CHAPTER I

OBJECTIVES

General Objectives

The Bachelor of Science in Nursing (BSN) students from Group 37 of Section 13J
aims that they will be able to formulate a comprehensive case analysis of a patient with
Ovarian new growth. After three (3) days of learning the nursing care management of a client
with the mentioned disease by undertaking the required hours of hospital exposure as student
nurses at Metro Davao Metro Davao Medical and Research Center, Inc.. Simultaneously, they
will be able to grasp the accurate information and widen their knowledge about Ovarian new
growth.

Specific Objectives

In the span of learning the appropriate nursing interventions and the proper approach
of the nursing process for a client with Ovarian new growth, the following specific
objectives will guide the students to accomplish their general objectives. Specifically, this
groups attains the following:

a. Interpret the patient’s hospital data;

b. Determine the problem and the relevant information from the patient's profile,
doctor’s progress notes, patient’s chart and laboratory results;
c. Gather personal and clinical information that will serve as baseline data;
d. Present the patient’s profile including the biographic data and clinical data;
e. Discuss and review the anatomy and physiology of the affected organ or system of the
patient;
f. Indicate the pathophysiology of the illness with its corresponding, predisposing and
precipitating factors, its etiology and its symptomatology, and its schematic diagram
and narrative description.
g. Present the gathered data during health assessment;

1
h. Discuss the course in the ward, treatment, or interventions, and surgical management
undergone by the patient
i. Discuss different drugs under the patient treatment regimen;
j. Present the undergone nursing management through nursing care plans and nurse’s
notes;
k. Discuss the nursing management rendered to the patient.

2
 CHAPTER II

INTRODUCTION

Ovarian tumors are abnormal growth in the ovaries, they are mostly fluid-filled sacs
or a mass (Healthwise Staff, 2022) . Ovarian tumors are frequently linked to hormonal
stimulation and/or ovulation (Mulita et. al., 2020) . As they grow in size, they may develop
symptoms such as abdominal, pelvic, or lumbar discomfort or pain, progressive abdominal
distension, nausea, or vomiting (Da Costa Leite et. al., 2020). Tumor markers, such as
CA-125, can be useful in distinguishing between benign and malignant ovarian tumors.
Surgery is the preferred treatment for serous cystadenomas. In large tumors, ovarian
cystectomy or unilateral salpingo-oophorectomy is usually considered (Mulita et. al., 2020).

Ovarian tumors prevalence estimates vary greatly, with most publications estimating
ovarian tumors in 8% to 18% of both premenopausal and postmenopausal women. In the
United States, approximately 5% to 10% of women undergo surgical exploration for ovarian
tumors during their lifetime, though only 13% to 21% of these cysts are malignant (Ross and
Fortin, 2016) In premenopausal women, progressive abdominal distension should raise the
possibility of an ovarian tumor, such as mucinous cystadenoma. These tumors are benign, but
when they grow large enough, difficulties emerge, and surgical excision can be dangerous
(Leite, et. al., 2020). Northern and western European and North American women are the
most affected, whereas Asian, African, and Latin American women are the least affected.

Ovarian tumors can be malignant or benign, researchers and scientists are still trying
to figure out what causes these cells to thrive and if left untreated may progress to cancer
(Coonrod et. al, 2023). The Philippine General Hospital is one of only two facilities in the
country that offers Gynecologic Oncology training. Although main surgery is conducted at
the Philippine General Hospital, post-operative referrals are frequently received from other
health facilities that may not have a gynecologic oncologist. There are currently 123 qualified
gynecologic oncologists practicing throughout the Philippines, with the bulk based in the
National Capital Region. Suspicion of cancer in an ovarian mass should prompt referral to
these subspecialists.

In the Philippines, there is no accepted standard recommendation for examining

individuals with an ovarian mass. Local standards recommend numerous ways of evaluation,

3
including the Risk of Malignancy Index (RMI), which takes menopausal state, ultrasound
findings, and CA-125 into account. The Risk of Ovarian Malignancy Algorithm (ROMA) is
another risk classification technique based on tumor markers such as CA-125, HE4, and
menopausal state. Davao Doctors Oncology Center (DDOCCI) serves the bulk of cancer
patients in Mindanao. It has treated around 3,000 people in the last ten years. According to
DDOCI statistics from 1999 to 2009, the top five cancers in Mindanao are as follows: (1)
gynecologic cancer (27%), (2) head and neck cancer (23%), (3) breast cancer (15%), (4)
metastatic cancer (10%), and (5) lung cancer (9%).

4
 CHAPTER III

PATIENT’S PROFILE

ii. Biographic Data

Name : Patient A.R

Age : 16 years old
Gender : Female
Birthday : October 27, 2006
Place of Birth : Davao City
Civil Status : Single
Nationality : Filipino
Occupation : Student

iii. Clinical Data

Chief Complaint : Abdominal Distention

Date of Admission : October 03, 2023
Time of Admission : 4:28 AM
Manner of Admission : Advised for Admission
Hospital : Metro Davao Medical and Research Center, Inc
Ward : 5A
Room : 505
Attending Physician : Dr. M. Gonzales
Dr. J. B Iligan
Dr. B. Lu
Primary Diagnosis : Ovarian New Growth

5
Vital Signs upon Physical Examination

Temperature 36.3 °C Oxygen Saturation 98%

Respiratory Rate 23 cpm Height 160 cm

Pulse Rate 77 bpm Weight 50.5 Kg

Blood Pressure 100/60 mmHg BMI 19.48

iv. Past Health History

The patient has irregular menstruation and first onset of menstruation is at the age of
13 years old and last menstruation period of the patient August 10, 2023. The patient has a
history of bronchial asthma but she has no maintenance medication. The patient is allergic to
food, specifically seafood.

v. Present Health History

2 weeks prior to the admission the patient’s chief complaint is bloated. The patient is
consulted and given lactulose 15 ml OD for temporary relief. Abdominal bloating and
abdominal pain are noted. The patient is advised by the physician for admission.

vi. Family History

Upon interview, there is no history of new ovarian growth in the family. But the father
of the patient has a history of hypertension, and that is inherited from his mother, and the
mother of the patient has a history of bronchial asthma, and that is inherited from her father.
The sister of the patient is well.

6
Genogram:

7
 CHAPTER IV

REVIEW OF ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM

The female reproductive system comprises both internal and external organs. It
produces hormones and plays a role in fertility, menstruation, and sexual activity. In addition
to these functions, it also bears the responsibility of nurturing the growing fetus and
facilitating its passage into the external environment. The female counterpart is
predominantly situated within the pelvic cavity.

External parts

● Labia Majora, often referred to as the "large lips," surround and provide protection
for the remaining external reproductive organs.
● Labia minora, also known as the "small lips," can exhibit diverse sizes and shapes.

8
 ● Clitoris, The clitoris, also known as the glans clitoris, is an organ that possesses
numerous nerves, contributing significantly to sexual sensation and orgasm.
● Hymen, is a tissue fragment that covers or encircles a portion of your vaginal
opening. It develops during the course of your development and is present at the time
of birth.

Internal parts

● Vagina, is a muscular passage connecting the cervix (the lower section of the uterus)
to the external body.
● Cervix, situated at the base of the uterus, features a central opening that permits the
entry of sperm and the exit of menstrual blood.
● Uterus, is a hollow, pear-shaped organ that provides a space for a developing fetus
during pregnancy.
● Ovaries are compact, oval-shaped structures positioned on both sides of your uterus.
They generate both eggs and hormones.
● Fallopian tube, These are slender tubes connected to the upper section of your uterus,
acting as conduits for your egg (ovum) to journey from your ovaries to your uterus.

Ovaries

The ovaries are glandular structures, small and oval-shaped, situated in the lower
abdomen on both sides of the uterus, ovaries are supported by various muscles and ligaments
within your pelvis.They are responsible for the production and storage of eggs, also known as
ovum, and the synthesis of hormones that regulate both your menstrual cycle and pregnancy.

