ANDRES BONIFACIO COLLEGE

SCHOOL OF NURSING
COLLEGE PARK, DIPOLOG CITY

CARE OF PATIENT WITH OVARIAN CYST

Submitted by Submitted to
Mr. Eduard Francis Q. Luayon Mrs. Julyn Marie A. Gallardo , RN, MN
Ms. Sheena E. Napuecas Clinical Instructor
Ms. Meville Mejias
BSN-IV Students

December 09, 2021

 VISION

A center of excellence in instruction, research, technology, extension, athletics, and the arts.

MISSION

We commit to provide affordable quality education with values in industry, intelligence, integrity and undertake relevant
research and socially-responsive community service using innovative technologies.

The School of Nursing’s Vision

Excellence in nursing education

The School of Nursing’s Mission

The School of Nursing shall generate competent, compassionate professional nurses committed to
a. Practice high standard of nursing care utilizing research and evidence-based practices that are culturally
appropriate and sensitive;
b. Be actively involved in local, national and global issues affecting nursing, people’s health and the environment;
c. Ongoing holistic growth and development of the self and others.
 TABLE OF CONTENTS

I. Learning Objectives

II. Introduction

III. Anatomy and Physiology

IV. Patient’s Profile

V. Pathophysiology

VI. Nursing Care Plans

VII. Drug Study

VIII. References
 LEARNING OBJECTIVES
General Objectives

At the end of my case presentation, the learners shall be able to acquire enough knowledge regarding Ovarian
Cysts and conduct a comprehensive case study of illness/condition, and to provide a holistic care to patients diagnosed
with Ovarian Cysts through effective nursing care to the client by putting to use the knowledge we have acquired.

Specific Objectives

Within an hour, the listeners will be able to

1. Define the terms and concepts related to the case of Ovarian Cysts.
2. Identify the developmental data of the patient.
3. Determine the disease process of Ovarian Cysts through its pathophysiology.
4. Recognize the relevance of drug to the patient by obtaining familiarity and doing drug studies on various
medications.
5. Present medications and its indications to be given to the patient with Ovarian Cysts.
6. Discuss the implications of the laboratory results of the patient with Ovarian Cysts.
7. Create efficient nursing care plan based on actual high-risk of health need.
 INTRODUCTION

A cyst is a sac which contains fluid or semi-solid material. Ovarian cysts

may develop at any time but are most common from puberty to the

menopause. Most are small and clinically unimportant, and only a few

require removal. Ovarian cysts range in size from microscopic to a large

pelvic mass, and may cause difficulty by enlargement, pulsion, traction,

torsion, infection, malignant change, or rupture. Most cystic enlargements

disappear within a few months.

Cysts which do not disappear in that time are often inflammatory or endometrial or may have malignant potentialities. The

following factors must be considered in any ovarian enlargement: size, persistence, bilaterality, adherence, hormone

production, surface nodulation, papillar formations or neighboring irregularities, and ascites. Surgery is generally required

if a tense ovarian enlargement progresses to more than 6 cm in diameter within 4 months. Abdominal pain, bleeding, or a
palpable pelvic mass may require exploratory laparotomy. Treatment is based upon an estimate of whether the growth 'is

benign or malignant, the consequences of its development, and the risk of its removal or destruction

Classification of Ovarian Cysts.

(1) Functional cysts (follicle, granulosa lutein, theca lutein).
(2) Inflammatory cysts (tubo-ovarian).
(3) Endometrial cysts (endometriomas).
(4) Inclusion cysts,
(5) Parovarian cysts.

(1) Functional Cysts.

Follicle and corpus luteum cysts are normal transient physiologic structures.
 
A. Follicle (Retention) Cysts: Follicle cysts are common, frequently bilateral,
multiple cysts which appear. at the surface of the ovaries as pale blebs filled with a
clear fluid. They vary in size from microscopic to 4 cm in diameter (rarely larger).
These cysts represent the failure of an incompletely developed follicle to become
atretic or resolve. They are commonly found in prolapsed adherent ovaries or when
a thickened, previously inflamed ovarian capsule restricts ovarian function.
 
