PERPETUAL HELP COLLEGE OF MANILA

1240 V. Concepcion St., Sampaloc, Manila

Submitted to:

Mrs. Josephine Dela Cruz, RN

Clinical Instructor

Submitted by:

Abordo, Nena Bell Jill - Physical Assessment & Nursing Care Plan
Alpecho, Kathreen Mae - Drug Study
Alunday, Radigundee - Medical and Surgical Management
Awat, Cassandra Von - Etiology or Risk Factors
Barzaga, Cristine - Diagnostic Procedure
Cabarrubias, Alvin Ray D. -Gordon’s Health Pattern, Pathophysiology,
Statement of Nursing Diagnosis & Nursing Care Plan
Canlas, Veronica - General Objectives, Nursing Care Plan & Discharge Plan
Changco, Mariaelis - Anatomy & Physiology
Commendador, Maritonee - Client’s Data & Health History
Corpuz, Nichael Bonn - Introduction

1
PERPETUAL HELP COLLEGE OF MANILA

Format for Case Presentation

I. Client’s Data

II. Health History

• Family Health History
i. Maternal Health History
ii. Paternal Health History
• History of Past and Present Illness
• Risk Factors Associated with Disease
i. Non- modifiable Factors
ii. Modifiable Factors

III. Physical Assessment

• Subjective- Gordon’s Health Pattern
• Objective- Kozier’s reference

IV. Definition of Disease/Introduction

V. Pathophysiology of the Disease

VI. Anatomy and Physiology

VII. Diagnostic Procedures done to Client

VIII. Medical/Surgical Management done

IX. Drug Study

X. Statement of nursing problems/nursing diagnosis based on grouped data(Gordon’s)

XI. Priority Nursing Problem/Nursing Care Plan

• Actual
• Potential

XII. Discharge Plan

2
PERPETUAL HELP COLLEGE OF MANILA

Table of Contents

I. Client’s Data………………………………………….………..… 1

II. Health History…………………………………………………… 2

• Family Health History…………………………………………… 2
iii. Maternal Health History…………………………….. 2
iv. Paternal Health History……………………………… 2
• History of Past and Present Illness………………….…....… 2
• Risk Factors Associated with Disease……………………… 3
iii. Non- modifiable Factors……………………………… 3
iv. Modifiable Factors…………………………………….. 3

III. Physical Assessment……………………………………………. 5

• Subjective- Gordon’s Health Pattern……………………….. 5
• Objective- Kozier’s reference…………….……………..…… 9

IV. Definition of Disease/Introduction…………………..…… 32

V. Pathophysiology of the Disease……………………………… 33

VI. Anatomy and Physiology……………………………….………. 34

VII. Diagnostic Procedures done to Client………………….…. 41

VIII. Medical/Surgical Management done……………….………. 46

IX. Drug Study………………………………………….……………. 50

X. Statement of nursing problems/nursing diagnosis

based on grouped data(Gordon’s)…………………...………. 62

XI. Priority Nursing Problem/Nursing Care Plan………...…... 63

• Actual
• Potential

XII. Discharge Plan…………………………………………………… 64

3
General Objectives:

 This study on myoma aims to look into the indispensible information

regarding the disease, its pathophysiology resulting to the theoretical

signs and symptoms and correlate them with those manifested by the

patient

 It is also aims to develop our skills, knowledge and attitude in providing

proper nursing care needed to have an effective nursing management and

list the criteria used for diagnosing myoma

 Develop good Nurse-Patient relationship

Specific Objectives:

In order to meet the general objective of the study, the ff intended to be done:

 To be able to acquire knowledge regarding myoma through research

 To be able to develop a better understanding on the use of medications

and its implication on the treatment of myoma

 To be able to implement the appropriate plan of nursing management for

patients with myoma

4
I. Client’s Data

Name- De Luna, Rima Mejica

Age – 32

Chief complaint: VAGINAL BLEEDING

Diagnosis -AUB problem sec. to prolapsed submucosal myoma. G4P4

Time admitted – 6:10 PM

Ward- OB GYNE

Address- 417 NBB Navotas

B-day – 11/19/78

Religion- Roman Catholic

Father name- Loreto Dulay

Mother name- Crisanda Mejica

Husband name- Dante de Luna

Admitting physician – Dr. Macasadia

Pertinent physical findings:

BP 100/80 HR 89 RR 20 TEMP. 37

WT 44.5 kgs HT 1.43 BMI 21.76 kg/m2

Slightly pink palpebral conjunctivas SCF clear BS. A dynamic pericardium WRRR (-)
murmurs inspection + fleshy mass at introiter + moderate bleeding submucus. IE
10x5x5 cm prolapsing mass with stalked abnormal

Personal and social history:

Alcohol- occasional

B-GYNE history:

Menarche 15year old interval 28-30 duration 3days

5
Cornstarches 19 year old symptom- dysmenorrheal

OB score

G1 2000 male NSD del. Midwife (-) complication

G2 2006 female NSD del. Midwife (-) complication

G3 2007 preterm (7mos)

G4 2008 female NSD del. Midwife (-) complication

No. of sexual partner – 1 partner

Previous pap smear – NONE

Method of contraceptive (+) 2008 trust pills

6
II. Health History

•Family Health History

i. Maternal Health History

(+) hypertension

ii. Paternal Health History

(+) hypertension, (+) diabetes mellitus

•History of Past and Present Illness

2 months PTA patient noted increase menstruation duration and amount

for 5 days. No inter menstrual bleeding noted. 1 day PTA, patient while

strains during defecations. (+) bleeding during defecation. She strained and

noted prolapsed mass at urination and prompted consult.

• Risk Factors Associated with Disease

v. Non- modifiable Factors

-Anovulatory bleeding

-Midcycle bleeding associated with ovulation

-High levels of unopposed estrogen

vi. Modifiable Factors

-Complications of an early, undiagnosed pregnancy

-Breakthrough bleeding while they are taking oral

contraceptives

-Genetic abnormalities, race, and related to age of

menarche, obesity, and parity

7
• Classification of Myomas

1. Intramural. Found in the uterine wall, surrounded by myometrium. Clinical

manifestations include increased uterine size, vaginal bleeding between menses and

dysmennorrhea

2. Submucosal. Located directly under the endometrim, involving the endometrial cavity.

May become pedunculated (grow on a stalk). Clinical manifestations include prolonged

vaginal bleeding and cramps and the tumor may be seen protruding through the cervix.

