SOUTHEAST ASIAN COLLEGE, INC.

E. RODRIGUEZ, Q.C

COLLEGE OF NURSING BSN - 221

Submitted to: Ms. Lorena Espina Clinical Instructor Submitted by: Baltazar, Francis Jofel D. Fronda, Sharmaine Angela Q Ganadin, Maria Jerissa Ann M. Idian, Marinella Ignacio, Anni Beatrice Jose, Ivy Grace R. Lanuza, Geneva V. Malabanan, Nikki Franz Marcelino, Summer Betina Nicole V. Olayan, Allyn Pamintuan, Chester

INTRODUCTION

Myoma uteri / uterine myomais the most common tumors of the genitalia tract. Myoma is commonly called fibroid (tumor made of muscle tissues), that can be solitary or multiple, in the lining (intra cavity), muscle wall (intramural) and outside surface (serosal) of the uterus. Myomaare estimated to occur in 20-40% of women during their reproductive years (20-40 yrs. of age). It develops when theres a hyper production of estrogen and progesterone. The majority of the researchers say that the growth of myoma depends on concentration of cystosolic receptors to the sex hormones and their interaction with estrogen/endrogen hormones. In accordance to chemical observations, it can be admitted that both growth and regression of myoma are estrogen dependent. The tumor tends to grow very quickly during pregnancy which the body is producing extra estrogen and decrease after menopause. Fibroids are a common reason for hysterectomy because they often result in menorrhagia which can be difficult to control.

CLINICAL MANIFESTATIONS: menorrhagia pelvic pain abdominal pain lower back pain

CLASSIFICATIONS OF MYOMA

1. Intramural. Found in the uterine wall, surrounded by myometrium. Clinical manifestations include increased uterine size, vaginal bleeding between menses and dysmenorrhea 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

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

THEORETICAL FRAMEWORK

Dorothea Orem: The central idea of the theory of self-care deficit is that the requirements of persons for nursing are associated with the subjectivity of mature and maturing persons to health-related or health care-related action limitations Patient x has been menopause for 4 years then suddenly experienced a painful and heavy bleeding for 9 days her chief complaint was prolonged and profuse vaginal bleeding

BIOGRAPHIC DATA

Name: Patient X Age: 49 years old Address: #492 T. Molina St.,Baler, Aurora Religion: Roman Catholic Civil Status: Single Chief Complain: Prolonged Dx: Uteri Myoma Date/Time Admitted: 01/03/2012 (3:05 pm) Ward: Medicine Ward Admitting Physician: Dr. Tiburcio

NURSING HEALTH HISTORY

PRESENT HEALTH HISTORY Present illness started 9 days prior to admission when patient had been experiencing prolonged and profused vaginal bleeding with dysmenorrhea. The patientdidnt consult a physician nor had taken any medication. 2 days from that, the patient is still having the same condition of prolonged and profuse vaginal bleeding and dysmenorrhea is now accompanied with dizziness. Because of this condition, patient consulted a private physician and was given a 15mg of Hemostan and 500mg of Buscopan both taken for 3 times a day. But not admitted. Until Janruary 3, 2012, patients condition of vaginal bleeding had increased and by this condition, patient decided to consult again a private physician and was consulted for blood transfusion and hence was admitted. She had an examination of transrectal ultrasound and was diagnosed of Myoma Uteri (Submucosal).

PAST HEALTH HISTORY Patient claimed that she had experienced common childhood diseases and minor illnesses, such as common colds, chicken pox, mumps and measles. According to her, she has no recollection for her immunization status because according to her, it was not common practice during her childhood days. The patient also stated that she was never hospitalized and claimed no allergies to drugs, foods, or other environmental substance.

FAMILY HEALTH HISTORY Patient X has a familial history of hypertension, cancer and emphysema. Her mother died due to ovarian cancer at the age of 78 while her father died at the age of 70. Both of her parents have Hypertension.

