Arellano University

Jose Abad Santos Campus

College of Nursing

A Case Study

Ovarian New Growth

(Mucinous Cystadenomacarcinoma)

Presented by:

BSN III BLOCK 6

INTRODUCTION:

The ovary is a pair of reproductive glands in women that are located in the pelvis, one on
each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries
produce eggs (ova) and female hormones.

Ovarian cysts are closed, sac-like structures within an ovary that contain a liquid,
gaseous, or semisolid substance.

Types of Ovarian Cyst

 Follicular
 Corpus Luteum
 Hemorrhagic
 Dermoid
 Endometriosis
 Polycystic ovarian syndrome
 Cystadenoma
o A malignant cystic or semisolid tumor most often occurring in the ovary.
I. BIOGRAPHIC DATA

Name: Patient X
Age: 50 y/o
Sex: Female
Address: Soro soro Ilaya, Batangas City
Nationality: Filipino
Marital Status: Married with 4 children
Occupation: Housewife
Religion: Roman Catholic
Admission date/ time: October 03, 2010/ 6:39 am

II. NURSING HEALTH HISTORY

(Upon Admission)

 CHIEF COMPLAINT
Abdominal Enlargement : 36 inches abdominal girth

 REASON FOR VISIT

“Lumaki ang tiyan ko.” as verbalized by the client.

 HISTORY OF THE PRESENT ILLNESS

Patient noticed enlarging abdomen and it was accompanied by weight loss and difficulty of
eating. Consulted a Gynecologist and was diagnosed of having a cyst on her left ovary through
UTZ on September 8, 2010. Her UTZ result showed 10 cm in diameter specimen of ovarian
mass. Consulted to Mary Mediatrix Medical Center hence admitted. She had undergone a
laparotomy on October 4, 2010.

 PAST HISTORY
Before the end of August 2010, the client experience influenza for 1 week. The client has
not undergone any operations and hospitalizations. She also has no allergies and injuries.
  FAMILY HISTORY OF ILLNESS

Father,
Mother, 80
78 Deceased
deceased

Patient, 50

Legend:

HPN, stroke
Gallbladder
dse.

Ovarian cyst

III. PATTERNS OF FUNCTIONING

Gordon’s Functional Pattern

 Health Perception – Health Management Pattern

The patient does not smoke and not an alcohol drinker. She does not feel any symptoms
until she noticed enlargement of her abdomen followed by weight loss and that is the
time she decided to consult it with the Gynecologist and undergone different laboratory
exams and was advised to undergo laparotomy.

 Nutrition – Metabolic Pattern

Before admission, the patient eats more on vegetables, meat and fruits. After the
operation, the patient was placed NPO for 1 day then take general fluids with crackers as
diet. IVF of D5NSS 1L x 60cc/hour and hooked for the second bottle.
 Elimination
When the patient is not diagnosed with ovarian cyst, she eliminates 2-3 times a day. She
drinks 6 glasses of water everyday and urinates regularly. When she was hospitalized, she
has indwelling Foley catheter with 30 cc/hour dark yellow urine and she does not
defecate even once for 3 days.

 Activity – Exercise Pattern

She spends her time taking care of her grandchildren and their piggery business as a form
of exercise. After the operation, she was advised to have complete bed rest.

 Sleep – Rest Pattern

When the patient was not diagnosed with ovarian cyst, she sleeps 6 hours a day. She has
a good quantity of sleep, but when she was hospitalized she sleeps irregularly because of
the pain on the incision site and also because of fever.

 Cognitive – Perceptual Pattern

Our patient is very cooperative and answers all the questions asked to her without any
confusion.

 Self- Perception and Self Concept Pattern

She still manages to smile and have a strong determination to cope up with her condition.
She gets all the support from her family.

 Coping- Stress Tolerance Pattern

When patient encounters big problems she handles it by talking things over to her
husband. She also has determination to solve any problems.

 Role Relationship Pattern

Our patient is with her husband and 4 children. She is 50 years old and a housewife
focusing on their piggery. Her family was extended and very close to their neighbors.

 Sexuality – Reproductive Pattern

Our patient is not sexually active anymore because of her age and condition. She is still
menstruating and her last menstrual period was October 1, 2010. She has an irregular
menstrual cycle. At the age of 11 years old, she began menstruating. Obstetric history G4
P4.