3. Subserosal. Found on the outer surface (under the serosa) of the uterus. Tends to

become pedunculated, to wander, and to be multiple and large. Clinical manifestations

include backache, constipation and bladder problems.

4. Wandering or parasitic. A pedunculated leiomyoma that twists on its pedicle, breaks

off, then attaches to other tissues, particularly the omenum.

5. Intraligamentary. Implants on the pelvic ligaments. May be displace the uterus or

involve the ureters.

6. Cervical. Occur infrequently and may obstruct the cervical canal

8
III. Physical Assessment

• Subjective- Gordon’s Health Pattern

During
Health Before Hospitalization Hospitalization Analysis
Patterns

- Pt had abnormal uterine

bleeding for almost 4 days. - during her
Pt is a non smoker and a hospitalization,
occasional alcohol drinker. Pt she’s was rushed
have the family illness of to the emergency - She only
1. Health hypertension and diabetes. room & a vaginal seeks medical
perception - Mrs. D doesn’t have regular myomectomy was help whenever
Health medical check-ups and only done. after that needed.
management seeks medical attention when operation, she still The patient is
Pattern the need arises. Whenever feels weak anxious if the
she had headaches, she rest probably because fibroid is
for a while and take of losing too much cancerous or
paracetamol when needed. blood. She’s not.
Pt. perceived her menstrual anxious if the
cycle was regular until the mass that was
fourth day of excessive taken is
bleeding and presence of cancerous or not.
mass when she urinated.

- According to Mrs. D., she - Normal eating

eats three times a day. He pattern is at on
usually eats vegetables, fish the minimum of
and meat whenever they 3 times per
have extra money. The - during her day, depending
patient verbalized that she hospitalization, the upon metabolic
seldom eat fruits. doctor ordered need and
2. Nutritional In terms of fluid intake, the NPO until the third demands. Fluid
– Metabolic client stated that he day wherein she intake is on the
Pattern consumes at an average of was on soft diet. average of 8 to
5-6 glasses of water per day, 10 glasses per
distributed at around 2 day.
glasses in the morning, 3 at - She have to
noon and 1 glass at evening increase her
before hospitalization. She is fluid intake. In

9
the one who always prepare terms of her
their food. food intake and
frequency,
There are no
Patient’s WT 44.5 kgs HT remarkable
1.43 BMI 21.76 kg/m2 deviations

Normal BMI range:

<18.5…………...underweight
18.5-24.9………..healthy
25.0-29.9…………overweight
30≥……………………obesity

- During - Normal bowel

- Bowel Habits: Mrs. D hospitalization, movement is 1
defecates once a day with a since the patient to 3 times a
brownish stool. was on NPO, day and
3. Elimination Bladder Habits: She voids 3- there were voiding at 1200
Pattern 5 times a day with amber changes on her to 1500ml/day.
colored urine in small bowel and bladder - Mrs. D’s
amount. Pt urinates not more habits. She was bowel and
than 1000ml per void. on indwelling foley bladder habits
catheter. has changed
during
hospitalization.

- She stop taking - Well

- Mrs. D usually does walking walks during her described bout
when she gets bored before hospitalization her activities in
4. Activity her hospitalization. Pt is a because it is daily living like
Exercise housewife. She usually do contraindicated in exercising. She
Pattern household choirs and she’s operation is well informed
proud to say that it’s a good performed. that doing
form of exercising. So, she only do household
bed rest and tries choirs is a
to turn on each simple way of
side because she exercise.
always wake up.

5. Sleep – - before the Pt was - during her - Based from

Rest Pattern hospitalized, she mostly hospitalization, Kozier

10
sleep 7pm or 8pm at night The pt had stated Fundamentals
and wakes up at 8 in the that he of Nursing, 8-
morning. When she don’t experienced sleep 10 hours of
have anything to do after difficulties. She sleep is
lunch, he usually have a nap. always wake up in needed to have
different intervals. an adequate
Before going to rest and an
sleep she always environment
think about the that is
mass that was conducive to
taken out of her if health is
it’s benign or necessary to
malignant. provide comfort
to an individual.
- The client has
an abnormal
state of sleep
and rest.
Frequent
thinking about
her situation is
the primary
cause of sleep
deprivation.

- Patient does not have any - during her - There is no

hearing problems. hospitalization, symptoms of
She is oriented to time and there is no pain while we
place and can recall past significant change are doing an
events. Patient is a high in the status and interview.
school graduate. Mrs. D is perception of his
6. Cognitive- able to understand, and five senses.
perceptual communicate with others and
pattern make decisions on her own.
She is able to see, feel, hear,
smell, taste by testing him
like pinching, giving some
sentence to read and saying
words that she have to repeat
it after we said it.

7. Self- - Patient described herself as - during in her - pt is being a

perception a hardworking person. She hospitalization, positive thinker
and self claimed her happiness and she never think despite of what

11
concept contentment will be more felt negative things happened to
pattern if only his illnesses were that will make her her health
absent. Pt is contented to down while
have provided her family with recovering with
good life. her illness.

- Patient described himself as - during her - pt is still being

a loyal wife to her husband hospitalization, a good mother
as well a responsible mother her husband is to her kids
8. Role to her kids. Her husband aware of her despite of her
Relationship comes home every weekend current situation. current health
pattern from work as a contractual She is worried status.
carpenter. She takes care of about her kids if
her kids and do the cooking they’re doing well
and laundry form them. She without her. She is
send them to school also concerned if
everyday. they’re eating well.

- Patient had her 1st - during her - The Pt.

menstruation at the age of hospitalization, analyzed
15. She used to use pills she clearly clearly about it
9. Sexuality – Patient claims to have no describe the and able to
Reproductive history of STD or UTI. She patterns of understand the
pattern doesn’t have any problem satisfaction and physical and
with her sexual intercourse. dissatisfaction psychological
with sexuality. effects of his
current health
status on her
sexual
expression.

- Defines stress as something - during her - Able to

that can make someone tired. hospitalization, describe
Currently stressed because she doesn’t general coping
10.Coping of current physical condition. change her pattern and
and Stress Long term stressor include perception toward effectiveness of
Tolerance financial problems, and short her situation. the pattern in
term stressor include the She’s aware that terms of stress
problems in the community being hospitalized tolerance.
and family. Goes to is a stressful
neighbors and friends to situation. She tries
relieve stress and she shares to get well
her problem them. because she
Sometimes she brings her misses her kids.

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kids to shopping malls to
stroll and in that way her
stress is relieved.