Symptoms are usually not present unless torsion or rupture with hemorrhage
occurs, in which case the symptoms and signs of an acute abdomen are often
present, Large or numerous cysts may cause aching pelvic ains dyspareunia, and
occasionally abnormal uterine bleeding. The ovary may be slightly enlarged and
tender to palpation, and the vaginal smear will often show a high estro-
gen level and a lack of progesterone stimulation. Salpingitis, endometriosis, lutein cysts, and neoplastic cysts must be Considered in
the differential diagnosis. Most follicle cysts disappear spontaneously within 60 days without any treatment; when symptoms are
disturbing, warm douches, pelvic diathermy, and reestablishment of the ovarian hormone cycle may be helpful. Ovulation may be
simulated following 5 days of therapy with a
single injection of progesterone in oil, 5 mg I. M. ; hydroxyprogesterone caproate (Delalutin), 1.25-2.5 mg I. M. ; or
medroxyprogesterone (Provera@), 10 mg orally. Ovulation may be induced with clomiphene citrate (Clomid@) 50 mg orally daily for
5 days.
 
Pain as the result of a prolapsed adherent ovary may require laparotomy, Ovariectomy is justified in disabling and chronic or
recurring salpingo-oophoritis. Malignant change does not occur. Any cyst which becomes larger than 5 cm in diameter or which
persists longer than 60 days probably is not a
follicle cyst.
 
Lutein Cysts: Two types are recognized: (1) granulosa lutein cysts, found within a corpus luteum; and (2) theca lutein cysts,
associated with a proliferative hydatid form mole, choriocarcinoma, clomiphene citrate; or chorionic gonadrotropin
 
B. Granulosa lutein cysts - Corpus luteum cysts are functional, nonneoplastic enlargements of the ovary caused by the unexplained
increase in secretion of fluid by the corpus luteum which occurs after ovulation or during early pregnancy. They are 4-6 cm in
diameter, raised, and brown; and are filled with tawny serous fluid. A contracted blood clot is often found within the cavity.
 
Corpus luteum cysts may cause local pain and tenderness, and either amenorrhea or delayed menstruation followed by brisk
bleeding after resolution of the cyst. They are usually readily palpable. Corpus luteum cyst may encourage torsion of the ovary,
causing severe pain; or it may rupture and bleed, in which
case laparotomy is usually required to control hemorrhage
 
into the peritoneal cavity. Unless these acute complications develop, symptomatic therapy is all that is required. The cyst will
disappear within 2 months in nonpregnant women, and will gradually become smaller during the last trimester in pregnant women.
It is necessary to distinguish between a cystic corpus luteum and a corpus luteum cyst.
The former is much smaller and is a normal variation of no clinical importance.
 
C. Theca lutein cysts - Theca lutein cysts range in size from minute to 4 cm in diameter. They are usually bilateral, are filled with
clear straw-colored and occasionally bloody serous fluid, and are found only in associati on with hydatidiform mole,
choriocarcinoma, or gonadotropin and clomiphene therapy.
 
Abdominal symptoms are often minimal. A sense of pelvic weight or ache may be described. Rupture of the cyst may result in
intraperitoneal bleeding. Continued signs and symptoms of pregnancy, especially hyperemesis and breast paresthesias, are also
reported.
Laboratory studies disclose startlingly high titers of chorionic gonadotropin. Curettage should be done if there is any question of
retained products of conception, a proliferative mole, or choriocarcinoma. Extrauterine pregnancy should be considered, The
remote possibility of bilateral papillary cystadenoma should be considered in the differential diagnosis. Ovarian surgery is not
required inasmuch as the cysts disappear spontaneously following elimination of the molar pregnancy, destruction of the
choriocarcinoma, or discontinuation of chorionic gonadotropin.
 
(2) Inflammatory Cysts (Tubo-Ovarian Cysts).
Distortion and adherence Of the tube and ovary as the result of salpingitis following
acute gonorrhea, an infected abortion, Or appendicitis cause an inflammatory adnexal
mass up to 15 cm in diameter with cyst formation. Severe and persistent pelvic pain is
typical. Metrorrhagia or hypermenorrhea occurs concomitantly. If the pain is unilateral,
acute appendicitis, intrapelvic bleeding, and endometriosis must be ruled out.

The white blood count and sedimentation rate are markedly elevated. Pregnancy tests
will be negative. Antibiotics, analgesics, and local heat or cold will give relief. Surgery is
not indicated if appendicitis and ectopic pregnancy Can be excluded unless symptoms
do not subside 3-4 weeks. in which case laparotomy is justified.
 
 
(3) Endometrial Cysts (Dndometrloma).
Functional ectopic endometrium which implants on the ovary retains its ability to bleed periodically With the proper hormonal
stimulus. Alternate oozing and healing with each period results in cyst formation.
 
Patients affected with functioning endometriosis are in the premenopausal age group; neoplasms are more commonly seen during
the perimenopausal years. Endometrial cysts vary from microscopic in size ("powder burns") up to 10-12 cm in diameter. Dense
adhesions to neighboring viscera are common. The interior of the cyst is filled with thick chocolate- colored old blood. The cyst wall
is found to contain active tissue. Local bleeding occurs from the stroma at the time of the period. Hemosiderln. pseudoxanthoma
cells, and chronic inflammatory elements with fibrosis are recognized .
 
