BSN-2A

Vasquez, Ma. Ruth

Orfiana, Joyce Anne DISORDERS OF
Duque, Erika
THE OVARIES
Roldan, Ryan NCM -107
Pacete, Ashlie Ace
FOLLICULAR CYST

DISORDER OF THE OVARY

WHAT IS FOLLICULAR CYST?
 FOLLICULAR CYSTS
 Are also known as benign ovarian cysts or functional cysts. Essentially they’re

fluid-filled pockets of tissue that can develop on or in your ovaries. They commonly

occur in women of reproductive age, as a result of ovulation. It’s rare for prepubescent

girls to develop follicular cysts. Postmenopausal women don’t get them at all. Any cyst

that occurs in a woman after menopause needs to be evaluated.

 Most follicular cysts are painless and harmless. They are not cancerous. They often

resolve on their own, within a few menstrual cycles. You may not even notice you have

a follicular cyst.

 In rare cases, follicular cysts can lead to complications that require medical attention.
Symptoms of Follicular Cysts

Most follicular cysts don’t cause any symptoms. If you have a follicular cyst that becomes large or

ruptures, you may experience:

 pain in your lower abdomen

 pressure or bloating in your lower abdomen

 nausea or vomiting

 tenderness in your breasts

 changes in the length of your menstrual cycle

Seek medical treatment immediately if you feel sharp or sudden pain in your lower abdomen,

especially if it’s accompanied by nausea or fever. It may be a sign of a ruptured follicular cyst or a

more serious medical emergency. It’s important to get an accurate diagnosis as soon as possible.
Treatment of Follicular Cyst

 In most cases, ovarian cysts go away without treatment. Birth control

pills may be used to establish regular menstrual cycles and prevent cyst
formation. Large ovarian cysts that do not go away without treatment
may need to be surgically removed. A laparoscopy may be used to
remove an ovarian cyst.
Medical Management
Your healthcare provider may give you medications containing hormones (such as birth control pills) to stop

ovulation and prevent future cysts from forming. If you do not ovulate, you will not form functional cysts. In

some cases, surgery may be necessary to remove a cyst. The type of surgery used depends on the size of

the cyst and how it appears on the ultrasound. The different procedures used include:

 Laparoscopy: This is a procedure in which the doctor inserts a small device through a small incision in

the abdomen. He or she views the reproductive organs and pelvic cavity using the device. The doctor can

remove the cyst through tiny incisions.

 Laparotomy: This procedure uses a bigger incision to remove the cyst. The cyst will be tested for cancer.

If it is cancer, the doctor may need to remove one or both ovaries, the uterus, a fold of fatty tissue called

the omentum and some lymph nodes. Lymph nodes are small, bean-shaped structures found throughout

the body that produce and store infection-fighting cells, but may contain cancer cells.
Health Teaching

 For women that are not seeking pregnancy, birth control pills may help

regulate menstrual cycles and prevent follicle formation.

 Large ovarian cysts may twist, rupture, or bleed, causing severe pain.

You should seek immediate medical attention if you experience symptoms

of shock, which may include passing out, rapid breathing,
dizziness/lightheadedness, weakness, and cold or clammy skin.
ENDOMETRIAL CYST
ENDOMETRIAL CYST

Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the
ovaries. They get their name from their brown, tar-like appearance, looking something
like melted chocolate. They’re also called ovarian endometriomas.
The color comes from old menstrual blood and tissue that fills the cavity of the cyst. A
chocolate cyst can affect one or both ovaries and may occur in multiples or singularly.
ENDOMETRIOSIS

Endometriosis is a common disorder in which the lining of the

uterus, known as the endometrium, grows outside the uterus and
onto the ovaries, fallopian tubes, and other areas of the
reproductive tract. The overgrowth of this lining causes severe
pain and sometimes infertility.
Signs and Symptoms

The most common sign of endometriosis is pain in your lower

belly that doesn’t go away. It can get worse before and during
your period. You may also have very heavy bleeding. Pain
during sex is likely.

