Myoma Case Study

HOLY ANGEL UNIVERSITY College of Nursing

In Partial Fulfilment of Requirements for RLE 104

UTERINE

LEIOMYOMA

A Case Study

Presented To: Leonor S. Lumanlan MAN, RN

Submitted By: Joven, Michelle Anne L. Lacsamana, Claire D. Laquindanum, Philein S. Liwanag, Ma. Kristina T. Lopez, Ruchia D. Magcamit, Cindy F. Maniulit, Joe Anne Mae A. GROUP 3 of N-404 September 20, 2010

Uterine Leiomyoma: A Case Study 2

All things are possible with God

In completing this case study, the members of this group encountered many individuals who helped by offering their time, knowledge, and skills.

Before the formal beginning, the group would like to give thanks and acknowledge those individuals who made this study complete.

We would like to first give thanks to the patient, and her family, in being more than hospitable in providing necessary information in completing the family history and allowing the physical assessment to be done completely.

We would like to thank the staff of St. Raphael Foundation Medical Center, who helped clarify many things from the chart and also help give information concerning the patient and his treatments.

We would also like to give a special thank you to our clinical instructor, Ms. Leonor S. Lumanlan for giving their advice based on case studies presented in previous rotations, so that ours may be strengthened somehow.

And last but not least, To the God Almighty, for although this case study was made and passed at such a turbulent time (with preliminary examinations underway with concurrent data collection from our own individual thesis), it was through Gods will that it had been completed, and completed whole-heartedly with much eagerness and passion.

The Members of Group 3 St. Raphael rotation G September 20, 2010

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TABLE OF CONTENTS

INTRODUCTION BRIEF DESCRIPTION OF THE DISEASE NURSE-CENTRED OBJECTIVES NURSING HISTORY PERSONAL HISTORY FAMILY HEALTH-ILLNESS HISTORY HISTORY OF PAST ILLNESS DIAGNOSTIC & LABRATORY PROCEDURES PHYSICAL ASSESSMENT ANATOMY & PHYSIOLOGY PATHOPHYSIOLOGY BOOK-BASED CLIENT-CENTERED MEDICAL MANAGEMENT SURGICAL MANAGEMENT NURSING CARE PLAN DISCHARGE PLANNING LEARNING DERRIVED REFERENCES 44 50 53 60 69 71 72 7 8 9 10 16 34 4 6

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W

e learn more by looking for the answer to a question and not finding it than we do from learning the answer itself.~Lloyd Alexander, American Author, 1924

In the field of nursing, one encounters a wide-array of various diseases and conditions. In order to give adequate and holistic care to individuals, it is necessary that nurses be equipped with the proper knowledge and skills for dealing with different health states. It is only through continuous learning that nurses acquire the necessary skill. A case study is a means of continuing such learning. In doing a case study, the students delve into the question, what is this disease condition? Student nurses learn actively and will be able to handle patients and experience what it means to care for a patient with that particular condition. They learn, from continuous interaction with the patients along side with inquires into books and informative journals of the disease process, it symptoms, and corresponding treatments.

Myomas are one of the conditions which student-nurses encounter during their exposure at the clinical setting. The disease comprises of complexities of the anatomical concepts that surveys a thorough description to understand its manifestations and formulate interventions. It is interesting on our part to learn its definition, causes, and proper management. The studentnurses chose the case to be able to have an insight about the condition.

Brief Description Myoma is a condition where there is a benign growth or tumor of smooth muscle in the wall of the uterus. The said growth is made up of fibrous tissue; hence it is often called a fibroid tumor. Uterine fibroids can be present and be in apparent. Fibroids vary in size and number, and

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are most often slow-growing and usually cause no symptoms. It may grow as a single nodule or in clusters, and may range in size from 1 mm to more than 20 cm in diameter. Myomas are the most frequently diagnosed tumor of the female pelvis, and the most common reason for hysterectomy. Although they are often referred to as tumors, they are not cancerous. Most myomas develop in women during their reproductive years. Myomas do not develop before the body begins producing estrogens. Myomas tend to grow very quickly during pregnancy when the body is producing extra estrogen. Once menopause as begun, the myoma generally stops growing and may begin to shrink due to the loss of estrogen. Fibroids may be removed if they cause discomforts or if they are associated with uterine bleeding. Approximately 25% of myomas will cause symptoms and need medical treatment. Statistics Approximately 25 % of the myomas will cause symptoms and need medical treatment. Myomas that that do not produce symptoms, do not need to be treated. The said 25 % of women cause significant morbidity, including prolonged or heavy menstrual bleeding, pelvic pressure or pain, and in rare cases, reproductive dysfunction. In the Philippines, the estimated number of women is 86,241,697 squared, and the 4,312,084 had been affected of Myoma.