Cancer of the ovary which is histologically characterized by an adenoid pattern. is now classified as "endometrioid carcinoma."
Metaplastic change may develop from basic mesothelium without the histologic demonstration of classic endometriosis hence the
term endometrioid. Malignancy arising in identifiable areas of endometriosis is less common than the adeno or endometrioid
variety. Symptomatology includes infertility, hypermenorrhea. "dyspareunia. and secondary or acquired dysmenorrhea.
 
Dysmenorrhea is generally pre or comenstrual and is or an aching, crescendo, or curious '"grinding" type. with referral pain toward
the Sacrum and rectum. Laboratory tests are not diagnostic. Not all " chocolate cysts" are endometrial in origin. Bleeding into any
cystic cavity will later yield decomposed blood. The wall of a corpus luteum will show a yellowish lining zone. Papillary processes or
thickened areas of actual neoplasia will be seen in cystadenomas.
 
(4) Inclusion cysts
 
These small ( often microscopic) cysts just beneath the surface of the ovary occur in post inflammatory states or after the
menopause. A minute amount of serous fluid fills the single loculus. The germinal epithelium becomes inverted or buried in one
small area, perhaps within a fissure. No discomfort or disability results from these cysts, which are usually found by the pathologist.
It is postulated that cystadenomas may originate from inclusion Cysts because of unknown growth stimuli. No treatment is required
for inclusion cysts. Cystadenomas are easily recognized and should be resected.
 
 
(5) Parovarian Cysts.
 
Parovarian cysts lie between the tube and ovary, usually near the distal end of the broad ligament. They are rarely larger than 3-4
cm. They develop from the remnants of the mesonephric or paramesonephric system. The lining elements may be flattened as a
result Of pressure within the cystic cavity, but where they are intact the classic cell types
seen in the fallopian. tube can be demonstrated.
 
These cysts are only found in the postpubertal female. As with most nonmalignant cysts, these abnormalities are asymptomatic
unless they reach palpable size, produce pressure symptoms, Or become infarcted by torsion.

Signs and symptoms

Often times, ovarian cysts do not cause any symptoms. However, symptoms can appear as the cyst grows. Symptoms
may include:

 abdominal bloating or swelling

 painful bowel movements

 pelvic pain before or during the menstrual cycle

 painful intercourse

 pain in the lower back or thighs

 breast tenderness

 nausea and vomiting

Severe symptoms of an ovarian cyst that require immediate medical attention include:

 severe or sharp pelvic pain

  fever

 faintness or dizziness

 rapid breathing

These symptoms can indicate a ruptured cyst or an ovarian torsion. Both complications can have serious consequences if
not treated early.

Causes
Most ovarian cysts develop as a result of your menstrual cycle (functional cysts). Other types of cysts are much less
common.

Functional cysts

Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and
progesterone and release an egg when you ovulate.

If a normal monthly follicle keeps growing, it's known as a functional cyst. There are two types of functional cysts:

 Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and travels down the
fallopian tube. A follicular cyst begins when the follicle doesn't rupture or release its egg, but continues to grow.

 Corpus luteum cyst. When a follicle releases its egg, it begins producing estrogen and progesterone for
conception. This follicle is now called the corpus luteum. Sometimes, fluid accumulates inside the follicle, causing the
corpus luteum to grow into a cyst.
Functional cysts are usually harmless, rarely cause pain, and often disappear on their own within two or three menstrual
cycles.

Other cysts

Types of cysts not related to the normal function of your menstrual cycle include:

 Dermoid cysts. Also called teratomas, these can contain tissue, such as hair, skin or teeth, because they form
from embryonic cells. They're rarely cancerous.

 Cystadenomas. These develop on the surface of an ovary and might be filled with a watery or a mucous material.

 Endometriomas. These develop as a result of a condition in which uterine endometrial cells grow outside your
uterus (endometriosis). Some of the tissue can attach to your ovary and form a growth.

Dermoid cysts and cystadenomas can become large, causing the ovary to move out of position. This increases the
chance of painful twisting of your ovary, called ovarian torsion. Ovarian torsion may also result in decreasing or stopping
blood flow to the ovary.
Risk factors

Your risk of developing an ovarian cyst is heightened by:

 Hormonal problems. These include taking the fertility drug clomiphene (Clomid), which is used to cause you to
ovulate.

 Pregnancy. Sometimes, the cyst that forms when you ovulate stays on your ovary throughout your pregnancy.