- Patient is a Roman Catholic - during her - able to

11.Value – and goes to church on hospitalization, determine the
Belief Pattern Sundays with her kids and there is no change patterns of
claims to pray everyday. She with her religious values and
values health life. She believes beliefs(spiritual)
and sees it as a wealth. God will help her or goals that
Patient does not have any recover faster guides his
superstitious beliefs. choices and
decisions.
.

• Objective- Kozier’s Reference

Vital signs

Normal Actual Analysis Interpretation

Vital signs Findings

On the disease
Blood process, any condition Cardiac output will often
pressure 120/80 160/90 that may affect the affect the delivery of oxygen
cardiac output, blood to the cells of the body and
volume, blood viscosity when the system or tissues
has direct effect on the does not get the required
blood pressure. oxygen for the metabolic
The patient was in process cellular function will
distress during the be altered.
assessment.

(Kozier, B. (2004).

13
Fundamentals of
Nursing p. 510).
Inflammation is a local,
nonspecific defensive Febrile
Temperature 36.5- 39.4 response of the tissues
37.5 to an injurious or The rate of loss depends
infectious agent. It is an primarily on the surface
adaptive mechanism temperature of the skin
that destroys or dilutes which is intern a function of
the injurious agent, skin blood flow. The blood
prevents further spread flow of the skin varies in
of the injury, and response to changes in the
promotes the repair of body core temperature and
damaged tissue. to changes in temperature
of the external environment.
Patient has an
increased WBC count
of 12.3% (August 23,
2010)

(Kozier, B. (2004).
Fundamentals of
Nursing p. 634).
Pulse wave represents the
Normal Range stroke volume output or the
Pulse rate 60-100 92 output or the amount for
(Kozier, B. (2004). blood that enters the
Fundamentals of arteries with each
Nursing p. 496). ventricular contraction.
Several factors that The effectiveness of
Respiratory 16-20 24 increase respiratory respiration is important for

14
rate rate include stress and the uptake of oxygen from
increase environmental the air into the blood and
temperature. release carbon dioxide from
the blood into expired air.
(Kozier, B. (2004).
Fundamentals of
Nursing p. 506).

Skin
PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATION
FINDINGS FINDINGS
Skin color
varies from Fair There is a The skin is dry and
Skin Inspection light to deep complexion decrease in flaky because
brown; from with dry and hemoglobin sebaceous and sweat
ruddy pink to flaky skin. because of glands are less active.
light pink, blood loss Dry skin is more
from yellow Pale in prominent over the
overtimes to appearance. extremities. Pallor is
olive. the result of
Generally inadequate circulating
uniform blood. Normal blood
except in No edema, circulation relies on
areas abrasions, muscle activity.
Palpation exposed to lesion. Immobility impedes
sun; areas of circulation and
lighter Temperature diminishes the supply
pigmentation is higher of nutrients to specific
(palms, lips than normal area. Pressure ulcers

15
nail beds) in range. are due to localized
dark skin ischemia, a deficiency
people. in the blood supply to
the tissue.
No edema, Generalized edema is
abrasions, most often an
lesion. indication of impaired
Temperature venous circulation and
is uniform in some cases reflects
and w/in cardiac dysfunction
normal range and venous
abnormalities.
Increase temperature
from the normal level
maybe due to tissue
destruction, pyrogenic
substances, or
dehydration on the
hypothalamus.

( Fundamentals of
Nursing by Kozier,
pp.529, 535,540,576,
1071)

Nails Inspection Convex Convex, Patient’s nail Pallor may reflect poor
curvature; smooth in beds are pale arterial circulation due
angle of nail texture, may be due to to diminished
plate about pallor, decreased circulating blood
160o capillary refill oxyhemoglobin volume.
- with smooth is 4-5 level on the

16
texture seconds on blood.
- color is the hands.
highly Nail bed (Fundamentals of
vascular& color is pale Nursing by Kozier,
pink in light on both p542)
skinned lower and
clients; dark upper
skinned extremities.
clients may
have brown
or black
pigmentation
in
longitudinal
streaks
with intact
epidermis on
tissue
surroundings
- blanch test-
prompt return
of pink or
usual color
(gen. <3 sec)

Head
NORMAL ACTUAL
PARTS METHOD FINDINGS FINDINGS ANALYSIS INTERPRETATION
Each hair

17
Hair Inspection Evenly Hair is black, grows from a Poor hygiene due
distributed hair thin and evenly single, live to impaired
over the scalp distributed over follicle has its physical mobility.
with thickness, the scalp. No own roots in The injury limits her
variable infection or the activities of daily
amount of infestation subcutaneous living. No
Palpation body hair. No noted. tissue of the significant relative
infection or It is dry and skin. Oil is there to help her
infestation. sticky. glands next to manage her poor
hair follicle hygiene.
provides gloss
and, to some
Scalp Inspection White, clean, Dry scalp. degree water
Normal Findings
free from Clean, free from proofing of the
masses, lumps masses, lumps hair.
Palpation scars, lice, nits, scars, lice, nits,
dandruff, and dandruff, and
lesions no area lesions no area (Kozier, B.
of tenderness of tenderness (2004).
Fundamentals
of Nursing p.
541)

Skull Inspection Rounded( Round Normal Normal findings

normocephalic) (normocephalic), findings
Palpation & symmetrical, smooth skull
with frontal, contour.
parietal, Smooth, (Fundamentals
occipital, absence of of Nursing by
prominences) nodules or Kozier page
smooth, masses. 544.)

18
uniform,
absence of
modules or
masses

Eyes
NORMAL ACTUAL
PARTS METHOD FINDINGS FINDINGS ANALYSIS INTERPRETATION

Eyebrows Inspection Symmetrically Symmetricall Normal

aligned. y aligned findings.
Equally and equal
distributed, movement. Normal findings
curled slightly Hair evenly (Kozier, B.
outward distributed. (2004).
Fundamentals
of Nursing p.
732).

Eyelashes Inspection Equally Eyelashes Normal

distributed, are equally findings.
Curled slightly distributed
outward and curled (Kozier, B. Normal findings
slightly (2004).
outward. Fundamentals
of Nursing p.
1152)

Eyelids Inspection The skin is Lids closes Normal Normal findings

intact, no symmetricall findings

19
discharge and y, bilateral
no blinking and
discoloration. no visible
The lids close sclera above
symmetrically corneas (Kozier, B.
blinks when lids (2004).
involuntary are open Fundamentals
and with of Nursing p.
bilateral 548
blinking.