Some women who have an endometrial cyst feel sore or

notice pressure. Others don’t have any symptoms at all. You
may not know you have a cyst until your doctor feels it during
a pelvic exam or sees it on ultrasound.
Diagnosis
◦Your doctor will talk to you, listen to your symptoms, and ask about any pain
you have. During a pelvic exam, she’ll press on areas in your belly. She may be
able to feel a cyst this way.
◦Your doctor will probably want to do an imaging test to see inside your body.
One way is with an ultrasound. It uses sound waves to create a
picture. Magnetic resonance imaging (MRI) provides a more detailed view of
your ovaries. It uses a powerful magnetic field.
◦Your doctor may also do a blood test to check for cancer, see if
you’re pregnant, or if there’s an infection.
◦Another way to check for an endometrial cyst is through a laparoscopy. During
this outpatient surgery, your doctor will make a tiny incision (cut) in your belly
button and insert a thin camera. This allows your her to see any cysts up close,
assess their size, and decide how best to treat them.
Treatments
Your doctor will consider your age, any pain you’re in, and whether you plan to have a baby in
the future. Based on that, she’ll choose a treatment plan that could include:
◦ Watchful waiting. If you’re not in pain and the cyst is small, your doctor may suggest that
you wait 6-8 weeks to see if it goes away on its own. She’ll use an ultrasound test to make
sure this is happening.
◦ Medicine. Your doctor may give you medicine to help shrink the cyst. A group
of medications that doctors call “GnRH agonists” puts your body into temporary menopause.
Your ovaries stop making estrogen, which can help ease any symptoms you have. GnRH
agonists can cause some of the same side effects as menopause, like hot flashes, bone
density loss, and less sex drive. You shouldn’t take them if you’re trying to get pregnant.
◦ Surgery. Your doctor may talk with you about surgery if you have intense pain, medicine
doesn’t help, or your cyst is larger than 1.5 inches. She may choose this option to keep the
cyst from twisting or breaking open, which can cause more severe problems.
◦ Sometimes, the doctor may be able to drain the fluid in a cyst. In other cases, you may need
to get the whole cyst taken out. This may ease your pain and prevent other cysts from
growing.
Treatments

If you’re sure that you never want to get

pregnant, your doctor could remove your
ovaries. Your uterus could be taken out as well,
but doctors only do this procedure, called
a hysterectomy, if nothing else helps. You and
your doctor should talk about all of your
options.
 SEROUS
CYSTADENOMA
SEROUS CYSTADENOMA

Ovarian serous cystadenoma, also (less precisely) known as serous cystadenoma, is the most
common ovarian neoplasm, representing 20% of ovarian neoplasms, and is benign.
It has a very superficial resemblance to the most common type of ovarian cancer (serous carcinoma of
the ovary) under the microscope; however, (1) it is virtually impossible to mix-up with its malignant
counterpart (serous carcinoma), and (2) does not share genetic traits of indeterminate serous tumours,
also called serous borderline tumours, that may transform into serous carcinoma.
Serous cystadenomas (of the ovary) are not related to serous cystadenomas of the pancreas, i.e. the
presence of an ovarian or pancreatic one does not suggest an increased risk for the other one.
Signs and Symptoms
◦ Bilateral.
◦ Asymptomatic except for signs of pelvic pressure.
◦ Irregular and possibly painful menstruation: It may be heavier or lighter than before.
◦ Pain in the pelvis: This may be a persistent pain or an intermittent dull ache that spreads to the
lower back and thighs. It may appear just before menstruation begins or ends.
◦ Dyspareunia: This is pelvic pain that occurs during sexual intercourse. Some women might
experience pain and discomfort in the abdomen after sex.
◦ Bowel issues: These include pain when passing a stool, pressure on the bowels or a frequent
need to pass a stool.
◦ Abdominal issues: There may be bloating, swelling, or heaviness in the abdomen.
◦ Urinary issues: The woman may have problems emptying the bladder fully or she may or feeling
the need to urinate frequently.
◦ Hormonal abnormalities: Rarely, the body produces abnormal amounts of hormones, resulting in
changes in the way the breasts and body hair grow.
◦ Some symptoms may resemble those of pregnancy, for example, breast tenderness and nausea.
Diagnostic Treatments
◦ Watchful waiting (observation)
Sometimes watchful waiting is recommended, especially if the cyst is a small,
functional cyst (2 to 5 centimeters) and the woman has not yet undergone
menopause
An ultrasound scan will check the cyst a month or so later, to see whether it has gone
◦ Birth control pills
To reduce the risk of new cysts developing in future menstrual cycles, the doctor may
recommend birth control pills. Oral contraceptives may also reduce the risk of
developing ovarian cancer.
Diagnostic Treatments
◦Surgery
Surgery may be recommended if:
there are symptoms
the cyst is large or appears to be growing
the cyst does not look like a functional cyst
the cyst persists through 2 to 3 menstrual cycles.
Two types of surgery are:
Laparoscopy, or keyhole surgery: The surgeon uses very small tools, to remove the cyst
through a small incision. In most cases, the patient can go home the same day. This type of
surgery does not usually affect fertility, and recovery times are fast.
Laparotomy: This may be recommended if the cyst is cancerous. A longer cut is made across
the top of the pubic hairline. The cyst is removed and sent to the lab for testing. The patient
usually stays in the hospital for at least 2 days.
Cancer treatment
If the cyst may be cancerous, a biopsy can be taken for testing.
If the result shows that cancer is present, more organs and tissue may need to be removed,
such as the ovaries and uterus.
NURSING MANAGEMENT