 Endometriosis. This condition causes uterine endometrial cells to grow outside your uterus. Some of the tissue
can attach to your ovary and form a growth.

 A severe pelvic infection. If the infection spreads to the ovaries, it can cause cysts.

 A previous ovarian cyst. If you've had one, you're likely to develop more.
Complications

Some women develop less common types of cysts that a doctor finds during a pelvic exam. Cystic ovarian masses that
develop after menopause might be cancerous (malignant). That's why it's important to have regular pelvic exams.

Infrequent complications associated with ovarian cysts include:

 Ovarian torsion. Cysts that enlarge can cause the ovary to move, increasing the chance of painful twisting of your
ovary (ovarian torsion). Symptoms can include an abrupt onset of severe pelvic pain, nausea and vomiting. Ovarian
torsion can also decrease or stop blood flow to the ovaries.

 Rupture. A cyst that ruptures can cause severe pain and internal bleeding. The larger the cyst, the greater the risk
of rupture. Vigorous activity that affects the pelvis, such as vaginal intercourse, also increases the risk.
Diagnosis

Pelvic exam

Tests and procedures used to diagnose ovarian cancer include:

 Pelvic exam. During a pelvic exam, your doctor inserts gloved fingers into your
vagina and simultaneously presses a hand on your abdomen in order to feel
(palpate) your pelvic organs. The doctor also visually examines your external
genitalia, vagina and cervix.

 Imaging tests. Tests, such as ultrasound or CT scans of your abdomen and

pelvis, may help determine the size, shape and structure of your ovaries.

 CA 125 blood test. Blood levels of a protein called cancer antigen 125

(CA 125) often are elevated in women with ovarian cancer. If your cyst is
partially solid and you're at high risk of ovarian cancer, your doctor might
order this test. Elevated CA 125 levels can also occur in noncancerous
conditions, such as endometriosis, uterine fibroids and pelvic
inflammatory disease.

 Laparoscopy. Using a laparoscope — a slim, lighted instrument inserted into your abdomen through a small incision — your
doctor can see your ovaries and remove the ovarian cyst. This is a surgical procedure that requires anesthesia

 Genetic testing. Your doctor may recommend testing a sample of your blood to look for gene changes that increase the risk of
ovarian cancer. Knowing you have an inherited change in your DNA helps your doctor make decisions about your treatment
plan. You may wish to share the information with your blood relatives, such as your siblings and your children, since they also
may have a risk of having those same gene changes.

ANATOMY AND PHYSIOLOGY OF OVARIAN CYSTS

 PATIENT’S PROFILE

Name: Patient X Ward: OB/GYNE Ward

Age: 39 years old Admission Date: December 02 , 2021
Gender: Female Admission Time: 7:00 AM
Civil Status: Married Attending Physician: Dr. Gonzales
Address: Dapitan City Past health history :Been diagnosed of breast
cancer
Date of Birth: June 21, 1982
Chief Complaints: “Sakit akong tiyan dayon
Place of Birth: Dapitan Cuty naka experience ko og spotting bali 1 month”
Religion: Roman Catholic Final Diagnosis: Ovarian Cysts
Nationality: Filipino

History of Present Illness:

 Prior to admission, the patient experienced bleeding and dull pain on the abdominal area. The patient was
then admitted to Corazon C. Aquino Hospital

PHYSICAL ASSESSMENT 1. INTEGUMENTARY SYSTEM

 SKIN
Inspection
GENERAL APPEARANCE  Generally white skin color
 Admitted at Ob-gyne ward, 39 years old, lying
 Skin appears dry.
on bed awake, and oriented to time. Verbalized
“Isa ra ka oras akong tulog kay nag akatar ko  Has 1 mole on arm.
sakong anak”
 Post-op cesarean section
Palpation
 Skin is warm to touch
1. VITAL SIGNS
 No pain upon palpation
Vital Signs 8:00 AM 12:00
 Good skin turgor
(November 9, 2021) PM
 No lesions, edema, lumps, and masses when
Temperature 36. 4 36.4 ◦c
palpated
◦c  Skin is slightly dry
Respiration 18 cpm 17 cpm
Pulse Rate 65 bpm 77 bpm
 HAIR
BP 120/80 100/80
Inspection
mmHg mmHg  Black in color and distributed well
 Hair is straight
  EYES
 NAILS Inspection
Inspection  Eyes are aligned to each other and sclera is white
 Short nails  Each pupil constricts when looking or reflected by
 clean in appearance a light
 No clubbing of fingers  Eyeballs are aligned normally in the sockets
Palpation  Eyelids are symmetrical
 Return to usual color after 2 seconds (Blanch Test)  Dark circles under eyes.

