Case study of a patient with Recurrent uterine myoma

Certification

EXAM NUMBER:

INDEX NUMBER:

This is to certify that this work was conducted by Gabriel Anita Amarachi

Mr Nicholas Clement

( Supervisor)

DEDICATION

All glory to God the Father, son and the holy spirit who I dedicate this work to.

Acknowledgement
My profound gratitude goes to God almighty with whom the success of this nursing case study was
made possible.

Abstract

This is a case of Mrs. N.C. who was diagnosed with Recurrent uterine myoma with right
complex adnexa cyst on October 9th 2023.

This case study explores the diagnostic and therapeutic challenges faced in managing
Mrs.N.C with recurrent uterine myoma and a complex cyst in the right adnexa.
The study delves into the patient's medical history, imaging findings, and the
multidisciplinary approach employed to address the recurrent nature of uterine
myoma alongside the complexity of the adnexal cyst. Emphasis is placed on the
selection of appropriate treatment modalities, including surgical interventions and
medical management, with a focus on optimizing patient outcomes and quality
of life.

In this case, we discuss the challenges of handling complex situations relating to

uterine myoma and right adnexa cyst emphasizing the importance of personalized care
and teamwork among different medical specialties for positive results.

. As for Mrs. N.C, she was admitted at Federal University Teaching Hospital (FUTH) Owerri
accompanied by her husband and was discharged on 3rd November 2023

Myomas or uterine fibroids are lumps that grow on the uterus. Fibroids can grow on the
inside, on the outside, or in the wall of the uterus. They are usually called fibroid tumors, or
leiomyomas by healthcare team. Fibroids are very common in women in their 30s and 40s. By the
time they are 50, about 80 women out of 100 have fibroids. The female hormones
estrogen and progesterone aids in the growth of fibroid, these hormones are at their
highest level in the female body during the years the female menstruates therefore
fibroid is prone to grow during this period and it usually shrink after menopause. The
symptoms of fibroid may be mild, like periods that are a little heavier than normal. If
the fibroids bleed or press on a patient’s organs, the symptoms may make it hard for
her to enjoy life.

MY SIWES EXPERIENCE

My SIWES posting started with medical surgical nursing experience at Federal University
Teaching Hospital (FUTH) Owerri. On the first day we reported, a warmth reception was
given to us and orientation as well.

I had a very wonderful and in a way stressful experience mainly because I was trying to
adjust to the environment, postings and shifting.

My midwifery experience was also at FUTH which was awesome because I was able to see live
deliveries, some birth defects in newborns and so many other experiences.

Psychiatric experience was at Neuropsychiatric Hospital Rumuigbo Portharcourt

On the first day we arrived at the hostel provided by school authority, we did some clean up
and settled in. The next day was a free day for us to rest , we eventually resumed the upper
day, we had several lectures with different lecturers that would always tell us that the
psychiatric environment is the only normal environment because the mentally ill people come
there and get well before going back.

Community posting was at Ama jk health center, Owerri municipal. It was an interesting one
as well because I had the opportunity to participate in immunization of new borns and
children under 5. I learnt several family planning methods and treatment of minor illnesses.

Introduction

Uterine myomas also called leiomyomas, uterine. fibroids, or fibromyomas are discrete,
rounded, firm, white to pale pink, benign myometrial tumours composed mostly of smooth
muscle with varying amounts of fibrous connective tissues.

The recurrent nature of uterine myomas poses a significant clinical challenge,

affecting up to 70% of women of reproductive age (Smith & Jones, 2020). In
conjunction with this, the emergence of complex adnexal cysts, particularly on the
right side, adds a layer of complexity to the diagnostic and therapeutic landscape
(Brown et al., 2021).
 Uterine myoma or leiomyomas are extremely common benign tumours of the
uterine smooth muscles (K. Barjon, 2022). They are benign clonal neoplasms that
contain an increased amount of extracellular collagen, elastin and are surrounded
by a thin pseudo-capsule. They may enlarge to cause significant distortion of the
uterine surface or cavity. Their size will then be described in menstrual weeks,
as in a pregnant uterus . Most fibroids are asymptomatic; usually asymptomatic in
pregnancy but may interfere with conception and may cause spontaneous abortion,
missed abortions, painful red degeneration or infarction of the fibroids, abnormal foetal
presentation, obstructed labour, and an increased likelihood of premature deliveries,
caesarean deliveries, postpartum haemorrhage and whereas, in the non-pregnant state its signs
and symptoms are menorrhagia, metorrhagia, menometorrhagia, infertility, constipation, urinary
incontinence, and leiosarcoma transformation.

