication
Action n Effects Considerations

Generic: relief of allergic Competitive Hypersensitivity, Constipation, Monitor

Diphenhydramine symptoms blocks effect of acute attacks of dizziness, dry cardiovascular
hydrochloride caused by histamine at asthma; mouth, loss status especially
histamine peripheral lactation. appetite, with pre-existing
Brand: Sominex release including receptor site nausea, cardiovascular
anaphylaxis, Use cautiously in nervousness, disease.
Dose/Route/Freq. seasonal and severe liver restlessness, Monitor for
: rhinitis. disease; seizure trouble sleeping, adverse effect
Adult: disorders; vomiting, especially in
25-50 mg Parkinson’s prostatic swelling of the children and adult
Oral disease and hyperplasia; mouth
Tid or Qid dystonic reaction ulcer
from medication
IV/IM
10-50 mg precaution of
q4-6 motion sickness
Generic Name: Pharyngitis, Second- Contraindicated Body as a whole: determine the
Cefuroxime tonsillitis generation in patients thrombophlebitis history of
infections of the cephalosporin hypersensitive to (IV site) pain, hypersensitivity
Brand Name: urinary and that inhibits cell drug burning, cellulitis reaction to
Zoltax lower respiratory wall synthesis -Use cautiously cephalosporins,
tracts and skin promoting in patients GI: penicillin, and
Classification: and skin osmotic hypersensitive to Diarrhea, nausea, history of allergies
Antibiotic structure, instability; penicillin antibiotics before therapy is
infections usually because of the associated with initiated
Dosage/Route/ caused by bactericidal possibility of colitis -report onset of
Frequency: streptococcus cross-sensitivity loose stools
500mg/tab pneumonia and with another Skin: rash, -absorption of
1tab staphylococcus beta-lactam pruritus, urticaria, cefuroxime is
PO aureus antibiotic. increased serum enhanced by food
- Use with cretonne and -notify prescriber
caution in BUN decreased about rashes or
breastfeeding creatine superinfection
women and in clearance
patients with a
history of colitis
or renal
sufficiency
Generic Name: Adjunctive Exhibits anti- Hypersensitivity CNS: dizziness, Before:
Celecoxib treatment to inflammatory, to drug drowsiness, Assess the
decrease the analgesic and sulfonamides or headache, patient’s history of
Brand number of antipyretic, other NSAIDs insomnia, fatigue allergic reaction to
Name:celebre adenomatous action due to -Severe hepatic CV: peripheral a the drug
colorectal polyps in inhibitor of the impairment Edema -monitor complete
Dosage/route/ familial enzyme -history of EENT: blood count,
Frequency: adenomatous asthma or Ophthalmic electrolyte level,
400mg OD prn polyposis urticaria effects, tinnitus, creatinine
-advance renal pharyngitis, clearance, and
disease rhinitis sinusitis occult fecal blood
-late pregnancy GI: test and liver
Nausea,diarrhea function test
,constipation, results every 6-12
abdominal pain, months.
dyspepsia,
flatulence, dry
mouth,GI
bleeding
Generic Name: Adjunctive Exhibits anti- Hypersensitivit During: instruct patients
Celecoxib treatment to inflammatory, y to drug Hematologic: to take drug with food
decrease the analgesic and sulfonamides decreased or milk
Brand number of antipyretic, or other hemoglobin - teach patient to avoid
Name:celebre adenomatous action due to NSAIDs or hematocrit aspirin and other
colorectal polyps in inhibitor of the -Severe NSAID (such as
Dosage/route/ familial enzyme hepatic ibuprofen and
Frequency: adenomatous impairment naproxen)
400mg OD prn polyposis -history of
asthma or After: advise patient to
urticaria immediately report
-advance renal bloody stool,bloody
disease vomit, or sign or
-late symptoms of liver
pregnancy damages(nausea,fatigue
, lethargy, yellow eyes,
or skin tenderness on
upper right side of
abdomen)
Generic Name: Relief of Anti- Contraindication Use cautiously Do not increase or
Mefanamic acid moderate pain inflammatory with with double the dose.
when therapy analgesic and hypersensitivity asthma,renal or Follow the exact
Brand Name: will not exceed antipyretic to mefanamic hepatic as prescribed
Ponstel 1wk treatment of activities related acid,aspirin impairment,GI -Do not
primary to inhibition of allergy and as bleeding, heart crushchew or
Dose/route/ dysmenorrhea prostaglandin treatment of failure,pregnanc crash capsule and
frequency: -Mefanamic synthesis preoperative y lactation tablet
500mg acid’s given to pain with -Do not
patients for relief coronary artery CNS: administer with
Minimum dose of acute to by pass grafting. headache,dizzin anticoagulants and
125m moderately ess, insomia, other drug that
Capsules 250mg severe pain cause GI upset
GI: dysuria,renal
Route : impairment
PO
Hematologic:
bleeding platelet
inhibition with
hight doses
neutropenia
PROCEDURES
(NURSING
MANAGEMENT)
IMPAIRED COMFORT
NURSI
ACTIVITY NG
INTOLERANCE
DIAGN
KNOWLEDGE
DEFICIENT OSES
(POSTOPERATIVE
CARE)
 PRIORITIZATION:
NURSING DIAGNOSES
 DEFINITION: “”perceived lack