9
Estrogen and progesterone are hormones produced by ovaries, contributing significantly to
reproductive development and the menstrual cycle. Ovaries consist of three layers. The outer
layer resembles a medicinal capsule. The middle layer, known as the ovarian cortex,
comprises connective tissue and houses the ovarian follicles. The innermost layer, called the
medulla, contains blood and lymphatic vessels.

DIGESTIVE SYSTEM

Digestive system is a complex network of organs and processes that work together to
break down and absorb nutrients from the food we eat. Its primary functions include the
ingestion of food, mechanical and chemical breakdown of food into smaller, absorbable
components, absorption of nutrients and water, and the elimination of waste. Digestive
system provides energy and nutrients needed for growth, maintenance, and overall
well-being. Organs in the digestive system are essential for effective breakdown and
absorption of nutrients from the food we consume.

● Mouth - Nutrients begin their journey into the digestive system through the mouth,
also known as the oral cavity, which is a cavity lined with a mucous membrane.
● Pharynx - After leaving the mouth, food moves towards the back into both the
oropharynx and laryngopharynx.
● Esophagus - A muscular tube connecting the mouth to the stomach which transports
food from the mouth to the stomach through peristalsis.

10
● Stomach - The C- shaped stomach is on the left side of the abdominal cavity, largely
concealed by both the liver and the diaphragm. The stomach serves as a temporary
reservoir for food and functions as a location for the initial breakdown of food.
● Small Intestine - The small intestine is the major digestive organ of the body. Small
Intestine is a muscular tube that stretches from the pyloric sphincter to the beginning
of the large intestine.
● Large Intestine - The large intestine has a greater diameter compared to the small
intestine but is shorter in length. Its primary roles include extracting water to
dehydrate indigestible food remains and expelling these residues as feces from the
body.
● Pancreas - The pancreas, a triangular gland with a soft, pink texture, spans the
abdomen from the spleen to the duodenum. It generates enzymes capable of breaking
down all types of digestible foods.
● Liver - The largest gland in the body is the liver, situated beneath the diaphragm on
the right side and covering the stomach almost entirely. One of the liver's digestive
roles is the production of bile.
● Gallbladder - The gallbladder is a small, pear-shaped organ located beneath the liver.
Its primary function is to store and concentrate bile, a digestive fluid produced by the
liver.

11
 CHAPTER V

PATHOPHYSIOLOGY

I. Definition of Diagnosis

Abnormal growths in or on the ovaries are known as ovarian growths. A mass, or

neoplasm, is a more solid development, whereas a cyst is a sac filled with fluid. The majority
of these growths are benign, meaning they don't produce symptoms and are not malignant
(Healthwise Staff, 2022). Symptoms of ovarian new growth can vary but may include pelvic
pain, bloating, changes in bowel habits, and abdominal discomfort. Ovarian new growths can
include various types of tumors, such as cysts, teratomas, or ovarian cancer. Non-cancerous
growths may occasionally require surgical excision. (Husney, A., et. al., 2022)

The risk of developing an ovarian tumor might be increased by a number of factors.

The ovaries are deep within the body, so you might not notice any symptoms or indicators of
an ovarian tumor until it's rather large. Ovarian tumors fall into two main categories: benign
and malignant. A benign mass is an atypical growth of tissue that occurs inside or on the
surface of the ovary and grows slowly. It can become a malignant tumor if treatment is not
received; a malignant tumor is an abnormal mass of tissue composed of cancerous
cells.(Dignity Health, n.d.)

According to Leite, C., et. al., 2020, when premenopausal women experience
progressive abdominal distension, an ovarian tumor should be suspected. Ovarian cysts are
the source of most abdominal cysts. Differential diagnoses cover a broad spectrum.
Regretfully, imaging investigations can't always pinpoint the source. When a patient presents
with an abdominal cyst, it is important to keep in mind the wide range of possible diagnosis.
The prevalence of ovarian cysts is high in premenopausal women. Cysts are capable of
growing to large sizes. Although these tumors are benign, when they get large, problems can
occur and removal surgery could be fatal.

12
II. Etiology

Predisposing Factors Present Justification

Genetics Tumors of the ovaries can run in families. If a mother, sister, or daughter has (or has
had) an ovarian tumor, the likelihood of developing one is raised. Additionally, the
risk increases with the number of relatives who have ovarian cancer or tumors.
Another factor that may increase your chance of ovarian cancer or tumors is your
father's side. (American Cancer Society)

Less than 10% of patients under the age of 18 have malignant ovarian tumors, with
the majority having functional cysts. The majority of cases in the research including
Age ✔ surgical intervention in patients under the age of eighteen indicate benign tumors,
such as functional cysts. However, 10% or more of ovarian tumors are cancerous.
When compared to the postmenarchal period, malignant tumors are more common
during the premenarchal period. (C. O. Marginean et al., 2019)

Ovarian tumors occur in 30 percent of females with regular menses, and in 50

✔
percent of females with irregular menses. They are most common in premenopausal
(Female Gender)
Sex women. (Moini, J., et. al., 2020)

13
 Adipose tissue, sometimes known as fat tissue, produces excess estrogen, and
Obesity or Overweight
studies have linked high estrogen levels to an increased risk of ovarian, breast,
endometrial, and other cancers. (NCI, 2022)

Precipitating Factors Present Justification

When estrogen and progesterone are balanced, they work together to signal your
Hormonal Imbalance ✔
body to release an egg every month. However, when there’s an imbalance, your
ovary may not receive the signal it needs to release the egg, leaving the follicle
closed and positioned to continue as an ovarian cyst/mass. (Serrano OB-GYN,
2023)

III. Symptomatology

SIGNS AND SYMPTOMS PRESENT JUSTIFICATION

Bloating is one sign of an ovarian disease, but it can also be brought on by infections or
bladder obstructions. An individual with an ovarian problem may have bloating that is either
✓ chronic or painful. This is due to a buildup of fluid called ascites in your abdomen and can
BLOATING
also come with pain. (Gardner, 2023) Some types of cysts, including those associated with
ovarian cancer, produce hormones such as estrogen, progesterone, testosterone, and thyroid
stimulating hormone. Any of these hormones could have an impact on bowel function and
result in bloating. (Chudnoff, 2023)

14
 One study found that 25% of people with ovarian problems had bothersome gastrointestinal
(GI) symptoms like constipation. Patients with problems in the ovary are most likely to be
CONSTIPATION ✓ constipated. (Ratini, 2022) Digestive issues that result in gas and/or the buildup of digestive
contents are often the functional cause of a constipated belly. Causes might be: gas from
functional indigestion, food intolerances or irritable bowel syndrome (IBS).

Impaction often occurs in people who have had constipation for a long time. The muscles of
the intestine forget how to move stool or feces on their own. There’s a buildup of poop that
FAECAL IMPACTION ✓ you’re unable to pass. Fecal impaction causes discomfort in your body due to
gastrointestinal pressure from waste buildup. (Cleveland Clinic, 2022) Colon distension can
result from fecal impaction, which is an increase in colonic content brought on by
constipation. Furthermore, a higher colonic content accelerates the pace of fermentation and
gas generation.

This occurs when the ovarian cyst is large and active , compressing the bladder or rectum,
which causes dysuria. It is possible for patients with ovarian cyst to present with issues that
URINARY RETENTION ✓
mimic bladder problems. These problems include urinary retention or distention. (Cureus,
2022)

Ovarian problems and its treatments can affect appetite. The resulting pressure in the
LOSS OF APPETITE ✓
stomach caused by the cyst can cause loss of appetite. (Moffitt, 2022)

ABDOMINAL ✓ Ovarian cysts can cause severe abdominal pain if they rupture or cause twisted ovaries (also
DISCOMFORT/PAIN
called ovarian torsion). (Silver, 2020)

WEIGHT GAIN X In some ovarian problems, weight gain is a common symptom, especially if the patient

15
suffers from polycystic ovary syndrome (PCOS). High rates of glucose intolerance due to
abnormalities in β-cell and insulin action function are linked to PCOS. Because obesity
significantly worsens these abnormalities, obese women with PCOS who are of
reproductive age have extremely high rates of glucose intolerance. But in cysts or mass,
weight gain is not that common, and may only lead to bloating. (Henigsman, 2023)

16
IV. Schematic Diagram

17
 V. Narrative

The risk of triggering the mass varies on different factors, like one’s genetics, age
(16), sex (female), and obesity, which are considered as the predisposing factors, or those
factors that are known to be non-modifiable. Another factor that affects a patient with new
growths is an imbalance in their hormones, that is caused by the increase of luteinizing
hormones and hyperstimulation of ovaries, and resulting in an increased estrogen, which is an
imbalance of the hormones.. On the other hand, if there is an imbalance, your ovary could not
get the signal it needs to release the egg, which would cause the follicle to remain closed and
develop into an ovarian cyst that later changed into an ovarian mass.

