A Case Analysis on Ovarian cysts

____________________

A Case Analysis Presented to 

The faculty of Nursing Department
Charmaine Orocio, RN

____________________

In Partial fulfilment of the

Requirements in NCM-209
Delivery Room Rotation

By:

Karl Angelo Montano, Stn

BSN 2B
Group 2

March 27, 2020

 INTRODUCTION

Pregnancy is in the every dream of every woman. It is an adventure wherein

physical and psychological changes are to be encountered by women. A healthy
mom and healthy baby - that's the goal for every pregnancy.A healthy lifestyle should
be adopted by soon-to-be-mother’s in order to achieve the goal of the pregnancy.
Nutrition and lifestyle is very important during this period because the baby totally
relies to the mother. That is why, being pregnant entails a great responsibility on
women. They are to bear a child in their womb, wherein whatever they will take in
will also go to the baby directly.

Ovarian cysts are found on transvaginal sonograms in nearly all

premenopausal women and in up to 18% of postmenopausal women (women
develop one or more Graafian follicles each menstrual cycle, which appear as cysts
on imaging).  Most of these cysts are functional in nature and benign. Mature cystic
teratomas, or dermoids, represent more than 10% of all ovarian neoplasms. Ovarian
cysts are the most common fetal and infant tumor, with a prevalence exceeding
30%. Among women for whom sufficient numbers of cases are available to calculate
rates based on age, incidence in those aged 30-54 years is highest in white women,
followed by Japanese, Hispanic, and Filipino women. For women aged 55-69 years,
the highest rates occur in white women, followed by Hispanic and Japanese women.
Among women aged 70 years or older, the highest rate occurs among white women,
followed by those of African descent and Hispanic women.

According to DOH the incidence of ovarian cysts is 12th overall, and ranks 5th
among females. An estimated 2,032 cases will occur in 2016. Incidence increase
starting at age 40. Its risk factors are nulliparity, history of breast or endometrial
cancer and of menstrual difficulties. Increased familial incidence has also been
reported. Pregnancy and oral contraceptives are possibly protective. The role of
exogenous hormones as a protective factor is still being studied. The warning signs
of ovarian cysts are usually asymptomatic at the outset and many case are detected
late. It is usually detected because of an abdominal mass, or mass felt during pelvic
examination. For early detection Thorough annual pelvic examinations may detect
early ovary cancer. This is recommended to start at age 40.
 This case study will pave way to the improvement of the nursing research,
education and practice. This may contribute to the statistical reports of different
agencies who manage to study complications during pregnancy for them to
investigate more and to provide information to certain researchers. Every study’s
goal is to provide information as to develop the nursing education. It opens the
discovery of new information, especially about the maternal and child health care.
Through utilizing the principles and concepts we have learned in the course of our
education as student nurses, we are to apply and practice what we have learned and
for us to render the appropriate and proper care to our patients who are
encountering the same condition.
 PATHOPHYSIOLOGY

Predisposing factor Precipitating factor

 Hormonal problems  Severe pelvic
 Previous ovarian infection
cysts  Pregnancy
 Endometriosis  Smoking
 Maternal age  Tubal ligation

Epidemiology
Idiopathic

Increased luteinizing hormone

Hyperstimulation of ovaries

Increase estrogen Hormonal imbalances Increase HCG

Abnormal proliferation of follicle

 Menstrual irregularities
Follicles fail to ovulate and fail to undergo atresia and continue to grow

Dull, unilateral lower quadrant pain Cyst grow in size up to 15 cm in diameter Increase abdominal girth

Increase pelvic pressure

Hemorrhage & acute pain Rupture of the cyst

Fatigue & sense of heaviness

Urinary
in thefrequency,
pelvis constipation & painful defecation
Infection

Sepsis

DEATH
 Narrative Pathophysiology

An increase in ovarian cysts occurs when hormonal imbalance are common,

around puberty and menopause. An increase in LH, called an LH surge, triggers
hyperstimulation of ovaries thus releasing of an egg from an ovary. This will then
lead to hormonal imbalances that will cause the increase of estrogen and HCG.
Abnormal follicular development is a hallmark of polycystic ovarian syndrome
(PCOS), which is a disorder characterized by enlarged polycystic ovaries, abnormal
menstrual bleeding, and increased androgen production. As time pass by the cyst
will grow up to 15 cm in diameter this will then cause Dull, unilateral lower quadrant
pain and an increase in abdominal girth and increase in pelvic pressure. Urinary
frequency is a common sign in an increase pelvic pressure because the urinary
bladder is affected. As the cyst grows bigger in diameter this will rupture and will
cause infection. If it is not treated this will lead to sepsis which is an infection in the
blood that will affect different organs and eventually this will lead to death.
 Discharge Plan

