HEMORRHAGIC

ENDOMETRIOSES, LEFT
OVARIAN CYST, BILATERAL
ADENOMYOSIS

JANUARY 5, 2015
DOCOT, RENELYNE D.

HEMORRHAGIC
ENDOMETRIOSES, LEFT
OVARIAN CYST, BILATERAL
ADENOMYOSIS
I. Patient Profile
a. Demographics
Name: OB
Hospital Number: 00429579
Birthday: May 6, 1968
Age: 46 years old

Religion: Jehovahs Witness

Occupation: Homemaker
Civil Status: Married
Educational
Attainment:
Graduate

College

b. Nursing Assessment
Neurological Assessment: GCS = 15, oriented to person, place and time.
Normal affect: appropriate to situation. Pupils equal and reactive to light and
accommodation. Pupillary size at 2-3 mm.Active Range of Motion of all
extremities with symmetry of strength. No weakness and problem with balance.
Verbalization is clear and understandable. Able to swallow food without difficulty.
Sensation is intact without numbness.
Cardiovascular/ Peripheral Assessment: Pulses are strong and palpable. It is
regular in rhythm. Blood pressure is 130/80. No edema or calf tenderness.
Extremities are normal in color and warm to touch.
Respiratory Assessment: Respiration is 20 bpm at rest. Breath sounds are
clear. With positive complaint of dyspnea. Symmetrical lung expansion. Capillary
refill is less than 3 seconds.
EENT Assessment:No sensory deficits noted. No visible foreign body, infection,
bleeding, infection present. Pupil reactive to light and accommodation.
Gastrointestinal Assessment: With direct tenderness but soft abdomen. Some
tenderness on palpation. With localized onset of pain on Left Lower Quadrant
area. Normal and active bowel sounds heard in all four quadrants. Tolerated
prescribed diet, but with pre existing nausea. No rectal bleeding.
Genitourinary Assessment: No difficulty with urination. Urine is clear and light
yellow. No urethral and vaginal bleeding. No sexually related dysfunctions.
Integumentary Assessment: Skin is clean, warm, dry and intact. Skin color is
uniform in all body parts. Mucous membranes are pink and moist. No
inflammation, nodules, nail changes, ulceration, rashes and lesions noted.
Musculoskeletal Assessment: No limitation of Range of Motion. No muscle
weakness. Absence of joint swelling, pain and deformity on extremities. Condition
of surrounding tissue show no evidence of muscle atrophy. Steady gait and
independent ambulating.

Psychological/ Social Assessment: Normal affect, appropriate response to

situation. No mood swings observed. Lives with husband and kids.
Coping-Stress Tolerance Assessment: Good support system with family and
friends. No financial constraints.
Rest and Sleep Assessment: Difficulty with sleep during pain sensation. No
problems encountered like snoring and early walking.
Values-Belief Assessment: Religious restriction on blood transfusion.
Intravenous Therapy Assessment: PNSS1 liter at 100 ml/hr, infusing well. No
evidence of redness, edema or pain on surrounding site. Dressing is dry and
intact.
II. SAMPLE
Signs and Symptoms

Allergies
Medications

Past Medical History

Last Meal Taken

On and off onset and duration of pain, pain scale=

4/10(10 being the highest), with guarding behavior,
severe dyspnea with direct tenderness but soft
abdomen, onset of pain localized to left lower
quadrant area, positive nausea
No Known Allergies
Nalbuphine, Tramadol, Marvelon, Metformin XR,
Dimicron (double check for the correct medication of
your patient) This medication does not appear in your
drug profile.
GERD (unrecalled year)
Borderline Diabetes Mellitus
Hemorrhagic Cyst (Sept. 2014)
Last meal prior to admission was of siopao and 1
glass of water @ 2330H.

