ob cssepres

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NGeneral Objective:

After establishing the nurse patient interaction and providing care to the client

and by a thorough assessment and careful study of the clients condition. Students will

gain knowledge and develop skills enhance attitude through the utilization of the

nursing process on the care management of patient with --------------------------------

Specific Objectives:

To define what is ----------------

Present a theoretical framework for the study in relation to a nursing approach

applied to a patient with --------------------.

To know the nursing history, personal data, health history and physical and

functional assessment.

To present the anatomy and physiology

To expound the normal physiology and pathophysiology of the case

To present the laboratory examinations carried out duty for the client, including

its findings..

To discuss the pharmacological management of the disease.

To lay at hand the nursing care plan and the bounds to which the end are

accomplished.

To evaluate the quality of nursing care rendered to the patient

To enhance the knowledge and skills in the delivery of the nursing process

Show a Discharge Planning that the client may use upon discharge to the

hospital.

I. INTRODUCTION

A. Background of the study

a. Incidence, race, gender, age, ratio and proportion

About a fifth of women over 35 have fibroids. Myomas, commonly referred to as

uterine fibroids, are the most common benign (non-cancerous) tumors in women.

Approximately 75% of women will have fibroids at some point in their lives, and a third

of these women will have symptoms severe enough to need treatment

B. Rationale for choosing the case


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-------------------. Hence, we have chosen this case to gain more information

about the occurrence of such illness, its causative factors, and preventive actions and

how to care for a patient with such condition.

C. Significance of the Study

The significance of this study is to enhance/gain knowledge, to develop

skills and to apply the right attitudes of the student nurses in rendering and giving care

to the patient with ----------, its importance and implication. This study will serve as

guidelines in assessing and providing proper nursing care to patient with the same

problem or disease.

These are other significance of the study that would support the above statement:

1. to define and understand what is --------------

2. To know the nursing history, personal data, health history and physical and

functional assessment of the patient

3. To expound the anatomy and physiology and pathophysiology of the case

4. To present the laboratory examinations carried out duty for the client, including

its findings.

5. To discuss the pharmacological management of the disease.

6. To lay at hand the nursing care plan and the bounds to which the end are

accomplished.

7. to enhance the knowledge and skills in the delivery of the nursing process

8. Show a Discharge Planning that the client may use upon discharge to the

hospital.

D. Scope of Limitation

The study will only focus on ----------------------------which is indicative to the

clients health condition and its underlying nursing care relevant for the client within

----------duty at Quezon Medical Center

E. Conceptual and Nursing Theory


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Theoretical Framework:

VIRGINIA HENDERSON THEORY OF NURSING: 14 Basic Needs

Virginia Henderson conceptualized the 14 Fundamental Needs of humans. These are:

Breathing normally.

Eating and drinking adequately

Eliminating body wastes

Moving and maintaining a desirable position

Sleeping and resting

Selecting suitable clothes

Maintaining normal body temperature by adjusting clothing and modifying the

environment

Keeping the body clean and well groomed to promote integument (skin)

Avoiding dangers in the environment and avoiding injuring others

Communicating with others in expressing emotions, needs, fears, or opinions.

Worshiping according to ones faith

Working in such a way that one feels a sense of accomplishment

Playing or participating in various forms of recreation

Learning, discovering or satisfying the curiosity that leads to normal

development and health, and using available health facilities.

Since the diagnosis of our patient is----------we relate Hendersons Theory

because the internal and external surroundings may affect the patient.We

should Identify patients s ability to meet her own needs with or without

assistance, taking into consideration strength, will or

knowledge.-------------------------------------------------------------

As a nurse our goal is to give comfort, care and maintain optimal health care

that can aide our patient for her fast recovery.


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F. Related Literature of the study

Myoma Of The Uterus Definition

The fibroids are benign growths of muscle tissue from the uterus. They are in the formof nodules and occur in different parts of the uterine wall and rarely in the cervix..Fibroids account for many medical visits, tests, medications, and medical procedures.

They are also a major reason for work absences and reduced quality of life.

To determine if you have uterine fibroids, you must consult your physician. Fibroidscan be painful and uncomfortable. Most commonly, symptoms include cramping,abdominal pain, heavy menstrual bleeding, anemia, frequent urination, constipationand a distended stomach.

Myoma Of The Uterus Causes

Myoma is formed from cells that no longer divide properly. These cells then begin to

multiply excessively. Myoma growth depends on the function of the ovaries; children

and postmenopausal women show no (new) myomas.

Myoma of The Uterus Other causes: Hormonal disorders (increased estrogen)

The family suggests predominantly to genetic causes

External factors such as radioactive radiation may play a role

It quickly grows during pregnancy period or when taking birth control pills,

where the body produces more estrogen and stops during menopausal orduring a low level of estrogen.

synthetic chemicals are the reasons for the development of myoma that comes

from our food usually from commercial cattle and chicken, laundry detergents,and lotions that imitate estrogen.
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Myoma Of The Uterus Symptoms At the beginning, the fibroids are asymptomatic

Menstrual disorders caused by: proliferation of the uterine lining, impaired

contractility of the uterus caused by nodules on the uterine wall, disorders ofhemostatic mechanisms.

Irregular periods, intense or prolonged

In early menopause, fibroid growth may accelerate due to increased production

of estrogen, which also causes irregular periods, heavy and thick part.

Type pain and contraction deaf tiraillantes

Myomas that develop in the peritoneal cavity are usually asymptomatic.

When the myoma displaces adjacent organs because of its size, pain colic can occur.

When the fibroid puts pressure on the pelvis, impaired bladder function and urinary

urgency may occur. If the fibroid puts pressure on the rectum, it can result in

constipation. Growth of the myoma in the lower back causes back pain.