Understanding the risk factors contributing to the recurrence of uterine myomas is

crucial in tailoring effective management strategies (Smith & Jones, 2020). Genetic
predisposition, hormonal influences, and prior surgical interventions have been
identified as key factors influencing the reappearance of these benign tumors.

When addressing complex adnexal cysts, clinicians are confronted with diagnostic
challenges and surgical considerations that require a nuanced approach (Brown et al.,
2021). The integration of evidence-based guidelines, such as those outlined by the
National Institute for Health and Care Excellence (NICE, 2019), is essential for guiding
the comprehensive management of patients facing the intricate interplay of recurrent
uterine myomas and complex adnexal cysts.

Q.yang.2022 cited by 135— Uterine fibroid lesions were initially known as the uterine
stone. In the second century AD they were called scleromas, the term fibroid was first
introduced in the 1860's.

PERSONAL DATA OF THE PATIENT

Name: Mrs. N.C

Age: 46 years

Sex: Female

Occupation: Trader

Religion: Christianity

Marital status: Married

Parity: 5
Nationality: Nigeria

Address: 24b Amakohia Owerri, Imo State

Next of kin: Mr. N.B

Relationship of next of kin: Husband

Address of next of kin: 24b Amakohia Owerri, Imo State

Date of admission: 9th October 2023

Date of discharge: 3rd November 2023

Diagnosis: Recurrent uterine myoma with right complex adnexa cyst

PATIENT'S FAMILY, MEDICAL AND SOCIAL HISTORY

Mrs. N.C. is a middle aged woman of 46 years . She was born into the
family of Mr & Mrs. O. in Ahiazu Mbaise local government area of Imo state.
She is the fourth child of her family. She is married to Mr. N.B. and they have 5
children including males and females. She has a history of diabetes mellitus in
the family and is also suffering the disease. She is a trader; her hobbies are
singing and cleaning. She has a medical history of diabetes, high blood pressure
and recurrent fibroids and has undergone 3 myomectomies.

PATIENT'S GENERAL APPEARANCE ON ADMISSION

General inspection: On examination Mrs. N.C was experiencing discomfort and

distress due to pain in the abdomen, eyes were suncken

Hair: Few gray hairs. No alopecia

Head: Suncken eyes, no abnormality on the ear, mouth.

Thorax: Slightly elevated respiration.

Abdomen: Distended abdomen like that of a pregnant woman.

Upper Limbs: No hypotonia noticed at left and right upper limb, both left and
right lowers actively.

Skin: Pale skin

Palpation: tender and painful to touch.

Percussion: Dull sound heard on percussion.

Auscultation: Dull heart murmur.

Systematic review

Central nervous system: She is conscious and speaks well.

Respiratory system: No respiratory distress.

Gastro – intestinal system. : No diarrhea, no constipation, there's abdominal distention.

Cardiovascular system: Murmur was notice but with blood pressure of

160/100mmHg.

Musculoskeletal system: There's no stiffness of any part of the body.

Intergumentary system: There's scar in the abdomen due to previous surgeries,

no skin rash and no discoloration observed.

Objectives of this case study

The purpose of this case study is to gain knowledge, skills in assessment and
attitude in caring of patient with uterine myoma with right complex adnexa
cyst.

It specifically aims to find out:

1.) What is Uterine myoma?

2.) What is adnexa cyst?

3.) Predisposing factors or causes of uterine myoma with right complex adnexa cyst.

4.). How to assess signs and symptoms of uterine myoma with right complex
adnexa cyst.

5.) How the disease occur.

6.). Medical surgical management of the disease.

7.) Nursing intervention / management in caring for the patient.

8.) Prevention and treatment.

Definition of terms
1.) Myoma: Non cancerous growth in the uterus also known as uterine fibroid.

2.) Adnexal tumors : Are growth of cells that form on the organs and
connective tissues around the uterus.

3.) Uterine myomectomy : is a surgical procedure to remove uterine fibroids.

4.) Leiomyoma : Also know as fibroid is group of benign smooth muscle

tumours commonly present in premenopausal women.

