UTERINE MYOMA

Table of Contents

I. Introduction
II. Patient Profile
III. Patient History/ Nursing History
IV. Gordons Level of Health Functioning
V. Physical Assessment
VI. Anatomy and Physiology
VII. Laboratory Result
VIII. Course in the Ward
IX. NCP
X. Discharge Planning
XI. Drug Study
I. Introduction

When a benign tumor grows in the muscles of the uterus, it is known as uterine Myoma. These
tumors can grow very large, sometimes growing as large as a melon. The typical Myoma, however,
is around the size of an egg. When the Myoma penetrates the entire wall of the uterus, it is referred
to as uterus myomatosus. In certain very rare cases the tumors can become malignant. When this
happens, it is known as sarcoma. When the Myoma pushes on the intestines or the bladder, it can
result in constipation, pain of the bladder, or a constant need to urinate. If the tumor pushes on the
nerves in the spinal cord, it can result in pain of the back or the legs.

The causes of uterine Myoma are not fully understood. Some research suggests that Uterine
Myoma is less common in women who have had at least two children. For at least one form of
uterine Myoma, there seems to be a genetic predisposition.

Uterine Myoma often goes undetected. Ultrasounds, CT Scans, or MRIs may be necessary to
fully diagnose uterine Myoma. If you have symptoms of Uterine Myoma, your health care provider
will help you determine the best way to diagnose the problem.

Once it is diagnosed, Uterine Myoma can be treated through hormonal and/or herbal
treatments. Hormonal treatment typically does not cure the Uterine Myoma. Rather, they give a
temporary relief of the symptoms of Uterine Myoma. In addition, these hormones may have certain
side effects. If these hormone treatments do not work, surgery is typically an option. Surgical
options include the surgical removal of the Myoma tumors (known as an enucleation) or a complete
hysterectomy. Recent advances in laser surgery may make this an option also. If this is the case,
the surgery can become much less invasive, and can be done laparoscopically.

Predisposing factors:
Age (15-35)
Gender: female
Race
Lifestyle
Early menarche
Nulliparity
Use of oral contraceptives
High fat diet
Obesity
Family history
Anxiety

Precipitating factors:
Hormone replacement therapy (premarin)
Anovulation
 Luteal insufficiency

Uterine fibroids are the most common benign tumors found in women. They are clinically
obvious in 20-25% of women of reproductive age. Myomas have been associated with being of
black race, an increased body mass index (BMI) and non-smoker

Hormone replacement therapy (HRT) or in Britain, Hormone therapy (HT) is a system of

medical treatment for surgically menopausal, perimenopausal and to a lesser extent
postmenopausal women. It is based on the idea that the treatment may prevent discomfort caused
by diminished circulating estrogen and progesterone hormones. It involves the use of one or more
of a group of medications designed to artificially boost hormone levels. The main types of
hormones involved are estrogens, progesterone or progestins, and sometimes testosterone. It
often referred to as "treatment" rather than therapy,

HRT is available in various forms. It generally provides low dosages of one or more
estrogens, and often also provides either progesterone or a chemical analogue, called a progestin.
Testosterone may also be included. In women who have had a hysterectomy, an estrogen
compound is usually given without any progesterone, a therapy referred to as "unopposed
estrogen therapy". HRT may be delivered to the body via patches, tablets, creams, troches, IUDs,
vaginal rings, gels or, more rarely, by injection. Dosage is often varied cyclically, with estrogens
taken daily and progesterone or progestins taken for about two weeks every month or two; a
method called "sequentially combined HRT" or scHRT. An alternate method, a constant dosage
with both types of hormones taken daily, is called "continuous combined HRT" or ccHRT, and is a
more recent innovation. Sometimes an androgen, generally testosterone, is added to treat reduced
sexual desire/(libido). It may also treat reduced energy and help reduce osteoporosis after
menopause.

HRT is often given as a short-term relief (often one or two years, usually less than five)
from menopausal symptoms (hot flashes, irregular menstruation, fat redistribution etc.). Younger
women with premature ovarian failure or surgical menopause may use hormone replacement
therapy for many years, until the age that natural menopause would be expected to occur.

Attitudes towards HRT changed in 2002 following the announcement by the Women's
Health Initiative of the National Institutes of Health that those receiving the treatment (Prempro) in
the main part of their study had a larger incidence of breast cancer, heart attacks and strokes. The
WHI findings were reconfirmed in a larger national study done in the UK, known as the the Million
Women Study. As a result of these findings, the number of women taking hormone treatment
dropped by almost half. The Journal of the American Medical Association and elsewhere based on
these findings warn that women with normal rather than surgical menopause should take
prescribed HRT treatment at the lowest feasible dose, for the shortest possible time. For health
problems associated with menopause such as osteoporosis (a small percentage of
postmenopausal women are at risk of severe bone loss), other life-style changes and/or
medications are now recommended.
 An anovulatory cycle is a cycle during which the ovaries fail to release an oocyte.
Therefore, ovulation does not take place. However, a woman who does not ovulate at each
menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common
cause of infertility.

In addition to the alteration of menstrual periods and infertility, chronic anovulation can
cause or exacerbate other long term problems, such as hyperandrogenism or osteopenia. It plays
a central role in the multiple imbalances and dysfunctions of polycystic ovary syndrome.

During the first two years after menarche 50% of the menstrual cycles could be
anovulatories.

It is in fact possible to restore ovulation using appropriate medication, and ovulation is

successfully restored in approximately 90% of cases. The first step is the diagnosis of anovulation.
The identification of anovulation is not easy; contrary to what is commonly believed, women
undergoing anovulation still have (more or less) regular periods. In general, patients only notice
that there is a problem once they have started trying to conceive.

Temperature charting is a useful way of providing early clues about anovulation, and can
help gynaecologists in their diagnosis.