Myoma Of The Uterus Diagnosis

History taking into account the patients symptoms Myoma can be suspected during a routine gynecological examination

The consistency of the tumor, its relationship to the uterus and the number of

nodules are suspected of being myoma

Ultrasound examination to locate the myoma

Exploration of the uterus to rule out other tumors, polyps or abnormalities of the

uterus
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Exclusion of pregnancy or malignancy (tissue sample analysis)

Myoma Of The Uterus Treatment Options

Drug: hormonal treatment, that is to say, a progestin therapy, sometimes

allows the absorption of the myoma. Combined hormone therapy may beuseful for a regression of myoma and to prepare for subsequent surgery.

Specific hormone by GnRH analogues.

Surgical removal of myomas by abdominal incision above

the vagina or by laparoscopy (withconcomitant abdominal exploration)

Removal of the entire uterus (hysterectomy) through the vagina or by

laparotomy (abdominal incision)

Embolization (vessel sealing irrigating myoma under local anesthesia) is used

to shrink themyoma

Myoma Of The Uterus Possible Complications

Approximately one third of all myomas result in potentially

serious complications: infertility, recurrent miscarriages. In rare

cases, a myoma becomes malignant (approx. 0.1%). Myomas should however be

subject to regular medical checks.

Uterine myomas present during pregnancy can cause miscarriage.

Examinations (Diagnostic)

Myoma may be suspected during a routine gynecological examination

The consistency of the tumor, its relationship with the uterus and the number ofnodules are suspected of myoma

Ultrasound examination to locate the myoma

Exploration of the uterus to exclude other tumors, polyps or abnormalities of the

uterus

Exclusion of pregnancy or malignancy (analyzes tissue samples)

Treatment/ surgical interentionThe old-fashioned way was to perform a D&C (dilatation and curettage). This

involves a gentle scraping of the uterine lining. Unfortunately, this may miss the polypcompletely, since this procedure is done solely by feel. As the scraping instrumentgoes by, it will likely just push the polyp out of the way without grabbing it.Hysteroscopes now allow us to look right at the polyp as we grasp it or cut it awayfrom the uterine lining. This ensures that the polyp (or, in some cases, multiple polyps)is removed.

TOTAL ABDOMINAL HYSTERECTOMY BILATERAL SALPHINGOOOPHORECTOMY

This is the removal of the uterus including the cervix as well as the tubes andovaries using an incision in the abdomen.

Hysterectomy is the surgical removal of the uterus. Hysterectomy may betotal, as removing the body and cervix of the uterus or partial, also calledsupracervical.
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Salphingo refers specifically to the fallopian tubes that connect the ovaries tothe uterus.

Oophorectomy is the surgical removal of an ovary or ovaries.

Hysterectomy is also referred to as surgical menopause.Operative Position:

Supine

Indications:

Cancer

Dysfunctional uterine bleeding

Endometriosis

Non- malignant growths

Persistent pain to the Pelvis

Previous injury to the uterus

Postpartum obstetrical hemorrhage

Risk and Side Effects:

Increased bladder function problems

Greater risk of developing Cardiovascular problems such as atherosclerosis

Risk for developing osteoporosis

Preoperative Management:

The lower half of the abdomen and the pubic and perineal regions may be

shaved.

These area are cleaned with Povidine iodine.

To prevent contamination and injury to the bladder or intestinal tract, theintestinal tract and the bladder need to be empty. An enema and antisepticdouche may be prescribed the evening before the surgery.

Preoperative meds may be administered before the surgery.

Postoperative Management:

Monitor closely peripheral circulation

Rationale: To prevent thrombophlebitis and DVT ( noting varicosities,promoting circulation, using elastic compression stockings)

Monitor Input and Output

Rationale: Voiding problems may occur due to the fact that the surgical site isclose to the bladder

Indwelling catheter may be inserted

Potential Complications:

Hemorrhage

Deep Vein Thrombosis and Pulmonary Embolism

Bladder Dysfunction

Nursing Interventions:

Relieving AnxietyRationale: Explanations are given about the physical preparations and

procedures that are performed

Improving Body Image

Rationale: Patient may have strong emotional reactions to having ahysterectomy and strong personal feelings related to the diagnosis. Nurse who


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exhibits interest, concern, and willingness to listen to the patients fears will helpthe patient progress through the surgical experience

Relieving Pain

Rationale: Assess intensity of pain and administer analgesia as prescribed

Health Teachings:

Diaphragmatic Breathing Exercise

Foot and leg exercise

Incentive Spirometry

Coughing

Turning

Tell patient to resume activity gradually

Avoid straining and lifting

Early ambulation

General Liquid Diet post op

Effects:

It may cause infertility that affects emotionally for married women. Females

with this kind of ailment suffer the following: prolonged and very heavy menstruation,painless abdominal swelling, pain in the back of the legs, pelvic pain, constipation

,vaginal discharges, and complication during pregnancy.

Prescribe synthetic medicines for myoma such as steroids that can later resultto risky side effects in the different organs in the body. A type of myoma, uterinefibroid has significantly high chances to develop into uterine cancer.

II.Clinical Summary

A. General Data Profile

Name: Pt. XAddress:Birthday:Birth Place:Nationality:Religion:

Occupation:Date of Admission:Admitting Diagnosis:Attending Doctor:Dra. Macapagal.

B. Chief Complaint
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.

C. Nursing History

a) Childhood illness:

Influenza

b) Immunization:

Complete

c) Allergies :

With no known allergiesNo allergies to food

d) Accident: None

e) Hospitalization:

f) Medication used

g) Travel:

The usual route of travel is within the community of --------------

D. Family History

Legend:


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APPENDIX BGENOGRAM

- Female

- Male

- Cardiovascular Disease, Hypertension and Diabetes Mellitus

- Uterine Myoma and History of Hysterectomy- Hypertens

- Patient

E. Social History- Include theories of growth and development

.