Events that Lead to 2 days prior to admission, patient experienced

Admission
abdominal pain which persisted and not relieved with
ibuprofen hence consult then admitted.
III. Introduction
Reproductivehealth has not been a major concern for women in the past
years particularly in the Philippines. Women tend to seek OB-GYN consult only
during pregnancy, not even in some cases, or when the problem has already
affected activities of daily living. But as the years passed with the big influence
media has brought awareness of its importance and also because of concern in
the increasing population. Many women have taken more interest in their health
care, although some women still dont have the resources or the time.
The most common concern of women regarding reproductive health is the
menstrual period. But many other problems affect the reproductive system, and
whether the problem is serious or not, it can be anxiety producing.
Endemetrioses is quite one of the common health problems affecting the
reproductive system of women.It gets its name from the word endometrium, the
tissue that normally lines the uterus or womb. Endometriosis happens when this

tissue grows outside of the uterus and on other areas in the body where it doesn't
belong. Most often, it is found on the ovaries, fallopian tubes, outer space of the
uterus, or on the tissues that hold the uterus in place.
Endometriosis can happen to any girl or woman who has menstrual
periods, but it is more common in women in their 30s and 40s. It is a condition
wherein the exact cause is unknown. But several possible causes areproblems
with menstrual period flow. Retrograde menstrual flow is the most likely cause of
endometriosis. Some of the tissue shed during the period flows through the
fallopian tube into other areas of the body, such as the pelvis. Another is genetic
factors because endometriosis runs in families; it may be inherited in the
genes.Immune system problems since faulty immune system may fail to find and
destroy endometrial tissue growing outside of the uterus. Also, Immune system
disorders and certain cancers are more common in women with endometriosis.
And hormones like estrogen appear to promote endometriosis as well.
Researchers are looking at whether endometriosis is a problem with the body's
hormone system.Surgery on the abdominal area, such as a Cesarean (Csection) or hysterectomy, is also a possibility, endometrial tissue could be picked
up and moved by mistake. For instance, endometrial tissue has been found in
abdominal scars.
While most cases of endometriosis are diagnosed in women aged around
25 to 35 years, endometriosis has been reported in girls as young as 11 years of
age. Endometriosis is rare in postmenopausal women. Endometriosis is more
commonly found in white women as compared with African American and Asian
women. Studies further suggest that endometriosis is most common in taller, thin
women with a low body mass index (BMI). Delaying pregnancy until an older age
is also believed to increase the risk of developing endometriosis.
Its prevalence in the United States is 18-20% (13.6 million) women are
affected. Although there are no exact numbers of Filipinas affected, around 4
million is estimated to be affected based on extrapolated prevalence.
Endometriomas form in women who had endometriosis. It is an ovarian
cyst. This can result to pain and infertility.Many ovarian cysts don't cause
symptoms. Others can cause: pressure, swelling, or pain in the abdomen, pelvic
pain, dull ache in the lower back and thighs, problems passing urine completely,
pain during sex, weight gain, and pain during your period, abnormal bleeding,
nausea or vomiting, and breast tenderness. Severe symptoms are pain with fever
and vomiting, sudden, severe abdominal pain, faintness, dizziness, or weakness
and rapid breathing. Most cysts are not cancerous. Women who are past
menopause (ages 5070) with ovarian cysts have a higher risk of ovarian
cancer.
Endometrial tissue also invades the uterine wall that may cause the uterus
to become enlarged, firm and tender on palpation. This condition is
adenomyosispreviously named as endometriosis interna, adenomyosis actually
differs from endometriosis and these two disease entities are found together in
only 10% of the cases. The incidence is highest in women 40-50 years of age.
In the conduct of this study, I utilized the patients chart as a background to
the management of the patient. It is focused on the time the patient is admitted at