Hormonal imbalance leads to an abnormal proliferation of the follicle. The total

length of the follicular phase will shorten due to the accelerated recruitment of follicles, and
the follicle released for ovulation will be immature. Menstrual abnormalities would result
from the follicle's failure to ovulate, undergo atresia, and enlarge. When there’s a failure on
how the follicle ovulates, and leads to menstrual irregularities, then this would become an
ovarian mass. Different types of diagnostic tests are used in order to detect the mass, and its
underlying issues, which are immunology and ultrasound. Immunology results showed a
tumor marker of CA 125, with the result of 40.49. Ultrasound revealed the patient’s large
pelvis, which showed an abdominal cystic mass, as described. Ovarian pathology considered.
Minimal ascites.

This mass will show signs and symptoms that is caused by the ovarian mass, like the
increase in abdominal girth size (83cm), that leads to bloating, constipation, fecal impaction,
urinary retention, loss of appetite, abdominal discomfort or pain (Pain Scale: 5/10), weight
gain, and the continued increase in the patient’s abdominal girth. The patient's symptoms and
the most likely diagnosis will determine how the ovarian mass or tumor is treated. If the
condition begins to hurt, they must be surgically removed, so that malignancy can be
prevented. The growth of ovarian neoplasms will continue, necessitating surgery, which leads
to the removal of the patient’s left ovary.

18
 CHAPTER VI

COMPREHENSIVE ASSESSMENT

GUIDELINES NORMAL VALUES DAY 1 DAY 2 DAY 3

October 5, 2023 October 6, 2023 October 7, 2023

I. Mental Status

● awake , coherent, and ● The patient was ● The patient was ● The patient was
● State of mental
responsive awake, coerent, and awake, coerent, and awake, coerent, and
consciousness
was able response was able response was able response

● Oriented to time, ● the patient is aware of ● the patient is aware of ● the patient is aware of
● Orientation place, and person time, place, and time, place, and time, place, and
person person person

● Can understand simple ● Simple concepts can ● Simple concepts can ● Simple concepts can
● Intellectual capacity concepts be understood by the be understood by the be understood by the
patient patient patient

● Can speak English and ● The patient is fluent in ● The patient is fluent in ● The patient is fluent in
● Vocabulary level tagalog languages both English and both English and both English and
Tagalog. Tagalog. Tagalog.

● Listens and responds ● The patient listens ● The patient listens ● The patient listens
● Attention span with full thoughts carefully and responds carefully and responds carefully and responds
fully. fully. fully.

● Understands ● Understands the ● Understands the ● Understands the

● Ability to understand instructions given by nurse's instructions nurse's instructions nurse's instructions
the nurse

19
II. Status of Special Senses

● Able to hear normally ● the patient's ability to ● the patient's ability to ● the patient's ability to
a. Auditory perception and whispered voices hear normal and hear normal and hear normal and
whispered voices whispered voices whispered voices

● Can see near objects ● The patient can see ● The patient can see ● The patient can see
without the need of things in close things in close things in close
b. Visual perception
glasses proximity without proximity without proximity without
glasses. glasses. glasses.

● Speaks clearly and ● The patient speaks ● The patient speaks ● The patient speaks
c. Speech perception audible clearly and audibly. clearly and audibly. clearly and audibly.

● Identifies area of light ● Identifies light touch ● Identifies light touch ● Identifies light touch
touch, differentiate areas and distinguishes areas and distinguishes areas and distinguishes
d. Tactile perception
between sharp and dull between strong and between strong and between strong and
sensations dull feelings dull feelings dull feelings

● Able to distinguish ● the patient's ability to ● the patient's ability to ● the patient's ability to
e. Olfactory perception different kinds of odor recognize specific recognize specific recognize specific
kinds of odors kinds of odors kinds of odors

III. Motor ability

● Able to sit and walk ● Capable of sitting and ● Capable of sitting and ● Capable of sitting and
a. Current mobility without assistance walking without walking without walking without
assistance assistance assistance

● Relaxed with ● The patient is relaxed, ● The patient is relaxed, ● The patient is relaxed,
b. Posture shoulders back and with shoulders back with shoulders back with shoulders back
both feet stable and both feet stable. and both feet stable. and both feet stable.

20
 ● Can flex and extend ● The patient is able to ● The patient is able to ● The patient is able to
c. Range of motion extremities flex and extend her flex and extend her flex and extend her
extremities. extremities. extremities.

● Firm, developed, and ● The patient is ● The patient is ● The patient is

d. Muscle and nervous
coordinated dependable, mature, dependable, mature, dependable, mature,
status
and well-organized. and well-organized. and well-organized.

● None ● None ● None ● None

e. Loss of extremities

IV. Body Temperature

● 36.5°C - 37.5°C ● 36.3 °C ● 36.9 °C ● 36.7 °C

a. Ranges (warm to touch)

V. Respiratory Status

● 12 - 20 cpm ● 23 cpm ● 20 cpm ● 19 cpm

a. Character ● Regular and
spontaneous

● None ● None ● None ● None

b. Use of respiratory

c. Interference with ● None ● None ● None ● None

respiration

d. Abnormal respiratory ● None ● None ● None ● None

opening

21
VI. Circulatory Status

a. Characteristic of ● Regular, strong, and ● Regular, strong, and ● Regular, strong, and ● Regular, strong, and
arterial pulse palpable palpable palpable palpable

● 60 - 100 bpm ● 77 bpm ● 86 bpm ● 98 bpm

b. Apical-radial pulse

● 90/60 mmHg - 120/80 ● 100/60 mmHg ● 110/90 mmHg ● 110/80 mmHg

c. Blood pressure mmHg

● (DP x 2 + SP / 3 = 70 -
d. Mean arterial pressure 100 mmHg

● None ● D5NSS 1L @ 10cc/hr ● D5LR ● D5LR

e. Intravenous Fluids

VII. Nutritional Status

● Teeth straight with no ● teeth in perfect ● teeth in perfect ● teeth in perfect

cavities alignment and free of alignment and free of alignment and free of
● Lips are pink, smooth, cavities; lips smooth, cavities; lips smooth, cavities; lips smooth,
● Condition of buccal and moist. rosy, and hydrated. rosy, and hydrated. rosy, and hydrated.
cavity ● Tongues is deep red Pink, sturdy, and Pink, sturdy, and Pink, sturdy, and
with papillae smooth gums follow smooth gums follow smooth gums follow
● Gums are smooth, the bright red tongues the bright red tongues the bright red tongues
firm, and pink and papillae. and papillae. and papillae.

● Masticates food well ● NPO ● NPO ● Masticates soft food

● Digestion of food and able to digest food well (soft diet)
without difficulty

22
 ● Within normal BMI ● 19.98 ● 19.50 ● 19.59
● Weight range

VIII. Elimination Status

● Defecates 1-2 times ● Constipated ● Constipated ● Constipated

day, light brown in ● Bowel Sounds - Soft ● Bowel Sounds - Soft
Bowel
color,soft to hard in
consistency

● Voids freely at least ● Dark yellow in color, ● At least once a day, ● Pale yellow in color,
1-4 times a day, amber voids freely at least voids freely; 220 voids freely at least
Bladder
in color, 800-200 thrice a day, 355 cc/day, dark yellow in once a day 220 cc/day
cc/day cc/day color (Foley Cath)

● None ● None ● None ● None

Abnormalities

IX. Status of Skin and Appendages

● No inconsistency, ● Upon assessment No ● Upon assessment No b. Upon assessment No

wounds, or bruising bruises, wounds, or bruises, wounds, or bruises, wounds, or
a. Skin ● Light to dark brown, inconsistent color. inconsistent color. inconsistent color.
smooth, turgor present Light to dark brown, Light to dark brown, Light to dark brown,
smooth texture smooth texture smooth texture

● Lustrous, shiny, and ● Lustrous, shiny, and ● Lustrous, shiny, and ● Lustrous, shiny, and
c. Hair well-distributed well-distributed well-distributed well-distributed

● Well-trimmed, clean, ● The patient's nails are ● The patient's nails are ● The patient's nails are
d. Nails firm, and pink nail neatly clipped, hard, neatly clipped, hard, neatly clipped, hard,
beds and pink. and pink. and pink.