 Value Belief Pattern

She is Roman Catholic and attends mass every Sunday. She also believes in “medico” or
“albularios”. Before she consulted a Gynecologist, she went first to medico and she was
advised to take “pito-pito” as a medication.
 IV. PHYSICAL ASSESSMENT

General Survey:
As of oct 5, 2010
Vital signs are: body temperature of 38 C; pulse rate 82 beats per minute with regular
rhythm upon palpation; respiratory rate of 22 cycles per minute with regular rhythm; with equal
expansion of the chest; blood pressure of systolic 110 and diastolic of 70 mmHg. Patient is
conscious and coherent. Conversant and well oriented. Client is responsive to questions both
verbally and physically.

Post-Op Findings: October 05, 2010

Ears Inspection, Ears are symmetrical upon inspection. Pinna and
Part to be Palpation
Method external auditory canalsFindings
examined are intact upon inspection. She reported no history of
Skin Inspection, Palpation ear pain,
Brown ringing
skin in the ear,
complexion. or ear infections.
Hypertrophic scar whichShe
is does
not use hearing
approximately 4.5aids to facilitate
inches long notedhearing.
on the lower
abdomen. Skin on
Eyes Inspection, the
Eyesright
arearm is punctured
symmetrical dueinspection.
upon to intravenous fluid has
Patient infusion
but with no noted
Palpation brownish black eyes. Eyelashes and eyebrows are
swelling, reddening, heat and pain. Body hair is fine and
equally but finely distributed on both sides of the face.
thinly distributed. Skin is
Pupils are equal, round, reactive to light. No unusual
warm to touch, with good skin turgor, and with adequate
discharges from the lacrimal ducts noted upon
moisture upon palpation.
palpation. She reported use of correctional eyeglasses
because she is farsighted.
Head Inspection, Palpation Head is symmetrical upon inspection. Short, fine, black &
Nose Inspection, Nose is symmetrical with good septal deviation noted
Palpation white hair noted inNo
upon inspection. thinlesions
distribution. No masses
and scars noted.noted
Nasalupon
palpation.
mucosa isThe red client doesn’t complain
with adequate of dizziness,
nasal hair and vertigo
and headache upon
accumulated mucus thesecretions
interview. noted
She has no family
upon inspection.
Patient is mental
history of able todisorders
breathe without
noted upondifficulties.
assessmentPatient
of is
able to family
her/his smell pleasant
background. and foul odors suggesting
good olfaction.

Neck Inspection, Neck muscles are symmetrical upon inspection. Skin

palpation on the neck is intact with good integrity. Carotid pulse
is palpable. Voice is clear and well modulated.

Breast and Axilla Inspection, Symmetrical breast with round, brown and reverted
palpation nipples noted upon inspection. No unusual discharges
upon palpation of the nipples. She has no family
history of breast carcinomas on both father and mother
 sides.

Chest and lungs inspection Respiratory rate of 22 cycles per minute, regular in
rhythm.

TEST– urinaryNormal
Genito Findings
Inspection Actual Finding
Patient Interpretation
has IFC with an average Urine Output of 30 cc
Color Pale Yellow Yellow Excess
per hour. Monitoring sweating,
of urine notevery
output drinking
hourenough
and
recorded every shift. liquid
Transparency Transparent Turbid Symptom of a bacterial infection
Extremities: Inspection,
Upper Extremities: Palpation
Right Upper: She has limited motion due to muscle weakness.

Left Lower: With normal movement upon doing ROM, no

weakness noted.

Lower Extremities She can move both lower extremities. She uses
support leggings to prevent edema.