Sclera & Inspection Shiny, smooth Pale Patient has Pallor may reflect
Conjunctiva
& pink or red conjunctiva, decreased poor arterial
in color smooth and hemoglobin circulation due to
shiny. level of 10.2 diminished
g/dl. circulating blood
(September 6, volume
2010)
(Kozier, B. (2004).
Fundamentals of
Nursing p. 554).

Cornea Inspection transparent, transparent, Normal Normal Findings

shiny & shiny & Findings
smooth, smooth,
details of the details of the
iris are visible iris are
visible

Pupils and Inspection Black in color, Iris black in Normal Normal findings
Iris equal in size, color, equal findings.

20
normally 3-7 in size and
mm in round in
diameter, shape. Iris is
sound- flat and
smooth border round. Pupil
iris flat & diameter is (Kozier, B.
sound. Pupils 3mm. (2004).
constrict when Pupils Fundamentals
looking at near constrict of Nursing p.
object and when light is 554).
dilate when directed
looking at far towards it,
objects. and dilate
when light is
removed.

Visual Inspection Able to read Able to read Normal Normal Findings

Acuity newsprint with newsprint Findings
20/20 vision with 20/20
on snellen vision on
chart. snellen
chart.

Ears
PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATION
FINDINGS FINDINGS

Auricles Inspection The color is Auricles Normal Normal Findings

the same as aligned at the Findings

21
facial skin, outer canthus
symmetrical, of the eyes,
the auricles symmetrical
aligned with and color is
outer canthus the same as
of the eye the facial skin.
Palpation

Mobile, firm
and not
tender, pinna
recoils after it
is folded.

Ear Inspection Distal third Distal third Normal Normal findings.

Canal contains hair contains hair findings.
follicles and follicles and
glands. Dry glands. Dry
cerumen, cerumen.
grayish-tan
color or sticky,
wet cerumen (Kozier, B.
in various (2004).
shades of Fundamentals
brown. of Nursing p.
556-557)

Hearing Inspection Normal voice Normal Voice Normal Normal findings

Acuity tones audible. tones audible. findings
Sound is

22
heard in both
ears or
localized at
the center of
the head According to
(Weber Kozier page
Negative). 597.
Air conducted
hearing is
greater than
bone
conducted
hearing
(positive
Rinne)

Nose

PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATION

FINDINGS FINDINGS

Nose Inspection Symmetric Symmetric and Normal Normal Findings

and straight straight Findings
No No discharge in
discharge in flaring
flaring Uniform in
Uniform in color
color Not tender, no
Not tender, lesion

23
no lesion

Facial Palpation No No tenderness Normal Normal findings.

Sinuses tenderness noted. findings

(Kozier, B.
(2004).
Fundamental
s of Nursing
p. 561)

Septum Inspection Air moves Nasal septum Normal Normal findings

freely as the intact and in findings
client midline.
breathes
through the
nares. Nasal
septum Kozier page
intact & in 560-561
midline

Mouth
PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATION
FINDINGS FINDINGS

Lips Inspection Uniform pink Pale, Dry Paleness is Blood loss decrease
Palpation color due to hemoglobin level and
Soft, moist, decrease in since the patient isn’t

24
smooth hemoglobin allowed to take any
texture and dry liquids
Symmetry of because of
contour dehydration
Ability to
purse lips

Buccal Inspection Uniform pink Presence of Immobility Foul breath odor is

mucosa color foul breath related to due to poor self
Soft, moist, odor. invasive hygiene and lack of
smooth procedure motivation from others
texture done

Gums Inspection Pink gums, Pinkish gums, Normal Normal findings.

moist, firm no retraction, findings.
texture to moist and firm.
gums. (Fundamental
s of Nursing
by Kozier,
p603)

Tongue Inspection Central Pink in color, Normal Normal Findings

Palpation position moist, no Findings
Pink color, lesions,
moist, tenderness and
slightly nodules.
rough; then, Tongue is on (Fundamental
whitish the middle. s of Nursing

25
coating Client was able by Kozier,
Smooth; to move tongue p603)
lateral from side to
margins; no side and up
lesions and down.
Raised
papillae
Moves
freely, no
tenderness
Smooth
tongue base
with
prominent
veins.

Teeth Inspection 32 adult Without Tooth loss Normal findings

teeth dentures and occurs as a
smooth, incomplete result of
white, shiny teeth, yellowish dental
tooth enamel in color with disease but is
pink gums pink gums. 4 preventable
moist. teeth on upper with good
and 7 on lower. dental
hygiene.

(Fundamental
s of Nursing
by Kozier
p566)

26
Uvula Inspection Soft, moist, Soft, moist, and Normal Normal findings.
smooth pink findings.
texture Pink
and smooth. (Fundamental
s of Nursing
by Kozier
p604)

Tonsils Inspection No No discharge. Normal Normal findings.

discharge. Pinkish in findings.
Tonsils of color. normal
normal size. size
Pink and (Fundamental
smooth s of Nursing
posterior by Kozier
wall. p604)

Neck

PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATION

FINDINGS FINDINGS

Neck Inspection Proportional Proportionate Muscles in Normal Findings

to size of the to the size of the neck like
head, head and sternocleido
symmetrical symmetrical. mastoid and
and straight. Unable to trapezius
Freely move. draw the

27
movable head to the
Palpation without side and
difficulty. elevate the
There are no chin and
No palpable palpable lymph elevate the
lumps or nodes. Head shoulders to
tenderness cannot easily shrug them.
The trachea flex and rotate. (Fundamental
is in the Trachea is in s of nursing
Central the central by Kozier p5)
placement in placement and
midline of no indication of
neck, spaces possible neck
are equal on tumor or
both sides. thyroid
enlargement.

Thorax

PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATI

FINDINGS FINDINGS ON
Chest
size and Inspection Anteroposterior Anteroposterior Normal Normal findings
shape to transverse to transverse in findings.
chest is ratio of 1:2,
symmetrical. chest is (Fundamentals
symmetrical of nursing by
Kozier p549)

28
Breath Auscultation Bronchovesicular Patient has a Normal Normal findings
sounds breathe sound. clear, Findings
bronchovesicular
breath sound. (Fundamentals
of Nursing by
Kozier p549)

Posterior Palpation Full and Full and Normal Normal findings

symmetric chest symmetric chest findings
expansion. expansion. Quiet
Premitus tactile and rhythmic,
most clearly at and effortless
the apex of the breathing.
lungs
Quiet, rhythmic
and effortless
respiration.
Vesicular and Resonant except
bronchovesicular on the scapula, (Fundamentals
Percussion breath sound. there is lowest of nursing by
point of Kozier p549)
Notes resonate, resonance over
except over scapula.
scapula, the
lowest point of
resonance is at
the diaphragm.