our floor, the fifth coming from the emergency department. The interventions
done here were done on the fifth floor. The scope of this study is focused on the
reproductive health problem of the patient. The encountered limitation of this
study is mostly with time, since the patient was discharged after 2 days and also
the verification of the predisposing factors that may be present to the patient
I decided to pursue this study because of its complicated nature that
posed a threat to reproductive health and womens body image. Reproductive
health issue is still a sensitive issue for many. This case, although common as
single condition, became a complicated case altogether and required more
aggressive treatment, that is surgery and that the patient had decided to be the
treatment option later. Reproductive health issue is still a sensitive issue for many
and this study had provided valuable information that would be vital to my future
nursing practice.
IV. Anatomy and Physiology this is more of the ideal Anatomy and physiology (you
show what is happening to your specific patient)
A.Uterus
The uterus, also known as the womb, is a hollow, muscular, pear-shaped
organ found in the pelvic region of the abdominopelvic cavity. It is located
posterior to the urinary bladder and is connected via the cervix to the vagina on
its inferior border and the fallopian tubes along its superior end. Many smooth
muscle cells in the walls of the uterus provide it with great extensibility and
contractile strength.
The endometrium, or lining of the uterus, consists of a thick layer of
epithelial and connective tissues that are shed and regrown periodically during
the menstrual cycle.
Female hormones encourage the growth of the endometrium to support
the potential implantation of an embryo in the event of a successful fertilization of
an ovum. At the end of the menstrual cycle, if a fertilized ovum has not implanted
into the endometrium, the endometrium is cut off from its blood supply and is
shed along with the ovum as menstrual flow. Menstrual flow then exits the body
through the cervix and vagina so that the uterus can grow a new endometrium for
the next ovum.

During pregnancy, the tiny embryo implants itself into the tissues of the
endometrium and begins to grow inside of the uterine lining. Tissue from the
embryo begins to merge with the tissues of the uterus to form the placenta and
umbilical cord that allow for the exchange of respiratory gases, nutrients, and
wastes between the mother and the developing embryo. The walls of the uterus
extend and grow to accommodate the growing embryo as it enters the fetal stage
of development. At the end of pregnancy the cervix dilates and the muscles of
the myometrium contract to push the fetus into the birth canal to initiate childbirth.
Endometrioses occurs when cells from the lining of the womb (uterus)
grow in other areas of the body. This can cause pain, heavy bleeding, bleeding
between periods, and problems getting pregnant.
These growths stay in the body--they do not shed during menstrual period.
But, like the cells in the uterus, these growths react to the hormones from the
ovaries. They grow and bleed during period. Over time, the growths may add
more tissue and blood. The buildup of blood and tissue in the body leads to pain
and other symptoms.

Adenomyosis is a condition in which the inner lining of the uterus (the

endometrium) grows into the muscle wall of the uterus (the myometrium).The
myometrium may respond to this intrusion with muscular overgrowth. If an island
of endometrial tissue is contained within the myometrium, it forms an
adenomyoma.The cause of adenomyosis remains unknown, but the disease
typically disappears after menopause. Women who experience severe discomfort
from adenomyosis, certain treatments can help, but hysterectomy is the only
cure.

B. Ovaries
The ovaries are small, oval-shaped glands that are located on either side
of the uterus. The ovaries produce eggs (ova). They also produce the main
female sex hormones which are released into the bloodstream.
Located laterally to the left and right of the uterus and inferior to the
fallopian tubes, the ovaries are connected to the uterus via the ovarian ligaments.
In response to luteinizing hormone produced by the anterior pituitary
gland, the ovaries produce the female sex hormones including estrogen and
progesterone. Estrogen is the primary female sex hormone that develops the
female sex organs and creates the female secondary sex characteristics.
Progesterone is involved in the maturation of the endometrium for the
implantation of an embryo and the production of milk by the mammary glands.
The ovaries contain all of the oocytes that will eventually mature into ova
and be released during ovulation. Many female sex hormones, including
estrogen, progesterone, follicle stimulating hormone, and luteinizing hormone
control the development of ova and trigger ovulation. At birth the ovaries each
contain anywhere from several hundred thousand to several millions follicle cells
that can potentially become mature ova. However, the vast majority of these
follicle cells fail to develop into mature ova and instead only around 400 ova are
released throughout a womans lifetime.