Luteal insufficiency Luteal insufficiency leads to inadequate ovarian progesterone

production, which in turn results in an incomplete secretory endometrium and ineffective ovum
implantation. Dydrogesterone almost doubles pregnancy rates compared to placebo.
II. Patient Profile
a. Ward: Medical Center Manila, 6th floor Main Building, Room 605 Bed 5
b. Date of Admission: August 31 2009
c. Patient Name: Asis, Rowena Jacavan
d. Address: 147-C Anak Bayan, Paco Manila
e. Age: 44
f. Gender: Female
g. Birthday: November 2, 1964
h. Educational Status: College Under Graduate
i. Religion: Roman Catholic
j. Nationality: Filipino
k. Civil Status: Married
l. Occupation: Vendor
m. Health Care Financing: Phil. Health
n. Informant: Roselinda Mojica
o. Reliability: In-law
p. Admission Data:
i. Chief Complaint: “Sumasakit ang aking likod at may matigas sa akin tiyan at habang
tumatagal lalong lumalaki ito” as verbalized by the client.
ii. Initial Diagnosis: Lower back pain and abnormal mass in the abdomen
iii. Final Diagnosis: Myoma Uteri, Intramural with subsenous component Q4P4

III. Patient History/ Nursing History

a. History of Present Illness
“Noong December last year, napansin kong may parang tumutubong bukol sa tiyan ko.”, as
verbalized by the client. It was observed movable,firm and non-tender. ”Kumunsulta lang ako ng doktor
nung nagsimula ng sumakit talaga nung July 2009, pero nung August lang ako nagpacheck-up” as
verbalized by the patient. In addition, the patient complained of early satiety and bloatedness. According to
the patient, during her first consultation, she had undergone an ultrasound procedure and was diagnosed
with an enlarged uterus with myoma. She was advised for a surgery but she refused. Then last August 26,
2009, the patient sought consultation at MCM OPD for second opinion. She undergone ultrasound again
which diagnosed a huge myoma 32 x 37 cm. Then she was advised for a surgery hence she had her
admission 5 days later, August 31, 2009.
b. Past Medical History
The patient has already bore four children with an OB Score of G4P4 (4004). Her first child was
born full termed in the year 1993 through Caesarean section procedure. The child’s weight was 2,800 g
(6.39 lbs).In the year 1995, the patient bore their second child full termed through Caesarean Section
procedure. The weight of the child was 2,700 g (6.4 lbs). Her third child was born full termed in the year
1997 through Caesarean section procedure with a child weight of 3,000 g (). In the year 1998, she bore their
fourth child, full termed through Caesarean Section procedure. The child’s weight was 2,500 g (5.5 lbs).
c. Family Health History
According to the patient, her maternal side has a history of hypertension while her paternal side
has a history of pulmonary tuberculosis and other lung diseases.
 d. Personal and Social History
“Ang hanapbuhay ko talaga ay pagtitinda.”, as verbalized by the client. During our interview, the
patient denied that she’s a smoker but when we look at patient’s chart, it revealed that the patient is a
smoker for about five years and consumes five sticks a day. According to the patient she is a non-alcoholic
beverage drinker.
”Una akong nagkaroon ng regla nung thirteen ako, regular naman siya, mga 28-30 days bago
‘yung susunod.”, as verbalized by the patient. According to her,, her menstruation lasts for three days and
consumes 5-6 pads a day. “Hindi naman ako heavy flow talaga pag nireregla, yung tama lang ‘di
masayadong malakas, hindi naman masyadong mahina. Hindi din sumasakit ‘yung puson ko.”, as
verbalized by the patient. The patient had her last menstruation last July 2009.
According to the patient, she had her first sexual intercourse when at the age of 29, which was with
her husband, Reynaldo Asis. They’ve been married for 16 years. She didn’t experience any postcoital
bleeding and dyspareunia. “Never ako gumamit ng pills or kahit anong iniinom na contraceptives”, as
verbalized by the patient. According to the patient she had her last PAPSMEAR last August 21, 2009.

IV. Gordons Level of Health Functioning

Level Of Functioning Before Hospitalization During Hospitalization Analysis/Interference

HEALTH Patient did not consult a health
PERCEPTION/HEALTH care provider upon noticing a
MANAGEMENT gradually enlarging mass on her
PATTERN abdomen because she perceives
that she is healthy, due to lack of
alarming symptoms such as pain,
fatigue, bleeding and even weight
loss.
Patient feels secured
because she is
surrounded by health care
providers that will give her
needed attention.

The patient is taking her health for Patient is unable to go to

granted despite having abdominal work and now realizes the
mass. She still goes to work importance of health.
regularly.

Being a mother of 4, she is She thinks that it is best if

practical that when she feels
something, she asks for other
people’s opinion before consulting
medical providers.
NUTRITIONAL AND Consumes 1500ml of water a
METABOLIC PATTERN day.
she consults professional
health care providers and
not rely on other people’s
mere experience.
She was ordered by the
physician to SOFT DIET.

Consumes 3-4 bottles of soda

(12oz) daily.

3-Day Diet Recall

ELIMINATION PATTERN Difficulty in defecation. Folycatheterization was

 Fecal consistency/color: performed.
Hard/Brown
Defecates once a day.

Urinates 200cc per void. 6 times Output: 1L – 1.5L

daily.
(+) perspiration during dry season
ACTIVITY EXERCISE Patient has 5+ muscle strength in
PATTERN performing desired activities.
No excess perspiration.
Due to surgery, patient
feels weak.

Considers walking and dancing Movement restrictions due

as her form of exercise. to spinal anesthesia prior
to surgery and abdominal
binder.

Physical ADL’s Physical ADL’s

Bathing – 0 Bathing – 2
Feeding – 0 Feeding – 0
Dressing – 0 Dressing – 2
Toiletries – 0 Toiletries – 2
Transfer – 0 Transfer – 2
Managing Money – 0 Managing Money – 0

Instrumental ADL’s Instrumental ADL’s

Using telephone – 0 Using telephone – 0
Shopping – 0 Shopping – 2
Preparing Food – 0 Preparing Food – 4
Laundries – 0 Laundries – 4
Transportation – 0 Transportation – 2
Taking Meds – 0 Taking Meds – 2
Housekeeping – 0 Housekeeping – 4
SLEEP-REST PATTERN Sleeps approximately 2-3 hours Increase hours of sleep
a day without naps (5-6 hours)

Has trouble in falling asleep due Has sleep interruptions

to enlarged abdomen and due to surgery
occasional pain in the abdomen.
(5 days prior to consultation)

Watching television, listening to Sleep is her only form of

music, bonding with her children
is form of relaxation.
ROLE-RELATIONSHIP The patient lives with her 4
PATTERN daughters. She is the only one
taking care of them because his
husband is an OFW in Dubai.
SEXUAL AND Menarche: @ 13 y/o
REPRODUCTIVE LMP: July 25, 2009
PATTERN
Has dysmenorrhea during
relaxation
Her children are the ones
who took care of her
during her hospital stay.
Patient didn’t have her
period while she was in
the hospital.
 menstruation which started since
menarche

Period lasts for 3-5 days and uses

5-6 pads a day

No problems with her genitalia

1st Sexual Intercourse:

29 y/o with her husband
Does not use oral contraceptives

Last PAPSMEAR: Aug. 21, 2009

(Normal)

G4P4
COPING STRESS When she is tired from work, she She spends time with her
smokes approximately 5 sticks a kids
day in a regular basis which
started since 21 years old.

She also spends time with her

kids to relieve stress
VALUES-BELIEF Her family is her priority Her fast recovery and her
PATTERN health status are
important to her right now.