PSYCHOCIAL THEORY ACCORDING TO ERIK ERIKSON


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STAGE AGE CENTRAL TASK INDICATORS OF

POSITIVE RESOLUTION

INDICATORS OFNEGATIVE

RESOLUTION

MIDDLEADULTHOOD

40-

60

GENERATIVITY

VS

STAGNANATION

FOCUSES ON

WORK OR

CAREER

COMMITMENT

ON FAMILY

STATUS AND

PARENTHOOD

FAILURE IN

CAREER

DISASTER

SELF-

ABSORPTION

According to this theory, middle adulthood focuses on work, career, and rightparenting. Based on this stage of Erikson, she has reached the task generativity and

stagnation. It correlates with his way of living up to now and experiencing the self-

absorption or stagnation. At his age, he has no career although before he was always

on impermanent work. Now, he focuses on being a mother to her childrens.

F. Environment/ Living condition

The environment where he lives is in almost their entire neighborhood knows

each other,-------------------Regarding the hospital environment at the Quezon Medical

Center where he was confined, it is not crowded; they have well ventilation which does

not interfere with his sleeping pattern and resting period.

G. Physical Assessment

Parameters Normal

Findings

Actual

Findings

Interpretation

GeneralAppearance

Concious,coherent

and

oriented

Not in

respiratory

distress

Cooperative

----------

Skin With good

skin turgor

------------ ----------

Hair Evenly

distributed

-------------


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Nails With good

capillary

refill of 2-3

seconds

With clean

and short

nails

With poor

capillary

refill of 4-5

seconds

--------------------

-

Skull & Face Generally

round, with

prominence

s in thefrontal and

occipital

area.

No

tenderness

noted upon

palpation.

Round

shped face

Nose in the

midline and

no

Discharges

Both nares

are patent

Eyes No eye

discharges

With

reddish

sclera

With

positive

blink relflex

No

impairment

of vision

With pale

conjunctiv

a

-----------------


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Ears The ear

lobes are

bean

shaped,

parallel,

and

symmetrical

.

The

auricles are

has a firm

cartilage on

palpation

The pinnarecoils

when folded

No

discharges

or lesions

noted at the

ear canal

Withmoderate

sense of

hearing

Mouth Pimkish lips

; without

missing

teeth; with

pink gums;

no foul

odor; with

symmetrical

contour

Dry lips

and pale

lips

The

patien-----------

-------------,

Muscoloskelet

al

(Upper &

Lower

Extrimities)

Both

extremities

are equal in

size.

Have the

samecontour with

prominence

s of joints.

No

involuntary


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movements

.

No edema

Color iseven.

Abdomen In

symmetrical

contour

No

abdominal

distention

Flat, roundand non-

tender

abdomen

upon

palpation.

H. Patterns of functioning

Functional Health

Pattern

Before

Hospitalization

During

Hospitalization

Interpretation

Health

managementpattern

SelfMedication

3rd time to behospitalized

He is justseekingmedicalattention inseverecases thatneededimmediateattention.

Nutritional/

Metabolic

a. number of meals aday

b. Appetite

3-4 times aday

w/ very goodappetite

3 times aday

w/ slightlypoorappetite

The numberof his mealshe is takingper day isdecreasedthan before

he washospitalizedand hisappetitedecreasesalso as wellas his waterintake.


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c. Glass of water perday

d. Body built

e. Height and weight

10 glasses ofwater

w/ normal body

built

5'4 and 55kg.

5 glasses ofwater

slightlysmaller thanbefore

5'4 and 54kg.

Decreasedin weightwas theresult ofthis.

Elimination

a. frequency ofurination

b. amount of urine /day

c. frequencyof bowel

d. consistency offeces

e. amount ofdefecated per day

10 times a day

moderate

Once a day

Formed

Moderate

8 times a day

Moderate

Irregular

The amount

of hisurinationdecreasedbut theamount of itis still thesame asbefore.

He has nofrequency ofhis boweleliminationthan before.

Activity and

Exercisea. Exercise

b. Fatigability

c. ADL

Active exerciseeveryday

not easily gettired

independent

non active

easily gettired

independent

He is easilyget tiredthan before,thats whyhe is notactive indoing someexercisesandbecause ofhiscondition.

Cognitive/

perceptuala. Orientation oriented to time oriented to

Thecognitiveand


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b. responsiveness

place andperson

responds

appropriately toverbal andphysical stimuli

time placeand person

responds

appropriatelyto verbal andphysicalstimuli

perceptualstatus of thepatient isstill intactand normal.

Thecondition ofthe patientis notaffected hisrecognitionandresponse.

Roles/ relationship

a. as a wife

b. as a mother

with goodrelationship tohis wife

with goodrelationship todaughter andson

with goodrelationship tohis wife

with goodrelationship todaughter andson

He still hasa good

relationshipwith hisfamily.

SELF

PERCEPTION/SELF CONCEPT

have a selfworth/importance

have a selfworth/importance

He still hasa self worthin spite ofhiscondition hestill that lifeis importantthat shouldbe livedpurposely.

COPING/STRESS He seeks forsome advice tohis friends andrelatives whenhe hasproblems,burdens andstresses.

He is alwaystalking withhis family andwife to lessenhis stresses.

He hasgood copingtechniques.

VALUES/BELIEFS He hasawareness theGod really exist

Hisawareness toGod becamestronger than

before

Even if hesufferedfrom hiscondition,

the patientneverforgets Godinstead hisawarenessbecamestrongerthan before.


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I. Course in the ward

On ---------------a 53y/o man was admitted with the complaint of -------------three

hours prior to admission and with BP of-------------. He was admitted under supervision

of Dra------------- to undergo treatment and further observation. His initial vital signs

was 35.5c, 66 pulse rate, 20 breaths per min and BP of----------------. Dra

------------ordered TPR every shift and record to determine changes in his

condition------------. The doctor ordered D5LR 1L @ 30gtts/min to infuse to provide

electrolytes and fluids in our body right in the state of hospitalization with decreased

appetite. Then the doctor ordered different laboratory tests and diagnostic test as

follows:

CBC to determine hgb, hct and RBC count and to assess the bloods ability to

carry oxygen. To determine the WBC count w/c signifies infection when

elevated.