5.) Hysterectomy : Surgery to remove the uterus.

Chapter 2

Literature review

Uterine Myoma (Fibroid): Uterine myomas, commonly known as fibroids, are

noncancerous growths of the uterus that often appear during childbearing years
(Smith et al., 2018). These tumors are composed of muscle cells and other tissues,
developing within or on the walls of the uterus. While they are typically benign,
uterine myomas can cause various symptoms, including pelvic pain, heavy menstrual
bleeding, and reproductive issues.

Complex Adnexal Cyst: A complex adnexal cyst refers to a fluid-filled sac or mass
located near the uterus, usually in the adnexal region, which includes the ovaries
and fallopian tubes (Jones & Brown, 2020). The term "complex" indicates that the cyst
contains both fluid and solid components, making it more intricate than simple
cysts. Complex. adnexal cysts can have diverse etiologies, including endometriomas,
dermoid cysts, or hemorrhagic cysts, and their presence may warrant further
investigation to determine the underlying cause and appropriate management
(Johnson, 2019).

An early 2003 study by Baird et al. showed that the estimated incidence of fibroids in
women by age 50 was 70% for white women and reached over 80% black women. Research
also indicates a substantial prevalence of uterine myomas, or fibroids, among women
in their childbearing years (Stewart et al., 2016). However, specific information regarding
the occurrence of uterine myomas associated with a right complex adnexal cyst is less
readily available. While adnexal cysts are commonly observed in gynecological
examinations, detailed prevalence data for cases involving complexity on the right
side is limited (Brown & White, 2018).

Uterine myoma develop from the muscle tissue of the uterus. They may
also grow in the fallopian tubes, cervix, or tissues near the uterus. Huyck KL
et al. (2008) demonstrated that the odds of having severe symptoms from uterine
fibroids are more than five times greater in black African women than in
Caucasians. However, with careful pathologic inspection of the uterus, the
overall prevalence of leiomyomas increases to over 70%, because
leiomyomas can be present but not symptomatic in many women. The
average affected uterus has six to seven fibroids. According to De La Cruz et
al., leiomyoma account for 39% of all hysterectomies annually.

Uterine myomas can vary in size, from being so tiny you cannot see them
with the naked eye to being the size of a melon. It is possible to
have one or many fibroids. Most women with fibroids have no symptoms
while others may have painful or heavy periods. If large enough, they may
push on the bladder, causing a frequent need to urinate.

The coexistence of a right complex adnexal cyst further complicates the

clinical scenario. Adnexal cysts, particularly those with complex features, raise
concerns about ovarian health. The differentiation between benign and
potentially malignant cysts becomes crucial for appropriate clinical management
(American College of Obstetricians. and Gynecologists,. 2017).

Classification of uterine myoma

Leiomyomas are classified by their location in the uterus.

1.)Subserosal leiomyomas are located just under the uterine serosa and may
be pedunculated (attached to the corpus by a narrow stalk) or sessile (broad-
based).

2.) Intramural leiomyomas are found predominantly within the thick myometrium but
may distort the uterine cavity or cause an irregular external uterine contour.

3.) Submucous leiomyomas are located just under the uterine mucosa
(endometrium) and, like subserosal leiomyomas, may be either pedunculated or
sessile. Tumors in subserosal and intramural locations comprise the majority
(95%) of all leiomyomas; submucous leiomyomas make up the remaining 5%.
Causes and predisposing factors of uterine myoma with right complex adnexa cyst.

Uterine fibroids are common. As many as one in five women may have fibroids
during their childbearing years. Half of all women have fibroids by age 50. Fibroids
are thought to be caused by:

1.) Genetic Predisposition: A familial tendency toward uterine myomas has been
observed, suggesting a genetic component in their development (Stewart et al., 2017).
Genetic factors may also play a role in the development of ovarian cysts.

2.) Hormonal Influences: Estrogen and progesterone, reproductive hormones that

regulate the menstrual cycle, have been implicated in the growth of uterine
myomas. Hormonal imbalances may contribute to the recurrent nature of myomas
and the development of ovarian cysts (Baird et al., 2017).

3.) Reproductive History: Factors such as early age at menarche, nulliparity, and
late menopause have been associated with an increased risk of uterine myomas.
Additionally, a history of ovarian cysts or reproductive disorders may contribute
to the development of complex adnexal cysts (Stewart et al., 2017; American College of
Obstetricians and Gynecologists, 2017).