She is a Roman Catholic, she

goes to church every Sunday

Has no restrictions on medical Allows all medical

procedures procedures
COGNITIVE No hearing difficulty No hearing difficulty
PERCEPTUAL PATTERN (+) Rinne’s Test and (-) Weber’s (+) Rinne’s Test and (-)
Test Weber’s Test

Wears corrective lenses Wears corrective lenses

Grade: 20/100 left eye
20/20 Right Eye

V. Physical Assessment:

BASELINE DATA

Vital Signs

Blood Pressure Pulse Rate Respiratory Rate Tempearture (˚C)

Pre-Operation 120/90 mmHg 71 bpm 20 cpm 37.1
Post-Operation 120/70 mmHg 78 bpm 17 cpm 36.6

Areas To Assess Pre-Operation Post-Operation Normal Findings Interpretation

Findings Findings
APPEARANCE AND MENTAL STATUS
1. Body Build Slim but has a Slim; bulk was Proportionate Sign of The mass
bulk on her gone mass was
abdomen removed
Height 5ft. 1 inch 5ft. 1 inch
Weight
2. Posture and Slightly lordotic Due to surgery, Relaxed; Erect Due to pressure and
Gait patient has posture; weight the posture is
restrictions on her coordinated altered
movements movement
3. Over-all Neat, no form of Nurses give her Neat, no form of No deviation from
Hygiene body odor after care bad odor normal findings
and Grooming
4. Signs of Distress noted Distress noted No distress noted Uncomfortable
Distress because of the
presence of mass
5. Signs of Illness Unhealthy Patient looks Healthy She has been
appearance healthier but is not Appearance diagnosed with
yet in optimum Myoma Uteri,
condition Intramural with
Subsenous
Component
She has undergone a
major surgery.
6. Client’s Mood Acts Acts appropriately Acts appropriately No deviation from
appropriately on in the given in a given normal findings
the given situation situation
situation
7. Client’s Attitude Cooperative and Cooperative and Cooperative and No deviation from
able to follow able to follow able to follow normal findings
instructions instructions instructions
8. Quality of Understandable; Understandable; Understandable; No deviation from
Speech moderate in moderate in pace; moderate pace; normal findings
pace; clear tone clear tone clear tone
9. Organization of Makes sense of Makes sense of Logical sequence; No deviation from
Thoughts reality reality makes sense of normal findings
reality
SKIN
1. Skin Color Light brown pale Variable Pre op patient’s skin is
pale due to blood loss;
poor circulation
2. Uniformity of Generally Generally uniform Generally uniform No deviation from
skin color uniform except except on areas except for areas normal findings
 on areas exposed to the exposed to the
exposed to the sun sun
sun
3. Assess edema, Edema on the Edema on the No edema The mass puts
if present lower lower extremities pressure on lower
extremities extremities; making
fluids retention
4. Skin lesions -Nevi on the -Nevi on the face Freckles, - Scar is due to
face and has a and has a scar on birthmarks, flat TAHBSO
scar on the the manus area and raised nevi
manus area -Has scar on the
-Has scar on the abdomen due to
abdomen due to CS Delivery
CS Delivery -Scar on Q4P4
5. Skin Moisture Moist on skin Moist on skin folds Moist in skin folds No deviation from
folds and axillae normal findings
6. Skin Uniform within Uniform within Uniform within No deviation from
Temperature normal range normal range normal range normal findings
7. Skin Turgor Springs back to Springs back to Springs back to No deviation from
previous state previous state previous state normal findings
HAIR
1. Evenness of Evenly Evenly distributed Evenly distributed No deviation from
hair growth in distributed normal findings
the scalp
2. Hair Thick hair Thick hair Thick hair No deviation from
thickness/thinne normal findings
ss
3. Presence of No infection No infection No infection No deviation from
infection normal findings but
there are risk for
infections
4. Amount of body Has some hair Has some hair on Variable No deviation from
hair on some parts some parts of the normal findings
of the body body
NAILS
1. Curvature and Convex @ 160˚ Convex @ 160˚ Convex curvature No deviation from
Angle of angle of nail angle of nail plate about 160˚ angle normal findings
Fingernail Plate plate of nail plate
2. Fingernail and Smooth texture Smooth texture Smooth texture No deviation from
toenail texture normal findings
3. Fingernail and Not highly Not highly Highly vascular Altered circulation
toenail bed vascularised vascularized
color
4. Blanch Test for Return to usual Return to usual Prompt return of Altered circulation
capillary refill color in 5 color in 5 seconds pink/usual color
seconds usually less than 4
seconds
SKULL AND FACE
1. Size, shape and Round, smooth Round, smooth Round, smooth No deviation from
symmetry of skull contour normal findings
 skull
2. Nodules, Smooth, uniform Smooth, uniform Smooth, uniform No deviation from
depression in consistency; consistency; consistency; normal findings
skull absence of absence of absence of
nodules nodules nodules
3. Facial Features Symmetric and Symmetric and Symmetric; No deviation from
equal equal palpebral features normal findings
equal in size
4. Signs of edema No edema No edema No edema No deviation from
and hollowness normal findings
of the eyes
5. Symmetry of Symmetric facial Symmetric facial Symmetric facial No deviation from
facial movements movements movements normal findings
movements
EYE STRUCTURE AND VISUAL ACTIVITY
1. Eyebrow hair Evenly Evenly distributed; Evenly distributed; No deviation from
distribution, distributed; skin skin intact; skin intact; normal findings
alignment, skin intact; symmetrically symmetrically
quality and symmetrically aligned; equal aligned; equal
movement aligned; equal movement movement
movement
2. Evenness of Equally Equally Equally No deviation from
hair and distributed; distributed; curled distributed; curled normal findings
direction of curled slightly slightly outward slightly outward
eyelashes outward
3. Eyelid surface No deviation from
characteristics: normal findings
 Position in relation to
cornea Intact Intact - skin is intact; no
No discoloration No discoloration discoloration; no
discharge
 Ability to blink Lids close Lids close -lids close
symmetrically symmetrically symmetrically
 Frequency of 17 blinks per 17 blinks per -15 to 20 blinks
blinking minute minute per minute
 Lower eyelids when Upper and lower Upper and lower -(open lids) upper
eyes are closed borders slightly borders slightly and lower borders
covered covered slightly covered
4. Color, presence Transparent; Transparent; Transparent; No deviation from
of lesions of the evident evident capillaries; evident capillaries; normal findings
bulbar capillaries; sclera is white sclera is white
conjunctiva sclera is white
5. Color, presence Shiny; smooth; Shiny; smooth; Shiny; smooth; No deviation from
of lesions in the red red pink/red normal findings
palpebral
conjuctiva
6. Edema in the No edema No edema No edema No deviation from
lacrimal glands normal findings
7. Lacrimal sac No edema; no No edema; no No edema; No No deviation from
and tearing tearing tearing normal findings
 nasolacrimal
sac
8. Clarity and Transparent; Transparent; Transparent; No deviation from
texture of the shiny; smooth; shiny; smooth; shiny; smooth; normal findings
cornea details of iris are details of iris are details of iris are
visible visible visible
9. Transparency 3mm in depth; 3mm in depth; 3mm in depth; No deviation from
and depth of transparent; no transparent; no transparent; no normal findings
the anterior shadows of light shadows of light in shadows of light in
chamber in the iris the iris the iris
10. Color, size, Equal in size; Equal in size; Equal in size; No deviation from
shape and black in color black in color black in color normal findings
symmetry of
pupil
11. Assess each No deviation from
pupil’s direct normal findings
and consensual
reaction
 Direct response
 Consensual Able to constrict Able to constrict -should be able to
Response Able to constrict Able to constrict constrict
-should be able to
constrict
12. Pupil’s reaction Constrict when Constrict when Constrict when No deviation from