V. LABORATORY/ DIAGNOSTICS TEST

Specimen: Urine Date: 10/01/2010

Specimen: Serum 10/01/2010

Blood typing “A”

Rh typing Positive(+)

Test Normal Findings Actual Finding Interpretation

Hemoglobin F (12-16) 11.2 Minimal Iron deficiency
Hematocrit F(38-47) 36.3 Minimal decrease on Fluid
volume concentration
WBC
Test Normal Actual Finding Interpretation
Test Normal
FindingsFindings Actual Finding Interpretation
Differential
Creatinine Count 61.88 –55-62
106.88 mmol/L 53.6%44.20 Normal
Decreased muscle mass
Neutrophils 20-40 34.8% Normal
Lymphocytes 4-10 8.7% Normal
Eosinophils 0-1 0.1% Normal
 VI. Medications, IV infusions, Blood Transfusions, Treatments Given

Drugs Mechanism Indication Contra- Side Nursing

of Action indication Effects Implications
Generic Drugs that act Treatment Heart failure Sedation, dizziness, -Watch out for
Name: to decrease of moderate secondary to chronic light-headedness, depression of vital
Morphine pain by to severe lung disease; cardiac constipation, urinary signs.
Sulfate binding with pain by arrhythmias; brain retention, -check for pupil
the opiate stimulating tumour; acute hypersensitivity, changes and
Brand receptors of opiate alcoholism; respiratory reaction (pinpoint
Name: the brain, receptors in convulsive states (eg, depression, euphoria pupils indicate
Avinza thus CNS status epileptics, leading to excessive overdose).
inhibiting tetanus, strychnine use or abuse -Monitor I&O
Class: transmission poisoning). (input and Output)
Narcotic of pain and bowel
impulses. movements.
-Avoid other CNS
depressants.
-have antidote
(naloxone)
already.
-watch out for
possible tolerance
and dependence.
 Drug Mechanism Indication Contra- Side Nursing
of indication Effects Implication
Action
Generic Act to reduce Treatment of mild Known alcohol Gastrointestinal -Assess for
Name: symptoms of to moderate pain intolerance irritation and history of
Ketorolac inflammation caused by ulceration, gastric upset,
by inhibiting inflammatory Use cautiously in: bleeding, bleeding.
Brand COX conditions; 1) History of GI dizziness, bowel -take with food
Name: enzymes symptomatic relief bleeding changes, allergy, or antacid or w/
Toradol which is of arthritic 2) Renal headache, ringing plenty of fluids
needed for conditions. impairment in the ears, to decrease
Class: biosynthesis (dosage reduction impaired hearing gastrointestinal
Nonsteroid of may be required) and vision, distress.
al Anti- prostaglandin 3)Cardiovascular palpitations, -monitor blood
inflammat disease nausea and counts.
ory Drugs vomiting, -watch for
(NSAID) lethargy, gastrointestinal
hyperventilation. bleeding, like
hematochezia
and melena.
- Instruct client
to avoid
alcohol
and maintain
adequate
hydration (2-3
L/day of fluids)
unless
instructed to
restrict fluid
intake.
-Instruct client
to avoid
taking ketorolac
with
aspirin or other
NSAIDs
such as
ibuprofen.
Drugs Mechanism of Indication Contra- Side Nursing
Action indication Effect Intervention
Generic Anti-anemic Preventio Contraindicat Gastrointestinal -May be taken
Name: preparations n& ed to patient irritation w/ meals to
Fortifer that provide treatment with stomach reduce GI
adequate of Fe upset. discomfort.
Brand amounts of iron deficiency
Name: and B-complex &
vitamins to nutritional
prevent and anemia
Class: treat anemia. and folate
Vitamins & Iron is essential deficiency
Minerals in the .
Antianemic formation of
blood,
transport and
storage of
oxygen and
acts as
cofactor for
proper
functioning of
cells.

