SUBMUCOUSAL

MYOMA
In Partial Fulfillment Of
Nursing Care Management 201
Related Learning Experience

Submitted by:
BSN 3-A
GROUP 3

Date of Defend:
October 23, 2009

1
Introduction

2
 Fibroids or uterine myomas are benign, non-cancerous growths
inside the uterus or in its muscular wall. Fibroids can vary enormously
in size, from that of a pea to that of a melon. Multiple growths may be
present at the same time, anywhere in the uterus. They are classified
according to their location:

Intramural fibroids – develop in the uterine wall.

Subserosal fibroids – develop in the abdomen outside the uterus.

Submucosal fibroids – develop inside the uterine cavity.

Myomas of the uterus are the most common solid pelvic tumours
in women, and are present in 20 to 25% of women aged 35 years.
Myomas are associated with infertility, the causal relationship in this
regard appearing to be more evident for submucosal myomas. Indeed,
myomas represent an increasing medical problem in women
attempting to conceive at a more advanced age, when the rate of
development of these lesions is also increased.

In their submucosal localization, myomas can be treated

exclusively using surgical procedures, and they may be accessible by
operative hysteroscopy—the standard surgical approach. Several
retrospective studies of small cases series were published during the
1990s demonstrating successful reproductive outcome after
hysteroscopic removal of submucosal myomas in infertile women.
Several hypotheses have been suggested to explain how submucosal
myomas cause infertility or repeated abortions, but none is definitive.

3
The aim of this retrospective study was to assess the pregnancy rate
compared with the improvement of menstrual pattern in menorrhagic
women after hysteroscopic resection of submucosal myomas
performed in infertile patients.

Most myomas are asymptomatic and do not cause any

particular problem. If this is the case, treatment is unnecessary.

Three Types of Treatments

1) Drugs: anti-haemorrhagics or anti-inflammatories can be used to

treat the patient's symptoms. Certain hormones can also be
beneficial. However, the efficacy of drugs and hormones is usually
limited and their effects temporary. Moreover, side effects may
limit the duration of the course of treatment.
2) Surgical removal: various surgical techniques can be used,
depending on the size, number and location of the fibroids:
a) Myomectomy involves the individual removal of each
leiomyoma. Different approaches can be used, including
coelioscopy, hysteroscopy or abdominal incision, but all entail a
hospital stay of several days followed by a one to six week
convalescence period. Myomectomy can complicate subsequent
pregnancies because it causes scarring of the uterine muscle
tissue.
b) Hysterectomy involves the removal of the entire uterus by
coelioscopy or surgery (either abdominal surgery or via a vaginal
approach). This treatment modality definitively eliminates the
fibroids but both hospital stay and convalescence period are
long. And of course, hysterectomy abolishes the possibility of
later pregnancy.
3) Embolisation: an alternative to surgery which preserves the
uterus, since the development of this technique in France in the
early 1990's, about 40,000 women have been treated across the
world. Embolisation results in shrinkage of the fibroids by blocking
their blood supply. This procedure attenuates or abolishes
symptoms (pain, bleeding, urination problems, etc.) in 90% of
subjects. Embolisation is performed with mild local anaesthesia and
involves a hospital stay of under 48 hours.

Postoperative pain is managed with various drugs or by means

of a small pump device with which the patient herself can control the
dose administered according to her degree of pain. A normal life style
can be resumed within one to two weeks.

4
 Gordon’s
Functional
Health Pattern

5
CHIEF COMPLAINTS: Vaginal bleeding, Dysmenorrhea

CURRENT HEALTH HISTORY:

For the past 2 years, patient had been experiencing
menstruation that lasted for a month associated with Dysmenorrhea.
Last July 2009 due to prolonged, severe uterine pain during
menstruation, the patient sought medical health assistance to a
private OB-Gynecologist. She was advised to have an ultrasound for
further evaluation. Based on the patient’s ultrasound result, the
impression was Utero-Prolapsed Endometrial Polyps vs.
Prolapsed Submucous Myoma. With these findings, the doctor
advised her to undergo for a surgery. Howerver, because of financial
constraint, the patient decided to have the surgery done in Ormoc
District Hospital. She was admitted at ODH last September 19, 2009,
and was scheduled for an operation on 29th of the same month.

PAST MEDICAL HISTORY:

Patient claimed that she had experienced common childhood
diseases and minor illnesses, such as common colds, chicken pox,
mumps and measles. She considers herself as a healthy individual.
Patient also said that she had never been hospitalized before, neither
suffered from serious illnesses nor undergone any surgical operation.
Common adult illnesses experienced were fever, cough and colds
which she self medicated with over-the-counter drugs.
She has no recollection of her immunization status because
according to her it was not a common practice during her childhood
days.
Patient was an occasional alcohol drinker and tobacco user.
Patient claimed no known allergies to drugs, foods or other
environmental substances.

FAMILY HISTORY:
Patient’s mother passed away of unknown cause. The patient is
the second of the nine siblings of which six are females and three are
males. She is married to a fisherman from San Isidro, Villaba Leyte who
sometimes earns less than 1 thousand pesos a day. They were blessed
with six children; all of them are still living. She claimed her family to
be healthy.

6
GENOGRAM:

Legends:

- Female - Deceased Female Relative

- Male - Deceased Male Relative

X - Client

7
HEALTH PERCEPTION & HEALTH MANAGEMENT:
As stated by the client, she perceived herself as a healthy
individual even before she had a surgery. Right now her normal
activities are affected due to her post-surgical operation. She can
ambulate with the aid of her significant others.
Whenever the patient has a health problem, she just takes a rest
or seeks medical assistance to their Barangay Health Center. To keep
healthy, the patient does exercises, such as walking and doing
household chores.
The patient claimed that she doesn’t know how to do self
physical exams, specifically Breast Self Examination, and cannot recall
her last immunization.
The patient used to drink alcohol and smoke occasionally. One
year ago, she stopped smoking.

NUTRITION & METABOLISM PATTERN:

24-hour dietary intake review (her usual daily menu)
• Breakfast: 1 cup of coffee and 1 piece of bread
• Snacks: Saging, camote, a cup of coffee
• Lunch: 1 cup of rice, fish, mixed vegetables
• Dinner: 1 cup of rice, fish, mixed vegetables

The patient normally eats her meals 8am-12nn-7pm. She doesn’t

take any vitamin supplements. Her diet is less in sugar and salt. She
drinks powdered juice, beer or tuba occasionally and mostly water. She
doesn’t have any difficulty chewing and swallowing food and drinks.

