CASE ANALYSIS

ON OVARIAN NEW GROWTH

INTRODUCTION
Ovarian cysts are small fluid-filled sacs that develop in a woman's ovaries. Most cysts are harmless, but some may cause problems such as rupturing, bleeding, or pain; and surgery may be required to remove the cysts. Women normally have two ovaries that store and release eggs. Each ovary is about the size of a walnut, and one ovary is located on each side of the uterus. One ovary produces one egg each month, and this process starts a woman's monthly menstrual cycle. The egg is enclosed in a sac called a follicle. An egg grows inside the ovary until estrogen (a hormone), signals the uterus to prepare itself for the egg. In turn, the uterus begins to thicken itself and prepare for pregnancy. This cycle occurs each month and usually ends when the egg is not fertilized. All contents of the uterus are then expelled if the egg is not fertilized.

In an ultrasound image, ovarian cysts resemble bubbles. The cyst contains only fluid

and is surrounded by a very thin wall. This kind of cyst is also called a functional cyst, or
simple cyst. If a follicle fails to rupture and release the egg, the fluid remains and can form a cyst in the ovary. This usually affects one of the ovaries. Small cysts (smaller than one-half inch) may be present in a normal ovary while follicles are being formed. Ovarian cysts affect women of all ages. The vast majority of ovarian cysts are considered functional (or physiologic). In other words, they have nothing to do with disease. Most ovarian cysts are benign, meaning they are not cancerous, and many disappear on their own in a matter of weeks without treatment. Cysts occur most often during a woman's childbearing years. Ovarian cysts can be categorized as noncancerous or cancerous growths. While cysts may be found in ovarian cancer, ovarian cysts typically represent a normal process or harmless (benign) condition.

Oral contraceptive/birth control pill use decreases the risk of developing ovarian
cysts because they prevent the ovaries from producing eggs during ovulation. The possible risk factors for developing ovarian cysts includes history of previous ovarian

cysts, irregular menstrual cycles, increased upper body fat distribution, early
menstruation (11 years or younger), infertility, hypothyroidism or hormonal imbalance, and tamoxifen therapy for breast cancer.

Usually ovarian cysts do not produce symptoms and are seen by chance on an ultrasound performed for other reasons. However, the following symptoms may be present: Lower abdominal or pelvic pain - may start and stop, and may be severe, sudden, and sharp. Ovarian cysts usually cause pain off on one side or the other, and the pain can radiate slightly around the flank. A cyst which is bleeding or leaking, some irritative fluid

can cause generalized pelvic and lower abdominal pain which may seem to spread from the
affected side. Long-term pelvic pain during menstrual period that may also be felt in the lower

back
Pelvic pain after strenuous exercise or sexual intercourse - may be a sign of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with internal bleeding

 Pain or pressure with urination or bowel movements- Urination may hurt if your bladder is inflamed. This may occur even if you don't have an infection. Something pressing against the bladder like in ovarian cyst Nausea and vomiting- may be a sign of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with internal bleeding Vaginal pain or spots of blood from vagina - Some functional ovarian cysts can twist

or break open (rupture) and bleed. Ovarian cysts are found on transvaginal sonograms in nearly all premenopausal women and in up to 18% of postmenopausal women. Most of these cysts are functional in nature and benign. Mature cystic teratomas or dermoids represent more than 10% of all ovarian neoplasms. The incidence of ovarian carcinoma is approximately 15 cases per 100,000 women per year. Annually in the United States, ovarian carcinomas are diagnosed in more than 21,000 women, causing an estimated 14,600 deaths. Most malignant ovarian tumors are epithelial ovarian cyst adenocarcinomas. Tumors of low malignant potential comprise approximately 20% of malignant ovarian tumors, whereas fewer than 5% are malignant germ cell tumors, and approximately 2% granulosa cell tumors.