VII. REVIEW OF SYSTEMS

EENT: [ ] rales
[X] impaired vision: farsightedness [ ] cough
[ ] pain [ ] barrel chest
[ ] gums [ ] bradypnea
[ ] hard of hearing [ ] shallow
[ ] deaf [ ] rhonchi
[ ] edema [ ] sputum
[ ] lesion [ ] diminished
[ ] teeth [ ] dyspnea
Assess eyes, ears, nose throat for [ ] orthopnea
abnormalities. [ ] labored
[ ] no problem [ ] wheezing
[ ] pain
RESPIRATORY: [ ] cyanotic
[ ] asymmetric [ x] no problem
[ ] tachypnea
[ ] apnea CARDIOVASCULAR:
[ ] arrhythmia [x] no problem
[ ] tachypnea
[ ] numbness NEURO:
[ ] diminished pulses [ ] paralysis
[ ] edema [ ] stuporous
[ ] fatigue [ ] unsteady
[ ] irregular [ ] seizures
[ ] bradycardia [ ] lethargic
[ ] murmur [ ] comatose
[ ] tingling [ ] vertigo
[ ] absent pulses [ ] tremors
[ ] pain [ ] confused
Assess heart sound, rate, rhythm, pulse, [X] vision : farsightedness
blood pressure. [ ] grip
circulation, fluid retention, comfort assess motor, function, sensation, LOC,
[X] no problem strength grip, gait, coordination, speech
[ ] no problem
GASTROINTESTINAL TRACT: MUSCULOSKELETAL AND SKIN:
[ ] obese [ ] poor turgor
[ ] distention [ ] cool
[ ] mass [ ] deformity
[ ] dysphagia [X] wound : along the incision site, with
[ ] rigidity intact and clean dressing and abdominal
[X] pain binder
Assess abdomen, bowel habits, swallowing [ ] rash
bowel sounds, comfort. [ ] skin color
[x ] no problem [ ] flushed
[x] pain:with a pain rate of 6/10 from a scale
GENITO-URINARY AND GYNE: of: 0=no pain, 1-3=mild, 4-7=moderate, 8-
[ ] pain 10=severe
[Dark yellow] urine color [ ] ecchymosis
[ ] vaginal bleeding [ ] diaphoretic
[ ] hematuria [ ] moist
[ ] discharge assess mobility, motion, gait, alignment,
[ ] nocturia joint function
assess urine frequency, control, color, odor, skin color, texture, turgor, integrity
comfort, gyne bleeding, discharge [ ] no problem
VIII. ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE ORGANS

Organ Functions

1. Vagina
a. Passageway of menstrual flow
b. Female organ for coitus; receives male penis
c. Passageway for the fetus during birth

2. Uterus
a. Houses and nourishes fetus until sufficiently mature to function outside the mother’s body
b. Uterine muscles propels fetus outside.

3. Fallopian Tube
a. Provides passageway for ovum as it travels from ovary to uterus.
b. Site of Fertilization.

4. Ovaries
a. Endocrine glands that secrete estrogen and progesterone.
b. Contain ova within follicles for maturation during the woman’s reproductive life.
Hormonal Regulation

PARTS OF THE
 OVARY
IX. PATHOPHYSIOLOGY

Mucinous Cystadenocarcinoma: A malignant cystic or semisolid tumor most often occurring in the
ovary. Rarely, one is solid. This tumor may develop from a mucinous cystadenoma, or it may be
malignant at the onset. The cysts are lined with tall columnar epithelial cells; in others, the epithelium
consists of many layers of cells that have lost normal structure entirely. In the more undifferentiated
tumors, one may see sheets and nests of tumor cells that have very little resemblance to the parent
structure.

PREDISPOSING
FACTOR
Race – North PRECIPITATING
Irregular menstrual cycle
America & Western
Europe Early menstruation
Least in Asia
Leuteinizing Hormone

Hyperstimulation of Ovaries
HCG
Estrogen

Hormonal Imbalance

Abnormal Proliferation of
Follicle

Menstrual Follicles Fail to Ovulate and Fatigue and

Irregularities Fail to Undergo Atresia Sense of
Heaviness in
the Pelvis

Continue to Grow
Abdominal
distention

Cyst Grow in size up to

15 cm in Diameter

Infection

DEATH
 X. LIST OF PRIORITIZED NURSING PROBLEMS (Based on Gordon’s Functional
Health Pattern)

Nursing Diagnosis Reason for Prioritization

i. Pain related to post-op Because Nursing care focus first on pain
procedure management
ii. Hyperthermia related Second priority in GFHP and signifies that there is
to medication something wrong from within.

iii. Constipation related to abdominal Third priority in GFHP

muscle weakness
iv. Altered Sleeping Fifth priority in GFHP. An individual needs
Pattern related to environmental adequate sleep pattern in order to renew her
changes strength.