Anterior Inspection Quiet, rhythmic Effortless Normal Normal findings

and effortless Respiration. Findings

29
respiration.

Palpation Full and Full and (Fundamentals

symmetric chest symmetric chest of nursing by
expansion. expansion. Kozier p549
Same as box 29—5;
posterior vocal p617)
fremitus, fremitus
is normally
decreased over
heart and breast
tissue.

Breast
PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATIO
FINDINGS FINDINGS N

Breast Inspection No masses and n/a. The patient The patient

Palpation lumps refused to be refused to be
assessed assessed

Areola Inspection Dark in color in n/a The patient The patient

Palpation contrast to refused to be refused to be
surrounding skin. assessed assessed
No masses,
lumps and
lesions.

30
Nipples Inspection Size is n/a The patient
Palpation proportional. No refused to be
discharged or assessed
secretions.

Abdomen
PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPREATTION
FINDINGS FINDINGS

Skin Inspection Unblemished Unblemished Normal Normal findings

integrity skin, uniform skin, uniform findings
in color. in color
According to
Kozier page
592-598

Contour Inspection Flat, Distended Abdomen is Uterine fibroids

and rounded. distended creates pressure to
Symmetry Symmetric due to the bladder and
contour. uterine rectum
fibroids

Movement Inspection Symmetric Symmetric Normal Normal findings

movements movement findings
caused by caused by
respiration. respiration,
no visible

31
vascular According to
pattern. Kozier page
592-598

Bowel Auscultation Audible Audible bowel Normal Normal Findings

sounds bowel sounds. Findings
sounds. hypoactive
Normal Bowel
bowel sounds= 4
sounds = 5- per minute
35 per
minute

Clean Clean Normal Normal findings

Umbilicus Inspection findings

According to
Kozier page
592-598

Bladder Palpation Not palpable Not palpable Normal Normal findings

findings

According to
Kozier page
592-598

Liver Palpation May not be No Normal Normal findings

32
palpable. enlargement. findings
Border feels Not palpable
smooth According to
Kozier page
592-598

Urogenitalia System
METHOD NORMAL FINDINGS ACTUAL ANALYSIS INTERPRETATION
FINDINGS
Inspection
Pubic hair evenly n/a The Patient The Patient refused
distributed, pubic skin refused to be to be assessed.
intact, no lesions Foley catheter assessed
intact. Foley catheter is
due to patient’s
inability to void by
herself.
Inspection Skin of vulva area is
slightly darker than the The Patient The Patient refused
rest of the body, labia n/a refused to be to be assessed
round full and relatively assessed
symmetric
Inspection Clitoris does not
exceed 1cm in width The Patient The Patient refused
and 2cm in length, no n/a refused to be to be assessed
inflammation, swelling assessed
or discharge
Palpation No enlargement and The Patient
tenderness n/a refused to be The Patient refused

33
assessed to be assessed

Musculoskeletal System
PARTS METHOD NORMAL ACTUAL ANALYSIS INTERPRETATION
FINDINGS FINDINGS

Upper Inspection Equal in Equal in size Normal Normal Findings

Extremities size on on both Findings
both sides. sides.
Palpation Equal in Equal in
strength, strength, (Fundamentals
coordinated coordinated of Nursing by
movement. movement. Kozier p1068)
Able to Able to
tolerate tolerate wide
wide range range of
of motion. motion. No
No difficulty difficulty
upon upon
bending bending and
and stretching.
stretching. No lesions,
No lesions, no scars and
no scars no deformity.
and no
deformity.

Lower Inspection Equal in Equal in size Normal Normal Findings

Extremities size on on both Findings

34
both sides. sides. (Fundamentals
of Nursing by
Palpation Kozier p1068)
Able to Able to
tolerate tolerate wide
wide range range of
of motion. motion. No
No difficulty difficulty
upon upon
bending bending and
and stretching.
stretching. No lesions,
No lesions, no scars and
no scars no deformity.
and no
deformity.

Peripheral Palpation Symmetric Weak pulse A weak pulse Patient has edema
pulse full on right and both feet and may be due to
pulsation left dorsalis indicates reduced blood
pedis pulse reduced circulation.
capillary
perfusion

(Fundamentals
of Nursing by
Kozier, p496)

35
IV. Definition of Disease/Introduction

Myomatous or fibroid tumors of the uterus are estimated to occur in 20%

to 40% of women during their reproductive years. It is thought that women are

genetically predisposed to develop this condition, which is almost always

benign. Fibroids arise from the muscle tissue of the uterus and can be solitary

or multiple, in the lining (intracavitary), muscle wall (intramural), and outside

surface (serosal) of the uterus. They usually develop slowly in women

between 25 and 40 years of age and may become quite large. A growth spurt

with enlargement of the fibroid tumor may occur in the decade before

menopause, possibly related to anovulatory cycles and high levels of

unopposed estrogen. Fibroids are a common reason for hysterectomy

because they often result in mennorrhagia, which can be difficult to control.

36
V. Pathophysiology of the Disease

Benign Tumors of the Uterus

Fibroids
(leiomyomas, Fibromyomas, myoma)

Anovulatory Cycles High levels of unopposed estrogen

Intermingled varying amounts of

fibrous connective tissue

Resembling the muscles in

the walls of the organ

Usually multiple and vary

from pea-sized to masses

Located in the Located lower In the body of Close beneath

Lower uterus down on the cervix uterus its lining membrane

Pedunculated Intramural Intramural Protruding Intracavitary

Intracavitary myomas myomas myoma
Myoma Pedunculated serosal
myoma

Danger during press upon the

Childbirth bladder & rectum

Urinary problems Mennorrhagia

Constipation Metrorrhagia
Bloating

37
VI. Anatomy and Physiology

Ovaries

The paired ovaries (o-vah-rez) are pretty much the size and shape of almonds.

An internal view of an ovary reveals many tiny saclike structures called ovarian

follicles. As a developing egg within a follicle begins to ripen or mature, the follicles

enlarges and develops a fluid-filled central region called an antrum. At this stage, the

follicle , called a vesicular or Graafarian follicle, is a mature and the developing egg

is ready to be ejected from the ovary, an even called ovulation. After ovulation, the

ruptured follicle is transformed into a very different-looking structure called corpus

luteum, which eventually degenerates. Ovulation generally occurs every 28 days,

but can occur more or less frequently in some women. In older women, the surfaces

38
of the ovaries are scarred and pitted, which attests to the fact that many eggs have

been released.