Women from northern and western Europe and North America are affected most
frequently, whereas women from Asia, Africa, and Latin America are affected least frequently. Within the United States, age-adjusted incidence rates in surveillance areas

are highest among American Indian women, followed by white, Vietnamese, Hispanic,
and Hawaiian women. Incidence is lowest among Korean and Chinese women. Diagnostic exams for ovarian new growth often include: Ultrasonography- is the most favored imaging modality to assess ovarian cysts. Transabdominal ultrasonography allows for a better overall view of the abdomen and pelvis in visualizing large ovarian masses and their subsequent complications, such as

hydronephrosis or free fluid. It is best performed with a full bladder to use as an

acoustic window in order to better visualize structures. Transvaginal ultrasonography with a higher-frequency probe allows better resolution of the ovary than a

transabdominal lower-frequency probe.

 CT scanning - is more sensitive but less specific than ultrasonography in detecting ovarian cysts. This is best in imaging hemorrhagic ovarian cysts or hemoperitoneum due to cyst rupture. It can also be used to distinguish other intra-abdominal causes of acute hemorrhage from cyst rupture. MRI - is reserved for cases in which ultrasonography and CT scanning findings are indeterminate in identifying the mass as an ovarian cyst safely in a pregnant patient. CBC is a screening test, used to diagnose and manage numerous diseases. This test determines hemoglobin level that carries oxygen and carbon dioxide throughout the body. The results can reflect problems with fluid or loss of blood. Urinalysis is also done to help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. Proper treatment can stop the development of ovarian cysts. Medications are important for managing ovarian cysts and prevent the occurrence of ovarian cancer to those malignant cysts.

SIGNIFICANCE OF THE STUDY

This case study focusing on Ovarian New Growth was chosen among other cases in the clinical area so that each of the member of the group as well as the clinical instructors will gain an in-depth knowledge and understanding of the course of the disease, giving emphasis on the prevention of exacerbations and early treatment and management of

Ovarian New Growth. In such way, this case serves as a ground for enhancing critical
thinking skills, accurate synthesis of data, augment communication skills of Health Care Provider and eventually improve the rendering of holistic nursing care for clients who are

either potentially or currently suffering from Ovarian New Growth.

OBJECTIVES
General Objective;
This case study aims to educate and equip our fellow student nurse, as well as health care providers with the needed information regarding the preventive, promotive, curative, and

rehabilitative concepts of medical and nursing management of patient with Ovarian New
Growth and its complications and to render a quality, holistic, humanistic and patient centered nursing care to patient experiencing such disease in the actual hospital setting for

the achievement of optimum health and well-being.

Specific Objectives;
To conduct a thorough study regarding the normal structure and function of the human body systems affected specifically reproductive system, and how it is altered when the disease process occurs.

To discuss and to intervene with the different assessment and diagnostic

findings that will be evident and deem relevant to the patients case. To properly identify the history of the illness on its concept and

mechanism including its risk factors and signs/symptoms.

To understand condition of disease and associate it with patients having similar manifestations and identify complications.

 To know the nursing history, personal data, health history and physical assessment of
the patient. To formulate and implement an appropriate nursing care plan that will effectively

facilitate in the recovery and restoration of the patient health status.

To the group, to build harmonious working relationship and cooperation among the team.

To establish rapport and harmonious patient-SN relationship as well as further total

patient care in actual nursing field. To apply the knowledge, skills and attitude we learned from our Clinical Instructors

and experience to the nursing field in providing health care and wellness for the patient.
To practice professionalism in dealing with the patient, to their S.O, and to the members of the health care team.

PATIENTS PROFILE
Name: B.B Age: 52 years old Date of birth: March 10, 1960 Sex: Female Birth place: Kabugao, Apayao Address: Centro Maragat, Kabugao, Apayao Civil Status: Married Dialect: Isneg, tagalog Nationality: Filipino Religion: Roman Catholic Educational Attainment: Elementary Graduate Occupation: Farmer

Date of Admission: February 4, 2013

Time of Admission: 8:20 am Mode of Arrival: Wheel chair

Chief Complaint: severe abdominal pain

Admitting Diagnosis: Appendicitis Principal Diagnosis: Ovarian New Growth, probably cyst Attending Physician: Dr. Harold V. Jamorabon Consultant: Dr. Frederick B. Rua Source of Information: Patient, S.O, Patients chart Date of discharge: February 10, 2013 Time of discharge: 2:50 pm