Medication
Oral contraceptives: Birth control pills may be helpful to regulate the
menstrual cycle, prevent the formation of follicles that can turn into cysts, and
possibly reduce the size of an existing cyst.
Pain relievers: Anti-inflammatories such as ibuprofen (for example,
Advil) may help reduce pelvic pain. Narcotic pain medications by prescription may
relieve severe pain caused by ovarian cysts.

Exercise
 Relaxation exercise
 turning to sides every 2 hours if lying in bed for long hours
 do light activities such as walking, or sitting down
 Exercise social interaction with the family

Treatment
Surgical treatments for Ovarian Cysts

Functional ovarian cysts are the most common type of ovarian cyst.
They usually disappear by themselves and seldom require treatment. Growths that
become abnormally large or last longer than a few months should be removed or
examined to determine if they are in fact something more harmful.
Self-Care at Home
Pain caused by ovarian cysts may be treated at home with pain relievers,
including nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin),
acetaminophen (Tylenol), or narcotic pain medicine (by prescription). Limiting
strenuous activity may reduce the risk of cyst rupture or torsion.

Medical Treatment
Ultrasonic observation or endovaginal ultrasound are used repeatedly and
frequently to monitor the growth of the cyst.

Health Teachings:

 Proper hygiene.
 Proper diet such as eating nutritional foods that are rich in protein and Vit. C
to promote well-being.
 Increase physical activities.
 Avoid eating sweet foods.
 Adequate rest and sleep.

OPD (follow up)

7 days after the patient was discharge, patient should have his follow
up check up on the nearest health center or hospital
Diet
Increase oral fluid intake
Prevent eating of sweet foods
Have a high fiber diet
Nursing theory

“Hildegard Peplau’s Contribution to Nursing: Interpersonal Relations Theory”

Hildegard Peplau is regarded by many as the “Psychiatric Nurse of the

Century”. Peplau's theory is also referred as psychodynamic nursing, which is the
understanding of one’s own behavior. It explains that the purpose of nursing is to
help others identify their felt difficulties. She defined nursing as an interpersonal
process because it involves interaction between two or more individuals with a
common goal.

Peplau’s Interpersonal Relations theory emphasize on the importance of the

nurse-patient relationship in providing health care. She described the nurse-patient
relationship in a four-phase phenomenon. Each phase is unique and has
distinguished contributions on the outcome of nurse-patient interaction.

Phases of Nurse-Patient Relationship

1. Orientation The patient has a felt need and expresses the desire
for personal assistance. While the nurse assists the
patient in recognizing and understanding the patient
experience.
2. Identification The patient and the nurse explore the experience and
the needs of the patient which leads to a feeling of
relatedness. The nurse assists the patient in
reorienting his feelings and sustaining a constant
positive environment.
3. Exploitation The patient derives the full value of the relationship as
he moves on from a dependent role to an independent
one. The nurse project new goals but power is shifted
to the patient as these goals would be achieved
through personal or self-effort.
4. Resolution The patient earns independence over his care as he
gradually puts aside old goals and formulates new
ones.

Nursing Roles
 The nurse assumes several roles which empower and equip her in meeting
the needs of the patient. The roles could overlap one over the other and could be
observed as soon as the situation comes up.

Stranger
 Receives the client in the same way one meets a stranger in other life
situations provides an accepting climate that builds trust.
Resource Person:
 One who provides a specific needed information that aids in the
understanding of a problem or new situation
Teacher
 Who imparts knowledge in reference to a need or interest
Leader:
 Helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way
Surrogate:
 Helps to clarify domains of dependence interdependence and independence
and acts on clients behalf as an advocate.
Counselor:
 Helps to understand and integrate the meaning of current life
circumstances ,provides guidance and encouragement to make changes
Assumption
Peplau identifies two explicit assumptions:
1. The kind of person the nurse becomes makes a substantial difference in what
each patient will learn as he receives nursing care.

2. Fostering personality development toward maturity is a function of nursing and

nursing education. Nursing uses principles and methods that guide the process
toward resolution of interpersonal problems.