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STUDENT NURSE-CENTRED OBJECTIVES

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After 2 days of interaction with the patient and completing the case study, the student nurses will be able to: Know and understand the disease process and concept of Uterine Leiomyoma

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After 2 days of duty at St. Raphael Foundation Medical Center, the student nurses will be able to: Cognitive Review the proper physical assessment (IPPA) and how to do them efficiently. Understand the disease process: the causes, effects, management, treatment, and possible preventions. Determine the pathophysiology of the condition with their rationale for occurrence of each manifestation. Determine why certain management and medications are given and provided for the condition. Understand how and why certain diagnostic tests are done for the condition. Review the concepts about the anatomy and physiology with regards to the condition.

Psychomotor Perform efficiently physical assessment (IPPA) to the patient. Perform thorough health history from patient and significant others. Participate in the course of care of patient. Provide health teachings to the patient about certain interventions in the maintenance of health care.

Affective Establish rapport and therapeutic interaction with the patient and significant others to obtain necessary information and positive compliance to care being provided. Provide care and health teachings necessary for the betterment of the condition of the patient. Share the learning acquired to co-student-nurses to increase awareness and help them if ever they will encounter patient with the same condition.

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NURSING HISTORY PERSONAL HISTORY Ms. Myoma, a 57-year old female, stands as a mother of 6 children. She is widowed for 11 years since her husband had passed away because of Liver Complications. She lives in Davao City. His nationality is Filipino and was born in Davao City on the 7th of June, 1949. She was admitted in a private hospital in Mabalacat on September 10, 2010 at (time) with the initial diagnosis of Submucous Myoma and chief complaint of Vaginal Bleeding. Ms. Myoma graduated at a public high school and she didnt continue his college level due to financial problem. The one who support their family is her daughter who is a wife of a retired U.S. Navy. Ms. Myoma was raised as a Catholic, where she learned about religious values. She believes in super natural forces and superstitious beliefs. The client seeks medical help from a physician for a serious health condition although she admits to seek help from the Hoax doctor or the local albolaryo who would prescribe alternative medicine to relieve mild signs and symptoms and other bodily discomfort. Ms. Myoma resided at Davao City and occupies a simple house together with her son Mr. Boy, but due to her illness, her children brought her to live with them in Mabalacat so that they could watch her health carefully. Ms. Myoma did not report problems regarding her environment that could interfere with her condition but instead states that he forsake his diet by consuming 4 big cups of black coffee a day. She said that she doesnt exercise before but now she said that walking is her exercise. Ms. Myoma would usually wake up at 5:00 in the morning and then she would drink her coffee. She would clean the house afterwards. She takes her breakfast at 7:00 in

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the morning. He takes his lunch at 11:30 in the morning and his dinner at 7:00 in the evening. He usually sleeps at 8:30 in the evening. FAMILY HEALTH-ILLNESS HISTORY Hereditary disease in the family is Uterine Myoma and Hypertension which her mother, 1 sister and the patient had herself possessed. This shows that Uterine Myoma and Hypertension are evident in their family and are hereditary. GENOGRAM

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HISTORY OF PAST AND PRESENT ILLNESS Besides being hospitalized for her surgery, Ms. Myoma did not have any previous hospital stays. She had only consulted a doctor two years ago, because she noticed that she often had headaches. Upon the assessment with her doctor in Davao, they found that Ms. Myoma had hypertension. To treat this, Ms. Myoma took aspirin and an anti-hyper medication to which she could not recall the name of. In regards to her current illness, Ms. Myoma had noticed that she had begun having vaginal bleeding for about a year. She asked neighbors and friends about this, and because they had told her it was a normal occurrence which may happen as a result of menopause, she sought no further treatment. The bleeding, she explained to student nurses, was not painful, so she believed that it was not really a concern. After telling her children about her condition, her daughter kept insisting that she seek medical advice, however, she refused because of the high costs which comes from hospitalization. After sometime, the bleeding began to increase, and the patient finally listened to the advice of her children. She left for Mabalacat from Davao about a week prior to her hospitalization, in which he doctor referred her to Dr. Flores of St. Raphael Medical Center. After obtaining a necessary cardiopulmonary clearance as well as a pelvic ultrasound (September 9, 2010), the patient was immediately booked for a total hysterectomy which was done on September 11, 2010.