GORDONS FUNCTIONAL HEALTH PATTERN

PATTERN
1. HEALTH

BEFORE
Pt. sees herself as healthy when she feels unusual life pain and fatigue, she doesnt bother to consult a Dr. and just continue her daily activity. Pt. Xs life before her pre-confinement was normal, she eats what ever she wants, she eats fruits, vegetables and meats most of the time. She is fond of drinking coffee for about 2-3 cups a day.

PRESENT
The pt. have prolonged and profuse vaginal bleeding accompanied by dysmenorrhea and was confine to UDMC.

ANALYSIS
The pt. now believes on the importance of seeking of medical attention rather than home remedies.

PERCEPTION PATTERN

2.NUTRITIONAL AND METABOLIC PATTERN

During hospitalization, the pt. is on diet as tolerated. She eats fruits like apples and oranges. She also eats bread instead of rice. She said she lose her appetite due to uncomfortable feeling.

3. ELIMINATION

PATTERN

Bowel: Pt. defecates usually in the morning. The stool is brown in color and well form.

Bowel: Pt. defecates once a day but not everyday. Stool is soft, minimally in amount, and is

An individuals health status greatly affects eating habits and nutritional status.(Fundamental of Nursing by Kozier p.1178) The pt. was brought to the hosp. because of prolonged and profuse vaginal bleeding accompanied by dysmenorrhea. Patient elimination Pattern changed because of discomfort due to vaginal bleeding.

Bladder: Pt. Xs voids usually 6-8 times a day. Urine is yellow in color. No pain when voiding.

4. ACTIVITYEXERCISE PATTERN

5.SLEEP-REST PATTERN

Patient Xs daily activity are household chores everyday. Pt. like watching tv, usually in the afternoon and in the evening. Patient sleeps usually from 9pm until 6am. She has feels rested when sleeping and she thinks that her energy is sufficient for his activities. Patient X is a high school graduate from Victoria National High school in Samar. She wasnt able to continue in college due to financial problems. She can speak and understood by others. She read and write. Patient X is a friendly person. She considered herself as a holistic human being as long as her complete, healthy and her family is always there for her. Pt. can speak and understand tagalog, waray, visaya and english. She lives with her sister, nephews and nieces.

brown in color. Bladder: Pt. voids 3-4 times a day without pain but with discomfort due to vaginal bleeding. Patient needed a lot of assistance when moving due to present state.

Her activity tolerance is affected since she experienced her prolonged vaginal bleeding. Patient sleep and rest pattern was change when she was admitted due to her present state. There is a disruption to her sleeprest pattern because of the pt. disease. There was a change in her cognitiveperceptual pattern in terms of communicating to other due to pain.

Patient complain difficulty sleeping and sleeps for short period of time(3-4 hours) due to pain. She doesnt feel rested an uncomfortable. Patient wasnt able to communicate well because of weakness due to her present illness.

6. COGNITIVEPERCEPTUAL PATTERN

7. SELF-PERCEPTION AND SELF-CONCEPT PATTERN

Patient thinks that she cannot function well than before.

Events or situations may change the level of self-concept over time. Illness and trauma can also affect self-concept.

8.ROLE-RELATIONSHIP PATTERN

Due to the present condition, pts relatives support financially and emotionally.

Pt. is thankful to have relatives like them.

9.SEXUALITYREPRODUCTIVE PATTERN

Patient is single. She has no history of any sexual engagement.

Patient dont perform any form of sexual activity.

10.COPING-STRESS TOLERANCE PATTERN

When she is stressed, patient X usually eats a lot. When she is anxious, she prefers to be alone. Patient X is a Roman Catholic.

Recent hospitalization was a traumatic experience for her. This made her difficult to adjust. According to the patients, there are no practices that affect her hospitalization. She believes that she can recover and progress fast with her strong faith in God.

Her Familys support can provide big factor for her fast recovery.

11. VALUE-BELIEF PATTERN

Religious effort is still a part of patients life.

PHYSICAL ASSESSMENT BODY PART ACTUAL FINDINGS NORMAL FINDINGS ANALYSIS