Duct System

The uterine (fallopian) tubes, uterus, and vagina form the duct system of the

female reproductive tract.

Uterine (Fallopian) Tubes

The uterine (u’ter-in), or fallopian (fal-lo’pe-an) tubes form the initial part of the

duct system. They receive the ovulated oocyte and provide a site where fertilization

can occur. Each of the uterine tubes is about 10 cm (4 inches) long and extends

medially from an ovary to empty into the superior region of the uterus. Like the

ovaries, the uterine tubes are enclosed and supported by the broad ligament. Unlike

in the male duct system of the testes there is little or no actual contact between the

uterine tubes and the ovaries. The distal end of each uterine tube expands as the

funnel-shaped infundibulum, which has fingerlike projections called fimbrae (fim’bre-

e) that partially surround the ovary. As an oocyte is expelled from an ovary during

ovulation, the waving fimbrae create fluid currents that act to carry the oocyte into

the uterine tube, where it begins its journey toward the uterus. (obviously, however

many potential eggs are lost in the peritoneal cavity) The oocyte is carried toward

the uterus by a combination of peristalsis and the rhythmic beating of cilia. Because

the journey to the uterus takes 3 to 4 days and the oocyte is visible for up to 24

hours after ovulation, the usual site of fertilization is the uterine tube. To reach the

oocyte, the sperm must swim upward through the vagina and uterus to reach the

39
uterine tubes. This is a difficult journey. Because they must swim against the

downward current created by the cilia, it is rather like swimming against the tide.

Uterus

The uterus (u’ter-us “womb”), located in the pelvis between the urinary bladder

and rectum, is a hollow organ that functions to receive, retain and nourish a fertilized

egg. In a woman who has never been pregnant, it is about the size and shape of a

pear. (During pregnancy, the uterus increases tremendously in size to accommodate

the growing fetus and can be felt well above the umbilicus during the latter part of

pregnancy) The uterus is suspended in the pelvis by the broad ligament and

anchored anteriority and posterior by the round and uterosacrial ligaments,

respectively.

The major portion of the uterus is referred to as the body. Its superior rounded

region above the entrance of the uterine tubes is the fundus, and its narrow outlet,

which protrudes into the vagina below, is the cervix.

The wall of the uterus is thick and composed of three layers. The inner layer or

mucosa is the endometrium (en-do-me’tre-um). If fertilization occurs, the fertilized

egg (actually the young embryo the time it reaches the uterus) burrows into the

endometrium of the uterus (this process is called implantation) and resides there for

the rest of its development. When a woman is not pregnant, the endometrial lining

sloughs off periodically, usually about every 28 days, in response to changes in the

levels of ovarian hormones in the blood. This process is called menses.

40
Vagina

The vagina (vah-ji-nah) is a thin-walled tube 8 to 10 cm (3 to 4 inches) long. It

lies between the bladder and rectum and extends from the cervix to the body

exterior. Often called the birth canal, the vagina provides a passageway for the

delivery of an infant and for the menstrual flow to leave the body. Since it receives

the penis (and semen) during sexual intercourse, it is the female organ of copulation.

The distal end of the vagina is partially closed by a thin fold of the mucosa called

the hymen (hi-men). The hymen is very vascular and tends to bleed when it is

ruptured during the first sexual intercourse. However, its durability varies. In some

females, it is torn during a sports activity, tampon insertion, or pelvic examination.

Occasionally, it is so tough that it must be ruptured surgically if intercourse is to

occur.

Menstrual cycle

Although the uterus is the receptacle in which the young embryo implants and

develops , it is receptive to implantation only for a very short period each month. Not

surprisingly this brief interval coincides exactly with the time when a fertilized egg would

begin to implant, approximately 7 days after ovulation. The events of the menstrual, or

uterine cycle are the cyclic changes that the endometrium, or mucosa of the uterus,

goes through month after month as it responds to changes in the levels of ovarian

hormones in the blood.

Since the cyclic production of estrogens and progesterone by the ovaries is, in

turn, regulated by the anterior pituitary gonadropic hormones, FSH and LH, it is

41
important to understand how these “hormonal pieces” fit together. Generally speaking,

both female cycles are about 28 days long (a period commonly called a lunar month),

with ovulation typically occurring midway in the cycles, on or about day 14. The three

stages of menstrual cycle are described next.

• Days 1-5: Menses. During this interval, the functional layer of the thick

endometrial lining of the uterus is sloughing off, or becoming detached from the uterine

wall. This is accompanied by bleeding for 3 to 5 days. The detached tissues and blood

pass through the vagina as the menstrual flow. The average blood loss during this

period is 50 to 150 ml (or about ¼ to ½ cup). By day 5, growing ovarian follicles are

beginning to produce more estrogen.

• Days 6-14: Proliferative stage. Stimulated by rising estrogen levels produced

by the growing follicles of the ovaries, the basal layer of the endometrium regenerates

the functional layer, glands are formed in it, and the endometrial blood supply is

increased. The endometrium once again becomes velvety, thick, and well vascularized.

(ovulation occurs in the ovary at the end of this stage in response to the sudden surge

of LH in the blood.)

• Days 15-28: Secretory stage. Rising levels of progesterone production by the

corpus lutuem of the ovary act on the estrogen-primed endometrium and increase its

blood supply even more. Progesterone also cause the endometrial glands to increase in

size and to begin secreting nutrients into the uterine cavity. These nutrients will sustain

a developing embryo (if one is present) until it has been implanted. If fertilization does

occur, the embryo produces a hormone very similar to LH, which causes the corpus

luteum to continue producing its hormones. If fertilization does not occur, the corpus

42
luteum begins to degenerate towards the end of this period as LH blood levels decline.

Lack of ovarian hormones in the blood causes blood vessels supplying the functional

layer of the endometrium to go into spasm and kink. When deprived of oxygen and

nutrients, those endometrial cells begin to die, which sets the stage for menses to

begin again on day 28.

Although this explanation assumes a classic 28-day cycle, the length of the

menstrual cycle is quite variable it can be as short as 21 days or as long as 40 days.

Only one interval is fairly constant in all females; the time from ovulation to the

beginning of menses is almost always 14 or 15 days.