BLADDER ELIMINATION PATTERN:

She had normal urine elimination. But after removal of her
urinary catheter, she voids five times a day but in small amounts. The
amount of her daily voiding is approximately 1 cup, with light yellow
color.

BOWEL ELIMINATION PATTERN:

Before her hospitalization, she had a regular bowel elimination,
once daily. Since she was hospitalized she seldom eliminates with an
interval of 3 days. She doesn’t take any laxatives, or undergone
edemas to relieve her discomforts. But she eats fruits and vegetables
everyday to increase her fiber intake for easier bowel elimination. She
also drinks adequate fluid everyday.

SLEEP-REST PATTERN:

8
 The client usually sleeps 6 to 8 hours every night She usually
naps in the afternoon for 15 minutes only. But now that she is
hospitalized, her sleeping pattern is altered due to heat and
discomforts with her environment and present condition.

ACTIVITY & EXERCISE PATTERN:

Activity of Daily Living: The patient normally does household
chores and gone to the market to buy their food. Now that she is
hospitalized, her activities are altered.
Exercise Routine: Her daily living activities are her means of
exercise.
Occupational Activities: The patient doesn’t have a job, she is
just a plain housewife.

COGNITION & PERCEPTION PATTERN:

Ability to Understand: According to the doctor, her recovery is
progressing. But she still has to have to believe in the determination
that she can return to her normal state of health. Her best way to learn
something new is by watching shows on television.
Ability to Communicate: Inspite of the pains after the surgery,
the patient was relieved to know that she’s cured from her sickness.
The patient doesn’t have difficulty expressing herself to her family, but
due to the surgery, she cannot communicate well.
Ability to Remember: She verbalized that she was able to
recall important past events of her life.
Ability to Make Decisions: The patient informed to us that in
making major decisions, the whole family discusses and together
decides. Patient stated she did not have any difficulty in decision
making especially regarding her surgery, because she knew it will
make her feel better.

SELF-PERCEPTION & SELF CONCEPT PATTERN:

The patient describes herself as a happy person. Her family gives
her strength, but also gives her weakness. Her family was saddened
with her illness but they learned to accept it.
She feels uncomfortable and dissatisfied with her appearance.
She also feels pity to other people with disabilities.

ROLES & RELATIONSHIP PATTERN:

She is a housewife. Her major responsibility is to take good care
of her family and provide their daily needs. Her family is her priority in
her life.
Her neighborhood is clean and peaceful. They lived there for
over 10 years already. She is a member of a religious organization,

9
BEC (Basic Ecclesial Community), but recently, she is not active, due to
her surgery. She also participated in “PINTAKASI” in their community.

COPING & STRESS TOLERANCE PATTERN:

Her present condition is the most stressful in her life because it
affects her family financially and emotionally.
The major change in her life is not being able to perform
normally. Her family helps her to cope up with these changes she
undergoes. She often talks and prays with her family. Her family is her
inspiration in life.
SEXUALITY & REPRODUCTION PATTERN:
Menstrual History
Age of menarche: 16 years old
Menstruation: 4-5 days duration with moderate flow

Obstetric History
No. of Pregnancy: 5
Outcome of Pregnancy: Normal
Sex and Ages of Children:

VALUES & BELIEF PATTERN:

Her family is her priority in life. She is strict in keeping her family
healthy by eating three times a day. She also believes that health is
wealth.
Her major source of hope and strength in life is her family and
God. Her family prays together every night for continuous blessings
and good health.

10
 Physical
Assessment

11
MENTAL STATUS AND GENERAL APPEARANCE
Patient is 43 years old, female with fair complexion, with a
height of 5’5 feet, and weighs 49 kilos. She can ambulate but with
assistance; with stomach binder due to post-surgical incision. Vital
signs as of first assessment dated October 6, 2009, are as follows:
temperature 37.2°C axillary; heart rate 91 bpm; respiratory rate 26
cpm; BP 110/70 mmHg, taken at the left arm.
Patient is conscious and alert to all questions being asked. She’s
able to answer promptly, but not able to expand her answers. Oriented
to time, place, person and present situation. She’s also able to recall
both long term and short term memories.

HEAD AND SKULL

Head is normocephalic, and no lesions noted. Scalp is smooth,
has short, curly hair with white fine hairs noticed.
Face is oval in shape. She was asked to elevate, frown or lower
the eyebrows, close the eyes tightly, puff the cheeks, smile and show
the teeth, and she all made these procedures with ease. Symmetric
facial movements were also noted.

OBSERVE HEAD MOVEMENT

The client’s head movements are still good. She can move her
chin to and from her chest. She can point her chin upward, move her
head towards her shoulders and turn her head left and right with less
effort.

EYES
Eyebrows are slightly brown in color and thin, symmetrical and
evenly distributed. Eyelashes are short and straight, no lesions,
swelling and secretions noted on the eyelids and on both inner and
outer cantus. No edema on the lacrimal glands. Both eyes can move in
coordination, with the outer cantus parallel with the pinna of the ears.

EARS AND HEARING

Ears are equal in size. Color is the same with that of the skin. No
lesions, abnormalities, swelling or tenderness were found in the

12
auricles and earlobes. Tympanic membrane is pearly gray color. They
are symmetrical, firm and not tender. Voice tones are equally heard by
both ears.

NOSE AND SINUSES

Nose is slightly pointed and symmetrical. Nasal septum is normal
and with no signs of flaring, lesions and swelling. Is able to smell.
Some secretions of the nose are noted.
It has the same color with the skin of the face, no tenderness or
lesions noted in the external nose. Air moves freely as the client
breathes through the nares. The internal nasal cavity is normal, the
mucosa is pink, and has clear, watery discharge. The sinuses are
palpated and no evidence of swelling or lumps noted.

MOUTH AND OROPHARYNX

Lips are dry and slightly pale. Both upper and lower teeth are
slightly yellowish, but no cavities are noted. Hard and soft palates are
intact. The tongue is pink in color, moist, slightly rough, thick, has
whitish coating, is smooth, and has lateral margins and no lesions
noted. It is located at the center of the mouth, and is freely movable.
The gums are slightly dark in color, moist and firm.

NECK
No tenderness, nodules or lumps were noted in the neck. The
muscles in the neck are equal in size, head is centered, and have
coordinated smooth movements with no discomforts felt. Head flexes
at 45°, hyperextends at 60°, head laterally flexes at 40° and head
laterally rotates at least 70°.
The lymph nodes are not palpable. The trachea is in normal
placement in the midline of the neck and spaces are equal on both
sides. The thyroid gland is not visible on inspection. The gland ascends
normally during swallowing.