2. HEAD AND NECK

 HEAD  EARS
Inspection Inspection
 Symmetrical to facial features
 Head is still and upright in position  Symmetrical, aligned at the outer canthus of the
 Eyelids and eyebrows are symmetrical eye
 Ears are equal in size
 Cranial Nerve Assessment (Facial)  Few cerumen noted in both left and right ear
Inspection
 Facial features are round
 Eye brows are symmetrical  NOSES AND SINUSES
 Eyelids are symmetrical Inspection
 Color of the external nose is same as the rest of the
Palpation face
 No pain noted on the upon palpation  Nasal structure is smooth and symmetric
 Color is the same as the facial skin
  Nasal septum positioned at the center

 MOUTH MUSCULOSKELETAL SYSTEM

Inspection Inspection
 Lips are symmetric, dry  Posture is erect and comfortable for age
 Movements are well and coordinated
 NECK
Inspection NEUROLOGICAL SYSTEM
 Neck is symmetrical without bulging masses Inspection
 Neck movement is smooth  cooperates on assessment
 Comfortably moves the neck
GENITOURINARY SYSTEM
 ABDOMEN  Output: Urine: 4 Stool: 1
 Uterine contraction noted
 DRUG STUDY

Generic Name: OMEPRAZOLE Brand Name: Benzimidazole.

CLASSIFCATION INDICATION: COMMON SIDE EFFECT: NURSING
Proton pump inhibitor ·          PRILOSEC is a proton pump Frequent (7%): Headache. IMPLICATION:
inhibitor (PPI) indicated for the Occasional (3%–2%): Diarrhea,
treatment of active duodenal ulcer in  In cases of
adults, eradication of Helicobacter abdominal pain, nausea. Rare (2%):
DOCTOR’S ORDER: pylori to reduce the risk of duodenal Dizziness, asthenia (loss of strength, NSAID-induced
Omeprazole 40mg IV once on ulcer recurrence in adults, treatment energy), vomiting, constipation, upper gastritis,
of active benign gastric ulcer in
NPO adults, treatment of symptomatic respiratory tract infection, back pain, implement
gastroesophageal reflux disease rash, cough.
(GERD) in patients 1 year of age appropriate
ACTION:
and older, treatment of erosive manual therapy
esophagitis (EE) due to acid-
Inhibits hydrogen-potassium mediated GERD in patients 1 month ADVERSE EFFECT: techniques,
adenosine triphosphatase of age and older, maintenance of
healing of EE due to acid-mediated physical agents,
(H1/K1 ATP pump), an GERD in patients 1 year of age and Pancreatitis, hepatotoxicity, interstitial
enzyme on the surface of older, pathologic hypersecretory nephritis occur rarely and therapeutic
gastric parietal cells. conditions in adults. exercises to
Therapeutic Effect: reduce pain and
CONTRAINDICATION:
Increases gastric pH,
Hypersensitivity to decrease the need
reduces gastric acid
other proton pump
production. for aspirin and
inhibitors. Cautions: May
increase risk of fractures, other NSAIDs.
gastrointestinal infections.
AVIALABILITY:
Hepatic impairment, pts of
10 mg, 20 mg, 40 mg capsules;
Asian descent.
20 mg powder for oral
suspension
 PATIENT/FAMILY
PHARMACOKINETICS DRUG INTERACTION: TEACHING
Route Drug: Concomitant
Absorption: Poorly absorbed administration of diazepam and  Report any changes
from GI tract; 30–40% reaches omeprazole may increase in urinary elimination
systemic circulation. Onset: 0.5– diazepam concentrations. such as pain or
3.5 h. Peak: Peak inhibition of Concomitant administration discomfort associated
gastric acid secretion: 5 of phenytoin and omeprazole with urination, or
d. Metabolism: Metabolized in may increase phenytoin levels. blood in urine.
liver. Elimination: 80% Concomitant administration  Report severe
excreted in urine, 20% in of warfarin and omeprazole diarrhea; drug may
feces. Half-Life: 0.5–1.5 h.. may increase warfarin levels.
need to be
discontinued.
 Do not breast feed
while taking this
drug.
Generic Name: BISACODYL  Brand Name: Bisacolax, Bisco-Lax