Appropriate management of patients with an ovarian cyst depends on

the presence of symptoms, likelihood of torsion or rupture, and level of
concern for malignancy.
◦Symptomatic Cysts
◦ The differential diagnosis for pain in women with ovarian cysts include tubo-
ovarian abscess, ruptured ectopic, ruptured hemorrhagic cyst, and ovarian torsion. 8
◦ If the patient with pain is at low risk of a surgical emergency, pain medication and
outpatient management is appropriate. If pain persists, refer the patient to a
gynecologist. For a patient who appears toxic or is in shock, an immediate surgical
consultation with a gynecologist is warranted.
◦ For patients with symptomatic cysts that are concerning for cancer, consult a
gynecologic oncologists directly.
NURSING MANAGEMENT

Appropriate management of patients with an ovarian cyst depends on

the presence of symptoms, likelihood of torsion or rupture, and level of
concern for malignancy.
◦Symptomatic Cysts
◦ The differential diagnosis for pain in women with ovarian cysts include tubo-
ovarian abscess, ruptured ectopic, ruptured hemorrhagic cyst, and ovarian torsion. 8
◦ If the patient with pain is at low risk of a surgical emergency, pain medication and
outpatient management is appropriate. If pain persists, refer the patient to a
gynecologist. For a patient who appears toxic or is in shock, an immediate surgical
consultation with a gynecologist is warranted.
◦ For patients with symptomatic cysts that are concerning for cancer, consult a
gynecologic oncologists directly.
Simple Cysts
Cysts with a High Likelihood of
Malignancy
◦Women with ovarian cysts with a high likelihood of malignancy
should be referred directly to a gynecologic oncologist. High
likelihood of malignancy exists if malignant features are found
on ultrasound, in women with a personal history or a first-
degree relative with history of ovarian or breast cancer, or if
cancer antigen 125 (CA 125) is >35 (postmenopausal women)
or CA 125 >200 (premenopausal women) (Figure 7). Direct
referral to and treatment by gynecologic oncologists has been
shown to improve survival rates in women with ovarian cancer.
CYSTS WITH A
HIGH
LIKELIHOOD
OF
MALIGNANCY
Health Teaching
When to see a doctor
◦ Only a doctor can diagnose an ovarian cyst and determine if it is safe to treat it at home. Women who
think they might have ovarian cysts or PCOS should see a gynecologist. They will ask about the
woman's medical history and may perform an ultrasound or blood work.
◦ In rare cases, an ovarian cyst can become a medical emergency. A ruptured cyst can cause intense,
unbearable pain and heavy bleeding. A woman with a ruptured cyst may also experience dizziness,
nausea, or vomiting along with the pelvic pain. If this occurs, they should call a doctor immediately or
go to the hospital.
Outlook
◦ Ovarian cysts are common, and most are harmless and go away over time. Even when they persist,
treatment is safe and reliable and can prevent the cysts from causing serious harm.
◦ Home treatment for ovarian cysts will not make the cysts go away but can ease any pain or
discomfort. Women should be mindful of any changes in symptoms and should never ignore severe
pelvic pain.
◦ With proper home management and medical care, an ovarian cyst may be little more than a
temporary inconvenience.
DERMOID CYST
Dermoid Cyst
Cyst originates from
embryonic tissue; may
contain hair, cartilage,
and fat. Most common
ovarian tumor of
childhood: also occurs
at age 30-50 years
◦A bizarre tumor, usually benign, in the ovary that typically contains a diversity
of tissues including hair, teeth, bone, thyroid, etc. A dermoid cyst develops
from a totipotential germ cell (a primary oocyte) that is retained within the egg
sac (ovary). Being totipotential, that cell can give rise to all orders of cells
necessary to form mature tissues and often recognizable structures such as hair,
bone and sebaceous (oily) material, neural tissue and teeth.
 Signs and symptoms
• Asymptomatic-means no symptoms or signs of disease is
present.