THORAX AND LUNGS

Anteroposterior to transverse ratio is 1:2. The chest is
symmetric, and the spine is vertically aligned. Spinal column is
straight, right and left shoulders and hips are at same height. The skin
and chest wall are intact, with no tenderness and masses noticed.
Full and symmetric chest expansion was observed. Vocal
fremitus, is bilaterally symmetrical, and is heard most clearly at the

13
apex of the lungs. She has quiet, rhythmic, and slightly fast
respirations and full symmetric excursion.

PERIPHERAL VASCULAR SYSTEM

Arms: Are symmetrical, has intact skin, with no edema or tenderness
noted. They are able to move freely, with rapid and strong radial pulse
felt. Buerger’s test was done and original skin color returns within 10
seconds in the hands. Capillary refill test was made and there was an
immediate return of skin color.
Legs:Are symmetrical, with no presence of edema, and with visible
scars noted in both legs.

BREAST AND AXILLAE

Breasts are round in shape, slightly unequal in size, and
generally symmetric. The skin is uniform in color, and is smooth and
intact. No tenderness, masses, nodules or nipple discharges were
noted.

MOTOR FUNCTION
Patient was sitting on bed with legs slightly flexed with evident
weakness on it. Movements are limited but can reposition herself on
bed on her own but with slight facial grimace. She’s able to walk but
needs assistance.

14
Laboratories

15
 HEMATOLOGY LABORATORY REPORT
9/19/09

Labs Findings/Result Normal Values Interpretation

Hct 0.20 38-48%/L severe anemias;
Acute massive
blood loss
Neutrophils 0.75 40-60%/L acute infections
Trauma/surgery
Lymphocytes 0.75 20-40%/L bacterial
infections

LABORATORY REPORT
9/20/09

Labs Findings/Result Normal Values Interpretation

BUN 1.73 mmol/L 2.1-7.1 mmol/L low protein diet;
Starvation

HEMATOLOGY LABORATORY REPORT

9/25/09

Labs Findings/Result Normal Values Interpretation

Hgb 96gm/L 120-150gm/L various anemias
Severe/prolonged
Hemorrhage
Hct 29gm/L 38-48%/L severe anemias;
Acute massive
Blood loss

HEMATOLOGY LABORATORY REPORT

9/28/09

Labs Findings/Result Normal Values Interpretation

Hgb 7.6 gm/L 12-15gm/L various anemias
Severe/prolonged
Hemorrhage
Hct 23/L 40-50/L severe anemias
Acute massive
Blood loss

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 HEMATOLOGY LABORATORY REPORT
9/30/09

Labs Findings/Result Normal Values Interpretation

Hct 0.35 38-48% severe anemias
Acute massive
Blood loss

ROENTGENELOGIC REPORT
9/19/09

Procedures: Chest PA XRAY# 099168

Findings: The lung fields are clear.

The heart is not enlarged.
The hemidiaphragms & CP sulci are intact.
The osseous & soft tissue structures are
unremarkable.

Impression: No significant chest findings.

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 ULTRASOUND REPORT
GYNECOLOGY

Referred by: Dr. M. Napasindayao

Date: 07/27/09
LMP: 07/11 day 17

Uterus: 7.3x4.0x4.9 cm
Cervix: 2.4x3.1x3.7 cm
Endometrium: 1.0 cm
Right Ovary: 2.3x2.0x1.7 cm lateral
Left Ovary: 2.4x2.0x1.8 cm posterolateral
Other: No free fluid in the cul de sac

Remarks: The uterus is anteverted w/ irregular contour &

heterogenous in echopattern. The endometrium is hyperechoic w/
intact subendometrial halo.
Within the vaginal canal is a hyperechogenic structure measuring
6.1x3.3 cm originating w/in the uterus sonologic features suggestive of
Prolapsed Endometrial Polyps vs. Prolapsed Submucous Myoma.
The cervix is close,w/o nabothian cyst.
Both ovaries appear normal w/ small follicles less than 1cm
in diameter.
No fluid in the cul de sac.

Impression: Utero-Prolapsed Endometrial Polyps vs. Prolapsed

Submucous
Myoma
Both Ovaries appear normal w/ small follicles noted.
No fluid in the cul de sac.

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 Anatomy
and
Physiology

19
20
21
 EXTERNAL GENITALS

Vulva

The external female genitals are collectively referred to as The

Vulva. This consists of the labia majora and labia minora (while these
names translate as "large" and "small" lips, often the "minora" can be
larger, and protrude outside the "majora"), mons pubis, clitoris,
opening of the urethra (meatus), vaginal vestibule, vestibular bulbs,
vestibular glands.

The term "vagina" is often improperly used as a generic term to

refer to the vulva or female genitals, even though - strictly speaking -
the vagina is a specific internal structure and the vulva is the exterior
genitalia only. Calling the vulva the vagina is akin to calling the mouth
the throat.

Mons Veneris

The mons veneris, Latin for "mound of Venus" (Roman

Goddess of love) is the soft mound at the front of the vulva (fatty
tissue covering the pubic bone). It is also referred to as the mons
pubis. The mons veneris is sexually sensitive in some women and
protects the pubic bone and vulva from the impact of sexual
intercourse. After puberty it is covered with pubic hair, usually in a
triangular shape. Heredity can play a role in the amount of pubic hair
an individual grows.

Labia Majora

The labia majora are the outer "lips" of the vulva. They are
pads of loose connective and adipose tissue, as well as some smooth
muscle. The labia majora wrap around the vulva from the mons pubis
to the perineum. The labia majora generally hides, partially or entirely,
the other parts of the vulva. There is also a longitudinal separation
called the pudendal cleft. These labia are usually covered with pubic
hair. The color of the outside skin of the labia majora is usually close
to the overall color of the individual, although there may be some
variation. The inside skin is usually pink to light brown. They contain
numerous sweat and oil glands. It has been suggested that the scent
from these oils are sexually arousing.

22
Labia Minora

Medial to the labia majora are the labia minora. The labia
minora are the inner lips of the vulva. They are thin stretches of
tissue within the labia majora that fold and protect the vagina,
urethra, and clitoris. The appearance of labia minora can vary widely,
from tiny lips that hide between the labia majora to large lips that
protrude. There is no pubic hair on the labia minora, but there are
sebaceous glands. The two smaller lips of the labia minora come
together longitudinally to form the prepuce, a fold that covers part of
the clitoris. The labia minora protect the vaginal and urethral
openings. Both the inner and outer labia are quite sensitive to touch
and pressure.

Clitoris

The clitoris, visible as the small white oval between the top of
the labia minora and the clitoral hood, is a small body of spongy tissue
that functions solely for sexual pleasure. Only the tip or glans of the
clitoris shows externally, but the organ itself is elongated and
branched into two forks, the crura, which extend downward along the
rim of the vaginal opening toward the perineum. Thus the clitoris is
much larger than most people think it is, about 4" long on average.