to looking at a near looking at a near looking at a near normal findings
Accomodation object object object
Dilate when Dilate when Dilate when
looking at a far looking at a far looking at a far
object object object
13. Peripheral Can see objects Can see objects in Can see objects in No deviation from
Visual Fields in periphery periphery periphery normal findings
14. Six ocular Coordinated Coordinated Coordinated No deviation from
movements for movement; movement; moves movement; moves normal findings
eye alignment moves in unison in unison in unison
and
coordination
15. Location of light Light falls Light falls Light falls No deviation from
reflex symmetrically symmetrically on symmetrically on normal findings
on both pupils both pupils both pupils
16. Hirschberg Uncovered eye Uncovered eye Uncovered eye No deviation from
test/Cover Test does not move does not move does not move normal findings
17. Near Vision Able to read Able to read Able to read No deviation from
newsprint newsprint newsprint normal findings
18. Distance vision 20/100 vision 20/100 vision 20/20 vision uses corrective lenses
through
Snellen’s Chart
EARS AND HEARING
1. Color, Color same as Color same as Color same as No deviation from
symmetry and facial skin; facial skin; facial skin; normal findings
postion of symmetrical; symmetrical; symmetrical;
 auricles aligned with the aligned with the aligned with the
outer canthus outer canthus outer canthus
about 10˚ from about 10˚ from about 10˚ from
vertical vertical vertical
2. Texture, Mobile; firm; Mobile; firm; pinna Mobile; firm; pinna No deviation from
elasticity and pinna recoils recoils after folded recoils after folded normal findings
tenderness of after folded
auricles
3. Watch-Tick Audible Audible Audible No deviation from
Test normal findings
4. Weber’s Test Sound is heard Sound is heard on Sound is heard on No deviation from
on both ears/ both ears/ both ears/ normal findings
localized at the localized at the localized at the
center of the center of the head center of the head
head
5. Rinne’s Test AC>BC AC>BC AC>BC No deviation from
normal findings
NOSE AND SINUSES
1. Deviation in Symmetric; Symmetric; Symmetric; No deviation from
shape, size, straight; no straight; no straight; no normal findings
color and discharge discharge discharge
discharge in the
external nose
2. Areas of No tenderness No tenderness No tenderness No deviation from
tenderness, and lesions and lesions and lesions normal findings
masses/displac
ements of bone
3. Patency of both Air moves freely Air moves freely Air moves freely No deviation from
nasal cavities as the client as the client as the client normal findings
breathes breathes through breathes through
through the the nares the nares
nares
4. Presence of Mucosa pink; Mucosa pink; Mucosa pink; No deviation from
redness, clear watery clear watery clear watery normal findings
swelling , discharges; no discharges; no discharges; no
growths and lesions lesions lesions
discharges
5. Nasal septum Nasal septum Nasal septum Nasal septum No deviation from
between nasal intact with the intact with the intact with the normal findings
chambers midline midline midline
6. Maxillary and Not Tender Not Tender Not Tender No deviation from
frontal sinuses normal findings
MOUTH AND OROPHARYNX
1. Symmetry of Uniform pink; Uniform pink; soft; Uniform pink; soft; No deviation from
contour color soft; moist; moist; smooth; moist; smooth; normal findings
and texture of smooth; symmetric in symmetric in
the outer lips symmetric in contour contour
contour
2. Inner lips and Uniform pink; Uniform pink; Uniform pink; No deviation from
buccal mucosa moist; smooth; moist; smooth; moist; smooth; normal findings
 soft and elastic soft and elastic soft and elastic
3. Teeth and 32 adult teeth; 32 adult teeth; 32 adult teeth; No deviation from
gums smooth, shiny smooth, shiny smooth, shiny normal findings
enamel; pink enamel; pink enamel; pink
gums gums gums
4. Surface of Central position; Central position; Central position; No deviation from
Tongue pink; raised pink; raised pink; raised normal findings
papillae papillae papillae
5. Tongue Moves freely; no Moves freely; no Moves freely; no No deviation from
Movement tenderness tenderness tenderness normal findings
6. Baseline of the Smooth tongue Smooth tongue Smooth tongue No deviation from
tongue base with base with base with normal findings
prominent veins prominent veins prominent veins
7. Tongue and Smooth; no Smooth; no Smooth; no No deviation from
floor of the palpable palpable nodules palpable nodules normal findings
mouth nodules
8. Hard and Soft Soft palate is Soft palate is dark Soft palate is light Because of smoking in
Palate dark fading pink fading pink and pink and smooth the past years
and smooth smooth hard Hard palate is
hard palate is palate is slightly lighter pink and
slightly purple purple irregular
9. Uvula Position Midline soft Midline soft palate Midline soft palate No deviation from
palate normal findings
10. Color and Pink; smooth Pink; smooth Pink; smooth No deviation from
texture of posterior wall posterior wall posterior wall normal findings
oropharynx
11. Inspect tonsils Pink; smooth; Pink; smooth; no Pink; smooth; no No deviation from
no discharge; discharge; grade discharge; grade normal findings
grade 1 1 1
12. Gag reflex present Present present No deviation from
normal findings
NECK
1. Neck Muscles Equal in size; Equal in size; Equal in size; No deviation from
Head centered head centered head centered normal findings
2. Head No deviation from
Movement normal findings
 Sternocleidoma -head flexes @ -head flexes @ -head flexes @
stoid 45˚ 45˚ 45˚
(chin to chest) -head hyper -head hyper
 Trapezius extends @ 60˚ extends @ 60˚ -head hyper
muscle extends @ 60˚
(head to back)
-head laterally -head laterally
 Sternocleidoma flexes @ 40˚ flexes @ 40˚ -head laterally
stoid flexes @ 40˚
(side to side) -head laterally -head laterally
 Sternocleidoma rotates @ 70˚ rotates @ 70˚ -head laterally
stoid rotates @ 70˚
(turn head from R
to L)
 3. Muscle Equal strength Equal strength Equal strength No deviation from
Strength normal findings
4. Palpation of No deviation from
enlarged lymph normal findings
nodes
 Occipital Not Palpable Not Palpable Not Palpable
 Postauricular
 Preauricular
 Submandibular
 Submental
 Superficial
Anterior Cervical
 Posterior
Cervical
 Inferior Anterior
Cervical
 Supraclavicular
5. Palpation of Central Central placement Central placement No deviation from
trachea placement in in midline of neck in midline of neck normal findings
midline of neck
6. Inspection of Not visible on Not visible on Not visible on No deviation from
thyroid glands inspection inspection inspection normal findings
7. Palpation of Palpable Palpable Palpable No deviation from
thyroid glands normal findings
THORAX AND LUNGS
1. Shape and Anteroposterior Anteroposterior to Anteroposterior to No deviation from
symmetry of to transverse transverse has a transverse has a normal findings
thorax has a ratio of ratio of 1:2 ratio of 1:2
1:2 Chest Symmetric Chest Symmetric
Chest
Symmetric
2. Spinal Signs of Spine vertically Spine vertically No deviation from
Alignment Lordosis aligned aligned normal findings
3. Palpation of Intact; no Intact; no masses Intact; no masses No deviation from
posterior thorax masses normal findings
4. Palpation of Full; symmetric Full; symmetric Full; symmetric No deviation from
posterior chest chest expansion chest expansion chest expansion normal findings
for respiratory
excursion
5. Chest for vocal Bilateral Bilateral symmetry Bilateral symmetry No deviation from
(tactile) fremitus symmetry of of vocal fremitus of vocal fremitus normal findings
vocal fremitus
6. Percussion of Percussion Percussion notes Percussion notes No deviation from
the thorax notes resonance, except resonance, except normal findings
resonance, over the scapula over the scapula
except over the
scapula
7. Breathing Rhythmic; Rhythmic; Quiet; Rhythmic; No deviation from