4.)Race and Ethnicity: Studies have shown variations in the prevalence of uterine
myomas among different racial and ethnic groups, with higher rates in African
American women. The role of race and ethnicity in the development of
adnexal cysts is less clear but may have some influence (Baird et al., 2017; American
College of Obstetricians and Gynecologists, 2017).

5.)Environmental Factors: Lifestyle factors such as diet, obesity and

environmental exposures may contribute to the development and recurrence
of uterine myomas and adnexal cysts (Stewart et al., 2017).

6.) Inflammatory Processes: Chronic inflammation within the pelvic region could
potentially contribute to the development of both uterine myomas and adnexal
cysts (Stewart et al., 2017; American College of Obstetricians and Gynecologists, 2017).

Anatomy and physiology of the uterus

The human uterus is a pear-shaped organ which is made up of two

distinct anatomic regions: the cervix and the corpus.

The corpus is further divided into. the lower uterine segment and the fundus.

The cervix is a narrow cylindrical passage which connects at its lower

end with the vagina. The cervix widens at it's upper end to form the lower
uterine segment (isthmus); the lower uterine segment in turn widens into
the uterine fundus. The corpus is the body of the uterus which grows
during pregnancy to carry a fetus.

Extending from the top of the uterus on either side are the fallopian
tubes (oviducts); these tubes are continuous with the uterine cavity and allow
the. passage of an ova (egg) from the ovaries to the uterus where the egg
may implant if fertilized.

The thick wall of the uterus is formed of three layers: endometrium,

myometrium, and serosa.
 The endometrium (uterine mucosa) is the innermost layer that lines the cavity
of the uterus.

The myometrium is the middle and thickest layer of the uterus and is
composed of smooth (involuntary) muscle.

Blood supply to the uterus comes from the uterine arteries, ensuring proper
nourishment.

The outermost layer, or serosa, is a thin fibrous layer contiguous with

extrauterine connective tissue structures such as ligaments that give
mechanical support to the uterus within the pelvic cavity.

Functions of the uterus

1.) It provides an environment for the growing embryo.

2.) Menstrual function.

3.) To accept fertilized ovum.

Pathophysiology of Uterine Myoma with right complex adnexal cyst

The pathophysiology of recurrent uterine myomas (fibroids) with a right complex adnexal
cyst can be complex and multifactorial. Uterine myomas are benign tumors arising from
the smooth muscle layer of the uterus. Their recurrence may be influenced by
hormonal factors, genetic predisposition, and potential response to previous treatments.
The development of adnexal cysts on the right side suggests involvement of the
structures adjacent to the uterus, such as the ovaries or fallopian tubes. These cysts
can be functional or represent more complex conditions like endometriomas or
dermoid cysts.

Hormonal fluctuations and genetic factors may contribute to the recurrence of both
uterine myomas and adnexal cysts.

Clinical manifestations of uterine myoma

Common symptoms of uterine fibroids are:

1.) Abnormal uterine bleeding: The most common bleeding abnormality is menorrhagia
( prolonged uterine bleeding, also called hypermenorrhea). Normal menstrual
periods typically last four to five days, whereas women with fibroids often
have periods lasting longer than seven days. Abnormal bleeding can occur with
any of the three classes of fibroids, women with submucous fibroids seem
particularly prone to this complication.

2.) Pelvic pressure: results from an increase in size of the uterus or from a
particular fibroid. In addition to vague feelings of pressure because a fibroid
uterus is usually irregularly shaped , women can experience pressure on specific
adjacent pelvic structures including the bowel and bladder. Pressure on these
structures can result in difficulty with bowel movements and constipation or
urinary frequency and incontinence.

3.) Leiomyomas. are also associated with a range of reproductive dysfunction

including recurrent miscarriage, infertility, and complications of labor.

4.) Pain: The pressure and heaviness on the pelvis may press on nerves within
the pelvis thereby creating pain that radiates to the back or lower extremities.

Investigations / diagnostic tests

The diagnosis of uterine fibroids is made from the clinical manifestations;

• A Pelvic ultrasound scan is the test of first choice. Here, three-dimensional scan
is preferred to a two-dimensional scan due its higher resolution which helps to
rule out a pregnancy, other pelvic masses, a congenital uterine malformations.