Urinalysis to detect UTI and sugar in urine

With orders made as to administer the following medication:

----------------------------------------------------------------------------

------------------------------------------------------------------------------

-------------------------------------------------------------------------

On june -------------------------

On june ----------------------------

On june ---------------------

-

On june -------------------------------

On june ---------------------------------

J. Laboratory Diagnostic Procedures

June--------------


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Urinalysis - Macroscopic

Component Result NormalRange

Interpretation Implications NursingResponsibilities

Color YELLOW PALEYELLOW

toAMBER

ABNORMAL Clear Urine-ifa person hasbeen drinkingan excess ofwater ordiuretics suchas coffee orbeer, theurine mayhave little orno color.Nothing toworry about ifit happensoccasionally.Pale yellow isthe normalcolor of urine.Dark Colored-Liverproblems or

jaundice cancause theurine tobecomeconsistently adark yellowcolor. Be sureyou havebeen drinkingenough fluidsbefore

jumping toconclusions.

NursingResponsibilitiesfor Urinalysis:

A. Before theProcedure1. Explainthe procedureto the patientssignificantother.2. Obtainmaterialsneeded in theprocedure.3. Advisethe significantother to washperineal areaprior tocollection ofspecimen.

B. During the

Procedure1. Collect afresh urinespecimen in aurine container.2. Obtainclean catchmidstreamurine ifpossible.

C. After theProcedure1. Transfer the urinespecimen tothe laboratorypromptly.2.

Document theprocedure.

3. Attachthe result in thepatients chart.

Transparency SlightlyTurbid

Clear toSlightTurbid

NORMAL Turbid(cloudy) urinemay becaused by


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either normalor abnormalprocesses.Normalconditions

giving rise toturbid urineincludeprecipitationof crystals,mucus, orvaginaldischarge.

Abnormalcauses ofturbidity

include thepresence ofblood cells,yeast, andbacteria.

SpecificGravity

1.010 1.010 1.025

NORMAL --Albuminuria,dehydration,diarrhea,glycosuria,vomiting.-Diabetes

insidipus,overhydration, renaldisease.

Reaction(pH)

5 4.6 8.0 NORMAL - -Alkalosis,chronic renalfailure,diuretic use,gastricsuction,salicylate

intoxication,UTI,vegetablediet, vomiting.-Acidosis,

dehydration,starvation,UTI

Urinalysis Microscopic



RBC 2-3 NEGATIVE NORMAL Red cells and


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or RARE hemoglobinmay enter theurine from the

kidney orlower urinary

tract. Testingfor blood inthe urinedetects

abnormallevels ofeither redcells or

hemoglobin,which may be

caused by

excessive redcelldestruction,glomerulardisease,kidney or

urinary tractinfection,

malignancy,or urinary

tract injury.

WBC 4-6 NEGATIVEor RARE The presenceof white bloodcells in the

urine usuallysignifies a

urinary tractinfection,such as

cystitis, orrenal disease,

such as

pyelonephritis.

EpithelialCell

+ FEW NORMAL -sloughingoff of agingtissue.

-strong andactivedegenerationof kidneytubules. Infemales itindicatescontaminationfrom vaginaldischarges.

MucusThreads

++ FEW ABNORMAL -chronicinfection ofthe urethra orthe bladder.


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-it indicatesnopathologicalsymptoms.

Bacteria +++ FEW ABNORMAL -infection.

-normal fora healthyindividual.

Crystals



AmmoniumUrates

++ FEW ABNORMAL AmmoniumUratescrystals are

precipitatedwhen freeammonia ispresent as aresult ofbacterialaction onlongstandingspecimens.They are

often seenwhenphosphatesare presentin thespecimen.

Ammoniumuratecrystals canbe found inseveral

differentforms; theycan appearassheaves offineneedles, asdumbbells,and as"thornapple"

crystals,which areyellow,opaque,sphere-likebodies withirregular,


22/37

spine-likeprojections.They can bedissolvedby heating

and by theaddition ofacetic acid,which, uponstanding,results intheformation ofcolorlessuric acidcrystals.

Chemical Test

Component

Result NormalRange

Interpretation

Implications NursingResponsibiliti

es

Sugar NEGATIVE

NEGATIVE

NORMAL -Cushingssyndrome, DM

and pregnancy.- none.

Albumin POSITIVE NEGATIVE

ABNORMAL

-CHF,glomerulosclerosis, lupuserythematous,multiplemyeloma,nephroticsyndrome.

- none.

June-----------------------------

Blood Chemistry

Component

Result

NormalRange

Interpretation

Implications Nursing Responsibilities

Trueglucose

FBS

5.9106

3.10-6.40m

mol55-

NORMAL -DM,cushingssyndrome,acute

Nursing Responsibilities for

Blood Chemistry:

A. Before the


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115mg/dl

pancreatitis,severe liverdisease.-Insulin

overdose,

Addisonsdisease,hepaticdisease,hypothyroidism,Pancreatictumor,pituitaryhypofunction,

postgastrectomy.

procedure:

1. Check the

Doctors order.

2. Identify the

patient.

3. Check the vital

signs.

4. Decrease

patients

anxiety by

explaining the

procedure and

why it has to

be performed.

5. For blood

sample,

instruct that the

medical

technician willperform

venipuncture to

extract blood.

6. Acknowledge

questions

regarding the

safety of the

procedure.

B. During the

procedure:

1. If the test is to

be done at

bedside,

remain with the

patient.

2. Assist with the

collection of

specimen if

allowed.


24/37

C. After the procedure:

1. Check the site

for bleeding,

cyanosis, or

swelling.

