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GnRH
FSH
Graafian Follicle
Estrogen
Day 2
The above unit of blood finished at August 23, 2008, 2:20 a.m. There is no reaction
during and after the blood transfusion. At the same time, the second unit of whole
blood with a serial number B-08-4681 was hooked and consumed at 7:20 a.m. The
third unit of blood with a serial number B-08-4666 was started at same time. The
blood transfusion site was transferred from left to right at 11:20 a.m. At 12:30 p.m.,
the third unit of whole blood with a serial number B-08-4668 was consumed and
followed up of fourth unit of whole blood and consumed at 4:30 p.m. Intravenous
fluid number one consumed and followed the number two 5% Dextrose in Lactated
Ringers 1 liter plus one ampule of EC regulated at the same rate. By 11:10 p.m.
Lady L is under nothing per orem. Lady L informed about Total Hysterectomy
Bilateral Salphingo Oophorectomy with signed consent of her husband and her son
at the same day. Anesthesiologist on deck was informed. Cefuroxime 750 mg,
intravenous started every 8 hours after negative skin testing. At 11:40 p.m. Valium
tablet 5 mg one tablet was given as pre-operative drugs.
Day 3
August 24, 2008, at exactly 7:00 a.m. Lady L was brought to the operating room.
At 4:50 p.m. post-op orders were given. Monitor vital signs every 15 minutes until
fully stable. Nothing per orem temporarily. The patient was instructed to lie flat on
bed and low back rest for pneumonia precaution. Oxygen inhalation administered at
3 liters per minute. Suction secretion when necessary. Intake and output were
recorded hourly. 5% Dextrose Lactated Ringers 1 liter post-op to run at 15gtts/min
then to follow 5% Dextrose Lactated Ringers 1 liter at same rate. Last dose of
Cefuroxime to consumed, Metronidazole 500 mg slow intravenous push every 6
hours. Tramadol 500 mg after negative skin testing every 6 hour. Intravenous fluid
regulated at 30 gtts/min when blood transfusion finished. Repeat hemoglobin and
hematocrit.
At 5:20 p.m. the operation ended and at 6:40 p.m. patient was bought to the
intensive care unit and hooked to ventilator and Furosemide 40 mg IV was given. At
around 8:45 p.m Omeprazole 40 mg IV was given. Serum, sodium, potassium,
chloride, prothrombin time, partial prothrombin time done and result in Lady L was
nebulized if Combivent 1 neb and maintained every 8 hours potassium 30
millequivalent incorporate to her intravenous fluid and decrease it to 8 hours.
Another one unit of packed red blood cell, Calcium gluconate one ampule was given
thru slow intravenous push.
Day 4
August 25, 2008, 5a.m. patient was brought to room 206 and then nebulization
started and extubated at the time and secretion suctioned. Oxygen maintained at 4
liters per minutes via nasal canula. Diphenhydramine one ampule was given at 3:30
p.m, 30 minutes prior to blood transfusion. Blood type B with a serial # of BO8445 run at 4-6 hours. At 6:05 p.m Lady L was confirmed that she has a positive
flatulence. Measuring drained output was recorded shiftly.
Day 5
1 a.m. of August 26, 2008, to follow intravenous fluid 5% Dextrose Lactated Ringers
1 liter regulated at same rate and encouraged patient to turn side to side. Serum,
creatinine, and complete blood count done. At 9:37 a.m. the physician advised to
continue medications. At 10:00a.m. patients temperature is 38.2C and
paracetamol 200 mg one ampule was given thru intravenous. At 11:03 a.m.
nebulization was stopped. The physician suggests changing Cefuroxime to Tazocin
4.5 grams intravenous every 8 hours. Above intravenous fluid consumed and
followed up of 5% Dextrose in Lactated Ringers 1 liter regulated at same rate. At
3:15 p.m. incentive spirometer every 8 hours and two minutes oxygen inhalation
was discontinued. Patient was encouraged to ambulate. At 8:30 p.m. intravenous to
follow of 5% Dextrose Lactated Ringers 1 liter regulated at same rate. Foley
catheter was removed at 9:15 p.m. At 10:45 p.m Lady L gargled one tablespoon of
Orahex solution plus 30 cc water every 6 hours.
Day 6
Nursing care done. Vital signs are monitored and recorded. Intravenous fluid
regulated at 15 gtts/min Lady L has no further complaint. The patient is
ambulatory. Tazocin 4.5 grams intravenous every 8 hours was given. Attending
Physician did not visits the patient and no new orders were made that day.
Day 7
August 28, 2008, patient may have clear liquid then soft diet at 4 p.m., above
intravenous fluid consumed and followed up of 5% Dextrose Lactated Ringers 1 liter
regulated at the same rate. For possible discharge on the next day.