◦ Ovary enlarged on examination- There are several reasons

why your ovaries might become enlarged, or swollen. Some
causes of enlarged ovaries are harmless. During your menstrual
cycle, your ovary naturally swells up as an egg matures and
prepares for release. Fluid-filled sacs called cysts that form in
the ovaries are another possible reason for these organs to swell
up.
 Diagnostic treatments

◦Surgical Resection-Dermoid cysts are

common. They're usually harmless, but they
need surgery to remove them. They don't
resolve on their own. Dermoid cysts are a
congenital condition.
 Medical and nursing management
◦ Medical management
Watchful waiting (observation): An ultrasound scan will be carried out
about a month or so later to check it, and to see whether it has gone.
Hormonal birth control pills: prevents the development of new cysts in
those who frequently get them
Analgesic (Pain relievers): such as nonsteroidal anti-inflammatory
drugs, opiods' analgesic
 Health teaching

Before surgery
◦Follow the directions your doctor gives you before surgery.
They’ll let you know when you need to stop eating or
taking medications before surgery. Since general
anesthesia is used for this procedure, you’ll also need to
make transportation arrangements to go home.
 During surgery

◦ For periorbital dermoid cyst surgery, a small incision can often be made near
an eyebrow or hairline to help hide the scar. The cyst is carefully removed
through the incision. The entire procedure takes about 30 minutes.
◦ Ovarian dermoid surgery is more complicated. In some cases, it can be done
without removing the ovary. This is called an ovarian cystectomy.
◦ If the cyst is too large or there’s been too much damage to the ovary, the
ovary and cyst may have to be removed together.
◦ Spinal dermoid cysts are removed with microsurgery. This is done using very
small instruments. During the procedure, you’ll lie face down on an operating
table while your surgeon works. The thin covering of the spine (dura) is opened
to access the cyst. Nerve function is monitored carefully throughout the
operation.
 After surgery

◦Some cyst surgeries are done as outpatient procedures. This

means you can go home the same day.
◦Spinal surgeries may require an overnight stay in the hospital
to watch for any complications. If a spinal cyst has too strong
of an attachment to the spine or the nerves, your doctor will
remove as much of the cyst as is safely possible. The
remaining cyst will be monitored regularly after that.
◦Recovery after surgery can take at least two or three weeks,
depending on the location of the cyst.
CORPUS LUTEUM
CYST
WHAT IS A CORPUS LUTEUM CYST?

◦Abnormal changes in the follicle of the ovary after an egg has been
released can cause the egg's escape opening to seal off. Fluid
accumulates inside the follicle, and a corpus luteum cyst develops.
SIGNS AND SYMPTOMS

◦Delayed menstrual flow followed by prolonged bleeding.

◦Enlargement and tenderness of ovary.
◦Pelvic pain, which may present as dull or sharp aching
◦Abdominal fullness or heaviness
◦Bloating
◦Aching in the lower back and thighs
◦Painful intercourse
SIGNS AND SYMPTOMS

◦Weight gain
◦Painful menstrual bleeding
◦Breast tenderness
◦Need to urinate more frequently
◦Difficulty emptying the bladder
◦Difficulty emptying bowels completely
◦Abnormal vaginal bleeding
DIAGNOSTIC TREATMENTS
◦ Pregnancy test. A positive test might suggest that you have a corpus luteum cyst.
◦ Pelvic ultrasound. A wandlike device (transducer) sends and receives high-frequency sound waves (ultrasound) to
create an image of your uterus and ovaries on a video screen. Your doctor analyzes the image to confirm the
presence of a cyst, help identify its location and determine whether it's solid, filled with fluid or mixed.
◦ Laparoscopy. Using a laparoscope — a slim, lighted instrument inserted into your abdomen through a small incision
— your doctor can see your ovaries and remove the ovarian cyst. This is a surgical procedure that requires
anesthesia.
◦ CA 125 blood test. Blood levels of a protein called cancer antigen 125 (CA 125) often are elevated in women with
ovarian cancer. If your cyst is partially solid and you're at high risk of ovarian cancer, your doctor might order this
test.
Diagnostic treatments
◦ Watchful waiting. In many cases you can wait and be re-examined to see if the cyst goes away within a
few months. This is typically an option — regardless of your age — if you have no symptoms and an
ultrasound shows you have a simple, small, fluid-filled cyst. Your doctor will likely recommend that you
get follow-up pelvic ultrasounds at intervals to see if your cyst changes in size.
◦ Medication. Your doctor might recommend hormonal contraceptives, such as birth control pills, to keep
ovarian cysts from recurring. However, birth control pills won't shrink an existing cyst.
◦ Surgery. Your doctor might suggest removing a cyst that is large, doesn't look like a functional cyst, is
growing, continues through two or three menstrual cycles, or causes pain.
Medical and nursing management