Final Diagnosis: Ovarian New Growth

. The female reproductive system contains two main parts: the uterus, which acts as
receptacle for the males sperm, and the ovaries which produce the female egg cells. These parts are internal: the vagina meets the external organs at the vulva, which includes the labia, clitoris and urethra. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the fallopian tubes. At the certain intervals, the ovaries release an ovum, which passes through the fallopian tubes into the uterus.

The purpose of the female reproductive system is continuation of the human species by
the production of offspring. The female reproductive system produces gametes and provides for their union through fertilization following sexual intercourse. The female reproductive system is also responsible for gestation of the offspring .

Sexual reproduction couldn't happen without the sexual organs called the gonads. Although most people think of the gonads as the male testicles, both sexes actually have gonads: In females the gonads are the ovaries. The female gonads produce female gametes (eggs); the male gonads produce male gametes (sperm). After an egg is

fertilized by the sperm, the fertilized egg is called the zygote.

When a baby girl is born, her ovaries contain hundreds of thousands of eggs, which remain inactive until puberty begins. At puberty, the pituitary gland, located in the central part of the brain, starts making hormones that stimulate the ovaries to produce female sex hormones, including estrogen. The secretion of these hormones causes a girl to develop into a sexually mature woman.

The Individual Components of the Female Reproductive System

Vulva
The external part of the female reproductive organs is called the vulva, which means covering.

The fleshy area located just above the top of the vaginal opening is called the mons pubis. Two pairs
of skin flaps called the labia surround the vaginal opening. The clitoris, a small sensory organ, is located toward the front of the vulva where the folds of the labia join. Between the labia are openings to the urethra which is the canal that carries urine from the bladder to the outside of the body and vagina. Once girls become sexually mature, the outer labia and the mons pubis are covered by pubic hair. The vulva has a sexual function; these external organs are richly innervated and provide pleasure when properly stimulated. Since the origin of human society, in various branches of art the vulva has been depicted as the organ that has the power both "to give life", and to give sexual pleasure to humankind.

Vagina
The vagina is a muscular, hollow tube that extends from the vaginal opening to the uterus. The vagina is about 3 to 5 inches (8 to 12 centimeters) long in a grown woman. Because it has muscular walls it can expand and contract. This ability to become wider or narrower allows the vagina to accommodate something as slim as a tampon and as wide as a baby. The vagina's muscular walls are lined with mucous membranes, which keep it protected and moist. The vagina has several functions: for sexual intercourse, as the pathway that a baby takes out of a woman's body during childbirth, and as the route for the menstrual blood to leave the body from the uterus. A thin sheet of tissue with one or more holes in it called the hymen partially covers the opening of the vagina. Hymens are often different from person to person. Most women find their hymens have stretched or torn after their first sexual experience, and the hymen may

bleed a little. Some women who have had sex don't have much of a change in their hymens,
though.

Cervix
The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins
with the top end of the vagina. Where they join together forms an almost 90 degree curve. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. During menstruation, the cervix stretches open slightly to allow the endometrium to be

shed. This stretching is believed to be part of the cramping pain that many women
experience. Evidence for this is given by the fact that some women's cramps subside or disappear after their first vaginal birth because the cervical opening has widened.