Urethra

The opening to the urethra is just below the clitoris. Although it

is not related to sex or reproduction, it is included in the vulva. The
urethra is actually used for the passage of urine. The urethra is
connected to the bladder. In females the urethra is 1.5 inches long,
compared to males whose urethra is 8 inches long. Because the
urethra is so close to the anus, women should always wipe themselves
from front to back to avoid infecting the vagina and urethra with
bacteria. This location issue is the reason for bladder infections being
more common among females.

Perineum

23
 The perineum is the short stretch of skin starting at the bottom
of the vulva and extending to the anus. It is a diamond shaped area
between the symphysis pubis and the coccyx. This area forms the floor
of the pelvis and contains the external sex organs and the anal
opening. It can be further divided into the urogenital triangle in front
and the anal triangle in back.

The perineum in some women may tear during the birth of an

infant and this is apparently natural. Some physicians however, may
cut the perineum preemptively on the grounds that the "tearing" may
be more harmful than a precise cut by a scalpel. If a physician decides
the cut is necessary, they will perform it. The cut is called an
episiotomy.

24
 INTERNAL GENITALS

Vagina

The vagina is a muscular, hollow tube that extends from the

vaginal opening to the cervix of the uterus. It is situated between the
urinary bladder and the rectum. It is about three to five inches long in
a grown woman. The muscular wall allows the vagina to expand and
contract. The muscular walls are lined with mucous membranes, which
keep it protected and moist. A thin sheet of tissue with one or more
holes in it, called the hymen, partially covers the opening of the
vagina. The vagina receives sperm during sexual intercourse from the
penis. The sperm that survive the acidic condition of the vagina
continue on through to the fallopian tubes where fertilization may
occur.

The vagina is made up of three layers, an inner mucosal layer, a

middle muscularis layer, and an outer fibrous layer. The inner layer is
made of vaginal rugae that stretch and allow penetration to occur.
These also help with stimulation of the penis. microscopically the
vaginal rugae has glands that secrete an acidic mucus (pH of around
4.0.) that keeps bacterial growth down. The outer muscular layer is
especially important with delivery of a fetus and placenta.

Purposes of the Vagina

• Receives a males erect penis and semen during sexual

intercourse.
• Pathway through a woman's body for the baby to take during
childbirth.
• Provides the route for the menstrual blood (menses) from the
uterus, to leave the body.
• May hold forms of birth control, such as a diaphragm, FemCap,
Nuva Ring, or female condom.

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Cervix

The cervix (from Latin "neck") is the lower, narrow portion of

the uterus where it joins with the top end of the vagina. Where they
join together forms an almost 90 degree curve. It is cylindrical or
conical in shape and protrudes through the upper anterior vaginal wall.
Approximately half its length is visible with appropriate medical
equipment; the remainder lies above the vagina beyond view. It is
occasionally called "cervix uteri", or "neck of the uterus".

During menstruation, the cervix stretches open slightly to allow

the endometrium to be shed. This stretching is believed to be part of
the cramping pain that many women experience. Evidence for this is
given by the fact that some women's cramps subside or disappear
after their first vaginal birth because the cervical opening has widened.

The portion projecting into the vagina is referred to as the portio

vaginalis or ectocervix. On average, the ectocervix is three cm long
and two and a half cm wide. It has a convex, elliptical surface and is
divided into anterior and posterior lips. The ectocervix's opening is
called the external os. The size and shape of the external os and the
ectocervix varies widely with age, hormonal state, and whether the
woman has had a vaginal birth. In women who have not had a vaginal
birth the external os appears as a small, circular opening. In women
who have had a vaginal birth, the ectocervix appears bulkier and the
external os appears wider, more slit-like and gaping.

The passageway between the external os and the uterine cavity

is referred to as the endocervical canal. It varies widely in length
and width, along with the cervix overall. Flattened anterior to
posterior, the endocervical canal measures seven to eight mm at its
widest in reproductive-aged women. The endocervical canal terminates
at the internal os which is the opening of the cervix inside the uterine
cavity.

During childbirth, contractions of the uterus will dilate the cervix

up to 10 cm in diameter to allow the child to pass through. During
orgasm, the cervix convulses and the external os dilates.

26
Uterus

The uterus is shaped like an upside-down pear, with a thick lining and
muscular walls. Located near the floor of the pelvic cavity, it is hollow
to allow a blastocyte, or fertilized egg, to implant and grow. It also
allows for the inner lining of the uterus to build up until a fertilized egg
is implanted, or it is sloughed off during menses.

The uterus is only about three inches long and two inches wide, but
during pregnancy it changes rapidly and dramatically. The top rim of
the uterus is called the fundus and is a landmark for many doctors to
track the progress of a pregnancy. The uterine cavity refers to the
fundus of the uterus and the body of the uterus.

Helping support the uterus are ligaments that attach from the body of
the uterus to the pelvic wall and abdominal wall. During pregnancy the
ligaments prolapse due to the growing uterus, but retract after
childbirth. In some cases after menopause, they may lose elasticity
and uterine prolapse may occur. This can be fixed with surgery.

Some problems of the uterus include uterine fibroids, pelvic pain

(including endometriosis, adenomyosis), pelvic relaxation (or
prolapse), heavy or abnormal menstrual bleeding, and cancer. It is
only after all alternative options have been considered that surgery is
recommended in these cases. This surgery is called hysterectomy.
Hysterectomy is the removal of the uterus, and may include the
removal of one or both of the ovaries. Once performed it is
irreversible.

27
Fallopian Tubes

At the upper corners of the uterus are the fallopian tubes.

There are two fallopian tubes, also called the uterine tubes or the
oviducts. Each fallopian tube attaches to a side of the uterus and
connects to an ovary. They are positioned between the ligaments that
support the uterus. The fallopian tubes are about four inches long and
about as wide as a piece of spaghetti. Within each tube is a tiny
passageway no wider than a sewing needle. At the other end of each
fallopian tube is a fringed area that looks like a funnel. This fringed
area, called the infundibulum, lies close to the ovary, but is not
attached.