Hormone production by the Ovaries

As the ovaries become active at puberty and start to produce ova, production of

ovarian hormones also begins. The follicle cells of the growing and mature follicles

produce estrogen, which causes the appearance of the secondary sex characteristics

in the young woman. Such changes includes:

• Development of the breasts

• Appearance of axillary and pubic hair

• Enlargement of the accessory organs of the female reproductive systems

(uterine tubes, uterus, vagina, external genitalia)

• Increased deposit of fat beneath the skin in general, and particularly in

the hips and breasts

• Widening and lightening of the pelvis

• onset of menses, or the menstrual cycle

43
The second ovarian hormone, progesterone, is produced by a special glandular

structure of the ovaries, the corpus luteum. As mentioned earlier, after ovulation occurs

the ruptured follicle is converted to the corpus luteum which looks like and acts

completely different from the growing mature follicle. Once formed, te corpus luteum

produces progesterone (and some estrogen) as long as LH is still present in the blood.

Generally speaking, the corpus luteum has stopped producing hormones by 10 to 14

days after ovulation. Except for working with estrogen to establish the menstrual cycle,

progesterone does not contribute to the appearance of the secondary sex

characteristics. Its other major effects are exerted during pregnancy, when it helps

maintain the pregnancy and prepare the breasts for milk production. (however, the

source of progesterone during pregnancy is the placenta, not the ovaries.)

44
VIII. Medical/Surgical Management

Book-based

Treatment of uterine fibroids may include medical or surgical intervention and

depends to a large extent on the size, symptoms and location as well as the woman’s

age and her reproductive plans. Fibroids usually shrink and disappear during

menopause, when estrogen is no longer produced. Simple observation and follow-up

may be all the management that is necessary. The patient with minor symptoms is

closely monitored. If she plans to have children, treatment is as conservative as

possible. As a rule, large tumors that produce pressure symptoms must be removed

(myomectomy).

Medical Management

Asymptomatic leiomyomas can be observed every 6 months a practitioner if (1)

the client is not pregnant, (2) there is no excessive bleeding or pressure on the bladder,

bowel, or uterus and (3) the tumor is not rapidly growing.

Medications (e.g., leuprolide [lupron]) or other gonadotropin releasing hormone

(GnRH) analogues, which induce a temporary menopause like environment, may be

prescribed shrink the fibroid. This treatment consists of monthly injections, which may

cause hot flashes and vaginal dryness. Treatment is usually short term9ie, before

surgery) to shrink the fibroids, allowing easier surgery, and no alleviate anemia, which

may occur as a result of heavy menstrual flow. This treatment is used on a temporary

basis because it leads to vasomotor symptoms and loss of bone density.

45
Antifibrotic agents are under in investigation for long term treatment of fibroids.

Mifepristone, a progesterone antagonist, has also been prescribed; it appears to be

effective.

Surgical Management

Surgical treatment may involve cutting off the blood supply to the fibroid with

uterine artery embolization, laser surgery or myomectomy (removal of a tumor without

removal of the uterus).these procedures preserve the reproductive organs and

reproductive capability. Large leiomyomas may require hysterectomy.

Hysterectomy

Indications: three types of hysterectomy may be performed:

1. Total hysterectomy is a removal of the uterus and cervix, and can be performed

either abdominally or vaginally.

2. Total hysterectomy with bilateral salpingooophorectomy (TAH-BSO) is the

removal of uterus, cervix, fallopian tubes, and ovaries. Can be performed

abdominally or vaginally.

3. Radical hysterectomy same as a TAH-BSO plus removal of the lymph nodes,

upper third of the vagina, and parametrium. Usually performed if a malignant

tumor is found.

Contraindications: The only contraindication to hysterectomy is any heath

condition that prevents surgery.

46
Complications. Hemmorrhage and infection are the primary complications.

Outcomes. It is expected that the client will return home in 2 to 4 days and

resume regular activities within 4 to 6 weeks, depending on the type of

hysterectomy performed. Pain, abdominal bleeding, and anemia, if present, will

cease. For all procedures except myomectomy, menstruation ends.

Several other alternatives to hysterectomy have been developed for treatment of

excessive bleeding due of fibroids. These include the following:

 Hysteroscopic resection of myomas: a laser is used through a hysteroscope

passed through the cervix; no incision or overnight stay is needed.

 Laparoscopic myomectomy: removal of a fibroid through a laparoscope

inserted through a small abdominal incision

 Laparoscopic myolysis: a laser or electrical needles are used to coagulate the

fibroid

 Laparoscopic cryomyolysis: electric current is used to coagulate the fibroid

 Uterine artery embolization (UAE): polyvinyl alcohol or gelatin particles are

injected into blood vessels that supply the fibroid via the femoral artery, resulting

in infarction and resulting shrinkages. This percutaneous image-guided therapy

offers an alternative to hormone therapy or surgery.UAE may result in infrequent

but serious complications such as pain, infection, amenorrhea, necrosis and

bleeding. A although rare deaths and ovarian failure may occur. Women need to

weigh the risk and benefits carefully, especially if they have not completed

47
childbearing, this procedure has been found to cause fewer complications than

hysterectomy, but women may need further treatment in future.

 Magnetic resonance-guided focused ultrasound surgery (MRgFUS):

ultrasonic surgery is passed through the abdominal wall to target and destroy the

fibroid. Although not yet widely used, this noninvasive procedure is approved by

the U.S .food and drug administration for premenopausal women with bother

some symptoms due to fibroids and who do not want more children .it is an

outpatient treatment

Surgical Management

Client-based

Vaginal myomectomy involves removing fibroids through the vagina; as with

hysteroscopic myomectomy, therefore, there are no external scars. This operation is done when

the fibroids are moderate in size but too deep or numerous for hysteroscopic or laparoscopic

myomectomy. It is easier in women who have children as there tends to be more space in the

pelvis for this type of surgery.

The procedure is easiest when the fibroid(s) are at the back of the uterus, and most

difficult when they are mainly at the top; in that situation, laparoscopic myomectomy may be

preferred. Because conventional instruments are used, Vaginal myomectomy generally takes

less time than laparoscopic myomectomy and the repair of the uterus is stronger. Recovery in

terms of hospitalisation and return to normal activities is similar, and faster than with

laparotomy.

