The frequency of ovarian cysts in pregnancy is reported

to be 1 in 1000 pregnancies (Journal of Medical Case

Reports). A 43-year-old woman was diagnosed as having an
11.7 x 8.78 x 7.82 cm (l x w x ap) multi – loculated cystic
mass at the left adnexa.
As most ovarian cysts cause no symptoms, many cysts
are diagnosed by chance such that during a routine
examination. If symptoms are suggestive of an ovarian cyst,
the doctor may examine the abdomen and perform a vaginal
examination. The doctor may be able to feel an abnormal
swelling which may be a cyst. An ultrasound scan can
confirm an ovarian cyst. It is a safe and painless test which
uses sound waves to create images of organs and structures
inside your body.
 In view of the size of the cyst, options were
discussed with her including removal of the ovarian cyst
especially that the patient has a large size of cyst. The
type of operation depends on factors such as type of the
cyst, age, and whether it is cancerous or not.
She underwent Total Abdominal Hysterectomy
Bilateral Salpingo-Oophorectomy which she and her
husband agreed to. TAHBSO involves the removal of the
uterus, both ovaries, and the fallopian tubes through an
incision in the abdomen. The lymph nodes in the pelvis
may also be removed. The surgery removed completely
the cyst.
 A 43 year old, Mrs. E.G., admitted in Socsargen
County Hospital under the care of Dr. Marie Shiela
Burgos, had complaints of abdominal pain in the left
iliac region by about 2-3 weeks. An ultrasonography
of the pelvis done recently showed an 11.7 x 8.78 x
7.82 cm (l x w x ap) multi – loculated cystic mass at
the left adnexa. As per the report, the uterus is
retroverted and normal in size. It measures 6.19 x
5.52 cm (l x ap). There is no fluid seen in the uterine
cavity. The largest locule is filled with medium and
some high amplitude echoes.
 An ovarian cyst is a sac – filled with liquid
material arising in an ovary. Majority of ovarian cysts
are benign since it covers 95% of the all the cases
(http://en.wikipedia.org/wiki/Ovarian_cyst). Benign
cysts can cause pain, discomfort, and abnormal
uterine bleeding. They rarely cause death.
 The study focuses on the nature and possible
causes that lead to having an ovarian cyst. The
patient is married without a chance of having a child
since she was first diagnosed with an ovarian cyst
just one month after their marriage. Their struggles
as couples made it hard for them to adjust and
accept it at first. The case of the patient is same with
other women having the case of ovarian cyst which
made them feel anxious if it is malignant or benign.
This is for this reason why the student nurses
decided to have the case.
 The patient had undergone Total Abdominal
Hysterectomy Bilateral Salpingo Oophorectomy to remove
the cyst last July 25, 2010. Number of researches
regarding ovarian cyst has increased to come across with
more medical and nursing managements regarding patients
with the same case as Mrs. E.G. It is same with the increased
number of diagnoses together with the widespread
implementation of regular physical examinations and
ultrasound technology. This is a big implication on the nursing
research. In this case, screening and diagnostic tests will be
more encouraged and implemented to prevent ovarian cyst
as early as possible. Medical practitioners will be more
expected to treat this condition without having any
complications.
 At the end of the presentation, the student nurses should
be able to:

• General Objectives:
Comprehend and recognize salient points that are
important to remember when dealing with patients
diagnosed with ovarian cyst
Specific Objectives:
• Identify possible nursing problems that may arise
from having ovarian cyst
• Identify medical and nursing management for patients
undergoing surgery because of ovarian cysts
• Point out nursing interventions and health teachings
in regards with dealing to patients having certain
disease.
• Make others be aware of the feelings of the patients
• Encourage and promote importance of attending
follow up check-ups
• Name: Mrs. E.G.
• Age: 43 years old
• Address: Purok 5, Katangawan, GSC
• Religion: Roman Catholic
• Civil Status: Married
• Birthdate: November 14, 1966
• Birthplace: Caloocan, Metro Manila
• Sex: Female
• Room: Female Surgical Ward Bed E
• Date of Admission: July 25, 2010
• Attending Physician: Dr. Marie Shiela Burgos
• Chief Complaints: Abdominal Pain
• Admitting Diagnosis: Ovarian Cyst
• History of Present Illness
• Past Medical History
• Family Medical History
 Prior to admission, the patient had an episode of
abdominal pain by 2-3 weeks. She felt pain on her left iliac
region. She and her husband both decided to seek for
medical assistance at Socsargen County Hospital. They
consulted her attending physician and had an ultrasound
of her pelvis. She was advised and scheduled for a Total
Abdominal Hysterectomy Bilateral Salpingo Oophorectomy
to remove the said cyst on July 25, 2010.
Routine laboratory tests were also done such as
Hematolgy, Serology, Blood Chemistry, Urinalysis, and
Roentgenological Report before the said surgery.
 After the operation, she was instructed by her
attending physician for NPO. Hooked at her left cephalic
vein is an Intravenous Fluid of D5NSS 1L x 10 hours to
serve as the main line and PNSS 1L x KVO hooked at her
right brachial vein with a side drip of PNSS 500mL +
Narapin + Morphine Sulfate x 10mgtts/min. A Foley
Catheter was also inserted to her and attached to a uro
bag draining well with bloody urine.
 According to the patient, she had an immunization of
BCG, DPT, and OPV. She had a history of having chicken
pox infection when she was on her 4th grade during
elementary.
On this year is her second hospitalization. When she
was first diagnosed with ovarian cyst last January 2007,
she was advised to be admitted and scheduled to remove
her cyst by an operation. She agreed to be admitted during
that time, March 2007, making it her first time of
hospitalization. However, the operation was cancelled
because the ovarian cyst became smaller as seen on the
ultrasound result.
 There is no known inherited condition present in her
both paternal and maternal family. She’s the first in their
family to be diagnosed with certain disease.
• a muscular, hollow tube that extends from
the vaginal opening to the cervix of the
uterus.
• located between the bladder and the
rectum.
• provides the passageway for childbirth and
menstrual flow.
• it also receives the penis and semen during
sexual intercourse.
• A small hole at the end of the vagina
through which sperm passes into the uterus.
• During childbirth, the cervix dilates to permit
the baby to descend from the uterus into the
vagina for birth.
• located between the urinary bladder and the
rectum.
• a hollow organ about the size and shape of
a pear.
• serves two important functions: it is the
organ of menstruation and during
pregnancy it receives the fertilized ovum,
retains and nourishes it until it expels the
fetus during labor.
• about the size and shape of almonds.
• they lie against the lateral walls of the
pelvis, one on each side.
• the ovaries are for oogenesis which is the
process of production of eggs and for
hormone production.
• each tube is about 4 inches long and extends
medially from each ovary to empty into the
superior region of the uterus.
• transport ovum from the ovaries to the uterus. The
distal end of each fallopian tube is expanded and
has finger-like projections called fimbriae, which
partially surround each ovary.
• When an oocyte is expelled from the ovary,
fimbriae create fluid currents that act to carry the
oocyte into the fallopian tube.
 Ovary