23
X. States of physical Rest and Comfort

● Able to sleep 6-8 ● Able to sleep 3 hours a ● Able to sleep 1 and ● Able to sleep 2 hours a
a. Sleep/rest pattern hours a day day half hours a day day

● No presence of pain ● With the presence of ● With the presence of ● With the presence of
b. Presence of and discomfort pain and discomfort pain and discomfort pain and discomfort
pain/discomfort (2/10) (2/10) (7/10)

● None ● None ● None ● Abdominal Binder

c. Use of supportive aids

XI. Emotional Status

● Open, expressive, and ● Positive coping ● Positive coping b. Positive coping

verbalizes positive strategies are strategies are strategies are
a. Emotional reaction
coping mechanisms articulated, open, and articulated, open, and articulated, open, and
expressive. expressive. expressive.

● With high self-esteem ● With high self-esteem ● With high self-esteem d. With high self-esteem
c. Body image

● Able to interact with ● Able to interact with ● Able to interact with ● Able to interact with
other people other people other people other people
e. Ability to relate to
others

24
 XII. Nursing Diagnosis

1. Acute pain related to abdominal distention

2. Risk for infection related to postoperative incision
3. Decreased activity tolerance related to physical impaired mobility as evidenced by patient’s postoperative incisions
4. Impaired comfort related to bloating and abdominal distention as evidenced by disturbed sleeping pattern

ANALYSIS

The patient was responsive, coherent, and awake. She had the ability to walk and sit by herself. Her body temperature was recorded as
follows: 36.3°C on the first day, 36.9°C on the second, and 36.7°C on the third. Her vital indicators were within the usual range when they were
checked. teeth in ideal alignment and free of cavities; lips moisturized, smooth, and pink. Bright red tongues and papillae are followed by
smooth, firm, and pink gums. On the first to third day, the patient experiences constipation and has mild bowel sounds. After the patient's urine
was examined, it was found that on the first day, it was dark yellow in color and that the patient voids freely at least three times a day (355
cc/day); on the second day, it is at least once a day and is 220 cc/day; and on the third day, it is pale yellow in color and at least once a day is 220
cc/day (Foley Cath). No cuts, bruises, or uneven color during assessment. upon checking her skin Medium to deep brown, smooth texture. The
patient was able to sleep three hours a day on the first day, one and a half hours on the second day, and two hours on the third. On a ten-point
scale, the patient's level of pain and discomfort is between two and seven.

25
 CHAPTER VII

COURSE IN THE WARD, TREATMENT, AND INTERVENTION

i. MEDICAL MANAGEMENT

1. Doctor’s Progress Notes

Progress Notes Physician’s Order Rationale

Date and Time: Meds:

● Contains varying amounts of cations and anions that are used to replace
October 3, 2023 ● Start D5NSS at 10cc/hr fluid and electrolytes for clients with continuing losses.
4:28 AM
● Start Ceftriaxone Lyram 80 IVTT ● Used to treat bacterial infections in many different parts of the body.

WT: 50.5 kg
● Metronidazole 50g q8 IV drip ● An antibiotic that is used for specific infectious diseases
BP: 100/60 mmHg
● Omeprazole 40g OD ● Used to treat certain conditions where there is too much acid in the
T: 36.3 C stomach

RR: 23 cpm

SpO2: 98%

● History of bloating
● Consult dose given

● Abdominal pain every

26
 after eating

● (+) BA – no maintenance
medication

● (+) FOOD ALLERGY –

seafood

Date and Time: ● Please admit under the service of ● The patient will be under the service of a health provider specializing in
doctor Gonzales (PC) the patient’s condition, providing treatment
October 3, 2023
5:05 PM ● Please carry out above order ● Continuing the orders given above

Abd X-RAY: suspicious mid

abdominal ● Please do abdominal girth monitoring ● Abdominal girth is used to diagnose and monitor fluid build up and
q shift obstruction
● LMP: 12 of Sept. 2023
● I & O q shift ● Measuring I & O indicates the fluid balance for a patient
● AE: 82 cm
● VS Monitoring q4 ● Essential baseline data of the patient
● AWAKE: compatible no
sunken eyeballs ● Hgt monitoring q6 while on NPO ● Helps in monitoring the glucose level in the blood of the patient
● (-) murmur

● (+) tympanic Additional labs: ● To confirm pregnancy by detecting the presence of the hCG hormone in
● Pregnancy test (urine) a woman's blood or urine
● (+) full strong pulses
● Will inform AP (AP informed) ● To give updates about the patient’s health status
Symptoms:
● Refer accordingly ● Specialized healthcare professionals needs to know about the patient’s
● Bloating status

● Distension ● Thank you for this referral ● A way of confirming a referral

27
● Trapped Poop ● Patient seen and examined ● To assess the client’s condition and status

● Constipated ● History reviewed, PE done ● To understand the state of health of the patient further and to determine
within the history is related to any acute complaints to direct you toward
● Urinary Retention a diagnosis
● Appetite Loss ● Informed Dr. Bryan Ilagan through ● Informing a specialized health care professional about the status of the
SMS patient

● Awaiting response ● Awaiting for the confirmation of the referral

● Continue meds for now ● To advise the nurse on duty to continue previous meds ordered

● Refer Accordingly ● Specialized healthcare professionals needs to know about the patient’s
status

Date and Time: ● Patient received at the ward ● Confirmation of the endorsement of the patient to the nurse on previous
shift
October 3, 2023
9:22 PM ● Please relay results once in: ● Relaying results to a specialized healthcare professional to analyze
CRP and CXR - APL laboratory results
● CRP 0.600
● Please schedule for ultrasound ● Is used to make an image of a person's internal body structures.
● CXR (-)

● Continue NPO ● In the case of the patient NPO is ordered to prevent abdominal blockage.

Date and Time:

October 4, 2023
7:30 AM

● BP: 110/60

● HR: 90 bpm

28
 ● RR: 21 cpm

● T: 36.9

● SpO2: 90%

● Awake, comfortable

● Clear BS

● (-) Murmur

● Soft, distended,
Hypoactive

● (-) dullness

● P: DAT after UT2

● ABGIRTH: 83cm

S/O:

● (+) bloating,

● (+) abd discomfort,

● (-) vomiting,

● (-) loose stool,

● good sleep,

● on NPO

29
Date and Time: Meds: ● Used to treat bacterial infections in many different parts of the body
● Ceftriaxone OD
October 4, 2023
4:30 PM ● Metronidazole ● An antibiotic that is used for specific infectious diseases

● Omeprazole ● Used to treat certain conditions where there is too much acid in the
stomach

● On soft diet ● Refers to food that is soft in texture, low in fiber and easy to digest, used
after surgery or gut upset

Date and Time: ● For TRS tomorrow, pls Facilitate ● Facilitating patient needs is another responsibility of a nurse

October 4, 2023
7:00 PM ● For serum CA ● Serum calcium is usually measured to screen for or monitor bone
diseases or calcium-regulation disorders

● Relay results once available ● Relaying results to a specialized healthcare professional to analyze
laboratory results

● Continue meds ● To advise the nurse on duty to continue previous meds ordered

Date and TIme: ● For EX LAP, Oophorectomy at 12 NN ● An ovarian cyst is the most common reason for having an oophorectomy

October 5, 2023
5:30 AM ● Secure Consent & Approval for blood ● Provides a structure for a patient to make an informed choice regarding
typing the indications, risks, possible alternatives and benefits of a blood
transfusion

● Dulcolax 2 Suppository at bedtime ● Dulcolax is used to treat constipation or to empty the bowels before
surgery

● For Suctioning ● Suctioning can help maintain and establish the gas exchange, adequate
oxygenation, and alveolar ventilation.