2. Apply pressure

and warm

compress.

3. Check vital

signs for any

changes.

4. Document the

data (attach

result in the

chart).

Creatinine

132.6

1.5

64-124mm

ol/l0.7-

1.4mg/dl

ABNORMAL

-Impairedrenalfunction,dehydration,

cancer,heart failure,shock.-Decreasedmusclemass,debilitation.

TotalCholest

erol

4.7182

3.40-5.18mmol/l

130-200mg/

dl

NORMAL-Hypercholes-

terolemia,biliarycirrhosis,HPN,hypothyroidism, MI,pregnancy,hyperlipidemia,uncontrolledDM.

-Anemia,hyperthyroidism,malnutrition,malabsorption,starvation.


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Triglyceride

0.870

0.50-1.86mmol/l45-

165mg/

dl

NORMAL-Hypercholes-terolemia,biliary

cirrhosis,HPN,hypothyroidism, MI,pregnancy,hyperlipidemia,uncontrolledDM.

-Anemia,hyperthyroid

ism,malnutrition,malabsorption,starvation.

June-------------------

Complete Blood Count


Interpretation

Implications NursingResponsibilitie

s

Hemoglobin

14.8g/dl

8.7 to11.2mmol/

L14 to18g/dl(male)

NORMAL -COPD, hemo-concentration,heart failure, highaltitudes,polycythemia.

-Hemolyticreactions,hemorrhage, IDA,renal disease,sickle celldisease, systemiclupuserythematous.

Nursing

Responsibiliti

es for

Complete

Blood count:

A.Before the

procedure:

Check the

Doctors order.

Identify the

patient.

Check the vital

signs.

Decrease

patients

anxiety by

explaining the


26/37

procedure and

why it has to

be performed.

For blood

sample,

instruct that the

medical

technician will

perform

venipuncture to

extract blood.

Acknowledge

questions

regarding the

safety of the

procedure.

B. During the

procedure:

If the test is tobe done at

bedside,

remain with the

patient.

Assist with the

collection of

specimen if

allowed.

C. After the

procedure:

Check the site

for bleeding,

cyanosis, or

swelling.

Apply pressure

and warm

compress.

Check vital

signs for any


27/37

changes.

Document the

data (attach

result in the

chart).

Hematocrit 45.360%

42% to52%

0.42 to0.52

(male)

NORMAL -Dehydration,eclampsia, highaltitudes,polycythemia,congenital heartdisease, burns.

- Anemia, bonemarrow

dysfunction,cirrhosis,hemorrhage,hemolyticreactions,malnutrition,overhydration,pregnancy.

WBC 10100 5 to10,000/uL

5.0 to

10.0 x109/L

ABNORMAL

-inflammatoryand infectiousprocess,

leukemia,andtissue, necrosis.

-bone marrowfailure,chemotherapyand drug toxicity,overwhelminginfection,autoimmunedisease.

Differential

CountNeutrophils 86% 40% to

60%ABNORMA

L-bacterial or

acute infection,collagendiseases,CushingsSyndrome,eclampsia, gout,inflammatorydisease,ketoacidosis,

myelocytucleukemia, stress.

-Addisonsdisease, aplasticanemia,overwhelminginfection,


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radiation therapy.

Lymphocytes

14 35% to40%

ABNORMAL

-Chronicinfections,hepatitis,lymphocyctic

leukemia,mononucleosis,multiple,myeloma, viralinfection.

-Adrenocorti-Costeroidtherapy,leukemia, lupuserythematous,sepsis, whole

bodyirridation,prednisone therapy.

Blood Type O+

FSR O+

CLOTTING & BLEEDING TIMEPerformed on: November 12, 2009Purpose:

Clotting Time- are used to determine the integrity of the coagulation pathways, andplatelet function. In general, the common tests for the intrinsic or common pathways

are the activated partial thromboplastin time (APTT) and activated coagulation time(ACT). One-stage prothrombin time (OSPT) is usually used to evaluate the extrinsic orcommon pathways, and platelet count, clot retraction, bleeding time and activatedcoagulation time reflect platelet numbers and function.Bleeding Time- This test measures the time taken for blood vessel constriction andplatelet plug formation to occur. No clot is allowed to form, so that the arrest ofbleeding depends exclusively on blood vessel constriction and platelet action.

Clotting Time Bleeding TimePatients value: 3 minutes and 28 seconds

Patients value: 1 minute and 50 secondsNormal value: 2 6 minutes

Normal value: 1 -3 minutesImplications: No significant findings found.

PLATELET & PROTHROMBIN TIMEPerformed on: ---------------------------------------------Purpose: These tests will detect most coagulation protein problems. A relationbetween thrombocytopenia and time on bypass also was reported. The clinical picture,


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bleeding time, prolonged partial thromboplastin time test, and plasma prothrombintime test lead to the diagnosis.

Platelet and Prothrombin TimePatients value: 11.3Control value: 12.3

Implications: No significant findings found.

PREGNANCY TESTPerformed on: --------------------------Purpose: to determine whether or not a woman is pregnant.

Pregnancy Test - HCGPatients value: Positive

Implications: Increase HCG which is released by the trophoblastic cells of thefertilized ovum is a reliable marker of pregnancy.CHEST PA

Performed on: November 12, 2009Purpose: Chest X-rays can also reveal fluid in your lungs or in the spacessurrounding your lungs, enlargement of your heart, pneumonia, emphysema, cancerand many other conditions. Some people have a series of chest X-rays done overtime, to track whether a particular health problem is getting better or worse.

Findings: ---------------------------Conclusion: ------------------------------

ULTRASOUNDPerformed on:

----------------------Purpose: Ultrasound is performed routinely during pregnancy. Early in the pregnancy(at about seven weeks), it might be used to determine the size of the uterus or thefetus, to detect multiple or ectopic pregnancy, to confirm that the fetus is alive (orviable), or to confirm the due date.