Patterns Effortless Effortless effortless normal findings
8. Costal angle Costal @ 90˚ Costal @ 90˚ Costal @ 90˚ No deviation from
 and angle @ Ribs insert to Ribs insert to the Ribs insert to the normal findings
which the ribs the spine @ 45˚ spine @ 45˚ spine @ 45˚
enter the spine
9. Palpation of Full symmetric Full symmetric Full symmetric No deviation from
anterior chest excursion; excursion; thumbs excursion; thumbs normal findings
for respiratory thumbs normally normally separate normally separate
excursion separate 3-5cm or (1.5—2 3-5cm or (1.5—2
3-5cm or (1.5— inches) inches)
2 inches)
10. Palpate tactile Normally Normally Normally No deviation from
fremitus decreased over decreased over decreased over normal findings
the heart and the heart and the heart and
breast tissues breast tissues breast tissues
11. Percuss Resonance Resonance down Resonance down No deviation from
anterior chest down to the 6th to the 6th rib @ the to the 6th rib @ the normal findings
rib @ the level level of the level of the
of the diaphragm but flat diaphragm but flat
diaphragm but over the areas of over the areas of
flat over the heavy muscle and heavy muscle and
areas of heavy bone; dull on bone; dull on
muscle and areas over the areas over the
bone; dull on heart and liver; heart and liver;
areas over the tympanic over the tympanic over the
heart and liver; underlying underlying
tympanic over stomach stomach
the underlying
stomach
12. Auscultate the Bronchial and Bronchial and Bronchial and No deviation from
trachea tubular breath tubular breath tubular breath normal findings
sounds are sounds are sounds are
normal normal normal
13. Auscultate the Broncho- Broncho-vesicular Broncho-vesicular No deviation from
anterior chest vesicular and and vesicular and vesicular normal findings
vesicular breath breath sounds are breath sounds are
sounds are normal normal
normal
HEART AND CENTRAL VESSELS
1. Inspect and No deviation from
palpate precordium normal findings
for presence of
abnormal pulsations
 Locate angle of
Louis
 Aortic Area -no pulsation -no pulsation -no pulsation
(right 2nd intercostals
space) -no pulsation -no pulsation -no pulsation
 Pulmonic Area
(left 2nd intercostals
space) -no pulsation -no pulsation -no pulsation
 Tricuspid Area
(left 5th intercostals
space) -no pulsation -no pulsation -no pulsation
 Mitral Area
(laterally 2-3 inches
to the LMCL from the -no pulsation -no pulsation -no pulsation
tricuspid)
2. Auscultate the No deviation from
heart in the 4 normal findings
anatomic sites:
 Aortic Area -heard in all -heard in all sites -heard in all sites
sites (louder in (louder in the (louder in the
the apical area) apical area) apical area)
 Pulmonic -heard in all -heard in all sites -heard in all sites
Area sites (louder (louder @the (louder @the
@the base of base of the heart) base of the heart)
 Tricuspid Area the heart) -heard in children -heard in children
-heard in and young adults and young adults
children and -heard in older -heard in older
 Mitral Area young adults adults adults
-heard in older
adults
3. Palpate carotid Full pulsation; Full pulsation; Full pulsation; No deviation from
artery elastic arterial elastic arterial wall elastic arterial wall normal findings
wall
4. Auscultate No sound heard No sound heard No sound heard No deviation from
carotid artery normal findings
5. Jugular veins Not visible Not visible Not visible No deviation from
normal findings
BREAST AND AXILLAE
1. Breast size, Rounded shape; Rounded shape; Rounded shape; No deviation from
shape and slightly unequal; slightly unequal; slightly unequal; normal findings
symmetry of generally generally generally
breast symmetric symmetric symmetric
2. Skin of the Skin is uniform Skin is uniform in Skin is uniform in No deviation from
breast in color; smooth color; smooth color; smooth normal findings
3. Emphasize
retraction
 Raised arms -retracts -retracts -retracts No deviation from
above the head normal findings
 Push hands -retracts -retracts -retracts
together
 Press hands -retracts -retracts -retracts
down to hips
4. Size, shape, Round/oval; Round/oval; Round/oval; No deviation from
symmetry and bilaterally the bilaterally the bilaterally the normal findings
color of areola same; light pink same; light pink to same; light pink to
to dark brown dark brown dark brown
5. Size, shape, Round; everted; Round; everted; Round; everted; No deviation from
symmetry and equal in size; equal in size; equal in size; normal findings
nipple color similar in color; similar in color; similar in color;
 point in the point in the same point in the same
same direction; direction; no direction; no
no disharge disharge disharge
6. Palpate axillary, No tenderness; No tenderness; no No tenderness; no No deviation from
subclavicular, no masses; no masses; no masses; no normal findings
supraclavicular nodules nodules nodules
lymph nodes
7. Palpate breast No tenderness; No tenderness; no No tenderness; no No deviation from
no masses; no masses; no masses; no normal findings
discharges discharges discharges
8. Palpate areolar No masses; no No masses; no No masses; no No deviation from
and nipple discharges discharges discharges normal findings
ABDOMEN
1. Skin Integrity (+) stretch (+) stretch marks Unblemished skin No deviation from
marks (+) scar due to CS normal findings
(+) scar due to Delivery
CS Delivery
2. Contour and Concave in Concave in shape Flat/rounded; No deviation from
symmetry of shape scaphoid; no normal findings
abdomen evidence of
enlargement of
the liver or spleen
3. Abdominal No deviation from
movements normal findings
 Respiration Symmetric Symmetric -Symmetric
Movements Movements movements
 Peristalsis Not visible Not visible -Visible peristalsis
on very lean
people
-felt in thin person
 Aortic Not felt Not felt at the epigastric
Pulsations areas
4. Vascular Not visible Not visible Not visible No deviation from
Pattern normal findings
5. Auscultate Bowel sounds Bowel sounds not Audible bowel No deviation from
abdomen not audible audible sounds; absence normal findings
of arterial bruits
Arterial bruits Arterial bruits and and frictions rub
and friction rubs friction rubs are
are absent absent
6. Percuss Nothing heard Nothing heard Tympany over the Because ofthe
abdomen stomach and gas- presence of tumor
symmetrically filled bowel; (myoma)
dullness over the
liver and spleen;
resonance over
fluid-filled bladder
7. Perform light Presence of Presence of No tenderness; Because of the
palpation tenderness; firm tenderness; firm relaxed abdomen; presence of tumor
and movable and movable smooth and (myoma)
 consistent tension
8. Palpate liver Not palpable Not palpable May not be No deviation from
palpable; borders normal findings
feels smooth
MUSCULOSKELETAL SYSTEM
1. Muscle size Equal in both Equal in both Equal in both No deviation from
sides of the sides of the body sides of the body normal findings
body
2. Muscle tremors No tremors No tremors No tremors No deviation from
normal findings
3. Contractures in No contractures No contractures No contractures No deviation from
the normal findings
muscles/tendon
s
4. Palpation of Smooth and Smooth and Normally smooth; No deviation from
muscles while coordinated coordinated coordinated normal findings
active and movements movements movements
passive
5. Palpation of Firm Firm Normally firm No deviation from
muscles @ rest normal findings
6. Muscle strength Equal strength Equal strength on Equal strength on No deviation from
on each side each side each side normal findings
7. Skeleton No deformities No deformities No deformities No deviation from
normal findings
8. Edema in No edema No edema No edema; no No deviation from
bones tenderness; no normal findings
swelling
9. Joint Swelling Joint swelling Joint swelling No swelling No deviation from
normal findings
10. Joint range of No difficulty in No difficulty in Varies @ some No deviation from
motion motion motion degree in normal findings
accordance with a
person’s genetic
make-up and
degree of physical
activity