CLASSIFCATION INDICATION: COMMON SIDE EFFECT: NURSING

GASTROINTESTINAL Frequent: Some degree IMPLICATION:
AGENT; STIMULANT LAXATIVE Bisacodyl is used on a short-term basis of abdominal discomfort,
to treat constipation. It also is used to nausea, mild cramps,
DOCTOR’S ORDER: empty the bowels before surgery and faintness. Occasional: Rectal  Evaluate
certain medical procedures. Bisacodyl is
Bisacodyl 1 tab P.O administration: burning of periodically
in a class of medications called stimulant
laxatives. It works by increasing activity rectal mucosa, mild proctitis. patient's need
ACTION: of the intestines to cause a bowel for continued
Direct effect on colonic movement. ADVERSE EFFECT: use of drug;
smooth musculature by bisacodyl
stimulating intramural nerve Long-term use may usually
plexi. Therapeutic Effect: CONTRAINDICATION: result in laxative dependence, produces 1 or 2
Promotes fluid and chronic constipation, loss of soft formed
electrolyte accumulation in Acute surgical abdomen, nausea, vomiting, normal bowel function. stools daily.
colon, increasing abdominal cramps, intestinal obstruction, Overdose may result in  Monitor
peristalsis, producing fecal impaction; use of rectal suppository electrolyte or metabolic patients
laxative effect. in presence of anal or rectal fissures, disturbances (hypokalemia, receiving
ulcerated hemorrhoids, proctitis. hypocalcemia, metabolic concomitant
acidosis, alkalosis), persistent anticoagulants.
AVIALABILITY: Indiscriminate
diarrhea, vomiting, muscle
use of laxatives
100 mg chewable tablets; 200 weakness, malabsorption,
results in
mg tablets; 100 mg, 200 mg, 400 weight loss
mg sustained-release tablets; decreased
100 mg, 200 mg, 300 mg absorption of
sustained-release capsules; 100 vitamin K.
mg/5 mL suspension

PHARMACOKINETICS
Absorption: 5–15% absorbed
from GI tract. Onset: 6–8 h PO; DRUG INTERACTION:
15–60 min  Drug: Serum concentrations of
PR. Metabolism: Metabolized other ANTICONVULSANTS may decrease
in liver. Elimination: Excreted because of increased metabolism; PATIENT/FAMILY
in urine, bile, and breast milk.   verapamil, erythromycin, ketoconazo TEACHING
le, nefazadone may increase
carbamazepine levels; decreases
hypoprothrombinemic effects of ORAL  Add high-fiber
ANTICOAGULANTS; increases foods slowly
metabolism of ESTROGENS, thus to regular diet
decreasing effectiveness of ORAL to avoid gas
CONTRACEPTIVES. and diarrhea.
  Herbal: Ginkgo may decrease Adequate fluid
anticonvulsant effectiveness. intake includes
at least 6–8
glasses/d.
 Do not breast
feed while
taking this
drug without
consulting
physician.
Generic Name: Cefoxitin   Brand Name: Mefoxin

CLASSIFCATION INDICATION: COMMON SIDE EFFECT: NURSING

Cephalosporins, 2nd IMPLICATION:
Generation It is indicated for the prophylaxis of Rash (including
infection in patients undergoing exfoliative dermatitis and
uncontaminated gastrointestinal toxic epidermal necrolysis), urticaria  Determine
DOCTOR’S ORDER: surgery, vaginal hysterectomy, , flushing, pruritus, eosinophilia, previous
Cefoxitin 1gm IV   abdominal hysterectomy, or cesarean fever, dyspnea, and other allergic
section.
hypersensitivit
reactions y to
ACTION: including anaphylaxis, interstitial ne cephalosporins
Semisynthetic, broad-spectrum
CONTRAINDICATION: phritis and angioedema have been , penicillins,
beta-lactam antibiotic derivative noted. and other drug
of cephamycin C (produced allergies
by Streptomyces lactamdurans). Is contraindicated in patients who ADVERSE EFFECT: before therapy
Classified as second generation have shown hypersensitivity to is initiated.
cephalosporin; structurally and cefoxitin and the cephalosporin Body as a Whole: Drug fever,
 Lab tests:
pharmacologically related to eosinophilia, superinfections, local
group of antibiotics. Perform
cephalosporins and penicillins. reactions: pain, tenderness, and
culture and
Antimicrobial spectrum of induration (IM site),
sensitivity
activity resembles that of thrombophlebitis (IV
testing prior to
cefonicid. Considerably less site). GI: Diarrhea, pseudomembran
and
active than most cephalosporins ous colitis. Skin: Rash, exfoliative
against Staphylococci. dermatitis, pruritus,
periodically
Preferentially binds to one or urticaria. Urogenital: Nephrotoxici during therapy.
more of the penicillin-binding ty, interstitial nephritis. Periodic renal
proteins (PBP) located on cell function tests.
walls of susceptible organisms.  Inspect
injection sites
regularly.
 Report
evidence of
inflammation
AVIALABILITY: and patient's
1 g, 2 g injection DRUG INTERACTION: complaint of
 Drug: Probenecid decreases renal pain.
PHARMACOKINETICS elimination of cefoxitin.  Monitor I&O
rates and
Peak: 20–30 min after IM; 5 min pattern:
after IV. Distribution: Poor CNS Nephrotoxicity
penetration even with inflamed occurs most
meninges; widely distributed in frequently in
body tissues including pleural, patients >50 y,
synovial, and ascitic fluid and in patients
bile; crosses with impaired
placenta. Elimination: 85%
renal function,
excreted unchanged in urine in 6
the debilitated,
h, small amount excreted in
and in patients
breast milk. Half-Life: 45–60
receiving high
min.
doses or other
nephrotoxic
drugs.
 Be alert to
S&S of
superinfections
(see Appendix
F). This
condition is
most apt to
occur in older
adult patients,
especially
when drug has
 been used for
prolonged
period.
 Report onset
of diarrhea
(may be dose
related). If
severe,
pseudomembra
nous colitis
(see Signs &
Symptoms,
Appendix F)
must be ruled
out. Older
adult patients
are especially
susceptible.