XI. NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

S: Hyperthermia Within the shift: Goal was met as

”Mainit ang related to Goal: The evidenced by the
pakiramdam ko” medication patient’s body patient’s body
as verbalized by temperature will temperature of
the patient decrease from 37◦ C from 38◦C.
38◦C to 37◦ C

Independent:
Intervention 1: The patient was able to
Monitor Vital cooperate during vital
Sign sign monitoring.
Rationale: To
provide baseline
data

Intervention 2: The patient was able to

Perform Tepid verbalize comfortable
Sponge Bath feeling after TSB.
Rationale: to
provide and to
 decrease body
temperature

Dependent:
Intervention1: The patient was able to
Administer comply with
antipyretic drug medication schedule.
as ordered.
Rationale: To
reduce body
temperature

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

S: Constipation Within the shift: Goal was met.
related to The patient was
“Hindi pa ako Goal: The
abdominal able to establish
nakakadumi” as patient will
muscle normal pattern
verbalized by establish normal
weakness pattern of bowel of bowel
the client.
function movement.
O:
Independent:
Irritable Intervention 1: The patient was able to
Maintain intake adequate fluid.
adequate fluid
intake
Rationale: To
promote passage
of soft stool.

Intervention 2:
The patient was able to
Encourage a diet
of balanced fiber verbalized change in
and bulk. bowel pattern and
Rationale: To character of stool.
improve
consistency of
stool & facilitate
passage through
colon.
 Dependent:
Intervention 1:
Administer
medications as The patient shows
prescribed. compliance on drug
intake.

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

S: Altered Within the shift: Goal was met.
“hindi ako sleeping pattern Goal 1:able to The patient was
makatulog ng related to report able to report
maayos maya’t environmental satisfactory of satisfactory of
maya ako changes. sleep sleep.
nagigising” as
verbalized by Independent:
the patient
Intervention 1:
O: Dark circle Maintain Patient was able to
around the eyes slightly dark, relax on a slightly dark,
quite and well quite and well
Decrease ventilated ventilated environment
attention span environment
Frequent Rationale:
yawning Sleep is difficult
without
Restless in relaxation the
appearance unfamiliar
hospital
environment can
hinder
relaxation

Intervention 2:
Prepare patient Patient was able to
for necessary anticipate interruption
anticipated to her sleep
interruption to
her sleep
Rationale:
In order to feel
rested, the
patient usually
must complete
an entire sleep
cycle

Intervention 3:
Assist client in a Patient was able to
comfortable demonstrate
position comfortable position.

Dependent:

Intervention 1:
Administer Patient complied
medication as religiously to
ordered by the medications and
attending treatments as ordered.
physician
Rationale:
to prevent
further
aggravation and
occurrence of
complication.

Collaborative:

Intervention 1:
Increase
physical Patient was able to do
activities physical activities as to
Rationale: increase her ROM.
To promote
ROM
XII. DISCHARGE PLAN

Nursing care has a significant impact on the patient’s body recover. Often, many body
systems are impaired as a result of a laparotomy and conscientious care and timely
interventions can prevent debilitating complications. Nursing interventions focus on the
whole person.

Medication
a) Instruct the family members how to administer such medication prescribed.
b) Teach client what to do to lessen the side effects of the drugs.
c) Describe the importance of regularly taking of prescribed medications
d) Instruct the family to continue with follow up medical care
e) Advise the family not to miss the intake of medications given by the patient’s
physician upon discharge.

Environmental & Exercise

• Maintain a quiet, pleasant, environment to promote relaxation.(Provide clean and
comfortable environment.)
• Encourage client to continue deep breathing exercises. Provide splint such as
pillow to secure the incision site. This is to promote circulation of blood,
relaxation also.
• Avoid strenuous exercise heavy lifting, and sexual intercourse.

Treatment
• Continue home medications.
• For the follow-up check-up repeat,
• Encourage the family to let the patient to take multivitamins for immunity.

Hygiene
• Teach the patient or the family member on how and how often to clean the
incision site
• Encourage also family to maintain clean surroundings.

Others
• Encourage family for regular diagnostic examination
• Advised to consult physician if there are any problems or complications
encountered.
Diet
• Diets as tolerated as much as possible, unless contraindicated
• Increase intake of high fiber diet to avoid constipation.
• Increase fluid intake

Sexual and Spiritual

• supporting religious practices
• assisting clients with prayer
• referring client for spiritual counseling
• no sexual intercourse up to the time of the next follow-up check up.

In addition to providing physical care, we should encourage patient to verbalize any

questions pertinent to condition for further evaluation and follow up of the disease.