The activity of the female reproductive system is controlled by hormones

released both by the brain, and the ovaries. The combination of all these
hormones gives women their reproductive cycle.The length of the reproductive
(or menstrual) cycle is usually between 24-35 days. During this time an ova is
developed and matured, and the lining of the uterus is prepared to receive a
fertilised egg. If a fertilized egg is not implanted into the uterus, the lining of the
uterus is shed and is expelled from the body. This is the bleeding known as
menstruation (period). Traditionally, the first day of bleeding is known as day one
of the reproductive cycle. The key event in the cycle is ovulation, the release of a
mature ovum (egg) from the ovaries. This usually takes place around the 14th
day of a 28-day cycle. The first part of the cycle is concerned with developing an
ovum. What happens in the second part of the cycle depends on whether the
ovum is fertilized.
There are five main hormones that control the reproductive cycle. Three
are produced in the brain, while the other two are made in the ovaries.
Gonadotrophin-releasing hormone (GnRH) is made by a part of the
brain called the hypothalamus. GnRH travels to another part of the brain where it
controls the release of follicle-stimulating hormone (FSH) and luteinising
hormone (LH).
FSH is released by a part of the brain called the anterior pituitary. FSH is
carried by the bloodstream to the ovaries. Here it stimulates the immature ova to
start growing.
LH is also released by the anterior pituitary and travels to the ovaries. LH
triggers ovulation and encourages the formation of a special group of cells called
the corpus luteum.
Estrogen is produced by the growing ova and by the corpus luteum. In
moderate amounts estrogen helps to control the levels of GnRH, FSH and LH.

This helps to prevent the development of too many ova. Estrogen also helps to
develop and maintain many of the female reproductive structures.
Progesterone is mainly released by the corpus luteum. It works with
estrogen to prepare the lining of the uterus for the implantation of a fertilized
ovum. It also helps to prepare the breasts for releasing milk. High levels of
progesterone control the levels of GnRH, FSH and LH.
During the last few days of the cycle, around 20 small immature ova begin
to develop in the ovaries. This continues throughout the menstrual cycle. FSH
and LH encourage the growth of these ova. As they grow, the ova also start to
release increasing amounts of estrogen. The amount of estrogen produced
reduces the amount of FSH released. This helps to prevent too many ova
growing at the same time. Eventually one ovum outgrows the rest.
While this is happening in the ovaries, the estrogen produced also
stimulates
the
repair
of
the
lining
of
the
uterus.
The next stage in the cycle is the release of the mature ovum from the ovaries
into the pelvis. By this point in the cycle, levels of estrogen are high. Previously,
medium levels of estrogen reduced the amount of FSH and LH released. Now
this high level of estrogen is the signal for more FSH and LH to be released. LH
causes the ovum to burst through the outer layer of the ovary. Usually the ovum
is then swept into the uterine tubes.
Next the cells remaining when the ovum leaves the ovary become the
corpus luteum. This special group of cells is capable of producing several
different hormones, including progesterone and estrogen. These hormones
encourage the growth and maturation of the lining of the uterus.
What happens next depends on whether the ovum is fertilized by sperm. If
the ovum is fertilized, the corpus luteum continues to produce hormones. Another
hormone called human chorionic gonadotrophin (hCG) stops the corpus luteum
from breaking down. The cells covering the embryo produce hCG. It is the
hormone detected in pregnancy tests. If the ovum is not fertilized, the corpus
luteum can only live for a further two weeks. As it begins to break down, it
releases fewer of its hormones.
As the levels of progesterone and estrogen go down, they no longer
control the levels of GnRH, FSH and LH. So, these hormones increase and new
ova begin to develop - the start of a new cycle. In the uterus the decrease in
progesterone stimulates the release of chemicals that eventually cause the lining
of the uterus to die off. This is the blood flow experienced during menstruation.
Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an
ovary. Most ovarian cysts present little or no discomfort and are harmless. The
majority of ovarian cysts disappear without treatment within a few months.
However, those that have ruptured sometimes produce serious
symptoms.