• A magnetic resonance imaging is the gold standard test which is highly

accurate in depicting the size, number and location of myomas to choose
the therapeutical modalities.

•Saline sonohysterography can identify and characterise the location of submucosal

myomas missed on classical abdominal or transvaginal ultrasound.

• Plain X-Rays of the lower abdomen and pelvis usually identify only calcified
fibroids and sometimes large fibroids may be seen as soft tissue or calcified
masses.

• Hysterosalpingography: It evaluates the contour of the uterine cavity and the

patency of fallopian tubes.

• CT scan ( Computed Tomography Scan)

Medical Management

When uterine fibroids become symptomatic, medical or surgical treatment is

offered to the patient, depending on her age, symptoms and future fertility
desires.

Medical therapy includes:

• Progestins: Progestational therapy using norethindrone, medrogestone, and
medroxyprogesterone acetate has been successful. These compounds produce a
hypo-estrogenic effect by inhibiting gonadotropin secretion and suppressing ovarian
function.

•. 25 mg mifepristone produces reduction in leiomyoma size and uterine volume

and produces symptomatic improvement in women with fibroids.

• Gonadotrophin Releasing Hormone (GnRH) agonists have proven very useful for
limiting growth or temporarily decreasing uterine fribroid’s size.

• Oestrogen Receptors Modulators and Antagonists

Chapter 3

GENERAL MANAGEMENT OF RECURRENT UTERINE MYOMA WITH RIGHT COMPLEX

ADNEXA CYST

This management includes both medical and nursing depending on the case
that is being managed.

MEDICAL MANAGEMENT

The prescriptions of her drugs were detailed under the chemotherapy chart. The
drugs were served as ordered by the doctor and the side effects watched
for.

NURSING MANAGEMENT

The management of uterine myoma with right complex adnexa cyst in nursing
care is managed using the nursing process approach which are as follows;

1.) Assessment

2.) Diagnosis

3.) Planning

4.) Implementing

5.) Evaluation

ASSESSMENT: During assessment, fluid balance chart was provided to measure

the intake and output of the patient and replace lost fluid volume.

The important measures were as follows;

• Type of fluid
•By mouth

•By intravenous

•Urine

After the first assessment stage, the nurse should anticipate:

•Cardiac monitoring.

• Avoid dehydration.

• To monitor sugar levels.

• To monitor blood levels.

INSPECTION

HEAD: No presence of lice and hair well kempt.

FACIAL EXPRESSION: Patient was looking distresed.

EYES / EARS: No discharge

LIPS / MOUTH : No halitosis, no sore or wound, slightly dry and chapped lips.

SKIN: Has a scar on the abdomen due to multiple surgeries.

LEGS / HANDS: Edema on the lower extremities.

NURSING DIAGNOSIS OF MRS. N.C.

1.) Deficient fluid related to blood loss as evidenced by vaginal bleeding for
2 weeks decreased hemoglobin and hematocrit.

2.) Risk for infection related to exposure of surgical wound in the environment.

3.) Acute pain related to the pressure of the mass on the pelvic bone.

PLANNING

Here a goal is set up to be achieved by nurse's intervention, in;

1.) Deficient fluid volume

• Monitor for signs and symptoms of fluid volume deficit, weakness, rapid
pulse, dry mucous membrane.

• Administer intravenous fluids as ordered.

• Monitor vital signs.

• Check and record input and output.

2.) Risk for infection

• Ensure that the patient's environment is kept clean.

• Maintain aseptic technique while checking the patient.

3.)Acute pain

• Minimize pain crisis by giving prescribed analgesic.

IMPLEMENTATION

This is where the nurse assumes the doing position to achieve the set up
goals;

• There should be line of priorities done immediately to achieve the goal

for care.

• The patient is continuously assessed or monitored to note the response

to nursing care.

• The nurse goes back to the set plans of action to review it thereby
checking changes to response.

• Document all nursing care plan.

EVALUATION

This is where the nurse determines whether the set up goals has been
achieved.

• The patient was relieved of pain after 30 minutes of nursing intervention

as evidenced by facial expressions.

• Patient regained and maintained normal fluid balance between input and
output measurements.

