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Guides/ManualsMagazines/NewspapersRecipes/MenusSchool Work+ all categoriesFeaturedRecentPeopleAuthorsStudentsResearchersPublishersGovernment & NonprofitsBusinessesMusiciansArtists & DesignersTeachers+ all categoriesMost FollowedPopularRyan T Reyes We're using Facebook to personalize your experience.Learn MoreDisableHomeMy DocumentsMy CollectionsMy ShelfView Public ProfileMessagesNotificationsSettingsHelpLog OutWelcome to Scribd - Where the world comes to read, discover, and share... Were using Facebook to give you reading recommendations based on what your friends are sharing and the things you like. We ve also made it easy to connect with your friends: you are now following your Facebook friends who are on Scribd, and they are following you! In the future you can access your account using your Facebook login and password.Learn moreNo thanksSome of your friends are already on Scribd: 1First Page Previous Page Next Page / 13Sections not available Zoom Out Zoom In Fullscreen Exit FullscreenSelect View Mode View ModeSlideshowScroll Readcast Add a Comment Embed & Share Reading should be social! Post a message on your social networks to let others know what you re reading. Select the sites below and start sharing.Link accountReadcast this DocumentReadcast Complete!Click send to Readcast!edit preferencesSet your preferences for next time...Choose auto to readcast without being prompted.Ryan T ReyesAlvin P. CadagLink accountAdvancedCancel Add a CommentSubmitshare:Characters: 400 Share & EmbedAdd to Collections Download this Document for FreeAuto-hide: on PATIENTS PROFILE NAME: Patient x ADDRESS: Alano extension, Pagadian City SEX:Female BIRTHDATE: May 18, 1968 AGE: 41 y/o BIRTHPLACE: Davao del Sur NATIONALITY:Filipino RELIGION: Roman Catholic CIVIL STATUS:single FATHERS NAME: Juanito Pantullana MOTHERS NAME: Remedios Pantullana ADMISSION: DATE: February 28, 2010 TIME: 10:40 am Room/Ward:OB-WARD Chief complain: Hypogastric pain ADMISSION DIAGNOSIS: Uterine Myoma ATTENDING PHYSICIAN: Dr. Chandra Salvador HISTORY OF PAST ILLNESS: The patient was never been hospitalized before and had not experienced any kind of diseases. She only had mild illness such as cough,

fever and headache. She also experienced dysmenorrhea in the 1st 2nd day of her menstruation .HISTORY OF PRESENT ILLNESS: 3 years prior to admission, the patient noticed a mass on hypogastric area of her abdomen. She thought that it was only due to her loaded works and stress and so, she only consulted a hilot. She didnt mind to have a consultation on a doctor because of lack of financial budget. 1 year prior to admission, the patient had undergone free medical check up from the company where she was working with and so, the UTZs result found out that she had an enlarged uterus with intramural myoma uterine. PHYSICAL ASSESSMENT GENERAL SURVEY: Received lying on bed conscious and coherent without IVF. Patient is conscious and coherent, and also responsive to certain questions and instructions given to her. Tension and increased alertness was noted on the patient upon receiving her. VITAL SIGNS: T = 36.3oC P = 70 bpm R = 26 cpm BP = 120/70 mmHg SKIN warm to touch on upper extremities like in the palm of her hands cold temperature on the sole of the client Fair skin and brown in color Has a good skin turgor upon palpation Presence of scars on both upper and lower extremities HAIR Equally distributed hair Black with some white hair in color Slightly coarse No nodules, lumps and tenderness noted upon palpation Absence of lice and dandruff NAILS Nail beds are pinkish in color Smooth texture short nails with dirt noted good capillary refill, less than 2 seconds EYES symmetrical pupils are equally round and reactive to light accommodation pupils are black in color sclera is white eyebrows and eyelashes are equally distributed eyelashes are slightly curve pupils constricts symmetrically when lighted with a penlight Blurred vision on her both eyes EARS no deformities symmetrical no cerumen and dirt noted uniform in color no discharges noted mobile, firm, and not tender upon palpation helix of ears are in line with the outer canthus of the eye NOSE AND SINUSES nose is located in the midline of the face symmetrical proportionate to the face absence of discharges no nasal flaring uniform in color no skin breakdown nasal septum intact nasal hairs are evenly distributed no tenderness and pain upon palpation on facial sinuses MOUTH dry lips pinkish colored gums uvula is located at the midline of the soft palate teeth are yellowish in color with dental caries on his upper teeth hard palate is light pink in color tonsils are not inflamed buccal cavity is pinkish in color restricted tongue movement NECK AND THROAT neck muscles are equal in size absence of swollen lymph nodes trachea is centrally aligned no tenderness noted no thyroid gland enlargement noted thyroid gland ascends during swallowing equal strength during the assessment for his muscle strength ANTERIOR AND POSTERIOR CHEST quiet respiration no palpitations, no deformities symmetrical in shape absence of adventitious breath sound upon auscultation vesicular breath sound was present heart is not enlarged spine is vertically aligned absence of masses right and left shoulders are at same height full and symmetric chest expansion percussion notes resonate except over the scapula no visible pulsations on anterior and posterior areas of thorax from observing them to the side AXILLA presence of axillary hair skin is intact little perspiration noted no nodules and tenderness noted ABDOMEN has an enlarge mass noted on hypogastric area uniform in color no skin problems absence of bruits on all 4 quadrants no evidence of enlargement of liver and spleen liver is not palpable as well as the bladder MUSCULOSKELETAL has 10 fingernails and toenails uniform in color presence of scar in his calf and elbow presence of dirt in the fingernails and toenails no contractures noted Absence of tremors Has good muscle gait NEUROLOGIC Able to talk with sense Oriented Able to remember past events in life Coordinated and verbally responsive DOCTORS ORDER Date & Time Order 2-28-10 2-28-10 3-01-10 3-01-10 1:00pm Pls. admit TPR every 4H