V. Pathophysiology
Precipitating Factors:

Risk Factor:

Closed hymen (retrograde

menstrual flow)
Early menarche
Nulliparity
Period lasts 7 or more days
Faulty Immune System

Genetics
Women
Age (30s -40s)

Endometrial tissue grows outside

uterus

Growth in the ovaries

Ovarian Cyst
(CT scan= left ovarian
cyst)

Tissues react to hormones during

period

Tissues grow and bleed

Adenomyosis
Risk factor:
Women
Age (40s -50s)

Endometrial tissue invade

muscle wall (myometrium)

Muscular overgrowth

Uterus enlarged

Build up in the body

Stomach digestive problems
Painful
menstrual
bleeding/spotting

Lower abdominal pain/ tenderness on

palpation (positive on the patient)
cramps

Infertility/ Difficulty
getting pregnant

VI. Medical and Nursing Management

Laboratory Exams
Rationale
Diagnostic Tests
Complete Blood Count
It is one of the standard tests done on a
WBC 11.5x10^9/L (High)
patient.
Hemoglobin 119g/L (Low)
It helps diagnose the cause and/or
Hematocrit 0.36 L/L (normal)
severity of presenting symptoms.
Lymphocytes 20% (Low)
Segmenters 74% (normal)
Monocytes 4% (normal)
Eosinophils 2% (normal)

Urinalysis
Color= light yellow
Transparency= clear
Glucose= negative
Protein = negative
Bilirubin= negative
Ketone= negative
WBC 0-1/hpf (normal)
RBC 1-2/hpf (normal)
Specific gravity= 1.005; pH= 6.0

Part of a routine medical exam to screen

for signs of disease

Transvaginal Exam
Hemorrhagic endometrioses

To look at a woman's reproductive

Nursing Intervention
Nursing Responsibilities
Test preparation:
No fasting is required.
Explain that slight discomfort may
be felt when the skin is punctured.
Intervention:
Apply manual pressure and
dressings over puncture site.
Monitor the puncture site for
oozing or hematoma formation.
Test preparation:
The test involves only normal
urination, and there is no
discomfort.

To monitor if being treated for diabetes

Intervention:
Instruct proper hygiene
The urine specific gravity test reveals how
concentrated or dilute the urine is.

organs, including the uterus, ovaries,

and cervix.
Transvaginal ultrasound may be done for

Test Preparation:
Explain that patient will lie down
on a table with the knees bent and
feet may be held in stirrups.
A probe will be placed into the
vagina. The probe is covered with
a condom and a gel. Patient will
be asked to undress, usually from

the following problems:

Abnormal findings on a physical exam,
such as cysts, fibroid tumors, or other
growths
Abnormal vaginal bleeding and
menstrual problems
Certain types of infertility
Ectopic pregnancy
Pelvic pain

Abdominal CT Scan
Left Ovarian cyst

HbA1c
6.9% (High)

Done to look for:

Cause of abdominal pain or swelling
Hernia
Cause of a fever
Masses and tumors, including cancer
Infections or injury
Kidney stones
Appendicitis
HbA1c provides a longer-term trend, of
how high blood sugar levels have been
over thepast 3 months.
Check your treatment for diabetes.
For people with diabetes, an HbA1c
level of 48 mmol/mol
(6.5%) is considered good control

the waist down. A transvaginal

ultrasound is done with the
bladder empty or partly filled.
Intervention:
Assist the patient to dress up.
Reassure that there are no known
harmful effects of transvaginal
ultrasound on humans.
The test is usually painless,
although some women may have
mild discomfort from the pressure
of the probe. Assist in comfortable
position. Instruct perineal care.
Test Preparation:
Metal objects including jewelry,
eyeglasses, dentures and hairpins
may affect the CT images and should
be removed.