Epidemiologic studies from the 1970s-1990s reported inverse

relationships between oral contraceptive pill (OCP) use and
surgically confirmed functional ovarian cysts. Short-term treatment
with OCPs was thus used for initial management of ovarian cysts.
However, meta-analyses have since shown that there is no
difference between OCP use and placebo in terms of treatment
outcomes in ovarian cysts and that these masses should be
monitored expectantly for several menstrual cycles. If a cystic mass
does not resolve after this timeframe, it is unlikely to be a functional
cyst, and further workup may be indicated
Health teaching
How to prevent Corpus Luteum Cyst?
Ovarian cysts can’t be prevented. However, routine gynecologic examinations can
detect ovarian cysts early. Benign ovarian cysts don’t become cancerous.
However, symptoms of ovarian cancer can mimic symptoms of an ovarian cyst.
Thus, it’s important to visit your doctor and receive a correct diagnosis. Alert your
doctor to symptoms that may indicate a problem, such as:
◦changes in your menstrual cycle
◦ongoing pelvic pain
◦loss of appetite
◦unexplained weight loss
◦abdominal fullness
Carcinoma
 Carcinoma
Ovarian cancer that originates in epithelial woman
over 50 years of age. Tendency may be inherited;
environmental contamination such as use of talcum
powder may play role in development.
• Ovarian Cancer Stages and Corresponding 5-year Survival Rate
• Ovarian Cancer Stage I: 85%-90%;
• Ovarian Cancer Stage II: 70%-73%;
• Ovarian Cancer Stage III: 39%;
• Ovarian Cancer Stage IV: 17%.
• The staging of ovarian cancer is of great significance to the treatment plan and treatment effect. The
extent, size and metastasis of the tumor affect the doctor's choice of treatment plan. The age,
menopause and overall health status of the woman may have an impact on treatment options and
prognosis. Treatment for Ovarian Cancer
 Signs and symptoms

• Asymptomatic-means no symptoms or signs of disease is present.

• Intermenstrual Bleeding (IMB)- refers to vaginal bleeding (other than

postcoital) at any time during the menstrual cycle other than during
menstrual cycle. It can sometimes be difficult to differentiate true IMB
bleeding from metrorrhagia (irregular frequent periods).
 Diagnostic treatments