Soft diet Labs: CBC FBS ECG CXR for TAH once cleared refer to Dr. Uy for CP clearance Secure unit of FWB properly Start Bisacodyl @ HS Metronidazole 500mg 1 tab TID Seen and axamined History reviewed No previous admission Tea and crackers for lunch and dinner NPO post midnight For elective TAH Secure Consent Inform anesthesia on care OR personel Start IVF D5LR @ 30gtts @6H Cefuroxime 750mg IVTT every 8H ANST Bisacodyl suppository II/ rectum @ 6pm SS enema @ 9pm or 6 Cleaning enema @ 5am until rectum is clear All prep FF up blood for standby Continue V/S monitoring

BP: 100/60 HR= 76 RR= 16

Soft diet

DIAGNOSTIC TEST Ultrasound Report Date: 04-13-09 Examination Performed: Pelvic ultrasound Impression: Enlarge uterus w/ intramural myoma Laboratory Result: Hematology Date: 02- 25-10 Normal Values Indication WBC- HemoglobinDifferential count: Segmented neutrophils- Lymphocytes- Eosinophils- 3, 250 cu/mm 13.4 gms % 74% 20 % .6 % 5,000- 10,0000/cumm 14-17gms% 55-66% 20-35% 0.5-1% infection anemia Bacterial infection Within normal range Within normal range Hematology Date: 0302-10 Hemoglobin- 12.4 gms % Electrocardiogram Report 2-28-10 Analysis: 801 sinus rhythm, 401 short P-R internal DRUG STUDY Doctors Order: Metronidazole 500mg 1tab q 8 hrs P.O. Generic Name: Metronidazole Brand name: Metrocream, MetroGel, Vaginal, Metrolotion, Noritate Classification: Anti-infectives. Antiprotozoals, Anti-ulcer Indication: Inflammatory papules and pustules of acne rosacea, bacterial vaginosis Mechanism of action: Unknown. May cause bacterial effect by interacting with bacterial DNA Dosage: 500mg P.O. Adverse Effects: dizziness, headache, cramps,pain, nausea, diarrhea, constipation, rash Contraindication: Contraindicated in patients hypersensitivity to the drug. Nursing Responsibilities: Take full course of drug therapy; take the drug with food if GI upset occurs. Do not drink alcohol Your urine may appear dark; this is expected. Doctors Order: Cefuroxime 750mg q 8hrs ANST(-) Generic Name: Cefuroxime sodium Brand name: Kefurox, zinacef Classification: antibiotic, second generation cephalosporin Indication: pharyngitis, tonsillitis, infection of urinary and lower respiratory tract

Mechanism of action: hinders and kills susceptible bacteria Adverse Effects: dizziness, headache, malaise, diarrhea, nausea Contraindication: hypersensitivity to cephalosporin Nursing Responsibilities: 1. Asssess pts infection before therapy and regularly thereafter 2. Be alert for adverse reactions and drug interactions Generic Name: Ranitidine Brand Name: Zantac Classification: Histamine 2 antagonist Mode of Action: Competitively inhibits the action of histamine at the H2 receptors of the parietal cells f the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonist, gastrin, and pentagastrin. Dosage: Ranitidine 50mg q8 IVTT Indication: Post surgery antacid to prevent ulcer formation Contraindication: Hypersensitivity to ranitidine, lactation. Adverse Effects: malaise, insomnia, somnolence, urticaria, tachycardia, bradycardia, leukopenia, pancytopenia, thrombocytopenia, gynecomastia, impotence, hepatitis Nursing Responsibilities: Instruct patient to take his meal if nausea or vomiting occurs. metoclopramide Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN), Drug classes: GI stimulant, Antiemetic, Dopaminergic-blocking agent Therapeutic actions Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; Indications Relief of symptoms of acute and recurrent diabetic gastroparesis Short-term therapy (412 wk) for adults with symptomatic gastroesophageal reflux who fail to respond to conventional therapy Parenteral: Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable Contraindications: Contraindicated with allergy to metoclopramide; GI hemorrhage, mechanical obstruction or perforation; pheochromocytoma Adverse effects CNS: Restlessness, drowsiness, fatigue, lassitude,ins omnia, extrapyramidal reactions, parkinsonism-like reactions, akathisia, dystonia, myoclonus, dizziness, anxiety CV: Transient hypertension GI: Nausea, diarrhea Nursing considerations Take this drug exactly as prescribed. Do not use alcohol, sleep remedies, sedatives; serious sedation could occur. GENERIC NAME: BISACODYL BRAND NAME(S): Dulcolax, Fleet Bisacodyl, Magic Bullet Classification: stimulant laxative Action: It acts by irritating the digestive tract and stimulates intestinal activity Indication: . It is used to treat constipation or to clean out the intestinal tract before bowel examinations or bowel surgery Adverse Effects: stomach ache, cramping, weakness, sweating, irritation of the rectal area,dia rrhea, or dizziness Contraindication: hypersensitivity to the drug Nursing Responsibilities: If the patient is under 6 years of age, consult child s doctor before using this medication. Generic Name: Ketorolac tromethamine Brand Name: Toradol Classification: NSAID, Nonopioid analgesic Mode of Action: Reduces the production of prostaglandins, chemicals that cells of the immune system make that cause the redness,fever, and pain of inflammation and that also are believed to be important in the production of non-inflammatory pain. It blocks the enzymes that cells use to make prostaglandins (cyclooxygenase 1 and 2). As a result, pain as well as inflammation and its signs and symptoms - redness, swelling, fever, and pain - are reduced.