Intervention:
Assist the patient.
Instruct to return
activities.
Test preparation:
No need for fasting

to

normal

Intervention:
Apply manual pressure and
dressings over puncture site.
Monitor the puncture site for
oozing or hematoma formation.

VII. DRUG ANALYSIS you should include all the medications on board (Diamicron and metformin were not
included). For the indication of the medication, you should choose the reason applicable to your patient. Do not
include those other indication
Drug Name
Route, Dose,
Indication
Mechanism of
Side Effects
Adverse
Nursing
and
Action
Effects
Considerations
Frequency
Generic Name:
Route:
Relief of
Binds to mudizziness,
severe nausea, Teach patient
Tramadol
Intravenous
moderate to
opioids
sedation,
dizziness and
to avoid task
Hydrochloride
Dose: 50mg moderately
receptors and
drowsiness,
constipation
requiring
Brand
Frequency;
severe pain
inhibits reuptake impaired
rash, pruritus,
alertness
Name:Siverol
every eight
of
visual acuity, seizures
Instruct to
Class: Analgesic
hours for
norepinephrine
nausea, loss
report severe
(centrally acting)
pain
and serotonin:
of appetite
nausea,
causes effects
dizziness and
similar to
constipation
opioids:
dizziness,
somnolence,
nausea,
constipation, but
no respiratory
depressant
effects
Drug Name
Route, Dose,
Indication
Mechanism of
Side Effects
Adverse
Nursing
and
Action
Effects
Considerations
Frequency

Generic Name:
Nalbuphine
hydrochloride
Brand Name:
Nubain
Class: Opioid
agonist-antagonist
analgesic

Drug Name

Generic Name:
desogestrel-ethinyl
estradiol
Brand Name:
Marvelon
(desogen)
Class:
Contaceptive

Route:
Intravenous
Dose:5mg
Frequency:
every six
hours for
persistent
pain

Relief of
moderate to
severe pain

Other
indication:
Pre-operative
analgesic
Prevention
and treatment
of intrathecal
morphine
induced
pruritus, after
cesarian
section
Route, Dose,
Indication
and
Frequency
Route: Oral
Birth control
Dose: N/A
pills
Frequency:
once a day
Other
indication:
Hormonal
treatment

Acts as an
agonist at
specific opioid
receptors in the
CNS to produce
analgesia and
sedation but also
acts to cause
hallucinations
and antagonist
at mu-receptors

Dizziness,
sedation,
drowsiness,
impaired
visual acuity,
nausea, loss
of appetite

severe nausea,
vomiting,
palpitations,
shortness of
breath,
difficulty of
breathing,
hallucination,
numbness,
tingling and
flushing,
nervousness,
depression,
confusion

Mechanism of
Action

Side Effects

Adverse
Effects

Nursing
Considerations

spotting
breast pain or
tenderness
changes in
libido
changes in
vaginal
discharge
changes to
weight
depressed
mood
discharge
from the

an unusually
bad headache,
if headaches
become worse,
double vision
or sudden
changes to
your eyesight,
speech
problems,
aphasia ,
vertigo,
collapse or
have a seizure,

Instruct to seek
immediate
medical advice
if with any of
these of the
adverse
symptoms

regulates
menstrual cycle

Teach patient
to avoid tasks
requiring
alertness,
Instruct to
report severe
nausea,
vomiting,
palpitations,
shortness of
breath,/
difficulty of
breathing

breast
fluid retention
nausea

weakness,
sudden
numbness on
one side of
body, motor
problems or
stomachpain

VIII. Nursing Care Plan - you may think of a better nursing care plan

ASSESSMENT
Objective Cues
Pain scale=4/10
Positive guarding
behavior
Onset of localized
to left lower
quadrant area
Direct Tenderness
on palpation
BP 130/80

DIAGNOSIS

PLANNING
Short Term Goal:
Acute Pain related After 30 minutes
to medical
of nursing
condition as
intervention, the
evidenced by
patients pain will
Pain scale=4/10,
decrease from
Positive guarding pain scale of 4/10
behavior,
to 2/10.
Onset of localized
to left lower
quadrant area,
Long Term Goal:
Direct Tenderness After 2 days of
on palpation, and nursing
BP 130/80.
intervention the
patient will report
pain is controlled

INTERVENTION
Assess the
referred pain.
- This is
implied
already
Obtain patients
assessment of
pain (location,
characteristics,
onset/ duration)
Monitor skin color,
and vital signs.