PATIENT/FAMILY
TEACHING

 Report
promptly S&S of
superinfection
(see Appendix
F).
 Report watery
or bloody loose
stools or severe
diarrhea.
 Report severe
 vomiting or
stomach pain.
 Report infusion
site swelling,
pain, or
redness.
 Do not breast
feed while
taking this drug.
Generic Name: Ketorolac Brand Name: Toradol.
CENTRAL NERVOUS SYSTEM INDICATION: COMMON SIDE EFFECT: NURSING
AGENT; NSAID, TORADOL (ketorolac IMPLICATION:
ANALGESIC; ANTIPYRETIC tromethamine) ORAL is  Nasal Passage Irritation
indicated for the short-term ( ≤  Drowsiness  Correct
5 days) management of  Dizziness hypovolemia prior
DOCTOR’S ORDER: moderately severe acute  Headache to administration
ketorolac 30mg q6hrs pain that requires analgesia at  Nausea of ketorolac.
the opioid level, usually in  Diarrhea  Lab tests: Periodic
 Stomach Cramps
ACTION: a postoperative setting. Therapy serum electrolytes
should always be initiated with and liver functions;
It inhibits synthesis of IV or IM dosing of ketorolac urinalysis (for
prostaglandins and is a tromethamine, and TORADOL hematuria and
peripherally acting analgesic. (ketorolac ADVERSE EFFECT: proteinuria) with
Ketorolac does not have any tromethamine) ORAL is to be long-term use.
known effects on opiate used only as continuation A very serious allergic reaction to this  Monitor urine
receptors. treatment, if necessary. drug is rare. However, seek output in older
immediate medical attention if you adults and patients
AVIALABILITY: CONTRAINDICATION: notice any symptoms of a serious with a history of
10 mg tablets; 15 mg/mL, 30 Hypersensitivity to ketorolac; allergic reaction, including: fever, cardiac
mg/mL injection; 0.4%, 0.5% individuals with complete or swollen lymph nodes, rash, decompensation,
ophthalmic solution partial syndrome of nasal itching/swelling (especially of the renal impairment,
polyps, angioedema, and face/tongue/throat), severe heart failure, or
PHARMACOKINETICS bronchospastic reaction to dizziness, trouble breathing. liver dysfunction as
Route aspirin or other NSAIDs; during well as those taking
Absorption: Poorly absorbed labor and delivery; patients with diuretics.
from GI tract; 30–40% reaches severe renal impairment or at Discontinuation of
systemic circulation. Onset: 0.5– risk for renal failure due to drug will return
3.5 h. Peak: Peak inhibition of volume depletion; patients with urine output to
gastric acid secretion: 5 risk of bleeding; active peptic pretreatment level.
d. Metabolism: Metabolized in ulcer disease; pre- or  Monitor for S&S of
liver. Elimination: 80% intraoperatively; intrathecal or GI distress or
excreted in urine, 20% in epidural administration; in bleeding including
feces. Half-Life: 0.5–1.5 h.. combination with other NSAIDs; nausea, GI pain,
lactation. diarrhea, melena,
or hematemesis. GI
ulceration with
perforation can
DRUG INTERACTION: occur anytime
Drug: Concomitant during treatment.
administration of diazepam and Drug decreases
omeprazole may increase platelet
diazepam concentrations. aggregation and
Concomitant administration thus may prolong
of phenytoin and omeprazole bleeding time.
may increase phenytoin levels.  Monitor for fluid
Concomitant administration retention and
of warfarin and omeprazole edema in patients
may increase warfarin levels. with a history of
CHF.