Uterus: 16.1 x 11.6 x 7.4 cm antevertedCervix: 4.2 x 3.8 x 3.1 cm without Nabothian cystEndometrium: 2.3 cmRight ovary: not visualizedLeft ovary: 4.1 x 2.8 x 2.8 cm lateralOthers: no free fluid from the cul de sac

Remarks:

The uterus is anteverted with regular contour and inhomogenous myometrium.

Well circumiscribed heterogenous structure noted within posterior myometrium

measuring 7.0 x 7.2 x 5.5 cm suggestive of an intramural myoma withsubmucous component.

Cervix is closed and homogenous.

Endometrium is thickened and heterogenous suggestive of blood clots.

Impression:

Enlarged anterverted uterus with thickened endometrium

Uterine myoma

Implications: Results of the ultrasound suggest that the patient has a myomadescribed to be intramular and at the same time with submucous components. Byintramural, it means that the myoma is located within the uterine wall, while havingsubmucous components suggests that it lies just beneath the endometrium, the innermost layer of the uterus.
http://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Pregnancy


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ELECTROCARDIOGRAMPerformed on: November 12, 2009Purpose:Electrical impulses in the heart originate in the SA node and travel through the intrinsicconducting system to the heart muscle. The impulses stimulate the myocardial musclefibers to contract and thus induce systole. The electrical waves can be measured atselectively placed electrodes (electrical contacts) on the skin. Electrodes on differentsides of the heart measure the activity of different parts of the heart muscle. An ECGdisplays the voltage between pairs of these electrodes, and the muscle activity thatthey measure, from different directions, also understood as vectors. This display

indicates the overall rhythm of the heart and weaknesses in different parts of the heartmuscle. It is the best way to measure and diagnose abnormal rhythms of the heart,particularly abnormal rhythms caused by damage to the conductive tissue that carrieselectrical signals, or abnormal rhythms caused by levels of dissolved salts(electrolytes), such as potassium, that are too high or low.

Rate:Atrial: 89Ventricular: 89

Rhythm: SinusAxis: +30o

PR Interval: 0.16 secondsQRS:

0.08 secondsQT Interval: 0.32 secondsP wave: uprightORS: normal R wave progressionTransitional zone: V3 V4T Wave: uprightST segment: isoelectricInterpretation:Sinus rhythm, within normal limits

Implications: There were no significant findings noted.

K. Impression/ Diagnosis

Cerebrovascular accident hemorrhage right middle cerebral artery

Hypertension

iii. Clinical Discussion of the disease

1. Anatomy and Physiology
http://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Electrodehttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Electrode


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INTERNAL FEMALE ORGANSThe internal organs of the female consists of the uterus, vagina, fallopian tubes, andthe ovariesa. Uterus. The uterus is a hollow organ about the size and shape of a pear. It servestwo important functions: it is the organ of menstruation and during pregnancy it

receives the fertilized ovum, retains and nourishes it until it expels the fetus duringlabor.Location: The uterus is located between the urinary bladder and the rectum. It issuspended in the pelvis by broad ligaments.Divisions of the uterus: The uterus consists of the body or corpus, fundus, cervix, andthe isthmus. The major portion of the uterus is called the body or corpus. The fundusis the superior, rounded region above the entrance of the fallopian tubes. The cervix isthe narrow, inferior outlet that protrudes into the vagina. The isthmus is the slightlyconstricted portion that joins the corpus to the cervix.Walls of the uterus: The walls are thick and are composed of three layers: theendometrium, the myometrium, and the perimetrium. The endometrium is the inner

layer or mucosa. A fertilized egg burrows into the endometrium (implantation) andresides there for the rest of its development. When the female is not pregnant, theendometrial lining sloughs off about every 28 days in response to changes in levels ofhormones in the blood. This process is called menses. The myometrium is the smoothmuscle component of the wall. These smooth muscle fibers are arranged. Inlongitudinal, circular, and spiral patterns, and are interlaced with connective tissues.During the monthly female cycles and during pregnancy, these layers undergoextensive changes. The perimetrium is a strong, serous membrane that coats theentire uterine corpus except the lower one fourth and anterior surface where thebladder is attached.b. Vagina.

Location: The vagina is the thin in walled muscular tube about 6 inches long leadingfrom the uterus to the external genitalia. It is located between the bladder and therectum.Function: The vagina provides the passageway for childbirth and menstrual flow; itreceives the penis and semen during sexual intercourse.c. Fallopian TubesLocation: Each tube is about 4 inches long and extends medially from each ovary toempty into the superior region of the uterus.Function: The fallopian tubes transport ovum from the ovaries to the uterus. There isno contact of fallopian tubes with the ovaries.Description: The distal end of each fallopian tube is expanded and has finger-likeprojections called fimbriae, which partially surround each ovary. When an oocyte isexpelled from the ovary, fimbriae create fluid currents that act to carry the oocyte intothe fallopian tube. Oocyte is carried toward the uterus by combination of tubeperistalsis and cilia, which propel the oocyte forward. The most desirable place forfertilization is the fallopian tube.d. OvariesFunctions: The ovaries are for oogenesis-the production of eggs (female sex cells)and for hormone production (estrogen and progesterone).

BLOOD SUPPLYThe blood supply is derived from the uterine and ovarian arteries that extend from theinternal iliac arteries and the aorta. The increased demands of pregnancy necessitatea rich supply of blood to the uterus. New, larger blood vessels develop toaccommodate the need of the growing uterus. The venous circulation is accomplishedvia the internal iliac and common iliac vein.