RATIONALE
EVALUATION
To help determine
Short Term
underlying condition Goal
or organ dysfunction
requiring treatment. Goal met.
Patient report
pain is lessen
with pain scale
To rule out
of 2/10.
worsening of
underlying
condition.
Goal met.
Patient reported
that pain is
These are altered in controlled.
acute pain.

Assist in
comfortable
position and
provide quiet
environment.

To promote non
pharmacologic pain
management.

Instruct to do
relaxation

To distract attention
and reduce tension.

technique like
deep breathing or
focused breathing.

ASSESSMENT
Subjective Cues

DIAGNOSIS

Mild Anxiety related to

threat to health status
Kung
di
ko
pa as evidenced by
itoipatangaglbakalumalapa, patients verbalization,
as verbalized by the patient. kung di ko pa
itoipatangaglbakalumal
a pa.

Administer pain
medication
accordingly as
ordered.
Encourage to
have adequate
rest periods.

To maintain
acceptable level of
pain.

Review ways to
lessen pain, like
relaxation

To promote active
role in pain
management.

PLANNING
Short
Term
Goal:
Within 5-10
minutes of
nursing
intervention
patient will
verbalize
awareness
of feelings
of anxiety.

To prevent fatigue.

INTERVENTION
Identify patients
perception of
the threat
presented by
the medical
condition.
Monitor vital
signs.

Observe

RATIONALE
To
determine
cause of
anxiety.

To identify
responses
associated
with medical
and
emotional

EVALUATION
Short Term Goal
Goal met. Patient
verbalized
awareness of
anxiety.

Long Term Goal:

Goal met.
Patient used
support
systemeffectively,

Long Term
Goal:
Within the
shift/ 8
hours of
nursing
intervention
patient will
use
resources /
support
system
effectively.

behaviors.
Be available to
patient for
listening and
talking.
Encourage to
express
feelings.

condition.

discussing
condition.

Can point to
patients
level of
anxiety.
To reassure
patient of
care.

Discuss
information
related to
medical
condition.

To allow
discussion
of feelings.

Identify coping
skills and
support system.

For the
patient to be
informed
and
prepared.
To ensure
availability
of care after
discharge.

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Short Term
Subjective Cues:
Readiness for
Goal:
Patient verbalized,
enhance knowledge
Within 5-10
anoangtatanggalinpag related to patient
minutes of
total daw,
asking question,
nursing
hysterectomy?
anoangtatanggalinpag intervention
total daw,
patient will
hysterectomy?
exhibit
responsibility
for own
learning by
asking further
questions.
Long Term
Goal:
Within the
shift/ 8 hours
of nursing
intervention
patient will
verbalized
understanding
of information
gained.

Verify patients
knowledge about
the topic.

Deal with the

patients anxiety

Provide with
positive
reinforcements.
Give or discuss
to patient
information
related to
questions.

To ensure
accuracy and
completeness of
knowledge base
for future
learning.
Anxiety may
interfere with
understanding
information.
To encourage
continuation of
effort.
To satisfy
patients query.

Provide access
information for
contact person
(patients
physician)

To answer
questions/validate
information post
discharge.

Provide
information
about additional
resources like
websites.

Assist with further

learning.

Short Term
Goal:
Goal met.
Patient exhibit
responsibility
for learning by
asking further
questions.

Long Term
Goal:
Goal met.
Patient
verbalized
understanding
of information.