● Inform lab - Dr. Madis ● Informing a specialized health care professional about the status of the
patient

30
 ● For Intra op referral to Dr. Madis ● Specialized healthcare professionals needs to know about the patient’s
status

● Confirmed Dr. Lu ● Confirmation of the referral

● Secure 2u PRBC ● Packed red blood cells are transfused to prevent tissue hypoxia

● Properly timed consent with pt. Blood ● Provides a structure for a patient to make an informed choice regarding
type once available for standby for the indications, risks, possible alternatives and benefits of a blood
OR nurse transfusion

Date and Time: ● Provides a structure for a patient to make an informed choice regarding
● Off Secure the indications, risks, possible alternatives and benefits of a blood
October 5, 2023 transfusion
7:34 PM

Date and Time: ● NPO post midnight - Dr. Madis, Dr, ● In the case of the patient NPO is ordered since the patient will undergo
Joseph Beltran and Dr. Maromnion surgery tomorrow
October 5, 2023
8:20 PM ● Please follow up blood bank 2u PRBC ● Packed red blood cells are transfused to prevent tissue hypoxia
properly timed and crossmatched

Date and Time: ● The patient will be under the service of a health provider specializing in
● Conferred to Dr. Beltran the patient’s condition, providing treatment
October 5, 2023
9:13 PM

Date and Time: ● Rounds with Dr. Gonzales ● To assess the client’s condition and status before surgery

October 5, 2023
10:00 PM ● No absolute contraindications for ● Checking if there are any contraindications before the surgery to ensure
contemplated procedure with minimal patient safety
risk for complication

Date and Time Dr. Gonzales updated ● Monitoring patient status to watch out for unusualities before operation

31
 October 6, 2023 ● Continue monitoring
5:00 AM
● Please update once for transport to ● To inform the attending physician about the start of operation
OR

VS: ● Decreased IVF to 90 cc/hr ● Ensures the correct amount of fluid drips from a bag down the IV into
your vein at the correct rate
● 110/70

● 90

● 20

● 97%

● (-) murmur

● Distended abdomen

● PRESIS cut

Hospital day 3

Date and Time: ● For OR at 12 NN ● Reminder that patient is scheduled for operation

October 6, 2023
8:30 AM ● Please facilitate ● Facilitating patient needs is another responsibility of a nurse

● Please inform OBR OD once received ● Informing a specialized health care professional about the status of the
to OR patient

32
2. Laboratory/Diagnostic Examinations

PROCEDURE PURPOSE NORMAL RANGE RESULT INTERPRETA NURSING RESPONSIBILITY

TION
CBC The purpose of Hemoglobin: 121.00 g/L Normal ● Explain the purpose of the CBC,
CBC is to (120.00 - 140.00 g/L) the importance of the test, and any
evaluate the specific instructions or preparations
cells which Hematocrit: 0.37 Normal required.
circulate in (0.37 - 0.45)
blood, including ● Encourage the patient to void every
WBCs, RBCs Lymphocytes: 26.1 Low 1-2 hr before the procedure.
and PLTs. The CBC (35.00 - 45.00)
is able to assess ● Advise the patient not to consume
the total RBC: 4.5 Normal any foods and beverages (aside
health and are able to (4.50 - 5.00) from water) before the procedure.
identify a range
various diseases WBC: 8.7 Normal ● Assist the patient in a suitable
as well as conditions. (5.00 - 10.00) position for blood collection,
typically exposing the arm for
Monocytes: 7.1 Normal venipuncture.
(6.00 - 12.00)
● Monitor the patient for any signs of
Eosinophils: 3.7 Normal discomfort, dizziness, or other
(2.00 - 4.00) adverse reactions.

Basophils: 0.7 Normal ● Document the CBC procedure,

(0.00 - 2.00) including patient education, any
complications, and the patient's
Platelet: 383 Normal response.
(140.00 - 440.00)

Red Cell Indices Red blood cell (RBC) MCV: 81 Normal ● Explain the purpose of red blood
indices are part of the (80.00 - 96.10) indices, emphasizing their role in
complete blood count assessing the size, structure, and
(CBC) test. They are function of red blood cells.
used to help diagnose MCH: 26.9 Low

33
 the cause of anemia, a (27.50 - 33.20) ● Offer emotional support,
condition in which there particularly if the patient is anxious
are too few red blood MCHC 331 Normal about the results or the procedure
cells. (318.00 - 354.00) itself.

RDW - CV 15.1 High ● Observe the venipuncture site for

(11.50 - 14.5) any signs of hematoma, infection,
or other complications.

● Communicate relevant information

to the healthcare team, especially if
there are signs of complications or
if the patient has specific needs.

Immunology Tumor markers in Tumor Markers 40.49 High ● Explain the purpose of tumor
immunology refer to CA 125 (Ovary): marker testing, including its role in
substances that are (0.00 - 35.00) cancer diagnosis, treatment
produced either by monitoring, and follow-up.
cancer cells themselves
or by the body in ● Provide information about the
response to the presence specific tumor marker being tested
of cancer. and its relevance to the patient's
condition.

● Provide emotional support and

address any emotional responses
the patient may have to the results,
whether positive or negative.

● Assist in planning follow-up

appointments and monitoring,
especially if the tumor marker
results indicate the need for further
assessments or interventions.
● If needed, refer the patient to
support services such as counseling

34
 or support groups to help cope with
the emotional impact of the results.

Pregnancy Test The purpose of a Negative Negative ● Assist in collecting the appropriate
pregnancy test is to specimen (urine or blood) for the
confirm pregnancy by pregnancy test.
detecting the presence
of the hCG hormone in ● Ensure proper labeling of the
a woman's blood or specimen and accurate
urine. documentation of relevant
information.

● Ensure that the patient provides

informed consent before
conducting the pregnancy test.

Ultrasound Ultrasound is best used Liver: The liver is normal ● Assist the patient during the
to learn about The mean liver size is 7 in size. It exhibits a ultrasound examination, helping
conditions that involve cm for women and 10.5 homogenous with positioning and ensuring
soft tissues, such as cm for men. parenchyma with a cooperation for clear imaging.
organs, glands, and smooth outline. The
blood vessels. intrahepatic biliary ● Maintain patient privacy and
ducts are not dignity throughout the procedure,
dilated. There is no using drapes or gowns as needed.
focal lesion or
calcification seen. ● Provide information about the
purpose of the ultrasound, what to
expect during the procedure, and
Gallbladder: The gallbladder is any post-procedure care.
distended in
physiologic size. ● Assist in scheduling follow-up
The wall is smooth appointments or additional tests as
and not thickened. recommended by the healthcare
There are no team based on ultrasound findings.
intraluminal echoes
seen. The widest
anteroposterior

35
 diameter of the
common duct is 0.4,
No pericholecystic
unusualities.

PANCREAS & The pancreas and

SPLEEN: spleen are normal in
size and
configuration.
Parenchymal
appearance is
unremarkable.
There is no focal
lesion or
calcification seen.

KIDNEY: There is no
significant disparity
in the sizes of both
kidneys.

URINARY BLADDER: The urinary bladder

is distended.
Bladder wall is
smooth and not
thickened. There are
no intraluminal
echoes seen.

ULTRASOUND Large
WHOLE ABDOMEN pelvi-abdominal
IMPRESSION: cystic mass, as
described. Ovarian
pathology
Considered.
Minimal Ascites.