Produces Graafian Follicles

Oocytes becomes the Corpus Luteum

No Fertilization She Knew of Fertilization

Oocytes undergone Fibrosis Corpus Luteum continue to

produce Progesterone

Enlargement of the Corpus Luteum

Ovarian Cyst

pathophysiology
• Follicular cysts are generally very small and arise from
follicles that overdistend, either because they haven’t
ruptured or have ruptured and resealed before their fluid
was reabsorbed.
• Luteal cysts develop if a mature corpus luteum persists
abnormally and continues to secrete progesterone. They
consist of blood or fluid that accumulates in the cavity of
the corpus luteum and are typically more symptomatic than
follicular cysts.
• When luteal cysts persist into menopause, they secrete
excessive amounts of estrogen in response to the
hypersecretion of follicle-stimulating hormone and
luteinizing hormone that normally occurs during
menopause.
• Management Diagnostic Tests
• Drug Study
• Surgical Procedure
• HEMATOLOGY
• BLOOD CHEMISTRY
• URINALYSIS
• ROENTGENOLOGICAL REPORT
• ULTRASOUND REPORT
Name: Mrs. E.G. Age: 43 Sex: F Hospital No. 89
Physician: Burgos, Marie Shiela Admission No. 58693
Date: July 24, 2010
Examination Result Normal
Hemoglobin 129 g/L 110-150

Hematocrit 36% 38-47

Red Blood Cells 4.00 x 10^12/L 4.00-5.5

White Blood Cells 10.1 x 10^9/L 5.1-10

Neutrophils 0.78 0.50-0.65

Lymphocytes 0.16 0.25-0.40

Monocytes 0.04 0.03-0.09

Eosinophils 0.02 0.01-0.03

Platelet Count 331 150-400

Interpretation:
Hemoglobin result of 129g/L is within the normal range of
110-150.Hematocrit result of 36% is also within the normal
range of 38-47%.including the RBC, monocytes, eosinophils
and the platelet counts are in the normal range. RBC result is
4.00x 10^12/L from 4.00-5.5 normal range. While the
Monocyte result is 0.04 from a normal range of 0.03-0.09.
Eosinophils result of 0.02 from a normal range of 0.01-0.03.
Interpretation:
And a Platelet count of 331 from a normal range of 150-400.
Other results such as the Neutrophils, White Blood Cells and
Lymphocytes have deviations from the normal. For the white
blood cells, it has an increased result of 10.1x10^9/L from a
normal range of 5.1-10 which indicates infection. For the
neutrophils it also has an increased result of 0.78 from a
normal range of 0.50-0.65 that indicates infection and for
lymphocytes it has a decreased result of 0.16 from a normal
range of 0.25-0.40 which indicates infection.
Name: Mrs. E.G. Age: 43 Sex: F Hospital No. 89
Physician: Burgos, Marie Shiela Admission No. 58693
Date: July 24, 2010

Examination Result Normal

Glucose 99.00 mg/dL 70-105 mg/dL

Creatinine 0.80 mg/dL 0.6-1.3 mg/dL

Interpretation:
Glucose result of 99mg/dL is within the normal range of 70-
105mg/dL and 0.80mg/dL result of creatinine from a normal
range of 0.6-1.3mg/dL.For the blood chemistry interpretation
the glucose level and creatinine results are within the normal
ranges which indicates normal functioning of the kidney and
muscle fibers that provides energy to our body that is
converted to ATP.
Name: Mrs. E.G. Age: 43 Sex: F Hospital No. 89
Physician: Burgos, Marie Shiela Admission No. 58693
Date: July 24, 2010 CS No. C942TIL

Color: Yellow Sugar (-) Ketone

Appearance: Protein (-) Blood

Clear

Reaction: 6.0 Bile (-) Spec. Gravity: 1.020

Name: Mrs. E.G. Age: 43 Sex: F Hospital No. 89
Physician: Burgos, Marie Shiela Admission No. 58693
Date: July 24, 2010 CS No. C942TIL

Microscopic Test
Cells Crystals
Squamous Cells – Few CaCO3
Pus Cells – 3-4/ HPF Ca Oxalate
Red Blood Cells Triple Phosphates
Renal Cells Leucine/Tyrosine
Casts Ammonium Urates
Hyaline Cast Ammonium Biurates
RBC Cast Hippuric Acid
Pus Cast Amorhous Urates – Few
Finely Granular Cast Amorphous Phosphates
Coarsely Granular Cast Uric Acid
Name: Mrs. E.G. Age: 43 Sex: F Hospital No. 89
Physician: Burgos, Marie Shiela Admission No. 58693
Date: July 24, 2010 CS No. C942TIL