28
 LOCATION &
STRUCTURE FUNCTION
DESCRIPTION

During childbirth, contractions

of the uterus will dilate the
cervix up to 10 cm in diameter
The lower narrower
Cervix to allow the child to pass
portion of the uterus.
through. During orgasm, the
cervix convulses and the
external os dilates
Small erectile organ
Sexual excitation, engorged
Clitoris directly in front of the
with blood.
vestibule.
Extending upper part of Egg transportation from ovary
Fallopian
the uterus on either to uterus (fertilization usually
tubes
side. takes place here).
Thin membrane that
partially covers the
Hymen
vagina in young
females.
Outer skin folds that
Labia majora surround the entrance Lubrication during mating.
to the vagina.
Inner skin folds that
Labia minora surround the entrance Lubrication during mating.
to the vagina.
Mons Mound of skin and
underlying fatty tissue,
central in lower pelvic

29
 region
Provides an environment for
Ovaries maturation of oocyte.
Pelvic region on either
(female Synthesizes and secretes sex
side of the uterus.
gonads) hormones (estrogen and
progesterone).
Short stretch of skin
starting at the bottom
Perineum
of the vulva and
extending to the anus.
Pelvic cavity above
Urethra Passage of urine.
bladder, tilted.
To house and nourish
Uterus Center of pelvic cavity.
developing human.
Receives penis during mating.
Pathway through a womans
body for the baby to take during
Canal about 10-8 cm childbirth. Provides the route for
long going from the the menstrual blood (menses)
Vagina
cervix to the outside of from the uterus, to leave the
the body. body. May hold forms of birth
control, such as an IUD,
diaphragm, neva ring, or female
condom
Surround entrance to
the reproductive tract.
Vulva
(encompasses all
external genitalia)
Contains glands that secrete
The innermost layer of
Endometrium fluids that bathe the utrine
uterine wall.
lining.
Smooth muscle in Contracts to help expel the
Myometrium
uterine wall. baby.

30
Pathophysiology

31
 Risk Factors:

Increased risk of fibroids

a. overweight women
b. Advancing age
c. Black women
d. Family history
e. Nulliparity

Lower risk of fibroids

a. five pregnancies or more
b. menopause
c. oral contraceptive
d. tobacco use

increased level of secretion of estrogen & secretion of progesterone

somatic mutation of normal myometrium

growth of myoma (submucous)

abnormal backache constipation

endometrial pressure
bleeding

pelvic pressure/ bloating urinary problems

32
pain sensation

Ideal Signs
and
Symptoms

33
IDEAL S/S PATIENT’S MANIFESTATION
SCIENTIFICBASIS

Abnormal endometrial The patient consumed Submucous

myoma can
Bleeding 5 sanitary napkin in increase the size
&
A day surface mucosal
necrosis
& infection,which led
to
bleeding

Pain sensation Patient experienced Uterine

submucous
Abdominal pain with myoma stimulate
Pain scale of 8 spastic
contraction
Which can cause
acute
Abdominal pain

Backache pressure Patient claimed to have Due to the

pressure
A slight backache created by the
Myoma in which
Creates a feeling of
Heaviness or
bearing
Down sensation.

Constipation Patient had not defecated Growth in the

posterior
For 3 days wall of the uterus
Myoma can oppress
rectum
causing
constipation
Or even difficult

34
 defecation

Urinary problems Urinary frequency in small Oppression in

the
bladder
Amounts causing
frequent/difficult
Urination.

Summary of
Significant
Findings
35
SIGNIFICANT FINDINGS NURSING DIAGNOSIS

Health History:

Gordon’s Functional Health Pattern:

• Constipation Impaired bowel elimination

r/t
Irregular defecation habit

• Decrease Time of Sleep Altered sleep pattern

r/t
Uncomfortable sleep
environment

• Guarding of the Incision Area Risk for infection r/t

tissue
Trauma secondary to surgical
Incision.

• Inadequate Exercise Activity intolerance r/t

fatigue

• Decrease Movement Activity intolerance r/t

fatigue

Physical Assessment:

36
• Dry Skin Self-care deficit r/t inability to
Perform ADL.

• Decrease Appetite Imbalance Nutrition less than

Body requirements r/t
Inability
to ingest food secondary to
surgical incision.

• Surgical Incision Acute pain r/t tissue

trauma
secondary to surgical
incision.

Laboratories:

Hematology Laboratory Report

Significant Findings Nursing Diagnosis

Hct Fluid volume deficit r/t active

Fluid loss secondary to
bleeding

Neutrophils Risk for infection r/t

inadequate
Secondary defenses secondary
To decreased hemoglobin

Lymphocytes Risk for infection r/t

inadequate
Secondary defenses secondary
To decreased hemoglobin

BUN Starvation related to lack of

Nutritional Intake.

37
Hgb Fluid volume deficit r/t active
fluid
Loss secondary to bleeding

38
 Drug Study

GENERIC NAME: SCOPALAMINE HYDROBROMIDE

BRAND NAME: hyosine HBr

CLASSIFICATION
Anticholinergic, Antiemetic, Anti-motion sickness drug,
antimuscarinic, antiparkinsonian, Antispasmodic, Belladona alkaloid,
Parasympatholytic
Therapeutic actions

MECHANISMS OF ACTIONS
Anti motion-sickness, drug not understood; antiemetic action
may be mediated by interference with cholinergic impulses to the
vomiting center, has sedative and amnesia-ionducing properties,
blocks effects of acetylcholine at Muscarinic, cholinergic receptors that
mediate effects of parasympathetic postganglionic impulses, thus
depressing salivary and bronchial secretions, inhibiting vagal
influences on the heart, relaxingthe GI and Gi tracts, inhibiting gastric
secretions, relaxing the pupil of the eye (mediatric effect), and
preventing accommodation of near vision. (cycloplegic effect)

INDICATIONS

39
 Transdermal system: prevention and control of nausea and
vomiting associated with motion sickness and recovery from surgery.
Adjunctive therapy with antacids and H2 anqtihistamines in peptic
ulcer supportive treatment of functional GI disorder (diarrhea,
pylorospasm, hypermobility, IBC, spastic colon, acute intrcolitis,
panscreatitis, infant colic).
Pre-anesthetic medication to control bronchial, nasal, pharyngeal and
salivary secretions: prevent bronchospasm and laryngospasm; block
cardiac vagal inhibitory reflexes during introduction and intubation;
produce sedation.
Introduction of obstetric amnesia with analgesic calming delirium.
Treatment of postencephalitic parkinsonism and paralysis
agitants;relief of symptoms in spastic states.

Opthalmic solution: diagnostically produce mydriasis and

cycloplegia, preoperative and postoperative status in the treatment of
Iredocyclitis.