36
 3. Pharmacologic Management

OCTOBER 03, 2023 @ 4:28 AM

1. Metronidazole

Date Medication Mode of Action Dosage Indications Contraindications Side Effects Adverse Nursing
Ordered Effects Responsibilities

October GENERIC Although the Metronidazole is 1. Hypersensitivity to Appetite loss Encephalopat 1. Watch out for
3, 2023 NAME: precise mode of 50g q8 IV used to treat metronidazole or other hy seizures; notify the
METRONIDAZ action of drip bacterial nitroimidazoles Diarrhoea physician
OLE metronidazole is infections in (although cautious Seizures immediately if a
still unknown, it different areas of desensitisation has Dizziness patient develops or
Classification: is plausible that the body. It is also been applied) Superinfectio increases seizure
an intermediate in used to treat Headache n may occur activity.
Antibiotics the reduction infections caused 2. Use of disulfiram with
process of the by protozoa (eg, within the past two prolonged 2. Monitor signs of
drug, which is trichomoniasis weeks; use of alcohol Nausea use peripheral
Pharmacologic exclusive to and amebiasis) during therapy or neuropathy
class: anaerobic bacteria and infections within 3 days of Vomiting Severe (numbness,
and protozoa, caused by bacteria discontinuing therapy. hepatic tingling).
nitroimidazole binds to the that do not need Dark urine impairment
electron-transport oxygen to survive. 3. Assess dizziness
and Metallic taste that might affect
deoxyribonucleic gait, balance, and
acid in living REFERENCE: Dry mouth other functional
things to prevent activities.
the synthesis of Metronidazole:
nucleic acids. generic, uses, side
Metronidazole effects, dosages, 4. Be alert for
penetrates cells interactions, confusion, agitation,
passively by warnings. (2021, headache, or other
diffusion after August 5). alterations in mental
injection. After RxList. status.

37
that, the nitro https://www.rxlist
group is reduced .com/metronidazo
to nitro radicals le/generic-drug.ht 5. Monitor IV
by ferredoxin or m injection site for
flavodoxin. pain, swelling, and
Metronidazole is irritation. Report
selective to prolonged or
anaerobic or excessive injection
microaerophilic site reactions to the
bacteria because physician.
of the redox
potential of their 6. MONITOR
electron transport VITAL SIGNS.
sections. This
reduction of nitro
groups results in
the generation of
hazardous
metabolites

38
 2. Omeprazole

Date Medication Mode of Action Dosage Indications Contraindications Side Effects Adverse Nursing
Ordered Effects Responsibilities

October 3, BRAND Omeprazole is a Occasional: Omeprazole 1. Assess the

2023 NAME: proton pump 40mg OD Omeprazole is Eructation, is considered patient's medical
OMEPRAZOL inhibitor that Omeprazole is contraindicated in altered taste, a benign history, including
E inhibits secretion indicated for patients with a history dyspepsia. drug; any allergies or
of gastric acid by gastric ulcers in of hypersensitivity to however, the previous adverse
GENERIC irreversibly adults. the drug or any Rare: primary reactions to
NAME: blocking the excipients from the Rash, back pain. adverse omeprazole.
PRILOSEC enzyme system of dosage form. effects
Omeprazole is Hypersensitivity
hydrogen/potassi reported in 2. Explain the
also indicated for reactions like
CLASSIFICA um adenosine drug labeling purpose of
gastroesophageal anaphylactic shock,
TION triphosphatase, include omeprazole to the
reflux disease in angioedema,
Pharmacother the “proton headache), patient, ensuring
pediatric and interstitial nephritis,
apeutic: pump” of the abdominal they understand its
adult populations. anaphylaxis, urticaria,
Benzimidazole gastric parietal pain, role in treating their
cell. and bronchospasm diarrhea, condition.
may occur. nausea,
Clinical: vomiting , 3. Provide
Proton pump and information about
inhibitor flatulence in potential side effects
REFERENCE: adults. Other and what to do if
REFERENCE: than these they experience
‌ hah, N. (2023,
S adverse them.
February 7). Omeprazole - effects, 4. Instruct the patient
Omeprazole. StatPearls - NCBI cough, rash, to take the
StatPearls - NCBI Bookshelf. asthenia, medication on an
Bookshelf. (n.d.-b). back pain, empty stomach,
https://www.ncbi. https://www.ncbi. regurgitation, usually 30 to 60
nlm.nih.gov/book nlm.nih.gov/book upper minutes before a
s/NBK539786/?f s/NBK539786/ respiratory meal.
bclid=IwAR3uLz infection,
hvlhj4OsD6bomI constipation, 5. Monitor the
WF68r8acqQ9Uc and dizziness patient for

39
Q5AVvs9QAySP are also therapeutic response
YrsQ-RM8G7stA reported in 1 to the medication,
4 to 2 % of such as relief of
patients. symptoms.

6. Watch for any

signs of adverse
reactions, such as
allergic reactions or
gastrointestinal
issues.

7. Document the
administration of
omeprazole,
including the dose,
time, and any
relevant patient
responses or side
effects.

40
 3. Ceftriaxone

Date Medication Mode of Action Dosage Indications Contraindications Side Effects Adverse Nursing
Ordered Effects Responsibilities

October Brand Name: Ceftriaxone works 80 IVTT Lowers Contraindicated with Black tarry stools Phlebitis BEFORE:
3, 2023 Rocephin by inhibiting the respiratory allergy to Check doctor’s order
mucopeptide infections caused cephalosporins or Chest pain GI upset
Generic by Streptococcus penicillins. Use Introduce drug to the
synthesis in the
Name: pneumonia, cautiously with renal Chills Skin patient and educate
Ceftriaxone bacterial cell wall. Staphylococcus failure, lactation, Reaction her about its purpose
The beta-lactam aureus, pregnancy Cough (Pruritus) and importance
Classification: moiety of Haemophilus
Antibiotic ceftriaxone binds influenza, E. coli, Fever Headache,Di Assess for hepatic
cephalosporin to Enterobacter zziness and renal
carboxypeptidases aerogenes. Painful or impairment,
Intra-abdominal difficult urination Pancreatitis lactation, pregnancy
, endopeptidases,
infections caused
and by E. coli, Shortness of Bilary Assess skin status,
transpeptidases in Klebsiella breath Precipitates LFTs, renal function
the bacterial pneumoniae tests, culture of
cytoplasmic Sore throat Colitis affected area,
membrane. These sensitivity tests
enzymes are REFERENCE: Swollen
DailyMed Label: Glands DURING:
involved in
ceftriaxone Administer the right
cell-wall synthesis Unusual bleeding drug at the right dose
sodium injection,
and cell division. or bruising
powder for
Binding of Check the patency of
solution. Unusual the IV site and IV
ceftriaxone to
https://dailymed.n tiredness or line
these enzymes
lm.nih.gov/dailym weakness
causes the
ed/drugInfo.cfm?s Have vitamin K
enzyme to lose ready in case
etid=4d1ad77f-2c
activity; therefore, hypoprothrombinemi
the bacteria a occurs

41
produce defective 6b-4250-82e5-ab3 Do not mix
cell walls, causing 574444e08 ceftriaxone with any
cell death. antimicrobial drug

Discontinue if
REFERENCE:
hypersensitivity
Richards, D. M.,
reaction occurs
Heel, R. C.,
Brogden, R. N., AFTER:
Speight, T. M., Monitor ceftriaxone
Avery, G. S. blood levels in
(1984). patients with renal
Ceftriaxone. A impairment and in
patients with renal
review of its
and hepatic
antibacterial impairment
activity,
pharmacological Report severe
properties and diarrhea, difficulty in
therapeutic use. breathing, unusual
Drugs. tiredness or
fatigue,pain at
Jun;27(6):469-52
injection site
7. doi:
10.2165/0000349 Document and
5-198427060-000 record.
01.