Care study of the patient

Case Report:

A 46 - year - old woman with well - controlled diabetes mellitus and hypertension
was admitted through the General Surgery Clinic for investigation of abdominal
pain and a 4- year history of progressive abdominal distension. Her medical
history revealed 3 myomectomies, the first done at age 30 years and the
other 2 successively for uterine leiomyomas.

On physical examination, the patient’s vital signs were slightly elevated. Her
abdominal examination revealed a distended abdomen with mild tenderness in the
lower portion. After being examined, the patient underwent an exploratory
laparotomy, during which a pelvic cyst was found that measured 39 × 30.2 cm,
was filled with serous fluid (10.5 L), and an enlarged complex predominantly cystic
tumor that occupied most of the abdominal space. She was booked for total
hysterectomy and bilateral salpingectomy to avoid the recurrent growth. The surgery went
smoothly and there were no complications during or after the procedure. The
patient was discharged home 7 days later in stable condition. Postoperative
pathology using hematoxylin and eosin staining and immunohistochemistry with
desmin and alpha-smooth muscle actin resulted in a diagnosis of uterine
myoma with right complex adnexa cyst. When the patient was seen in the
outpatient clinic 2 weeks and 3 and 6 months after surgery, her tumor markers
were within normal limits.

DIAGNOSIS ON ADMISSION

Mrs. N.C was seen at the general surgery clinic by the doctor who made a
diagnosis of recurrent uterine myoma with right complex adnexa cyst.

The doctor after a proper and good history taking and thorough physical
examination, decided that Mrs. N.C should be admitted into Ward 4 gynae for
proper management.

INVESTIGATIONS ORDERED FOR MRS. N.C.

Mrs. N.C. was placed on the following investigations:

Hematoxylin and eosin staining.

Magnetic resonance imaging (MRI)

INVESTIGATION

1.)Hematoxylin and eosin staining

PATIENT'S RESULT

Shows spindle–shaped tumor cells with no mitosis ( 100X and 200X respectively)

2.) Magnetic resonance imaging (MRI)

 PATIENT'S RESULT

MRI showed a midline, well circumscribed cystic mass, with fine internal septae
and signal intensities consistent with fluid.

CHAPTER 4

NURSES PLAN OF ACTION

• Receive patient in ward 4 gynae with minimal disturbance

• Observe patient physically via inspection, palpation, percussion and auscultation.

• Monitor vital signs ( TPR, Bp and blood sugar level)

• Give the patient a bed, introduce patient to other patients

• Make patient comfortable

• Monitor intake and output chart

• Give prescribed medications to relieve pain and control bleeding.

• Assist patient in activities of daily living which she is unable to perform (if any)

• Closely monitor the IV infusion and regulate its flow.

• Reassure and health educate the patient and relatives.

NURSING DIAGNOSIS OF MRS. N.C.

1.) Deficient fluid related to blood loss as evidenced by vaginal bleeding for 2
weeks decreased hemoglobin and hematocrit.

2.) Risk for infection related to exposure of surgical wound in the environment.

3.) Acute pain related to the pressure of the mass on the pelvic bone.

Implementation

9th October, 2023

Mrs. N.C was fully admitted into ward 4 gynae

Her vital signs are: T=37.1°c, P=78b/m, R=22c/m, Bp=160/100mmHg, RBS= 210mg/dl

10th. October, 2023

Nursing care was rendered to Mrs. N.C i.e. keeping the patient in a comfortable
position, reassuring the patient about her condition thereby making the patient feel
more at ease about her case.

Vital signs: T=36.8°c, P=74b/m, R=20c/m, Bp=160/90mmHg, RBS= 180mg/dl

11th October, 2023

Nil complain from the patient and relatives. Nursing intervention was rendered such
as careful monitoring of vital signs , giving prescribed medication to Mrs. N.C. at the
right time, the patient was monitored for any adverse reaction that may occur.

Vital signs: T= 36.8°c, P=68b/m, R=22c/m, Bp= 155/90mmHg, RBS= 182mg/dl

12th. October, 2023

Careful monitoring of the patient was maintained

Vital signs : T=36.5, P=70, R=18c/m, Bp= 150/90mmHg, RBS= 190mg/dl

Nursing intervention was maintained till the discharge of the patient.