CONTRAINDICATIONS
Contraindicated with hypersensitivity to anticholinergic drugs;
glaucoma; adhesive between iris and lens; sterosing peptic ulcer,
pyloroduodenal obstruction, paralytic, intestinal atony, severe
ulcerative colitis, toxic megacolon, symptomatic prostatic hypertrophy,
bladder neck obstruction+, bronchial asthma, COPD, cardia arethmias,
tachycardia, myocardial ischemia; impaired metabolic, liver, renal
function ( increase likelihood of adverse CNS effects); myasthenia
gravis, pregnancy ( causes resp.depression in neonates, contributes to
neonatal hemorrhage); lactation period.
Use cautiously with down syndrome, brain damage, spasticity,
hypertension, hyperthyroidism; glaucoma or tendency to glaucoma
ophthalmic solution.

SIDE EFFECTS
CCNS=pupil dilation, photophobia, blurred vision, headache,
drowsiness, dizziness, mental confusion, excitement, restlessness,
hallucinations delirium the presence of pain.
CV=palpitations, tachycardia
GI=dry mouth, constipation, paralytic ileus, altered taste perception,
nausea, vomiting dysphagia, heartburn.
GU=urinary resistancy and retention, impotence

Hypersensitivity: Anaphylaxis, urtecaria, other dermatologic effects.

Other: suppression of lactation, flushing, fever, nasal congestion,
decrease sweating

40
NURSING INTERVENTIONS
1) Ensure adequate hydration; provide environmental control to
prevent hyperpyrexia.
2) Teaching points
3) Take as prescribed, 30-60 mins. Before meals, avoid excessive
dosage
4) Avoid hot environment. You will be heat intolerant, and dangerous
reactions may occur.
5) Avoid alcohol; serious sedation may occur.
6) When using transdermal system, take care to wash hands
thoroughly after handling patch and dispose of patch properly to
avoid contact with children ad pets.
7) You may experience these side effects:dizziness, sedations,
drowsiness (use caution driving or performing task that requires
alertness)constipation (ensure adequate fluid intake, proper diet)
dry mouth, blurred vision, sensitivity to light ( reversible, avoid task
that require acute vision, wear sunglasses);impotence (reversible);
difficulty urinating (empty bladder before taking drug)
8) Report rash, flushing, eye pain, difficulty breathing, tremors, loss of
coordination, regular heartbeat, abdominal distention,
hallucinations, severe or persistent dry mouth, difficulty urinating,
constipation, sensitivity to light

GENERIC NAME: METRONIDAZOLE

BRAND NAME: Viaflex

CLASSIFICATION
Antibacterial, antibiotic, antiprotozoal, Amobacide

MECHANISM OF ACTION
Bactericidal; inhibits DNA synthesis in specific amoerobes,
causing cell death; antiprotozoal-trichomonacidal, amebicidal.

INDICATION
1) Acute infection susceptible anaerobic bacteria.
2) Acute intestinal amoebiasis
3) Amoebic liver abscess
4) Trichomoniasis (acute and partners of patient with acute infection)
5) Bacterial vaginosis
6) Preoperative, intra-operative, post-operative prophylaxis for patient
undergoing colorectal surgery.
7) Topical application; Treatment of inflammatory papules, pustules
and erythema of rosacea.

41
8) Unlabeled uses; Prophylaxis for patient undergoing gynecologic
abdomen surgery.

CONTRAINDICATION:
1) Contraindicated with hypersensitivity to metronidazole; pregnancy
(do not use in 1st trimester)
2) Use cautiously with CNS disease, hepatic disease, candidiasis, blood
dyscrasis, and lactation.

SIDE EFFECTS
CNS=Headache, dizziness, vertigo, insomnia, incoordiantion, seizures,
peripheral neuropathy, fatigue.
GI=Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea,
GI upset and cramps.
GU=Dysuria, incontinence, darkening of the urine.
LOCAL=thrombophlebitis, redness, burning dryness and skin irritation.
OTHER=Severe, disufiram-like interaction with alcohol, candidiasis
(super infection)

NURSING INTERVENTION:
1) Administer oral doses with food.
2) Apply topically (metrogel) after cleansing the area. Advise patient
that cosmetics may be used over the area after application.
3) Reduce dosage in hepatic disease.

GENERIC NAME: CEFOROXIME

BRAND NAME: Ceftin

CLASSIFICATION
Antibiotic, Cephalosporine (2nd generation)

MECHANISM OF ACTION
Bactericidal; inhibits synthesis of bacterial cell wall, causing cell
death.

INDICATION
1. Oral
-Pharyngitis, tonsillitis caused by streptococcus pyogens.
-Otitis media caused by streptococcus pneumonae, S. pyogens,
haemophilus influenzae, moraxella catarrhalis.
-Low respiratory infections caused by S. pneumonae,
haemophilus parainfluenzae.
-UTI caused by Escherichia coli, klebsiella pneumonae.

42
 -Uncomplicated gonorrhea
-Skin and skin structure infections, including impetigo caused by
S. aureus, S. pyogens.
-Treatment of early lymedisease.
2. Parenteral
-Lower respiratory infections caused by S. pneumonae, S.
aureus, E. coli, klebsiella pneumonae, H. influenzae, S. pyogens.
-Dermatologic infections caused by S. aureus, S. pyogens, E.coi,
pneumonae, enterobacter.
-UTI’s caused by E. coli, K. pneumonae
-Uncomplicated and disseminated gonorrhea caused by
N.gonorrhea
-Septicemia caused by S. pneumonae, S. aureus, E. coli, K.
pneumonae, h. influenzae.
-Meningitis caused by S. pneumonae, H. influenzae, S. aureus,
N. meningitides.
-Bone and joint infections due to S. aureus.
-Pre-operative prophylaxis

SIDE EFFECTS:
CNS=Headache, dizziness, lethargy, paresthesis.
GI=Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,
pseudomembranous.
GU=Nephotoxicity
HEMATOLOGIC Bone marrow depression (decrease WBC, decrease
platelet, decrease hematocrit)
HYPERSENSITIVITY= Ranging from rash to fever to anaphylaxis;
serum sickness reaction.
LOCAL Pain, abcess at injection site, phlebitis, inflammation at IV site
OTHER=Superinfections, disulfram-like readction with alcohol.

NURSING INTERVENTIONS
1. Culture infection and a range for sensitivity test before and
during therapy if expected response is not seen.
2. Give oral drug with food to decrease GI upset and enhance
absorption.
3. Give oral drug to children who can swallow tablet; crushing the
drug results in a bitter unpleasant taste.
4. Have vitamin K available in case hypoprothrombinimia occurs.
5. Discontinue if hypersensitivity reaction occurs.

GENERIC NAME: ranitidine hydrochloride

BRAND NAME: Zantac

43
CLASSIFICATION
Histamine2 (H2) antagonist

MECHANISM OF ACTION
Competitively inhibits the action of histamine at the H2 receptors
of the parietal cells of the stomach, inhibiting basal gastric acid
secretion and gastric acid secretion that is stimulated by food, insulin,
histamine, cholinergic agonists, gastrin and pentogastrin.