42
 October 5, 2023 @ 5:30 AM

4. Dulcolax

Date Medication Mode of Action Dosage Indications Contraindications Side Effects Adverse Nursing
Ordered Effects Responsibilities

October 5, Brand Name: Direct effect on 2 -Treatment of -Abdominal pain Frequent: Some -Nausea/vom -Observe for
2023 Dulcolax colonic smooth Suppository constipation degree of iting/diarrhea evidence of
musculature by at bedtime -Appendicitis abdominal that doesn't constipation
Generic Name: stimulating -Colonic discomfort, stop
Bisacodyl intramural nerve evacuation -Intestinal obstruction nausea, mild -Assess pattern of
plexus. before cramps, -Muscle bowel activity,
CLASSIFICATI Therapeutic examinations or -Nausea faintness. cramps/weak stool consistency
ON: Effect: Promotes procedure ness
fluid and -Undiagnosed rectal -Encourage adequate
PHARMACOT electrolyte bleeding Occasional: -Irregular fluid intake
HERAPEUTIC: accumulation in Rectal heartbeat
GI stimulant colon, increasing -Vomiting administration: -Assess
peristalsis, burning of rectal -Dizziness, bowel sounds for
CLINICAL: producing -Pregnancy mucosa, mild peristalsis
Laxative laxative effect -Lactation. proctitis. -Fainting
-Monitor
References: -Decreased daily pattern of
urination bowel activity, stool
Kizior, R.J. & consistency; record
Hodgson, K. J. time of evacuation
(2023). Saunders
nursing drug -Assess for
handbook. abdominal
Pp.(231-233).Els disturbances
evier.
-Monitor serum
electrolytes in those
exposed
to prolonged,

43
 frequent, or
excessive use
of medication.

4. Surgical Management

Surgical Rationale Indication Result Nursing Management

Procedure
Exploratory A patient Patient A.R. is Patient’s left ovary, Pre-op:
laparotomy, left experiencing experiencing pain, infracolic omentum, ● Explained the procedure to the patient
salpingo-oophorectom symptoms such as bloating, accompanied and fallopian tube ● Consent secured
y, infracolic pain or discomfort with a distended was dissected ● NPO post midnight
omentectomy, bilateral from ovarian tumors abdomen ● Secured 2u PRBC properly timed and crossmatched with
lymph node dissection or cysts, a consent
salpingo-oophorecto Patient A.R. 's ● Placed in a supine position
my may be required. ultrasound resulted: ● Prepared patient’s skin
If you are at high Large pelvi-abdominal ● Administered pre-op medications:
risk for ovarian cystic mass, as ● Dulcolax 2 suppository at bedtime
cancer or some described. Ovarian
breast malignancies, pathology Considered. Post-op:
your surgeon may Minimal Ascites. ● Check vital signs
also prescribe a ● Clean wounds checked
prophylactic (or ● Watch out for unusualities
preventative) ● Administer ordered medication
salpingo-oophorecto
my.

44
ii. NURSING MANAGEMENT

1. Nursing Care Plan

a. Acute Pain

DATE & CUES NURSING GOAL & INTERVENTION RATIONALE EVALUATION

TIME DIAGNOSIS OBJECTIVES S
October 03, 2023 SUBJECTIVE: Acute Pain related to After 8rs of nursing Independent: Independent: “ GOAL MET”
“ I was wondering Abdominal Distention care the patient will
why I felt bloated all secondary to Ovarian be able to: 1.Monitor vital signs 1. It serves as a After 8 hours of
the time, then lately New Growth. baseline data to check nursing care the pt:
I felt pain in my - report relief from if there are any
tummy and it's hard Rationale: pain. deviations from her -Participated in
for me to defecate.” Acute pain arises as a vital signs. activities of recovery
as verbalized by the result of tissue injury after - report that pain is
patient. surgery and should controlled and 2. Assess the 2. pain is a subjective -Showed no guarding
resolve during the healing tolerable severity,frequency,and data,therefore it of abdomen when in
OBJECTIVE: phase. This can take up to characteristic of pain. should be reported pain, no signs of
- 7/10 pain scale three months, after which and to determine difficulty of breathing
- RR: 23 cpm the pain is deemed patient's level of pain
- Abdominal chronic or persistent. - Showed
distention improvement in
- abdominal girth: 83 mood.
cm 3. Provide 3. These methods are
nonpharmacologic pain used to provide -Verbalized pain
management such as comfort by altering relief
touch and frequent psychological
changing of position responses to pain. -Reported tolerable
pain.
Dependent: Dependent:

1. Provide 1. Pain management

pharmacologic pain using pharmacologic

45
management as ordered. methods involves
using opioids
(narcotics),
nonopioids
(NSAIDs), and co
analgesic drugs.

46
 b. Decreased Activity Tolerance

DATE & CUES NURSING GOAL & INTERVENTIONS RATIONALE EVALUATION

TIME DIAGNOSIS OBJECTIVES

October 03, Subjective: Decreased Activity After 8 hours of Independent: Independent: After 8 hours of
2023 Tolerance related to nursing care and nursing care and
patient verbalized Pain interventions, PT 1. Monitor vital and 1. This may cause in interventions,
“I’m afraid to move and SO will be able cognitive signs, watching decreased activity
to: for changes in BP, HR, RR; tolerance “GOAL MET”
because of the pain i Scientific Basis: note skin pallor or cyanosis
might feel with my and presence of confusion Patient and SO was
incision” Decreased Activity 1. Participate able to:
Tolerance is the willingly in
Objectives: insufficient endurance necessary/desired 2. Involve client/SO in 1. Showed a desire to
to complete required or activities planning activities as much 2. May give client participate willingly
desired daily activities. as possible opportunity to perform in necessary/desired
(+) surgical incision 2. Gradually desired or essential activities
exposed to activities activities during
(+) pain Pain is the unpleasant 2. Exposed to
or movements she periods of peak energy
sensory and emotional avoids, particularly 3. Assist with activities and activities or
Pain scale: 5/10 experience associated in changing provide/monitor client’s 3. To protect client movement she avoids,
with actual or potential positions to avoid use of assistive devices from injury such as turning to the
tissue damage. bed sores. side lying position.

Reference: 3. Verbalized 4. Provide comfort 3. Verbalized

understanding of measures 4. To enhance ability to understanding of
potential loss of participate in activities potential loss of
Doenges, M., ability for the mean
ability in relation to
Moorhouse, M., & existing condition time in relation to
Murr. A., (2022)., 5. Discuss the client’s existing condition
Nurse’s Pocket Guide: perceptions and fearful 5.Promotes an
Diagnosis, Prioritized feelings. Actively listen to atmosphere of caring
Interventions, and the client’s concern. and permits
Rationales., 16th ed explanation or
correction of
misperceptions

47
Dependent:
Dependent:

6. Note treatment related

factors, such as side effects 6. Which can affect the
and interactions of nature and degree of
medications given activity tolerance

Collaboration:
Collaboration:
7.Determine the client’s
current activity level 7. Provides a baseline
for comparison and an
opportunity to track
changes
8. Provide referral to other
disciplines, such as 8. To develop
exercise physiologist, individually
psychological appropriate therapeutic
counseling/therapy, regimens
occupational/physical
therapist, and
recreation/leisure
specialist, as indicated

48
49
50
 c. Disturbed Sleeping Pattern

DATE & CUES NURSING GOAL & INTERVENTIONS RATIONALE EVALUATION

TIME DIAGNOSIS OBJECTIVES

October 03, Subjective: Disturbed Sleeping After 8 hours of Independent: Independent: After 8 hours of nursing
2023 Pattern related to nursing care the patient care and interventions,
Patient stated that “ abdominal distention will able to: 1. Monitor client's vital 1. To evaluate patient
It's hard for me to signs and recovery stability. “GOAL MET”
sleep at night, so in Scientific Basis: A. The client will progress
the morning I just appear calm and A. The client's vital
sleep a little and Time-limited relaxed with vital signs 2. Offer relaxation and 2. A patient feeling signs are within normal
take a nap.” awakenings due to within normal limits calming techniques discomfort may need a limits
external factors. calming voice to
Objective: B. The client will remind them they are B. The client verbalizes
(+) Bloating Reference: verbalize a sense of safe. Teach breathing comfort and able to
(+) Abdominal pain comfort or and meditation exercise understand possible
Abdominal girth: Doenges, M., contentment. surgical procedures
83cm Moorhouse, M., & 3. Keep the 3. Reduce stimuli by regarding the existing
Murr. A., (2022)., C. The client will environment stress free decreasing outside condition
Laboratory: Nurse’s Pocket improve sleep quality noise, dimming the
- Tumor Guide: Diagnosis, and pattern. lights, and ensuring C. The client improved
Markers Prioritized privacy by keeping the sleeping pattern
CA 125 Interventions, and D. The client will door closed can help
(Ovary): Rationales., 16th ed participate in desirable the patient reducing D. The client responded
40.49 (H) and realistic health stress to interventions,
seeking behaviors teaching, and actions
4. Encourage the client 4. To provide relief and performed
for ambulation every 2 ambulate as tolerated.
hours