VI. Anatomy and Physiology

The Female Reproductive System

Sexual characteristics are divided into two types. Primary characteristics are directly related to
reproductive and that includes the sex organs (genitalia). Secondary sexual characteristics are attributes
other than the sex organs that generally distinguish one sex from the other but are not essential to
reproduction.

Mons Pubis/ Veneris – mountain of Venus, a pad of fatty tissue that lies over the symphysis pubis covered
by the skin and at puberty covered by pubic hair that serves as a cushion or protection to the symphysis
pubis
Labia Majora – large lips, longitudinal fold from perenium to pubis symphysis

Labia Minora – AKA Nymphae, soft thin longitudinal fold between labia majora

Clitoris – “key”, pea – shaped erectile tissue composed of sensitive nerve endings; sought of sexual
arousal in females

Fourchet – tapers posteriorly of the labia majora. Site of episotomy

- Sensitive to manipulation, torn during pregnancy

Vestibule – almond shaped area that contains the hymen, vaginal orifice and batholene’s gland

Urinary Meatus – small opening of urethra/ opening for urination

Skene’s Gland – AKA Paraurethral Gland, two (2) small mucus secreting glands for lubrication

Hymen – Membranous tissue that covers the vaginal orifice

Vaginal Orifice – external opening of the vagina

Vagina – female organ for sexual intercourse, passageway of menstruation, ¾ inches, 8 – 10 long
containing rugae

Rugae - permits considerable stretching without tearing during pregnancy

Uterus – hollow muscular organ, varies in size, weight and shape; organ of menstruation

Size: 1 x 2 x 3

Shape: pear shaped: pregnant - ovoid

Weight: Uterine involution

Non pregnant: 50 – 60 g

Pregnant: 1000 g

4th stage of labor: 1000 g

2nd week after delivery: 500 g

3rd weeks after delivery: 300 g

5-6 weeks after delivery: 50 -60 g

Fallopian Tube – 2 – 3 inches long that serves as a passageway of the sperm from the uterus to the
ampulla or the passageway of the mature ovum or fertilized ovum from the ampulla to the uterus.

Infundibulum – most distal part, trumphet shape, has fimbriae

Fembriae – finger like structures that collects the mature ovum from the ovary
Ampulla – outer 3rd and 2nd half, site of fertilization, common site for ectopic pregnancy

Isthmus – site of sterilization, site for BTL (Bi Lateral Tubal Ligation)

Interstitial – most dangerous site for ectopic pregnancy

Ovary - the ovum-producing reproductive organ, often found in pairs as part of the vertebrate female
reproductive system

6 major parts of the Ovaries

Germinal Epithelium – layers of epithelium that covers the surface of the body

Tunica Albuginae – whitish capsule of dense connective tissue located deep in the germinal epithelium

Stroma – region of tissue deep to the tinuca albuginea

Ovarian Follicle – the sackor bag that covers the ova during ovulation

Grafan Follicle – follicle that surrounds the ova during expulsion of the unfertilized egg out of the ovary

Corpus Luteum - a yellow endocrine gland found in the ovary formed when the follicle is discharged its
progesterone, estrogen and relaxin

3 Layers of Ovaries

Cortex – the outer layer of the ovary

Medulla – middle layer

Hilum – the inner layer which contains the stroma and hilar cells which excretes hormone like progesterone,
estrogen and relaxin

Oogenesis – process of maturation of ovum

30 weeks AOG – 6 million immature ovum

@ birth - 1 million immature ovum

@ puberty- 300-400 immature

@ 13 y/o – 300-400 mature oocytes

@ 23 y/o – 180-280 mature ovum

@ 33 y/o – 60-160 mature ovum

@ 26 y/o – 24-124 mature ovum

@26 y/o – 4 mature ovum

Functions of Estrogen and Progestin

Estrogen – hormone of woman

Primary Function

Responsible for the development of secondary characteristics in female

Inhibit production of FSH

Other function

Hypertrophy of the myometrium

Spinnbarkeit and Ferning Patter (Billing Method)