48
X. Statement of nursing problems/nursing diagnosis based on grouped
data (Gordon’s)

1. Activity Intolerance related to bed rest

2. Acute pain related to injury agents as manifested by trauma to tissues

3. Acute pain related to surgical procedure

4. Anxiety related to change in role status

5. Constipation or Risk for constipation related to decreased activity

6. Disturbed sleep pattern related to pain, lack of sleep privacy

7. Disturbed body image related to treatments

8. Hygiene self care deficit related to pain

9. Hyperthermia related to trauma as manifested by increase in body

temperature

10. Ineffective health maintenance related to lack of social support

11. Nausea related manipulation of GI tract, postsurgical anesthesia

12. Risk for infection related invasive procedure

13. Risk for loneliness related to affection deprivation

14. Self-care deficit related to weakness and tiredness

15. Urinary retention related to pain, fear

49
XI. Priority Nursing Problem/Nursing Care Plan

• Actual
Assessment Nursing Dx Inference Planning Intervention Rationale Evaluation
Acute pain Hysterectomy After 8 hours of Independent: 1. Provide After 8º of
Subjective: secondary to 1. Evaluate pain information about rendering
↓ rendering nursing
surgical regularly noting need for or nursing care,
The patient Breaking in intervention, the patient
procedure characteristic, effectiveness of the goalswas
verbalizes: the w ill be able to:
(hysterectomy) location intensity (0-10). intervention. met partially
“I felt pain on as evidence by continuity of - Decrease pain
2. Prevents undue asevidenced
2. Identify specific
my surgical reported the skin scale of 8 to 4 as by:
activity limitations. strain on operative
incision” pain with the ↓ evidence by
site.
- Decreased
3. Reposition as
pain scale of Imflamation stable vital signs.
3. May relieve pain
pain scale to
indicated.
Objective: 8 (pain scale process 4. Encourage of and enhance
the
- Reported from 1 – 10), triggered relaxation level of 5.
circulation
pain limited range of ↓ technique like deep
4. Relieves muscle
with the pain motion and breathing exercise.
Nerve ending and emotional
scaleof 8 (pain sleep 5. Monitor vital signs
compression tension.
scale from 1– disturbance DEPENDENT:
↓ 5. Changes in vital
10) pattern 1.Administer analgesic
Pain signs may be used

- Facial medication: Ketorolac for rough estimate

IVTT x 4 doses q 8 of pain.

Grimacing
hours DEPENDENT:
- Guarding
as prescribe by the 1. To relieve mild or
behavior
physician. moderate pain.

50
• Actual
Assessment Nursing Dx Inference Planning Intervention Rationale Evaluation

Subjective Hyperthermia Tumors of the After 30 min. of 1. Render TSB > To body After 30 min.
related to uterus nursing heat
evaporation
of nursing
“kanina pa po trauma as intervention, intervention,
has a cooling
siya nilalagnat” manifested by Located in the patient the body of
the body of effect
as verbalized by In body manifest >To the patient is
2. Fluid intake
the patient’s temperature of the uterus thermo circulation of able to reach
relative 39.4 oC regulating as blood the normal
Invasive evidenced by: range of body
Objective procedure > To promote temperature.
3. Removal of
> Skin excessive clotting heat loss
> T – 39.4% C Removal of temperature in > the patient
> Chilling tumors expected 4. Put cold > To absorb is able to
> Clammy Skin range compress to heat in said
areas. Thus,
verbalize
> Skin warm to Damage of forehead neck, understanding
the tissues axilla, and groin. heat loss
touch > Body of techniques
temperature >to determine of proper TSB
Trauma of w/in normal 5. Every 5
minutes check for if the temp. is
tissue limits w/in normal
temperature if the
temp. is w/in range
Hyperthermia > describes to normal range
prevent or
In body minimize inc. in 6. Teach the
temperature > Long strokes
body temp relative proper
TSB techniques creates
like avoiding long friction to the
> describe
strokes and only skin and it
proper produces
measures patting the wet
towel on the skin heat.
during TSB
51
• Potential
Assessment Nursing Dx Inference Planning Intervention Rationale Evaluation

Subjective Anxiety related Changes in After -encourage - this aids After

to change in physiologic continuous verbalization of comfort by continuous
“hindi ako Health status as status nursing concerns improving nursing
mapalagay kasi manifested by intervention, the patients intervention,
baka hindi ako irritability -assist patient in attitude the client
the client will
gumaling expressing toward the was able to:
be able to: feelings by active
agad.naaawa Worsening of situation.
listening
ako mga anak case -Verbalize -verbalized
ko.”As appropriate -provide accurate appropriate
verbalized by range of and concrete range of
the patient feeling. information about feelings.
Hospitalization what is being
done
Objective
-provide a calm -relieves
>Irritability and peaceful discomfort
Anxiety due to
>poor eye environment and pain.
thoughts of
contact not able to -encourage
>Expressed recover relaxation
concerns due to techniques
change in life
events -encourage to
>dry mouth project a positive
and realistic
attitude

52
XII. Discharge Plan

M- medication

 Advise the client to comply with the prescribe treatment regimen.

 Explain in a manner that can be understand as to name, actions, side effects
etc.
 Emphasize that strict compliance of treatment should be observed to prolong
life.

E- exercise Deep Breathing exercises.

 Keep emotional stress under control by using relaxation techniques such as

muscle relaxation exercises.

T- treatment

 Provide Rest periods between activities.

 Provide adequate ventilation and a quiet calm environment.

H- health teaching

 Instruct the client in energy saving activities.

 Instruct the patient to eat healty foods.
 Advise family to provide emotional support.

O- OPD

 Advise patient to comply with clinic follow up.

 Advise patient to comply with treatments.

D- diet

 Eat in small frequent meals of high nutritional value.

 Drink plenty of water at least 8 times a day.

S- spiritual

 Advise the significant others to guide and support the Patient by uplifting her
spiritual being.
 Maintain positive outlook in life.

53
Reference Books

Brunner & Suddarth, 2010, Textbook of Medical and Surgical Nursing

12th Ed., Lippincott & Willliams

Joyce M. Black, 2005, Mediccal-Surgical Nursing: Clinical

Management for Positive Outcomes 7 th Ed., Elsevier Inc.

Marguerrete Kinney, 1988, AACN’s Clinical Reference for Critical-

Care Nursing 2 nd Ed., Mosby

Harold Shyrock, 1985, Modern Medical Guide

McCane & Huether, 2008 Understanding Pathophysiology 4 th Ed.,

Mosby

Elaine M. Marieb, 2004, Essentials of Human Anatomy & Physiology

7th Ed., Pearson Education South Asia PTE LTD

Judith M. Wilkinson, 2005, Prentice Hall Nursing Diagnosis Handbook

with NIC interventions and NOC outcomes 7 th Ed., Pearson
Education South Asia

Stanly Loeb,1992, Nursing 92 Drug handbook, Springhouse

Corporation

Clayton and Stock, 2001, Basic Pharmacology for Nurses 12 th Ed.,

Mosby

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