Dependent: Dependent:

1. Administer 1. To control symptoms

medication as reduce frequency and

51
indicated severity of ovarian
mass and improve
2. Review laboratory exercise tolerance
data
2. To evaluate
significant findings and
client response to
laboratory test- pre op
and refer as needed

52
 d. Constipation

DATE & CUES NURSING GOAL & INTERVENTIONS RATIONALE EVALUATION

TIME DIAGNOSIS OBJECTIVES

October 03, Subjective: Constipation related After 8 hours of Independent: Independent: After 8 hours of nursing
2023 to decreased bowel nursing care the patient care and interventions,
"I haven't pooped motility as evidenced will able to: 1. Encourage the 1. Sufficient is needed
and fart since I was by no presence of patient to drink 2000 to keep fecal mass soft. "GOAL PARTIALLY
admitted and I am poop and flatulence 1. Relive from to 3000 mL of fluids a But take note of some MET"
having a hard time discomfort of day. patients having
because of constipation after cardiovascular 1. The patient stated that
constipation" as the interventions are put in limitations requiring she sometimes
patient verbalized. place. less fluid intake. experienced discomfort
Scientific Basis: 2. Implement food 2. Diet post-surgery when constipation
Objective: 2. Have a regular chart may be different from happened. Level of
Constipation is the bowel movement. the patient’s normal discomfort 05/10
● Hypoacti decrease in normal eating pattern.
frequency of Assessing the food 2. The patient had
ve bowel defecation intake of the patient irregular bowel
sounds accompanied by may help improve movement.
● (-) difficult or elimination.
defecatio incomplete passage of
n stool and / or passage 3. Provide a calm and 3. To reduce stress
of excessively hard, relaxing environment affecting normal bowel
dry stool. activity.

Reference: 4. Auscultate bowel 4. Bowel sounds are

sounds generally decreased in
Doenges, M., constipation.
Moorhouse, M., &
Murr. A., (2022)., Dependent: Dependent:
Nurse’s Pocket
Guide: Diagnosis, 5. Encourage to eat 5. To enhance easy

53
Prioritized high-fiber food defecation.
Interventions, and
Rationales., 16th ed 6. Encourage to avoid 6. Decrease gastric
gas-forming foods distress and abdominal
distension.

Collaboration: Collaboration:

7. Consult with a 7. Fiber resists

dietitian to provide a enzymatic digestion
well-balanced diet and absorbs liquids in
high in fiber and bulk. its passage along the
intestinal tract and
thereby produces bulk,
which acts as a
stimulant to defecation.

54
2. Discharge Plan

MEDICATION ● Encourage the patient and their support people to adhere to the
prescribed medication schedule as closely as possible, without ever
stopping or missing a dosage.
● Provide written and verbal information regarding the prescribed
drugs, such as the name of the drug, its dosage, its intended use, how
often it should be taken, its route, and any potential side/adverse
effects.
● If the patient's condition does not improve with prescribed medication
or if symptoms of the condition continue, advise the patient and their
support people to consult the physician.
● Discuss about drug-drug, herb-drug, and food interactions as well (if
prescribed or provided as take-home medication).

EXERCISE ● Inform the patient that a medical evaluation from a physician is

necessary in order to receive a recommendation for an exercise
regimen that is suitable for her present health condition.
● Highlight the importance of rest specially 1 week after the procedure
and remind the patient that she will most likely resume her regular
activities in 4 to 8 weeks post-op.
● Instruct the patient that she should rest for the first one to two days at
home in order to prevent herself from becoming exhausted. Napping
is also encouraged.
● Encourage the patient to take it easy and participate in slow pace
activities such as light housework and walking around the house.

TREATMENT Bandage Care

● Educate the patient and their support people regarding the wound
dressing.
➔ Educate them that steri-strips, which are tiny tapes, and a gauze
bandage will cover all of the incision.
➔ Every wound's outside gauze dressing should
be taken out 48 hours following the procedure.
➔ Instruct them not to take off the steri-strips. After putting the strips
in for seven to ten days, then they can remove them out.
➔ Remind them that it's okay if the strips start to peel off before the
seven-day mark. If any are coming loose, they can take them out and
discard them.

55
 Wound Care

● Advise the patient to always keep their wounds dry and clean after
steri-strips are removed.
● Inform the patient that there's a chance the wounds will seep a little
occasionally, of fluid (blood combined with a transparent yellow
liquid), and that this is normal.
● Remind the patient not to touch open wounds to prevent infection.
● Advise the patient to cover the wound with a pillow when
sneezing or coughing to reduce discomfort and protect the
incision.

HYGIENE Taking a bath

● Inform the patient that she can bathe as usual from 28 to 48 hours
after the procedure or after the outer gauze dressing is removed,
remind the patient to keep the steri-strips in place.
● After taking a bath, tell the patient to pat the wounds dry with a fresh
towel rather than rubbing them.
● Advise that the patient should avoid soaking in water for a long
period of time such as swimming for a minimum of four weeks
following surgery.
● Encourage the patient to use mild soap and water to cleanse the area
surrounding the incision on a regular basis, being careful not to get
soap on the steri-strips.

OUTPATIENT ● Instruct the patient and support people to make a follow up

(CHECK-UP)
appointment with their doctor or surgeon one to two weeks following
the process or as advised.
● Inform patients and those in support of potential signs and symptoms
that should prompt them to contact their physician,
such as:
➔ Temp above 38°C
➔ Jaundice
➔ Itchiness, swelling, presence of pus, or a bad smell at the incision
site
➔ Increasing pain after the incision
➔ Severe pain that persists despite taking pain medication.
➔ Respiratory Distress

56
 ➔ Stool or urine that is clay-colored or dark in color.
➔ (Symptoms that don't go away within a week:)
◆ Fatigue
◆ Diarrhea or Constipation
◆ Loss of Appetite

DIET Soft Diet:

● Encourage the patient to get a recommendation from a

a licensed dietician for suggestions on the most effective
food plan for her health.
● Suggest smaller, more frequent meals to ensure adequate nutrition
without overwhelming the patient.
● Explain the purpose of the soft diet, emphasizing the need to avoid
hard, crunchy, or tough foods.
● Clarify that the soft diet is designed to minimize chewing and make it
easier for the patient to swallow.

Food Consistency:
● Provide a list of allowed foods, such as:
➔ Cooked and soft vegetables (e.g., mashed potatoes,
well-cooked carrots)
➔ Soft fruits (e.g., bananas, applesauce, cooked and peeled
fruits)
➔ Tender meats (e.g., ground meat, well-cooked poultry, fish)
➔ Cooked grains (e.g., rice, pasta, oatmeal)
➔ Dairy products (e.g., yogurt, pudding, soft cheeses)
➔ Eggs (scrambled or soft-boiled)

Beverages:
● Encourage the consumption of water and other hydrating fluids.
● Consider recommending smoothies, milkshakes, or soups for added
variety and nutrition.

Nutritional Considerations:
● Emphasize the importance of maintaining a balanced diet.
● Consider the patient's nutritional needs and, if necessary, recommend
a nutritional supplement.

Monitoring and Follow-up:

57
 ● Instruct the patient to monitor any difficulties with swallowing or
digestion.
● Schedule a follow-up appointment with a dietitian or healthcare
professional to assess progress and make any necessary adjustments.

SPIRITUALITY ● Advise the patient to avoid stress as much as possible.

● Educate the patient on the benefits of mindfulness for promoting
peace of mind.
● Encourage the patient to designate a quiet and comfortable space at
home for relaxation.
● Suggest keeping a gratitude journal to focus on positive aspects of the
recovery journey.
● Provide contact information for mental health professionals if the
patient expresses the need for additional support.
● Emphasize the importance of staying connected with supportive
friends and family members.
● Encourage open communication with loved ones about emotional
well-being.

58
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