Others
Mucus Threads – Few
Bacteria
Yeast Cells
Interpretation:
Color yellow urine shows that it is within normal values of
straw- dark yellow; PH og 6.0 is also within the normal range
of 4.6-6.5 and clear appearance of urine from a normal
finding of clear-slightly hazy appearance. The specific gravity
result of 1.020 is within the normal range of 1.016-1.022.
Few squamous cells are seen in the urine which is normal.
The presence of ketone may indicate result from either
diabetic ketosis or some other form of calorie deprivation
(starvation). There’s an increase of number of pus cell result
of 3-4/HPF from a normal range of 1-2/HPF it indicates
infection.
 Name: Mrs. E.G. Age: 43 Sex: F Hospital No. 89
Physician: Burgos, Marie Shiela Admission No. 58693
Date: July 24, 2010 CS No. C942TIL

CXR Pa:
Lungs are clear. Heart is not enlarged. Trachea is midline. The
diaphragm/CP sulci are intact. No other remarkable findings.

Remarks: No significant chest findings

Name: Mrs. E.G. Age: 43 Sex: F Hospital No. 89
Physician: Burgos, Marie Shiela Admission No. 58693
Date: July 24, 2010 CS No. C942TIL

Pelvis:
The UB is unremarkable
The uterus is retroverted and normal in size. It measures 6.19 x 5.52
cm (l x ap). There is no fluid seen in the uterine cavity. There is an 11.7 x
8.78 x 7.82 cm (l x w x ap) multi-loculated cystic mass at the left adnexa.
Estimated volume of 421 cc. The largest locule is filled with medium and
some high amplitude echoes.
There is minute fluid at the cul-de-sac.

Remarks: Large ovarian cyst, left; Endometrioma considered

Fluid, cul-de-sac
• CEFUROXIME
• NALBUPHINE HYDROCHLORIDE
• RANITIDINE HYDROCHLORIDE
Brand Name: Zinacef
Generic Name: Cefuroxime
Classification: Antibiotic, Second
Generation Cephalosporin
Indications:
Lower respiratory infections caused by S.
pneumonia, H. parainfluenzae, H.
influenzae
UTIs caused by E. coli, Klebsiella
pneumonia
Contraindications:
Contraindicated with allergy to
cephalosporins or penicillins
Use cautiously with renal failure, lactation,
and pregnancy
Dosage:
Preoperative – 1.5 g IV 30-60 mins prior to
initial incision
Postoperative – 750 mg IV every 8 hours
for 24 hours after surgery
Mechanism of Action:
Bactericidal: Inhibits cell wall synthesis of
bacterial cell causing cell death
Adverse Reactions:
CNS – headache, dizziness, lethargy
GI – nausea, vomiting, diarrhea, abdominal pain
Local – pain, phlebitis, inflammation at IV site
Nursing Responsibilities:
Discontinue drug therapy if hypersensitivity
reaction occurs
Take the full course of the drug therapy even if
the patient feels better to prevent occurrence of
super infections
Observe and report presence of severe diarrhea
with blood, rashes and dyspnea since it may
indicate hypersensitivity reaction to the drug
Instruct patient to avoid alcohol while taking the
drug and for 3 days after because severe
reactions may often occur
Rationale: To prevent the patient from having
bacterial infection
Brand Name: Nubain
Generic Name: Nalbuphine Hydrochloride
Classification: Opioid agonist-antagonist
analgesic
Indications:
Relief of moderate to severe pain
Preoperative analgesia, as a supplement to
surgical anesthesia
Contraindications:
Contraindicated with hypersensitivity to
nalbuphine,
Use cautiously with emotional unstable patients
or those with a history of narcotic abuse
Dosage:
Induction – 0.3 – 3 mg/kg IV over 10-15 mins
Maintenance – 0.25 – 0.5 mg/kg in a single dose
Mechanism of Action:
Nalbuphine acts as an agonist at specific opioid
receptors in the CNS to produce analgesia and sedation
but also acts to cause hallucinations and is an
antagonist at mu receptors
Adverse Reactions:
CNS – sweating, headache, nervousness, confusion,
dizziness, floating feeling, warmth and blurry vision
CV – hypotension, hypertension, bradycardia,
tachycardia
GI – nausea, vomiting, cramps, dyspepsia
Respiratory – respiratory depression, dyspnea, apnea
Nursing Responsibilities:
Reassure patient about addiction liability, most patients
who receive opiates for medical reasons; do not develop
dependence syndrome
Observe and report severe nausea, vomiting,
palpitations, and dyspnea since it may indicate
hypersensitivity reaction to the drug
Rationale: To relieve the pain felt by the patient
Brand Name: Zantac
Generic Name: Ranitidine Hydrochloride
Classification: Histamine2 Antagonist
Indications:
Treatment of erosive esophagitis, heartburn, acid
indigestion, sour stomach
Contraindications:
Contraindicated with allergy to ranitidine, lactation
Use cautiously with impaired renal or hepatic
function, pregnancy
Dosage:
50 mg IV every 6-8 hours
Mechanism of Action:
Competitively inhibits the action of histamine at the
H2 receptors of the parietal cells of the stomach,
inhibiting basal gastric acid secretions and gastric
acid secretion that is stimulated by food, insulin,
histamine, cholinergic agonist, gastrin, and
pentagastrin
Adverse Reactions:
CNS – headache, dizziness, insomnia, vertigo
CV – tachycardia, bradycardia
GI – constipation, diarrhea, nausea, vomiting,
abdominal pain
Local – pain at site, local burning or itching at IV site
Nursing Responsibilities:
Provide concurrent antacid therapy to relieve pain
Observe and report presence of severe diarrhea and
rash since it may indicate hypersensitivity reaction to
the drug
Rationale: To avoid Gastrointestinal Distress
• Treatment depends on many factors, including
the type of cyst, its size, its location, the type
of material it contains and the woman's age.