PATIENT/FAMILY
TEACHING

 Watch for S&S of

GI ulceration and
bleeding (e.g.,
bloody emesis,
black tarry stools)
during long-term
therapy.
 Note: Possible CNS
 adverse effects
(e.g., light-
headedness,
dizziness,
drowsiness).
 Do not drive or
engage in
potentially
hazardous
activities until
response to drug is
known.
 Do not use
other NSAIDs while
taking this drug.
 Do not breast feed
while taking this
drug.
Generic Name: TRAMADOL Brand Name: Ultram.
CLASSIFCATION INDICATION: COMMON SIDE EFFECT: NURSING
Centrally acting synthetic Management of moderate Frequent (25%–15%): IMPLICATION:
opioid analgesic to moderately severe pain. Dizziness, vertigo, nausea,
Extended-Release: constipation, headache, drowsiness.  Assess for level
Around-the-clock Occasional (10%–5%): Vomiting, of pain relief and
DOCTOR’S ORDER: management of moderate pruritus, CNS stimulation (e.g., administer prn
Tramadol 50mg q6hrs to moderately severe pain nervousness, anxiety, agitation, dose as needed
for extended period. tremor, euphoria, mood swings, but not to exceed
ACTION: hallucinations), asthenia, diaphoresis, the recommended
CONTRAINDICATION: dyspepsia, dry mouth, diarrhea. Rare total daily dose.
Binds to mu-opioid Ultram, Ultram ER: Acute (less than 5%): Malaise, vasodilation,  Monitor vital
receptors, inhibits reuptake alcohol intoxication, anorexia, flatulence, rash, 1240 signs and assess
of norepinephrine, concurrent use of centrally trametinib underlined – top prescribed for orthostatic
serotonin, inhibiting acting analgesics, drug T blurred vision, urinary hypotension or
ascending and descending hypnotics, opioids, retention/ frequency, menopausal signs of CNS
pain pathways. Therapeutic psychotropic drugs, symptoms. depression.
Effect: Reduces pain. hypersensitivity to opioids.  Discontinue drug
ConZip, Severe/ acute and notify
AVIALABILITY: bronchial asthma, ADVERSE EFFECT: physician if S&S
50 mg tablets; 50 mg orally hypercapnia, significant of
disintegrating tablets respiratory depression. Seizures reported in pts hypersensitivity
receiving tramadol within occur.
PHARMACOKINETICS DRUG INTERACTION: recommended dosage range. May  Assess bowel and
Route Absorption: Rapidly absorbed have prolonged duration of action, bladder function;
Absorption: Poorly absorbed from GI tract; 75% reaches cumulative effect in pts with report urinary
from GI tract; 30–40% reaches systemic hepatic/renal impairment, serotonin frequency or
systemic circulation. Onset: 0.5– circulation. Onset: 30–60 syndrome (agitation, hallucinations, retention.
3.5 h. Peak: Peak inhibition of min. Peak: 2 h. Duration: 3–7 tachycardia, hyperreflexia).  Use seizure
gastric acid secretion: 5 h. Distribution: Approximately
precautions for
d. Metabolism: Metabolized in 20% bound to plasma proteins;
liver. Elimination: 80% probably crosses blood–brain
patients who have
a history of
excreted in urine, 20% in barrier; crosses placenta; 0.1% seizures or who
feces. Half-Life: 0.5–1.5 h.. excreted into breast are concurrently
milk. Metabolism: Metabolize using drugs that
d extensively in liver by lower the seizure
cytochrome P450 threshold.
system. Elimination: Excreted  Monitor
primarily in urine. Half-Life: 6– ambulation and
7 h. take appropriate
safety
precautions.

PATIENT/FAMILY
TEACHING

 Exercise caution
with potentially
hazardous
activities until
response to drug
is known.
 Understand
potential adverse
effects and report
problems with
bowel and
bladder function,
CNS impairment,
and any other
bothersome
adverse effects to
physician.
 Do not breast
feed while taking
this drug.
 NURSING CARE PLAN
Nursing Diagnosis:

Assessment Planning Intervention Rationale Evaluation

Subjective Data Independent

Objective data:
Nursing Diagnosis:

Assessment Planning Intervention Rationale Evaluation

Subjective Data Independent

Objective data:

Nursing Diagnosis:
 Assessment Planning Intervention Rationale Evaluation
Subjective Data Independent

Objective data:

Nursing Diagnosis:
 Assessment Planning Intervention Rationale Evaluation
Subjective Data Independent

Objective data:
Psychopathophysiology

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