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DIAGNOSTIC & LABRATORY PROCEDURES COMPLETE BLOOD COUNT Diagnostic Procedure HGB (g/dL) Indications or Purpose To measure the hemoglobin Date Ordered & Released Sept 10, 2010 Results 140 Normal Values 120-160 g/dl Analysis and interpretation Normal. Patient was able to compensate with decreased of oxygen carrying capacity and availability of oxygen increased. Normal. The ratio of solid particles in the blood of the patient is in proportion to the liquid part of the blood signifying that the blood is neither too diluted nor too concentrated. Normal. It means that the coagulation capacity and clotting factor of the patient is functioning well.

HCT (%)

To aid diagnosis of abnormal states of hydration, polycythemia and anemia and aids in calculation of erythrocyte indices

Sept 10, 2010

43.1

36.0 47.0

Platelet Count (x10 9/L)

To evaluate platelet production

Sept 10, 2010

246

150 400

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WBC (x10 9/L)

To determine for presence of for further tests such as WBC differential infection and also for determination count

Sept 10, 2010

9.1

4.8 10.8

Normal count. It means the patients immune function is intact and functioning in its optimum. Proximity of the WBC count to the high limit score means the body is trying to fight present developing infection or there is presence of bleeding in some parts of the body. The result is below normal range indicating the possible presence of a viral infection. The result is above normal range indicating infection. The result is above normal range

To provide a numeric estimate of the Segmenters (%) clients immune status. Differential Count:

Sept 10, 2010

40

55-65%

Lymphocytes (%)

To check for immune responses

Sept 10, 2010

48

25-35%

Eosinophils (%)

To determine presence of

Sept 10, 2010

05

2-4%

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multicellular parasites and certain infections

indicating the presence of a parasitic infection.

Monocytes (%)

To determine presence of Chronic inflammatory disease, Parasitic infection, Viral infection

Sept 10, 2010

07

2-6%

The result is above normal range. It means macrophages are activated.

COMPLETE BLOOD COUNT NURSING RESPONSIBILITIES BEFORE, DURING, AND AFTER PROCEDURE

Before the Procedure y y y y y Explain the procedure to the pt. and why it is indicated Inform the patient that fluid and food restriction is not required Inform the patient that a blood sample will be taken. Tell the patient that he may experience transient discomfort from the needle puncture Fill up laboratory request form properly and send it to the laboratory technician during the collection of sample/specimen. During the Procedure y y Inform the patient that pain may be felt through prick in the needle Instruct the patient to calm down to avoid uneasiness.

After the Procedure y y Apply brief pressure to prevent bleeding Apply warm compress if Hematoma will develop at the venipuncture site.

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PELVIC ULTRASOUND Diagnostic Procedure Pelvic Ultrasound Indications or Purpose Visualization of the organs of the pelvis, including the uterus, fallopian tubes, and ovaries. This study is done to detect any masses or obstructions in the region of the pelvis. Date Ordered & Released September 9, 2010 ResultsUterus: Size 6.1 x 4.9 x 5.9 cm, Anteverted, homogenous, No intermual/ subserous myomatous growth Cervix: Size: 2.6 cm x 2.5 cm. Abnormalities: No Focal lesions Endometrium: Endometrium is not delineated. There is a round hyperechoic mass noted measuring 3.2 x 3.8 3.9 cm suggesting endo metrial polyp vs. Submucous myoma Ovaries (Right) 1.7 x 2.4 x 2.4 cm lateral (Left) 2.1 x 2.0 x 2.6 cm Abnormalities: No pathologic ovarian lesion noted

Analysis and interpretation Central mass (3.2 x 3.8 x 3.9 cm) suggestive of endometrial polyp v. Submucous myoma.

PELVIC ULTRASOUND NURSING RESPONSIBILITIES BEFORE, DURING, AND AFTER PROCEDURE Before the Procedure Explain the procedure to the pt. and why it is indicated Instruct the patient to be placed on NPO for 8-12 hours post midnight Acquire a confirmed and informed consent prior to the procedure. Inform patient that the gel and the apparatus to be used may feel cold and uncomfortable as it will be placed on the skin to visualize the organs. During the Procedure y y y y y Provide privacy y Advise patient to remain still while the procedure is being informed After the Procedure y y Document that the procedure has been performed Inform physician when findings are available.

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BLOOD CHEMISTRY Diagnostic Procedure Glucose ; RBS Indications or Purpose To measure the amount of glucose in the blood right at the time of sample collection Date Ordered & Released Sept 10, 2010 Results 101 Normal Values

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Myoma Case Study