Ductile structure of the breast

Osteoblastic bone activity (causes increase in height)

Early closure of the epiphysis of the bone

Sodium retention

Increased sexual desire

Responsible for vaginal lubrication

Progesterone – Hormone of the mother

Primary Function- prepares the endometrium for implantation making it thick and
tortuous

Secondary Function – inhibit uterine contractibility

Others:

Inhibits LH (Hormone of ovulation) production

GI motility

Permeability of kidneys to lactose and dextrose causing + 1 in urine

Mammary gland development

BBT
 VII. PathoPhysiology:
Predisposing Factors

Modifiable: Non-Modifiable: ↑Estrogen and

↑Estrogen
Diet: ↑Cholesterole Intake → ↑Estrogen Multipara: G4P4(4004)→ Progesterone
Production Production(femal
e)

Exercise: ↓exercise → ↑ Fats Age: 44 (15-40)

Intramural Myoma Small Benign Tumor(fibroid tissue)

located on anterofundal
area

Monoclonal

Estrogen-Dependent Increase Fibroid Growth ↑Cell Division and DNA

Tumor replication

↑Circulating Estrogen
Estrogen Recptors ↑Estrogen at the site of
overexpressed tumor

Symptomatic Enlarged Fibriod

Symptom/s: Total Abdominal Hysterectomy and

Bilateral Salphingo
-Sever Pain Oopherectomy(TAHBSO)
VIII. Laboratory Result
IX. Course in the Ward

The patient was admitted on August 1, 2009 and diagnosed with Myoma Uterine and was operated
by the procedure of Total Abdominal Hysterectomy with Bilateral Salphingo- Oophorectomy on the following
day (September 1, 2009).

On September 2, 2009, 6:15 am, her vital signs were normal with a blood pressure of 120/70, her
heart rate is 78 bpm, has a respiratory rate of 17 cpm, and her temperature is 36.6 ˚C.

By 7:52 am on the same day, the patient has adequate and clear urine output, has normoactive
bowel sound and has a minimal vaginal bleeding. As the doctor ordered, the IVF of the patient should be
consumed, may have general liquid diet which consist of soft boiled egg, crackers and gelatin for lunch. Her
catheter can be removed once IVF is consumed. The patient may sit up in bed. The doctor added that once
the IVF is consumed, it should be shifted to oral medication.

1. Co-Amoxyclav (Natravol) 628 mg capsule every 2 hours

2. Mefenamic Acid (Istan) 500 mg capsule every 6 hours PRN for pain
3. Insert Dulcolax 1 rectal suppository STAT

By 6:30 pm of the same day, the patient may have a full diet.

September 3, 2009, her vital signs were still stable with a blood pressure of 120/80, has a pulse
rate of 71 bpm, her respiratory rate is 21 cpm and her temperature is 36.8˚C. By 6:38 am, the patient voids
freely with flatus and has bowel movements. Her abdomen was soft, non-tender and no vaginal bleeding.
The patient is now comfortable and has no complaint. The doctor ordered to increase oral fluid intake and
also prepare her PhilHealth requirements.

Exactly by 8:00 am, the wound dressing was done, the wound was well copulated. No discharge
found, stable vital signs and has a positive bowel movement. Still has no vaginal bleeding. By this time, the
patient may go home but still needs to take medication.

The patient is needed for a follow check up on September 11, 2009 10:00 at OBOAD.

By 6:05 pm, her vital signs were still stable. Her blood pressure is 110/70, has a pulse rate of 76
bpm, has a respiratory rate of 20 cpm and her temperature is 36.2˚C. Still has no vaginal bleeding with
flatus, has bowel movements and voids freely.

September 4, vital signs of the patient were still normal with a blood pressure of 120/70, has a
pulse rate of 74 bpm, her respiratory rate was 18 cpm and her temperature was 36.6˚C. By 6:45 am, upon
checking her condition, her abdomen is soft and non- distended. The patient voids freely, has positive flatus
and positive bowel movements. And finally, by 7:05 am, the doctor ordered to cancel the previously saved
blood.