INDICATION
1. Short term treatment of active duodenal ulcer at reduced
dosage.
2. Maintenance therapy for duodenal ulcer at reduced dosage.
3. Short term treatment of active, benign gastric ulcer
4. Short term treatment of GERD
5. Pathologic hypersecretory conditions
6. Treatment of erosive esophagitis
7. Treatment of heartburn, acid indigestion, sour stomach.

CONTRAINDICATIONS
Contraindicated with allergy to ranitidine, lactation.
Use cautiously with impaired renal or hepatic function
pregnancy.

SIDE EFFECTS:
CNS=Headache, malaise, dizziness, somnolence, insomnia, vertigo.
CV=Tachycardia, Bradycardia, PVC (Rapid IV Administration)
Dermatologic= Rash and alopecia.
GI=Constipation, diarrhea, nausea, vomiting, abdominal pain,
hepatitis, increase ALT level.
GU=Gynecomastia, impotence or decreased libido.
HEMATOLOGIC=Leukopenia, granulocytopenia, thrombocytopenia
and pancytopenia.
LOCAL=Pain at IM site, local burning or itching at IV site.

NURSING INTERVENTIONS:
1. Administer oral drug with meals and at bedtime.
2. Decrease doses in renal and liver failure.
3. Provide concurrent antacid therapy to relieve pain.
4. Administer IM dose undiluted, deep into large muscle group.
5. Arrange for regular follow up, including blood tests to evaluate
effects.

44
GENERIC NAME: TRAMADOL HYDROCHLORIDE

BRAND NAME: Ultram, Ultram ER

CLASSIFICATION
Analgesic (Centrally acting)

MECHANISM OF ACTION
Binds to un-opioid receptors and inhibits the reuptake of
norephinephrine and serotonin; causes many effects similar to the
opioids-dizziness, somnolence, nausea, constipation but does not have
the respiratory depressant effects.

INDICATION
1. Relief of moderate to moderately severe pain.
2. Relief of moderate to severe chronic pain in adults who need
around the clock treatment for extended period (ER tablets).

CONTRAINDICATIONS
1. Contraindicated with allergy to tramadol or opioids or acute
intoxication with alcohol, opioids, or psychoactive drugs.
2. Use cautiously in pregnancy; lactation; seizures; concomitant
use of CNS depressants, MAOI, SSRI, TCA; renal impairment;
hepatic impairment.

SIDE EFFECTS
CNS= Sedation, dizziness or vertigo, headache, confusion, dreaming,
sweating, anxiety, seizures.
CV= Hypotension, tachycardia, bradycardia.
DERMATOLOGIC= sweating, pruritus, rash, pallor, flatulence.
OTHER= Potential for abuse, anaphylactoid reactions.

NURSING INTERVENTIONS
Control environment (temperature, lighting) if sweating or CNS
effects occur.

DRUG NAME: METOCLOPROMIDE

CLASSIFICATION
Antiemetic, Dopaminergic, GI stimulant

MECHANISM OF ACTION
Stimulate motility of upper GI tract without stimulating gastric,
biliary, or pancreatic secretions; ppears to sensitize tissues to action of

45
acetylcholine; relaxes pyloric sphincter, which, when combined with
effects on motility, accelerates gastric emptying and intestinal transit;
little effect on gallbladder or colon motility; increases lower esophageal
sphincter pressure; has sedative properties; induces release of
prolactin.

INDICATION
1. Relief of symptoms of acute and recurrent diabetic gastroparesis
2. Short term therapy (4-12 weeks) for adults with sympathetic
gastroesophageal reflux who fail to respond to conventional
therapy.
3. Parenteral: prevention of nausea and vomiting associated with
emetogenic cancer chemotherapy.
4. Prophylaxis of postoperative nausea and vomiting when
nasogastric suction is undesirable.
5. Single-dose parenteral use: Stimulation of gastric emptying and
intestinal transit of barium when delayed emptying interferes
with radiologic examination of the stomach or small intestine.

CONTRAINDICATION
1. Contraindicated with allergy to metoclopromide; GI hemorrhage,
mechanical obstruction or perforation; pheochromocytoma;
epilepsy.
2. Use cautiously with previously defected breast cancer (one third
of such tumors are prolactin dependent); lactation, pregnancy;
fluid overload; renal impairment.

SIDE EFFECT
CNS=Restlessness, drowsiness,fatigue, lassitude, insomnia,
extrapyramidal reactions, parkinsonism-like reactions, akathisia,
dystonia, myoclonus, dizziness, anxiety.
CV=Transient hypertension
GI=Nausea, diarrhea

NURSING INTERVENTIONS
1. Monitor blood pressure carefully during IV administration.
2. Monitor for extrapyramidal reactions, and consult physician if
they occur.
3. Monitor diabetic patients, arrange for alteration in insulin dose or
timing if diabetic control is compromised by alterations in timing
of food absorption.

GENERIC NAME: PARACETAMOL

46
CLASSIFICATION
Antipyretic, Analgesic

MECHANISM OF ACTION
Paracetamol has long been suspected of having a similar
mechanism of action to aspirin because of the similarity in structure.
That is, it has been assumed that paracetamol acts by reducing
production of prostaglandins, which are involved in the pain and fever
processes, by inhibiting the cyclooxygenase (COX) enzyme.

INDICATION
The preparation is indicated in diseases manifesting with pain
and fever: headache, toothache, mild and moderate postoperative and
injury pain, high temperature, infectious diseases and chills (acute
catarrhal inflammations of the upper respiratory tract, flu, small-pox,
parotitis, etc.).

CONTRAINDICATIONS
Paracetamol should not be used in hypersensitivity to the
preparation and in severe liver diseases.

SIDE EFFECTS
In rare cases hypersensitivity reactions, predominantly skin
allergy (itching and rash), may appear. Long-term treatment with high
doses may cause a toxic hepatitis with following initial symptoms:
nausea, vomiting, sweating, and discomfort. Occasionally a
gastrointestinal discomfort may be seen.

NURSING INTERVENTIONS
Assessment & Drug Effects
1. Monitor for S&S of: hepatotoxicity, even with moderate
acetaminophen doses, especially in individuals with poor
nutrition or who have ingested alcohol over prolonged periods;
poisoning, usually from accidental ingestion or suicide attempts;
potential abuse from psychological dependence (withdrawal has
been associated with restless and excited responses).
2. Patient & Family Education
3. Do not take other medications (e.g., cold preparations)
containing acetaminophen without medical advice; overdosing
and chronic use can cause liver damage and other toxic effects.
4. Do not self-medicate adults for pain more than 10 d (5 d in
children) without consulting a physician.