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FACTS ABOUT THE MENSTRUAL CYCLEMenstruation is the periodic discharge of blood, mucus, and epithelial cells from theuterus. It usually occurs at monthly intervals throughout the reproductive period,except during pregnancy and lactation, when it is usually suppressed.a. The menstrual cycle is controlled by the cyclic activity of follicle stimulating hormone(FSH) and LH from the anterior pituitary and progesterone and estrogen from theovaries. In other words, FSH acts upon the ovary to stimulate the maturation of a

follicle, and during this development, the follicular cells secrete increasing amounts ofestrogen.b. Hormonal interaction of the female cycle are as follows:Days 1-5. This is known as the menses phase. A lack of signal from a fertilized egginfluences the drop in estrogen and progesterone production. A drop in progesteroneresults in the sloughing off of the thick endometrial lining which is the menstrual flow.This occurs for 3 to 5 days.Days 6-14. This is known as the proliferative phase. A drop in progesterone andestrogen stimulates the release of FSH from the anterior pituitary. FSH stimulates thematuration of an ovum with graafian follicle. Near the end of this phase, the release ofLH increases causing a sudden burst like release of the ovum, which is known as

ovulation.Days 15-28. This is known as the secretory phase. High levels of LH cause the emptygraafian follicle to develop into the corpus luteum. The corpus luteum releasesprogesterone, which increases the endometrial blood supply. Endometrial arrival ofthe fertilized egg. If the egg is fertilized, the embryo produces human chorionicgonadotropin (HCG). Thehuman chorionic gonadotropin signals the corpus luteum tocontinue to supply progesterone to maintain the uterine lining. Continuous levels ofprogesterone prevent the release of FSH and ovulation ceases.OVULATION

Ovulation is the release of an egg cell from a mature ovarian follicle. Ovulationis stimulated by hormones from the anterior pituitary gland, which apparently causes

the mature follicle to swell rapidly and eventually rupture. When this happens, thefollicular fluid, accompanied by the egg cell, oozes outward from the surface of theovary and enters the peritoneal cavity. After it is expelled from the ovary, the egg celland one or two layers of follicular cells surrounding it are usually propelled to theopening of a nearby uterine tube. If the cell is not fertilized by union of a sperm cellwithin a relatively short time, it will degenerate.

HORMONESEstrogen

Estrogens are a group of steroid compounds functioning as the primary female

sex hormone. Like all steroid hormones, estrogens readily diffuse across the cellmembrane. Once inside the cell, they bind to and activate estrogen receptors which inturn up-regulate the expression of many genes.

The three major naturally occurring estrogens in women are estrone (E1),estradiol (E2), and estriol (E3). Estradiol (E2) is the predominate form in nonpregnantfemales, estrone is produced during menopause, and estriol is the primary estrogen ofpregnancy.
http://en.wikipedia.org/wiki/Estronehttp://en.wikipedia.org/wiki/Estradiolhttp://en.wikipedia.org/wiki/Estriolhttp://en.wikipedia.org/wiki/Estronehttp://en.wikipedia.org/wiki/Estradiolhttp://en.wikipedia.org/wiki/Estriol


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Estrogens are produced primarily by developing follicles (Graafian follicles) inthe ovaries, the corpus luteum, and the placenta.Follicle-stimulating hormone (FSH)and luteinizing hormone (LH) stimulate the production of estrogen in the ovaries.Some estrogens are also produced in smaller amounts by other tissues such as theliver, adrenal glands, and the breasts. These secondary sources of estrogens are

especially important in postmenopausal women.While estrogens are present in both men and women, they are usually presentat significantly higher levels in women of reproductive age. They promote thedevelopment of female secondary sexual characteristics, such as breasts, and arealso involved in the thickening of the endometrium and other aspects of regulating themenstrual cycle.

Structural promote formation of female secondary sex characteristics decelerate height growth accelerate metabolism (burn fat) reduce muscle mass

stimulate endometrial growth increase uterine growth increase vaginal lubrication thicken the vaginal wall maintenance of vessel and skin reduce bone resorption, increase bone formation morphic change (endomorphic-> mesomorphic ->ectomorphic)

protein synthesis increase hepatic production of binding proteins

coagulation increase circulating level offactors2, 7, 9,10,plasminogen

decrease antithrombin III increase platelet adhesiveness Lipid

increase HDL, triglyceride decrease LDL, fat deposition

Fluid balance salt (sodium) and water retention

Hormones

increase cortisol, SHBG Gastrointestinal tract

reduce bowel motility

increase cholesterol in bile Cancer

support hormone-sensitivebreast cancers Lung function

promotes lung function by supporting alveoli(in rodents but probably inhumans).

ProgesteroneProgesterone acts with estrogen to bring about the menstrual cycle. During

pregnancy, it quiets the muscles of the uterus so that an implanted embryo will not beaborted and helps prepare breast tissue for lactation. Progesterone is produced byanother glandular structure in the ovaries, the corpus luteum. The corpus luteum

produces both estrogen and progesterone, but progesterone is secreted in largeramounts Ovaries are stimulated to release their estrogens and progesterone in acyclic way by the anterior pituitary gonadotropic hormones.Progesterone is sometimes called the "hormone of pregnancy", and it has many rolesrelating to the development of the fetus:

Progesterone converts the endometrium to its secretory stage to prepare the

uterus for implantation. At the same time progesterone affects the vaginalepithelium and cervical mucus, making it thick and impermeable to sperm. If
http://en.wikipedia.org/wiki/Ovarian_folliclehttp://en.wikipedia.org/wiki/Corpus_luteumhttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Follicle-stimulating_hormonehttp://en.wikipedia.org/wiki/Luteinizing_hormonehttp://en.wikipedia.org/wiki/Ovaryhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/wiki/Breasthttp://en.wikipedia.org/wiki/Manhttp://en.wikipedia.org/wiki/Womanhttp://en.wikipedia.org/wiki/Secondary_sexual_characteristichttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Menstrual_cyclehttp://en.wikipedia.org/wiki/Secondary_sex_characteristicshttp://en.wikipedia.org/wiki/Heighthttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Vaginal_lubricationhttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Mesomorphichttp://en.wikipedia.org/wiki/Ectomorphichttp://en.wikipedia.org/wiki/Ectomorphichttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Coagulation_factorhttp://en.wikipedia.org/wiki/Factor_IIhttp://en.wikipedia.org/wiki/Factor_VIIhttp://en.wikipedia.org/wiki/Factor_IXhttp://en.wikipedia.org/wiki/Factor_IXhttp://en.wikipedia.org/wiki/Factor_Xhttp://en.wikipedia.org/wiki/Factor_Xhttp://en.wikipedia.org/wiki/Plasminogenhttp://en.wikipedia.org/wiki/Antithrombinhttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/High_density_lipoproteinhttp://en.wikipedia.org/wiki/Triglyceridehttp://en.wikipedia.org/wiki/Low_density_lipoproteinhttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Cortisolhttp://en.wikipedia.org/wiki/SHBGhttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/w/index.php?title=Hormone-sensitive&action=edit&redlink=1http://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Cervix#Cervical_mucushttp://en.wikipedia.org/wiki/Spermhttp://en.wikipedia.org/wiki/Ovarian_folliclehttp://en.wikipedia.org/wiki/Corpus_luteumhttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Follicle-stimulating_hormonehttp://en.wikipedia.org/wiki/Luteinizing_hormonehttp://en.wikipedia.org/wiki/Ovaryhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/wiki/Breasthttp://en.wikipedia.org/wiki/Manhttp://en.wikipedia.org/wiki/Womanhttp://en.wikipedia.org/wiki/Secondary_sexual_characteristichttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Menstrual_cyclehttp://en.wikipedia.org/wiki/Secondary_sex_characteristicshttp://en.wikipedia.org/wiki/Heighthttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Vaginal_lubricationhttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Mesomorphichttp://en.wikipedia.org/wiki/Ectomorphichttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Coagulation_factorhttp://en.wikipedia.org/wiki/Factor_IIhttp://en.wikipedia.org/wiki/Factor_VIIhttp://en.wikipedia.org/wiki/Factor_IXhttp://en.wikipedia.org/wiki/Factor_Xhttp://en.wikipedia.org/wiki/Plasminogenhttp://en.wikipedia.org/wiki/Antithrombinhttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/High_density_lipoproteinhttp://en.wikipedia.org/wiki/Triglyceridehttp://en.wikipedia.org/wiki/Low_density_lipoproteinhttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Cortisolhttp://en.wikipedia.org/wiki/SHBGhttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/w/index.php?title=Hormone-sensitive&action=edit&redlink=1http://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Cervix#Cervical_mucushttp://en.wikipedia.org/wiki/Sperm


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pregnancy does not occur, progesterone levels will decrease, leading, in thehuman, to menstruation. Normal menstrual bleeding is progesterone-withdrawalbleeding.

During implantation and gestation, progesterone appears to decrease the

maternal immune response to allow for the acceptance of the pregnancy.

Progesterone decreases contractility of the uterine smooth muscle. In addition progesterone inhibits lactationduring pregnancy. The fall in

progesterone levels following delivery is one of the triggers for milk production. A drop in progesterone levels is possibly one step that facilitates the onset of

labor. It raises epidermal growth factor-1 levels, a factor often used to induce

proliferation, and used to sustain cultures, ofstem cells. It increases core temperature (thermogenic function) during ovulation.

It reduces spasm and relaxes smooth muscle. Bronchiare widened and mucusregulated. (Progesterone receptors are widely present in submucosal tissue.)

It acts as an antiinflammatory agent and regulates the immune response.

It reduces gall-bladderactivity. It normalizes blood clotting and vascular tone, zinc and copperlevels, cell

oxygen levels, and use of fat stores for energy. It may affect gum health, increasing risk of gingivitis (gum inflammation) and

tooth decay. It appears to prevent endometrial cancer(involving the uterine lining) by

regulating the effects of estrogen.

2. Pathophysiology(book based and client based)
http://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Gestationhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Lactationhttp://en.wikipedia.org/wiki/Lactationhttp://en.wikipedia.org/wiki/Labor_(childbirth)http://en.wikipedia.org/wiki/Epidermal_growth_factor-1http://en.wikipedia.org/wiki/Stem_cellhttp://en.wikipedia.org/wiki/Stem_cellhttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Progesterone_receptorhttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Gall-bladderhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Endometrial_cancerhttp://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Gestationhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Lactationhttp://en.wikipedia.org/wiki/Labor_(childbirth)http://en.wikipedia.org/wiki/Epidermal_growth_factor-1http://en.wikipedia.org/wiki/Stem_cellhttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Progesterone_receptorhttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Gall-bladderhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Endometrial_cancer


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3.Drug Study

4.ncp

Drug

Name

Indication

s

Action ContraindicationsAdverse

Reactions

Nursing

Responsibilities


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DISCHARGE PLAN

Medications

---------------------

---------------------

Environment

- instructed to provide a clean environment- advised to have things accessible for the client- instructed to have a clean and quiet home conducive for resting

- advised to listen to light music for relaxation- advised to have a safe home and free from any health hazards

Treatment

- advised to take medications at the right route, dose and time- advised to take medications as prescribed- instructed not to stop medication if not prescribed by the doctor

Health Teachings

- advised to have adequate rest and sleep- instructed to do deep breathing exercise when she feels pain and anxious.- encouraged patient to ambulate- instructed not to do strenuous activities- encouraged eating the proper diet as advised by the doctor.- advised to keep incision site clean and dry- advised to have diversional activities- instructed to take the medications at the right route, route dose and right time.

- encouraged verbalizing when in pain

OPD Check-up

Follow up check up after 1 week.


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Diet

High in protein and rich in vitamin C to promote healing

Regular calcium intake for fast bone recovery High fiber diet to prevent constipation

Increased fluid intake

ob cssepres

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