• For functional cysts a "watch and wait"

approach is taken. Functional cysts tend to
dissolve over time and treatment is not
needed. The doctors do, however, require the
woman to return after two menstrual cycles to
get a pelvic exam and/or ultrasound again.
• If the cyst is still present and growing (over 2
inches), the doctor may recommend a laparoscopy
to remove the cyst. If the cyst comes and goes, the
doctor may prescribe birth control pills. These pills
reduce the hormones that promote growth of cysts
and prevent formation of large cysts.

• For polycystic ovaries the treatment varies. A major

symptom of polycystic ovaries is infertility, and
whether the woman is trying to conceive or not
determines the treatment.
• If the woman is trying to conceive and having
fertility problems, the doctor will prescribe Clomid
which helps stimulate ovulation. If the woman is not
trying to conceive and is having infrequent or no
periods, the doctor will prescribe Provera. Provera
restores normal menstrual flows.
• For endometrial cysts, cystadenomas and dermoid
cysts the treatment is to surgically remove the cyst.
If the cyst is small enough the doctor can remove it
via laparoscopy. If the cyst is over 2 ½ inches in
diameter the available procedures are:
• For endometrial cysts, cystadenomas and dermoid
cysts the treatment is to surgically remove the cyst.
If the cyst is small enough the doctor can remove it
via laparoscopy. If the cyst is over 2 ½ inches in
diameter the available procedures are:
• Ovarian cystectomy - removal of cyst
• Partial oophorectomy - removal of the cyst and a portion of
the ovary
• Salpingo-oophorectomy - removal of the cyst, ovary and
fallopian tube. This procedure is done dependent upon the
size of the cyst and complications encountered such as
bleeding, rupturing and twisting of the cyst.
• Total abdominal Hysterectomy with bilateral salpingo-
oophorectomy - removal of the cyst, both ovaries, fallopian
tubes and uterus. This procedure is rarely used unless the
cyst is cancerous.