47
 5. Do not use this medication without medical direction for: fever
persisting longer than 3 d, fever over 39.5° C (103° F), or
recurrent fever.
6. Do not give children more than 5 doses in 24 h unless prescribed
by physician.
7. Do not breast feed while taking this drug without consulting
physician.

GENERIC NAME: NICOTINAMIDE MONONUCLEOTIDE

BRAND NAME: Nicotinamide

CLASSIFICATION
Nucleotides

MECHANISM OF ACTION
Treatment with high doses of nicotinamide (niacinamide, vitamin
B3) prevents or delays insulin-deficient diabetes in several animal
models of type 1 diabetes and protects islet cells against cytotoxic
actions in vitro. In recent-onset type 1 diabetes, nicotinamide
administration improves beta-cell function, without significantly
decreased insulin requirements. This review discusses the possible
mechanism of action of nicotinamide in vivo. It is proposed that the
key target of nicotinamide is the poly(ADP-ribose)polymerase (PARP),
and to a lesser extent (mono)ADP-ribosyl transferases (ADPRTs).
Suppression of PARP activity by nicotinamide not only decreases
consumption of NAD+, the substrate of PARP, but also has major
regulatory effects on gene expression, as shown for the major
histocompatibility complex class II gene. In addition, PARP activity
controls early steps of apoptosis. The possible suppression of ADPRTs
by nicotinamide would also affect CD38, a membrane-bound external
ADP-ribosyl transferase with potent immunoregulatory properties.
Taken together, it is proposed that high doses of nicotinamide
primarily affect ADP-ribosylation reactions in beta-cells as well as in
immune cells and the endothelium. As a consequence, cell death
pathways and gene expression patterns are modified, leading to
improved beta-cell survival and an altered immunoregulatory balance.

INDICATION
Indicated for non-pregnant patients with acne vulgaris, rosacea
or other inflammatory skin disorders who are deficient in, or at risk of
deficiency in, one or more of the components of Nicomide®.

48
CONTRAINDICATIONS
Nicomide® is contraindicated in patients with hypersensitivity to
any of its components. Supplemental copper is contraindicated in
those with Wilson's disease (hepatolenticular degeneration) a disease
of abnormal copper accumulation.

SIDE EFFECTS
Allergic sensitization has been reported rarely following oral and
parenteral administration of Folic Acid.
At recommended doses, Nicomide® is expected to be well tolerated.
Gastrointestinal distress such as nausea or vomiting have been
associated with the administration of nicotinamide or zinc at doses
greater than the recommended dose of Nicomide®.

Nicotinamide: Dizziness, headache, hyperglycemia, nausea, vomiting,

diarrhea, elevations in liver function tests, hepatotoxicity, blurred
vision, flushing, rash.

49
Discharge Plan

50
HEALTH VISIT:

 Advise the patient regarding her next visit for health as

scheduled by DRA. AGUDO.
o Her next visit is on October 16, 2009 at ODH 10:00 a.m.

ACTIVITY LEVEL:

 Discuss with patient the type and degree of any resulting

impairment and disabilities.
 Encourage the patient to do ROM exercises to promote muscle
strength, endurance and control, such as:

o Flexion – Raise each arm from a position by the side

forward and upward to a position beside the head.
o Extension – Move each arm from a vertical position beside
the head forward and downward to a resting position at
the side of the body.
o Hyperextension – Move each arm from a resting side
position to behind the body.
o Abduction – Move each arm laterally from a resting
position at the sides to a side position above the head,
palm and hand away from the head.
o Adduction – Move each arm from a position at the sides
across the front of the body as far as possible.

 Instruct the patient to avoid heavy activities at home and in the

community.
 Encourage the patient good nutrition and diet.

SIGNS AND SYMPTONS:

 Advise the patient to consult her physician immediately if the

following signs and symptoms of infection will appear:

 Fever above 38°C

 Pain not relieve with Physician’s medication
 Swelling at the incision site
 Redness around the area of incision

51
  Foul smelling discharges
 Presence of pus around the area of incision

MEDICATION:

 Provide information about the importance of continuing her

medication which are as follows:
o Vitamins (Lieroferon) {1 cap OD}
o Multivitamins and minerals with lysine {1 cap OD}
o Nicotinamide

 Advise the patient certain information pertaining to drugs

prescribed including side effects.
 Stressed the importance of proper intake of medication. High
dosage may result to a serious adverse effect.
 Provide information not to take alcohol when taking the
medications. It may interfere with the absorption of the
therapeutic effect of the drug.
 Emphasize to the patient that smoking may decrease drugs
effectiveness.

INCISION CARE:

 Discuss the importance of proper wound dressing. Improper

wound dressing may lead to infection.
 Instruct the patient to observe proper aseptic techniques or
wash hands before cleaning her wound at home.
 Teach the patient the proper cleaning of wound.
 Advise the patient to use antiseptic solution such as betadine,
sterile gauze and bandage in cleaning the wound.

NUTRITION:

 Advise patient to eat foods high in protein. This is to promote

wound healing.
 Emphasize the importance of eating nutritious foods.
 Encourage client to eat well balanced diet which include meat,
fish, liver, egg yolk (rich in protein), green leafy vegetables and
fruits (rich in vitamins and minerals). Citrus foods (vitamin C) for
absorption of Iron.
 Encourage patient to drink enough fluid daily.

52
EDUCATION:

 Discuss the related factors affecting wound healing, such as age

and inadequate dressing technique, medication and over activity.
 Advise client or significant others to keep surroundings clean and
stress free to avoid infection.
 Teach the client proper hygiene and good sanitation.
 Teach the client the importance of good nutrition and proper
diet.
 Advise the SO to give the client the whole support needed.
 Advise patient to follow the discharge instructions given.
 Encourage patient to submit to physical rehabilitation, keeping in
mind the goal to return to the highest level of function and
independence as possible and restore activities of daily living.
 Teach the patient proper wound care to prevent of infection.
 Encourage patient to have adequate rest and sleep to enhance
recovery.

53
Nursing Care
Plans

54
 Table of Contents

Submucosal Myoma

• Introduction 1
• Gordon’s Functional 4
Health Pattern
• Physical 10
Assessment
• Laboratory Findings 14
• Anatomy and 18
Physiology
29
• Pathophysiology
31
• Ideal Signs and
Symptoms 33
• Summary of
Significant Findings 36
• Drug Study 48
• Discharge Plan 52
• Nursing Care Plans

55