Dosage: Ketorolac 30mg q8 IVTT Indication: For short-term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics. It most often is used after surgery. Contraindication: Hypersensitivity to ketorolac, renal Impariment, aspirin allergy Adverse Effects: gastric or duodenal ulcer, renal impairment, liver failure, dysuria, bleeding, platelet inhibition, neutropenia, leukopenia, pancytopenia, thrombocytopenia, bone marrow depression Nursing Responsibilities: Infuse slowly as a bolus over no less than 15 seconds. NALBUPHINE HYDROCHLORIDE NUBAINE Drug Class: Narcotic agonist-antagonist analgesic Therapeutic Actions: Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at receptors Indications: Relief of moderate to severe pain. Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery. Contraindications/cautions: Contraindications: hypersensitivity to nalbuphine, sulfites; lactation. Adverse Effects: Sedation. Clamminess, sweating headache, nervousness, restlessness, depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations, euphoria, dysphoria, unreality. ANATOMY AND PHYSIOLOGY Vagina: A muscular passageway that leads from the vulva (external genitalia) to the cervix. Cervix: A small hole at the end of the vagina through which sperm passes into the uterus. Also serves as a protective barrier for the uterus. During childbirth, the cervixd ilat es (widens) to permit the baby to descend from the uterus into the vagina for birth. Uterus: A hollow organ that houses the baby during pregnancy. During childbirth, the uterine muscles contract to push out the baby. Each month, unless a fetus has been conceived, the uterine wall sheds its lining (see The Menstrual Cycle and Ovulationbelow). Ovaries: Two organs that produce hormones and store eggs. Each ovary releases one egg per month. Fallopian tubes: Muscular tubes that eggs released from the ovaries must traverse to reach the uterus. Kinds of Fibroids/myoma depends on their orientation in the uterine wall PATHOPHYSIOLOGY Precipitating Factor: Hyperestrogenic state Nulliparaty Predisposing Factor: Age of Patient: 41 y/o Gender: Female Stress Benign tumors originating in the smooth muscular uterine tissue. Stress within the myometrium Simple proliferation of smooth muscle cells Development of Leiomyomas (Fibroid) Diagnostic Test: Ultrasound: Impression: Enlarge uterus w/ intramural myoma CBCTreatment: GnRH Analogs S/S: Abdominal discomfort Urinary frequency

Prolonged bleeding with period Heavy menstrual bleeding Sensation of fullness Increased fibroid growth Myoma removed Patient recover Surgical Mngt: TAH Complication :Infertility Anemia Infection Decreased Fibroid growth Blood clot Infection Damage to urinary tract or bladder during surgery Early onset of menopause Rarely death Myoma pathophysio, gordon s ncp Download this Document for FreePrintMobileCollectionsReport DocumentReport this document?Please tell us reason(s) for reporting this document Spam or junk Porn adult content Hateful or offensiveIf you are the copyright owner of this document and want to report it, please follow these directions to submit a copyright infringement notice.Report Cancel This is a private document. Info and Rating Reads:2,703Uploaded:03/14/2010Category:School Work>Essays & ThesesRated:Copyright:Attribution Non-commercialPathophysiology by Irish C. Edombingo icesexyShare & Embed Related Documents PreviousNext p. p. p. p. p. p. p. p. p. p. p. p. p. p. p. p. p. p.More from this user PreviousNext 5 p. 4 p. 13 p. 5 p. 45 p.Add a Comment Submitshare:Characters: 400 Print this documentHigh QualityOpen the downloaded document, and select print from the file menu (PDF reader required).Download and Print Add this document to your CollectionsThis is a private document, so it may only be added to private collections.+ Create a New CollectionName:Description:Collection Type:public - locked public - moderated

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