Henderson’s theory and the four major concepts:

1. Person
 A developing organism that tries to reduce anxiety caused by needs.
 2. Environment
 Existing forces outside the organism and in the context of culture

3. Health
 A word symbol that implies forward movement of personality and other
ongoing human processes in the direction of creative, constructive,
productive, personal and community living.

4. Nursing
 A significant therapeutic interpersonal process. It functions cooperatively with
other human processes that make health possible for individuals in
communities.

“The kind of person that the nurse becomes makes a substantial difference in
what each patient will learn as he or she receives nursing care”. By Hildegard
Peplau.

This theory is anchored to our patient since she is pregnant and right now she
is experiencing a complication in pregnancy which would be dangerous to the baby.
And pregnant people are considered as high risk in the society and needs special
attention in giving care. She need more information to achieve a healthy pregnancy.

In utilizing the interpersonal model, the nurse must move in to explore the
patient’s feelings with care accompanied with respect and courtesy. As the nurse
and patient discuss feelings and concerns, the nurse will have the opportunity to
collect accurate data which will give a deep and thorough understanding of the
patient’s condition.

Nursing theory provide the principles that support nursing practice. These
nursing theories are important because it help us gain more knowledge on more
ways in giving care to our patients. It helps to differentiate what should form the
basis of practice by clearly describing what nursing does and what nursing is all
about. Through this, we can gain benefits of gaining this information which include
improved patient care, improved communication between nurse professionals and
guide for research and education.

Review of related studies

The great majority of ovarian cysts are asymptomatic functional cysts with
simple appearance and small size, but sometimes they grow to larger sizes and
rarely become clinically evident by being ruptured or causing ovarian torsion.
Although ovarian cysts are known to be more common and larger in adolescents
compared to children as a result of increased gonadotropin stimulation of ovaries
during puberty, very limited data exist about the epidemiology and characteristics of
ovarian cysts in the pediatric population. Characteristics of the ovarian cysts
including size, laterality, appearance, and frequency of ovarian cyst formation for
each age and for growth stages were analyzed in the present study. An ovarian cyst
with a solid component and/or septation, and/or internal echoes and/or echogenic
wall was considered as a complex ovarian cyst.

Peak ovarian cyst frequency was at age 15 years with a rate of 31.3%. Of the 126
adolescents with an ovarian cyst, 19 were found to have large ovarian cysts
occurring mostly during middle adolescence. Seven adolescents were found to have
a complicated ovarian cyst presenting with ovarian torsion and ruptured cyst. Of the
two girls with ovarian torsion, one had a simple right-sided ovarian cyst with a size of
7 cm and presented with right lower quadrant pain and vomiting, while the other girl
had a complex left-sided cyst with a size of 5.1 cm and presented with left lower
quadrant pain. In the present study, the frequency of ovarian cysts ≥1 cm was found
to be 1.8% in children aged 5-9 years and age-specific cyst frequencies in this age
interval varied between 1.5-2.7%. Thus far, the few studies documenting the
frequency of ovarian cyst formation in children reported largely varying rates most
probably due to the differences between the studies in terms of study design and
sample size.

The frequency of ovarian cysts measured between 3-5 cm seems to be higher than
normal in the series of Kanizsai et al since most ovarian cysts detected in
premenopausal women are functional cysts which are typically not larger than 3 cm
in diameter. With the onset of adolescence, ovarian cyst frequency increased with
age and made a peak by the age of 15 years and remained roughly elevated for all
cyst size categories throughout middle adolescence, presumably as a consequence
of normal ovarian developmental process.
 References

Black, J. Hawks, J., Keene, A (2016) Medical-Surgical Nursing. Clinical Management for
Positive Outcomes (10th edition) Philadelphia: W.B Saunders Company

Emeksiz, H. C., Derinöz, O., Akkoyun, E. B., Pinarli, F. G., & Bideci, A. (2017). Age-
specific frequencies and characteristics of ovarian cysts in children and
adolescents. Journal of Clinical Research in Pediatric Endocrinology, 9(1), 58-62.
doi:http://dx.doi.org/10.4274/jcrpe.3781

Smeltzer, S.C. & Bare, B.G. (2017).Textbook of medical-surgical nursing(10th Edition,

Volume 2). Philadelphia: Lippincott Williams and Wilkins. pp 553-538.