Nursing Management: Patient with Ovarian New Growth

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Running Head: OVARIAN NEW GROWTH

Nursing Management of a Patient with Ovarian New Growth

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Nursing Management of Patient with Ovarian New Growth S.,M. she is a 49 year old female, and nulligravida, under Dr. Cabanela. S.,M admitted that she smokes and drink liquor. She was diagnose with Ovarian New Growth and had her surgery last March 5, 2013 at Valenzuela Medical Center. She was admitted last March 4, 2013. At first S.,M feels pain on her lower pelvic for two years with on and off fever. She also said that her two sisters had a history of abnormal uterine bleeding. When the patient cannot bear the pain she decided to undergo ultrasound. The patient had a surgery to remove the found cyst on her ovaries, and a total abdominal hysterectomy with bilateral salphingo oophorectomy with frozen section was done. Often patients with ovarian new growth can feel pain and should be assessed for alteration of comfort and her pain level.

Pathophysiology Ovarian New Growth has no early symptoms. As Santos (2003) explained that signs can only be felt and seen when the disease is on it’s later stage, when its already sever, when it cannot be cure. The patient may felt constant pain in the pubis area when lying on a bed when go sideward or move. It should not be treated lightly so an operation should be performed immediately to avoid further complications. Ovarian New Growth happens when there is increase in Gonadotropin , affecting the LH, the ovaries will be hyperstimulated causing a hormonal imbalance. Thus it will cause an abnormal proliferation of follicle, when the follicles fail to ovulate it will continue to grow. Cyst grows in size up to 15 cm in diameter. This result to irregular menstrual periods, abdominal girth, fatigue, sense of heaviness in the pelvis, urinary frequency, constipation and painful defecation. The cyst could rupture and result to infection.
Ignatavicius(2006) noted that the risk factors include being over the age of forty, family history, diabetes mellitus, null parity, being under age of 30 years of age at first pregnancy, breast cancer, colorectal cancer, and infertility. S.,M states that her symptoms were present for two years that leads to her TAHBSO procedure.

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History
S.,M a 49 year old female, nulligravida, has no any medical history. She was diagnose with Ovarian New Growth and had surgery last March 5, 2013 and admitted was March 4, 2013. The patient had a check –up twice before she decided to undergone ultrasound, but her two check-ups she was diagnose with UTI and prescribed with some medicines for UTI, but the pain is still there. After the ultrasound the reading was ovarian new growth with sonomorphologic features as described suggestive of non- benign nature. And then this ovarian new growth found is removed through a total abdominal hysterectomy with bilateral salphingo oophorectomy.

Nursing Physical Assessment
S.,M was conscious and coherent, oriented to person place and time. The patient’s vital signs are, BP of 120/80mmHg, temperature was 35.9C, pulse rate of 88bpm, and respiratory rate of 20cpm. The patient stated her pain level was 6/10. The patient has an IV insertion site on the left arm and on going IVF of PNSS x KVO at 900 cc level during my shift. The patient’s skin was dry, warm to touch, and poor elasticity, with moderate hand movement. The patient’s surgical incision was two inches above the umbilicus out to the pubis area. There is a presence of flatus, but stated no bowel movement during my shift. Her diet was soft diet if it is positve flatus and on DAT diet if there is pisitive bowel movement. The frequency of her urine output was 2x during my shift. S.,M appeared pale and thin with generalized body weakness, her hair is well groom and have no foul smell. The patient can walk from her bed to the comfort room with the assistance of her watcher.

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Related Treatment
The patient has no allergies on latex, iodne, or adhesive and is using an abdominal binder for support. The patient has an IV insertion site on her left arm for the on going PNSS IVF. According to the note of Ignatavicius(2006), insertion site must be chosen carefully after consideration of skin integrity, vein condition and activities of daily living. It also stated that IV therapy involves the entire vascular system of multiple system. The patient stated her pain level is 6/10. According to Ignatavicius(2006), the Numeric Pain Distress Scale of 0-10 has 0-4 being no pin, 5-9 being the distressing pain, and 10 being unbearable pain. The patient was taking pain medication of Ketorolac bid. The physician’s order that the patient must be on soft diet if positive flatus and on DAT diet if positive bowel movement, to prevent constipation that which causes to more pain in her incision. Her other medication was Ferrous Sulfate bid (FeSO4) an iron preparation to elevates the serum iron concentration of the patient. Ascorbic Acid OD for the effective and fast absorption of the Ferrous Sulfate.

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Nursing Care Plan S.,M’s nursing diagnosis is alteration in comfort; acute pain related to post-op surgical wound as manifested by body weakness and irritable facial expresson. Patient’s appearance is pale and thin with generalized body weakness; her hair is well groom and has no foul smell with pain level of 6/10. The short term goal is to decrease the pain level from 6/10 to 4/10,and to understand the health teaching. Nursing interventions for patient include encourage do deep breathing exercise by demonstrating how to do it (every 4 hour daily with 5-10 breaths during exercise) to promotes healing of wound and decrease pain felt. Instruct patient to use relaxation techniques or to take a rest with minimal movement to distract attention and reduce tension. Encourage expression of feeling about pain because verbalization allows outlet for emotions and may enhance coping mechanism. Advised patient to eat soft foods that soften stool like papayas. Monitor vital signs for future monitoring. A dependent intervention is to administer analgesic as ordered (Ketorolac). After nursing intervention the patient pain level decreased to 4/10 scale, the patient can verbalized the heath teaching and she’s better now.

Recommendation As a nurse advice and encourage the patient to visit OPD for her follow-up check-up, and advise to take the medications on time if any, and encourage ambulation as a form of exercise for fast wound healing. Render health teaching, and remind the patient about her diet as physician’s order.