NCP #1: IMPAIRED of feeling of comfort, relief and

transcendence in physical,

COMFORT
psychospiritual, environmental
and social dimensions”
(Herdman, 2009)
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
Subjective: Impaired comfort r/t to post-surgery STG: After 8 hours of nursing Assess level of discomfort and pain (OPQRST) Establish comparative baseline data After 8 hours of nursing
“Masakit pa din yung pain (myomectomy) as evidenced interventions, the client will     interventions, the client
inoperahan sa akin, lalo na pag
by verbalization of patient, participate in pain relief/comfort Discuss concerns with client and active listen to identify underlying issues Determine the client’s specific needs and ability participated in pain
umuubo ako” as verbalized by abdominal guarding measures.   to change own situation relief/comfort measures.
the client   Provide distractions (e.g. therapeutic communication/engage client in    
  conversations)/ Encourage client to involve in healthy distractions (watch Promote ease and relaxation/refocus attention  
Expression of discomfort when   shows/videos/news; listen to music)    
coughing/moving        
    Instruct client to brace abdominal incision when she coughs by taking hands or    
4/10 pain   pillow and hugging it to incision while applying gently but firm pressure    
         
Objective:   Administer pain medications as needed    
         
Abdominal guarding        
Difficulty moving     Bracing action helps support incision and reduce  
      stress on the surgical site  
    Determine level of pain/ discomfort (OPQRST)    
         
         
  Remind client about comfort measures/pain-reducing techniques previously    
  discussed (e.g. bracing when coughing, use of distractions, light massage/back    
  rub)    
    Provide pharmacological pain relief  
  Encourage client to do whatever possible (ambulating with assistance, self-care)    
       
  Promote overall health measures (nutrition, adequate fluid intake, elimination, Identify progress to render appropriate care/  
  and appropriate vitamin supplementation) pain management modality  
       
    Reinforce knowledge/Habituate actions for  
    faster recovery  
       
       
       
LTG: After 2 days of nursing      
interventions, the client will report     After 2 days of nursing
increased comfort and a reduction     interventions, the client reported
of pain from 4/10 to 2/10   Enhance self-esteem & independence increased comfort and a
    reduction of pain from 4/10 to
    2/10.
 
 
Support and maximize opportunity for faster
wound healing
NCP #2: ACTIVITY
INTOLERANE
Assessment Diagnosis Planning Implementa
tion
Rationale
Evalu
ation
NURSING CARE
PLAN # 3
KNOWLEDGE DEFICIT:ABSENCE OR DEFICIENCY OF
COGNITIVE INFORMATION RELATED TO SPECIFIC TOPIC
ASSESSMENT
Subjective:
“Ano ang dapat kung gawin kung
maliligo ako sa bahay?”
 
“Gaano kaya katagal recovery ko?”
 
“Yung pinagbawal ba sa akin ni doc na
mga pagkain dito sa hospital, bawal din
kainin sa bahay?”
 
Patient verbalizations
Objective:
Observed desire to seek a higher level of
wellness
Demonstrated lack of knowledge in
health promotion behaviors
DIAGNOSIS
Deficient learning (postoperative care)
r/t lack of information about health
promotion behaviors (post myomectomy
wound care/nutritive diet for fibroid
management ) as manifested by client
verbalizations
PLANNING
STG: After 8 hours of nursing interventions,
the client will be able to identify strategies
and health promotion behaviors related to
postoperative care.
 
 
 
 
NCP # 3: KNOWLEDGE DEFICIENT (POSTOPERATIVE CARE)
 
  . Ensure an active role for the client (e.g. ask client to ambulate as
 
 
 
 
 
 
 
 
 
 
LTG: After 2 days of nursing interventions,
the client will be able to initiate and engage
in desired behaviors necessary for a more
effective wound healing and a healthier
lifestyle.
IMPLEMENTATION RATIONALE EVALUATION
Assess level of knowledge Establish comparative baseline data After 8 hours of nursing interventions,
    the client identified strategies and health
    promotion behaviors related to
  Confirm if the client is physically, emotionally postoperative care.
Determine client’s ability/readiness and barriers to learning capable to acquire information  
  Facilitate learning  
Provide an environment conducive to learning (removal of distractions: noise,    
use of smartphones)    
Discuss one topic at a time (wound healing steps/strategies, nutritional diet,
recovery stages); avoid
  Prevent information overload/ Enhance recall  
tolerated/follow a diet high in Vit. C, protein, and zinc)
  Promote a sense of control over the situation and is a  
  means for determining that the client is assimilating  
  and using new information  
Assess knowledge acquisition and application (verbalization & recall)    
Create an environment conducive to learning    
  Track learning progress  
Repeat discussion about postoperative care (wound care, nutritive diet for    
fibroid prevention and shrinkage) using therapeutic communication    
Encourage client to verbalize concerns/ feelings    
  Facilitate learning  
Extend positive reinforcement or    
feedback    
Reinforce learning After 2 days of nursing interventions, the
    client initiated and engaged in desired
    behaviors necessary for a more effective
    wound healing and a healthier lifestyle.
Decrease feelings of anxiety, tension, and frustration
Serve to motivate client and build confidence