Evaluation

Mrs. N.C was discharged on 3rd November, 2023. The medical and nursing
managements helped Mrs. N.C. to go home a happy and free woman

Nursing care plan

Drug chat for Mrs.N.C

Drug name Group Mode of Side effects Contraindicati Indicatio Nursing

action ons ns responsibil
ity

1.)Acetaminop Analgesics Provide GI upset, Allergy to the Pain Monitor

hen, Ibuprofen pain relief renal drug, severe relief pain
by impairment, renal levels,
inhibiting hepatoxicity dysfunction, administer
pain hepatic as
pathways dysfunction prescribed
 or , assess
reducing for signs
inflammati and
on. symptoms
of adverse
reaction.

2.)Ondansetro Antiemetics Block Headache, Allergy to the It Assess for

n, signals to constipation, certain prevents nausea
Metocloprami the brain's extra cardiac vomiting and
de vomiting pyramidal condition and vomiting,
center, side effects nausea administer
preventing as
nausea ordered
and
vomiting

3.)Cefazolin, Antibiotics Prophylacti Allergic Allergy to the Prophyla Monitor

Clindamycin c use to reactions, drug xis for signs
prevent against of
surgical GI upset surgical infection ,
site site administer
infections infection as
by prescribed
targeting
bacteria.

4.) Hormonal Agonists Hot flashes, Pregnancy, Shrink Monitor

Gonadotropin- Therapy Suppress bone density certain uterine for
Releasing hormones loss hormonal myomas hormonal
Hormone to shrink conditions before side
(GnRH) uterine surgery effects
Myomas and
before educate
surgery on
possible
changes

5.) Bowel Promote Nausea, GI obstruction, Bowel Ensure

Polyethylene Preparation bowel abdominal severe cleansing patient's
Glycol Agents cleansing bloating dehydration before complianc
for surgical e,
specific procedur monitor
 surgical e for
procedures dehydratio
n

6.)Heparin, Prevent Bleeding, Active Prevent Monitor

Enoxaparin Prophylactic blood clot thrombocytop bleeding , blood for
Anticoagula formation, enia severe clot bleeding,
nts especially thrombocytop formatio administer
in high- enia n as
risk cases. prescribed

Complications

Complications can arise from the location of the fibroids. These complications range
from intermittent bleedings to continuous bleeding over weeks, from single pain
episodes to severe menorrhagia and chronic abdominal pain with intermittent spasms,
from dysuria and constipation to chronic bladder and bowel spasms and even to
peritonitis. Infertility may be the result of continuous metro and menorrhagia, leading
to chronic infection and uterine spasms up to nonimplantation. Possible complications
resulting from treatment of these disorders are haemorrhages, infection, adhesions,
and secondary pain resulting from the treatment efforts.

Prognosis

About 1 out of 1,000 lesions are or become malignant, typically as a

leiomyosarcoma on histology. A sign that a lesion may be malignant is growth
after menopause. There is no consensus among pathologists regarding the
transformation of leiomyoma into a sarcoma.

However Mrs. N.C. has good prognosis because the surgery was successful and
there were no form of malignancy found.

Rehabilitation
Both the patient and family should be involved in planning for the care of patient
after hospitalization. Mrs. N.C. was rehabilitated starting from the day of admission till
the day she was discharged from the hospital.

Rehabilitation of patient includes:

• The family should be encouraged and supported to help patient in her maintenance of
personal hygiene.

• Patient relatives should be advised to engage in maintenance of personal hygiene,

environmental hygiene to avoid infection in the site that was operated on.

Health education of the patient and family on discharge

On discharge, Mrs. N.C and relatives are given health education regarding her general
condition.

Summary

Uterine fibroids are the most frequent benign uterine tumours in females of
reproductive age. Although benign in character they are associated with adverse
outcomes such as miscarriages, aseptic necrobiosis, foetal mal-presentation, obstructed
labour, premature births, caesarean sections, postpartum haemorrhage in pregnancy, and
an altered menstrual cycle, heavy menstrual bleeding, infertility.

Recent findings have shown that fibroids can undergo both growth and regression in
non-gravid uterus. Fibroid growth, both in the intra- and inter-gravid states, is variable
and can range from 18 to 120% per year. In the inter-gravid state, fibroids can grow or
undergo spontaneous regression. Factors that can predict fibroid growth include the starting
volume of fibroid, type of fibroid and age of patient. In the gravid state, fibroids
appears to grow in a non-linear pattern, with the most rapid growth occurring in the first
trimester.

References:

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