X. NCP
 XI. Discharge Planning
XII. Drug Study

DRUG Actions Indications Side Effect/Adverse Effect Nursing

Considerations
Drug Name: Amoxicillin inhibits CNS: agitation, dizziness, - Monitor patient
Co-Amoxiclav transpeptidase, fatigue, hyperactivity carefully for signs
preventing cross-linking (DAPAT PRE-OP and symptoms of
Brand Name: of bacterial cell wall PROPHYLAXIS) GI: nausea, vomiting, hypersensitivity
Natravol and leading to cell diarrhea, abdominal pain reaction.
death. Addition of - Monitor for seizures
Contraindications:
Drug Classification: clavulanate (a beta- when giving high
Hematologic: eosinophilia
Anti-infective lactam) increases doses.
drug's resistance to - Hypersensitivity to - Check patient's
Dosage/Route: beta-lactamase (an drug or any penicillin temperature and
625mg capsule enzyme produced by - Phenylketonuria watch for other signs
1 cap q8 bacteria that may (some products) and symptoms of
inactivate amoxicillin). - History of superinfection,
cholestatic jaundice especially oral or
or hepatic rectal candidiasis.
dysfunction - Instruct patient to
associated with this immediately report
drug signs or symptoms of
hypersensitivity
reaction, such as
rash, fever, or chills.
- Tell patient he may
take drug with or
without food.
- Inform patient that
drug lowers
resistance to some
types of infections.
Instruct him to report
new signs or
symptoms of infection
(especially of mouth
or rectum).
- Advise patient to
minimize GI upset by
eating small, frequent
servings of food and
drinking plenty of
fluids.
- Tell patient taking
hormonal
contraceptives that
drug may reduce
contraceptive
efficacy. Suggest she
use alternative birth
control method.
- Inform parents that
they may give liquid
form of drug directly
 to child or may mix it
with foods or
beverages.
- As appropriate,
review all other
significant and life-
threatening adverse
reactions and
interactions,
especially those
related to the drugs,
foods, and herbs
mentioned above.
Drug Name: Inhibits prostaglandin - This medication - Hypersensitivity to - If patient have had a
Mefenamic Acid synthesis by relieves pain and NSAIDs including aspirin or stomach ulcer or
decreasing the activity reduces any component of the bleeding, tell
Brand Name: of the enzyme, inflammation. formulation healthcare provider.
Istan cyclooxygenase, which - Short-term relief of - CNS: Headache, - Instruct patient to
results in decreased mild to moderate nervousness, dizziness avoid alcohol
Drug Classification: formation of pain - Integumentary: Itching, (includes wine, beer,
Analgesic prostaglandin rash and liquor) when
precursors Contraindications: - Endocrine: Fluid retention taking this medicine
Dosage/Route: - Hypersensitivity to - GI: Abdominal cramps, since it can cause
500mg capsule aspirin heartburn, indigestion, increases in stomach
tid for pain (acetylsalicylic acid) nausea,vomiting, diarrhea, irritation.
or other non- constipation, abdominal - Use caution if the
steroidal anti- distress/cramping/pain, patient has a
inflammatory dyspepsia, flatulence, weakened heart. It
agents. gastric or duodenal ulcer may cause increased
- Inflammatory with bleeding or shortness of breath
intestinal diseases. perforation, gastritis or weight gain. Then
- Active peptic ulcers - Hematologic: Bleeding recommend talking
- Renal Failure - Otic: Tinnitus with healthcare
provider or his own
physician.
- Avoid aspirin,
aspirin-containing
products, other pain
medicines, other
blood thinners
(warfarin, ticlopidine,
clopidogrel), garlic,
ginseng, ginkgo, and
vitamin E while
taking. Talk with
healthcare provider.
- If patient is allergic
to any medicine,
especially aspirin, or
have asthma. Make
sure to tell about the
allergy and how it
affected the patient
by consulting its
attending physician.
Drug Name: The only functional role Indications: Transient mild soreness Diabetics, patients
 Vitamin C of the vitamin to be - recommended for may occur at the site of prone to recurrent
categorically the prevention and intramuscular or renal calculi, those
Brand Name: established is its ability treatment of scurvy subcutaneous injection. undergoing stool
Poten-Cee to prevent and or cure - Its parenteral Too-rapid intravenous occult blood tests,
scurvy. In this role, administration is administration of the and those on sodium-
Drug Classification: however, it must affect desirable for solution may cause restricted diets or
Vitamins in some degree every patients with an temporary faintness or anticoagulant therapy
bodily function because acute deficiency or dizziness. should not take
Dosage/Route: the vitamin is needed for those whose excessive doses of
1 tablet a day literally to hold the absorption of orally vitamin C over an
body’s cell together. ingested ascorbic extended period of
Normal development of acid is uncertain. time.
cartilage, bone, and Vitamin C should be
dentine is dependent Contraindications: given with care to
upon an adequate -have diabetes, patients with
supply of vitamin C. -have kidney hyperoxaluria.
disease or an Tolerance may be
increased risk of induced with
kidney stone prolonged use of
formation, large doses.
-have a tartrazine
sensitivity
-have a sulfite
sensitivity
-are on a sodium
restricted diet
-are undergoing
testing of the stool
for blood
-are taking warfarin
(Coumadin).

Drug Name: Multivitamin Indications: -Vitamin A: Absorbtion of Known

Multivitamins supplement where a In vitamin vitamin A from the gastro- hypersensitivity to
poor dietary intake of deficiencies. intestinal tract may be any of the vitamins in
Brand Name: the relevant vitamins reduced by the presence of this product or a pre-
Cernevit exists. Contraindications: neomycin, cholestyramine, existing
Hypersensitivity to or liquid paraffin; hypervitaminosis.
Drug any of the absorption may also be
Classification:Vitamins ingredients. impaired in cholestatic
Pantothenol is jaundice and fat-
Dosage/Route: contra-indicated in malabsorption conditions.
1 tab OD haemophiliacs and
in patients with ileus -Vitamin B6: Reduces the
due to mechanical effects of levodopa.
obstruction.
-Vitamin C: Large doses
may cause diarrhoea and
other gastro-intestinal
disturbances and are
associated with the
formation of renal calcium
oxalate calculi.
APPENDIX:

I. Definition of terms

Myoma uteri - a benign tumor of the smooth muscle fibers of the uterus

salpingo-oophorectomy - is the surgical removal of a fallopian tube and an ovary

adhesiolysis - Surgery The surgical lysis of adhesions, usually by laparoscopy

Abdominal bloating - Abdominal bloating is a condition in which the abdomen (belly) feels full
and tight.

Tinnitus - is a ringing, swishing, or other type of noise that seems to originate in the ear or head

Vertigo - It is the sensation of spinning or swaying while the body is actually stationary with
respect to the surroundings

Epistaxis – (nose bleed) is the relatively common occurrence of hemorrhage from the nose,
usually noticed when the blood drains out through the nostrils

Dysphagia - is the medical term for the symptom of difficulty in swallowing

Orthopnea - The inability to breathe easily unless one is sitting up straight or standing erect.

Paroxysmal nocturnal dyspnea - A form of dyspnea characterized by the patient's waking from
sleep unable to breathe.

Engorged Neck Veins - Increased pressure and filling of the veins in the neck, making them
appear engorged and stand out

Cervical lymphadenopathy - The enlargement of the cervical lymph nodes.

Cyanosis - is a blue coloration of the skin and mucous membranes due to the presence of >
5g/dl deoxygenated hemoglobin in blood vessels near the skin surface.

heredofamilial disease - tending to occur in more than one member of a family and
suspected of having a genetic basis

cephalopelvic disporoportion - implies disproportion between the head of the baby ('cephalus')
and the mother's pelvis.

Abdominal hysterectomy - is a surgical procedure that removes your uterus through an incision
in your lower abdomen

Bilateral salpingo-oophorectomy - is a surgery in which both a woman's ovaries are removed,

along with the fallopian tubes
infundibulopelvic ligament – or suspensory ligament of ovary, a band of peritoneum that
extends upward from the upper pole of the ovary; it contains the ovarian vessels and ovarian
plexus of nerves.

vesicouterine ligament - a ligament that extends from the anterior aspect of the uterus to the
bladder.

uterosacral - pertaining to the uterus and sacrum.

Cardinal ligament - part of a thickening of the visceral pelvic fascia beside the cervix and vagina,
passing laterally to merge with the upper fascia of the pelvic diaphragm.

Transfixion suture - A crisscross stitch placed so as to control bleeding from a tissue surface or
small vessel when it is tied.

Laparotomy - Surgical incision into the abdominal cavity through the loin or flank.

Endometrium - is the inner membrane of the mammalian uterus

Hyperechoic - producing increased amplitude of waves returned in ultrasonography;

characteristic of bone and dense tumor tissue.

Poikilocytosis - the presence of poikilocytes in the blood

Poikilocytes - are erythrocytes with abnormal shapes

Round ligament of uterus - A fibromuscular band attached to the uterus on either side in front
of and below the opening of the fallopian tube and passing through the inguinal canal to the
labia majora.

Broad ligament of the uterus - is the wide fold of peritoneum that connects the sides of the
uterus to the walls and floor of the pelvis.