Day 8
August 29, 2008, removal of jackson-pratt drain was done and intravenous fluid was
terminated. There is no o objection for discharge. Home medications instructed and
patient may go home and start oral medication. At 8 p.m. patient was discharged
accompanied by her son via the wheelchair.
VII. LABORATORY
AUGUST 22, 2008
ULTRASOUND
Transvaginal Ultrasound
MEDICAL MANAGEMENT
Age
General health
Severity of symptoms
Size of fibroids
Some women may just need pelvic exams or ultrasounds every once in a
while to monitor the fibroid's growth.
SURGICAL MANAGEMENT:
Hysterectomy
Hysterectomy
A hysterectomy is a surgical procedure whereby the uterus (womb) is
removed. Hysterectomy is the most common non-obstetrical procedure of women in
the United States.
Why is a hysterectomy performed?
The most common reason hysterectomy is performed is for uterine fibroids
The next most common reasons are abnormal uterine bleeding, endometriosis, and
uterine prolapse (including pelvic relaxation). Only 10% of hysterectomy is
performed for cancer of the uterus or very severe pre-cancers (called dysplasia).
Uterine fibroids (also known as uterine leiomyomata) are by far the most common
reason a hysterectomy is performed. Uterine fibroids are benign growths of the
uterus, the cause of which is unknown. Although they are benign, meaning they do
not cause or turn into cancer, uterine fibroids can cause medical problems, such as
excessive bleeding, for which hysterectomy is sometimes recommended.
What tests or treatments are performed prior to a hysterectomy?
Prior to having a hysterectomy for pelvic pain, women usually undergo more
limited (less extensive) exploratory surgery procedures (such as laparoscopy) to
rule out other causes of pain. Prior to having a hysterectomy for abnormal uterine
bleeding, women require some type of sampling of the lining of the uterus (biopsy
of the endometrium) to rule out cancer or pre-cancer of the uterus. This procedure
is called endometrial sampling. In a woman with pelvic pain or bleeding, a trial of
medication treatment is often given before a hysterectomy is considered.
How is a hysterectomy performed?
Most commonly, a hysterectomy is done by an incision (cut) through the
Risks
Hysterectomy is a relatively safe operation, although like all major surgery it
carries risks. These include unanticipated reaction to anesthesia, internal bleeding,
blood clots, damage to other organs such as the bladder, and post-surgery
infection.
Other complications sometimes reported after a hysterectomy include changes in
sex drive, weight gain, constipation, and pelvic pain. Hot flashes and other
symptoms of menopause can occur if the ovaries are removed. Women who have
both ovaries removed and who do not take estrogen replacement therapy run an
increased risk for heart disease and osteoporosis (a condition that causes bones to
be brittle). Women with a history of psychological and emotional problems before
the hysterectomy are likely to experience psychological difficulties after the
operation.
Alternatives
Women for whom a hysterectomy is recommended should discuss possible
alternatives with their doctor and consider getting a second opinion , since this is
major surgery with life-changing implications. Whether an alternative is appropriate
for any individual woman is a decision she and her doctor should make together.
Some alternative procedures to hysterectomy include:
DISCHARGE PLANNING
Medication
Ciprofloxacin 500 mg 1tablet 3x a day for 1 week
Metronidazole 500 mg 1 tablet 3x a day for 1 week
Tramadol (Dolcet) 1 tablet 3x a day for pain
Environment
Instruct patients relative to provide the patient an environment
conducive for her easy recovery. Her place/room in their house must be the
most accessible area. Her environment should be free from contamination
and infection.
Treatment
The patient should follow the physicians prescription and should take his
home medication on the right time and right dose.
Health Teaching
Instruct the patient the importance of proper taking of medication on time.
Instruct the patient and her family the proper wound care to avoid contamination
and infection at surgical site.
Instruct the patient to eat nutritious foods.
Encourage ambulation for early recovery.
Good sanitation is advised.
Out Patient Department
The patient should return on the scheduled date of her follow up check-up on
September 5, 2008 in Metro Lipa Medical Center from 4:30 pm to 6:30 pm and
should continuously take her home medication as prescribed by her physician. The
patient should visit her physician whenever she feels any discomfort.
Diet
Diet as Tolerated. In order to attain proper diet, the patient should be guided
to the prescribed foods as advised by her physician. Her meals should include
Vitamin C-rich foods for wound healing.
Spiritual
Patient should enhance her spiritual relationship with God. Have faith and
trust in Gods divine power, and believed that the lord will help in her early recovery.
Keep on praying, because praying is the number one key to live a healthy life and to
be close to God.
XII. PROGNOSIS
The mortality rate in uterine myoma is low provided early diagnosis and
management are made and no complication will occur. According to the attending
physician the case of Lady L greatly improved after the management, therefore, the
prognosis is good.
XII. EVALUATION