Uterus
The uterus is located in the pelvic cavity, superior to the urinary bladder and between the two ovaries. It is shaped somewhat like an upside-down pear and is approximately 7.5 centimeters (3 inches) long and 5 centimeters (2 inches) wide. The uterus is covered by the broad ligament. During

pregnancy the uterus increases in size, contains the placenta to nourish the embryo/fetus, and expels the
baby at the end of gestation. The upper portion of the uterus, above the entry of the fallopian tubes, is the fundus. The body is the large central portion of the uterus. The cervix is the narrow, lower end of the uterus that opens into the vagina. The outermost layer of the uterus, also known as the serosa or epimetrium, is a fold of the peritoneum. The smooth muscle layer of the uterus is the myometrium. During pregnancy, the cells of the myometrium increase in size to accommodate the growing fetus. The myometrium contracts during labor and delivery at the end of gestation. The endometrium, or lining of the uterus, is composed of two layers. The basilar layer, which is adjacent to the myometrium, is vascular but is very thin. The basilar layer is a permanent layer. The functional layer of the

endometrium is regenerated and lost during each menstrual cycle. Estrogen and progesterone from the ovaries stimulate the growth of blood vessels to thicken the functional layer in preparation for a possible

embryo. If fertilization does not occur, then the functional layer is shed through menstruation.

Fallopian Tube
There are two fallopian tubes, each attached to a side of the uterus. The fallopian tubes are about 4 inches (10 centimeters) long and about as wide as a piece of spaghetti. The lateral end of each Fallopian tube encloses an ovary. The medial end of each tube opens to the uterus.

Fimbriae, found on the lateral end of each tube, are fringe-like protrusions that generate currents in the fluid surrounding the ovary. These currents pull the ovum into the Fallopian tube. Since an ovum cannot move on its own, the structure of the Fallopian tube ensures that the ovum will be moved to the uterus. A smooth layer of muscle in the tube contracts, generating peristaltic waves that push the ovum toward the uterus. The mucosa of the tube has many folds and is made of ciliated epithelial tissue. Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed area that looks like a funnel. This fringed area wraps around the ovary but doesn't completely attach to it. When an egg pops out of an ovary, it enters the fallopian tube. Once the egg is in the fallopian tube, tiny hairs in the tube's

lining help push it down the narrow passageway toward the uterus.

Ovary
The ovaries are a pair of oval-shaped organs located in the pelvic cavity on either side of the uterus. Each ovary is approximately 4 centimeters (1.5 inches) in length. Extending from the medial side of each ovary to the uterine wall are the ovarian ligaments. The broad ligament is a section of the peritoneum covering the ovaries. These ligaments assist in keeping the ovaries in place. Located within each ovary are several hundred thousand primary follicles. These follicles are present at birth. The ovary contains many follicles composed of a developing egg surrounded by an outer layer of follicle cells. Each egg begins oogenesis as a primary oocyte. At birth each female carries a lifetime supply of developing oocytes, each of which is in Prophase I. A developing egg (secondary oocyte) is released each month from puberty until menopause, a

total of 400-500 eggs.

PHYSICAL ASSESSMENT
Name of the patient: B.B.

Date of Assessment: February 7, 2013

Time of Assessment: 9:00 pm Weight: 50 kgs Height: 54

Initial V/S: RR - 17 cpm mmHg

PR 74 bpm Temp- 36.50C

BP-110/80

Mental Status and Orientation: Patient is conscious, coherent and oriented to person, time and place Appearance and Behavior:

AREAS ASSESSED SKIN Color

METHOD USED

NORMAL FINDINGS

ACTUAL FINDINGS

ANALYSIS

Inspection

Varies from fair to light brown-dark brown complexion, generally uniform in color except in areas exposed to the sun

Light brown in complexion

Normal

Edema
Skin lesions

Inspection
Inspection

No edema
No lesions

No edema
Normal

Normal
Normal

Skin Temperature

Inspection and palpation

Within normal range (36.5-37.05C)

Within normal range(36.50C)

Normal

Skin turgor
Texture Moisture Assess presence of rashes

Palpation
Palpation Palpation Inspection

Skin goes back immediately Smooth, soft

Dry, skin folds are normally moist No rashes

Skin goes back immediately Coarse, rough

Dry, skin folds are normally moist No rashes

Normal
Due to aging Normal Normal

NAILS

- Color of nail beds

- Texture - Shape - Capillary refill time

Inspection

Pink and clean

Palpation Inspection Blanch test

Smooth Convex curvature Prompt return to usual color (1-2 seconds)

Smooth Convex curvature

Normal Normal