• Hysterectomy- is an surgical procedure to remove a woman’s womb or uterus

• Salpingo-oophorectomy: is the removal of the fallopian tube (salpingectomy) and ovary
(oophorectomy)
• Surgical resection: Big trauma and high risk; Along with the tumor, both ovaries, uterus,
fallopian tubes and omentum will also be resected. 
• Radiotherapy and chemotherapy: Radiotherapy and chemotherapy are difficult to
thoroughly remove cancer cells; cause toxic and side effects, such as hair loss, vomiting, etc.
Chemotherapy kills both cancer cells and normal cells, cause damage to the immune system
at the same time. 80% of patient may suffer relapse after receiving these therapies.
 Minimally Invasive
Therapy: 2-3mm incision,
few side effects, little pain
Particle Implantation: Implanted
particles will keep emitting y-ray
within the tumor, targeting to the
cancer cells accurately; the radiation
of seeds to tumor last for 180 days,
high accuracy, millimeter minimally
invasive; few toxic side effects and
complications.
Interventional therapy: with a 1-2
millimeter incision, anti-cancer drugs
are directly given to the tumor,
causing fewer side effects and drug
concentration is 2-8 times higher
than systemic chemotherapy, killing
cancer cells more accurately
 Cryotherapy: compared with
surgery, cryotherapy is associated
with lower risks and less
complications. little bleeding and
quick recovery; few damage to
normal tissues and can be
performed repeatedly to prevent
recurrence of lung cancer.
 Medical and nursing management
• Medical management
Individuals should seek care from a gynecologic oncologist, these are
the doctors specifically trained to diagnose and treat patients with ovarian cancer.  
The single most important thing a patient can do may be to seek care at a “high
volume” cancer center where providers have experience treating ovarian cancer.
 “High-volume” centers have more extensive experience in treating ovarian cancer
and this is associated with improved survival rates.
 Nursing Management
Maintaining Tissue Integrity
• Stomatitis. Assessment of the patient’s subjective experience and an objective assessment of
the oropharyngeal tissues and teeth are important and for the treatment of oral
mucositis, Palifermin (Kepivance), a synthetic form of human keratinocyte growth factor, could
be administered.
• Radiation-associated skin impairment. Nursing care for patients with impaired skin reactions
includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain,
preventing additional trauma, and preventing and managing infection.
• Alopecia. Nurses provide information about hair loss and support the patient and family in
coping with changes in body image.
• Malignant skin lesions. Nursing care includes cleansing the skin, reducing superficial bacteria,
controlling bleeding, reducing odor, protecting the skin from further trauma, and relieving pain.
Promoting Nutrition
• Anorexia. Anorexia may occur because people feel full after eating only a small amount of
food.
• Malabsorption. Surgical intervention may change peristaltic patterns, later
gastrointestinal secretions, and reduce the absorptive surfaces of the gastrointestinal
mucosa, all leading to malabsorption.
• Cachexia. Nurses assess patients who are at risk of altered nutritional intake so that
appropriate measures may be instituted prior to nutritional decline.
• Relieving Pain
• Assessment. The nurse assesses the patient for the source and site of pain as well as those
factors that increase the patient’s perception of pain.
• Cancer pain algorithm. Various opioid and nonopioid medications may be combined with
other medications to control pain as adapted from the World Health Organization three-
step ladder approach.
• Education. The nurse provides education and support to correct fears and misconceptions
 about opioid use.
• Decreasing Fatigue
• Assessment. The nurse assesses physiologic and psychological stressors that can contribute to
fatigue and uses several assessment tools such as a simple visual analog scale to assess levels of
fatigue.
• Exercise. The role of exercise as a helpful intervention has been supported by several controlled trials.
• Pharmacologic interventions. Occasionally pharmacologic interventions are utilized, including 
antidepressants for patients with depression, anxiolytics for those with anxiety, hypnotics for patients
with sleep disturbances, and psychostimulants for some patients with advanced cancer or fatigue that
does not respond to any medication.
Improving Body Image and Self-esteem
• Assessment. The nurse identifies potential threats to the patient’s body image experience, and
the nurse assesses the patient’s ability to cope with the many assaults to the body image
experienced throughout the course of the disease and treatment.
• Sexuality. Nurses who identify physiologic, psychologic or communication difficulties related to
sexuality or sexual function are in a key position to help patients seek further specialized
evaluation and intervention if necessary.
Assisting in the Grieving Process
• Assessment. The nurse assesses the patient’s psychological and mental status, as well as the
mood and emotional reaction to the results of diagnostic testing and prognosis.
• Grieving. Grieving is a normal response to these fears and to actual or potential losses.
• Monitoring and Managing Potential Complications
• Infection. The nurse monitors laboratory studies to detect any early changes in WBC counts.
• Septic shock. Neurologic assessments are carried out, fluid and electrolyte status is
monitored, arterial blood gas values and pulse oximetry are monitored, and IV fluids, blood,
and vasopressors are administered by the nurse.
• Bleeding and hemorrhage. The nurse may administer  IL-11, which has been approved by the
FDA to prevent severe thrombocytopenia, and additional medications may be prescribed to
address bleeding due to disorders of coagulation.
• Promoting Home and Community-Based Care
• Nurses in the outpatient settings often have the responsibilities for patient teaching and for coordinating
care in the home.
• Teaching patients self-care. Follow-up visits and telephone calls from the nurse assist in identifying
problems and are often reassuring, increasing the patient’s and the family’s comfort in dealing with complex
and new aspects of care.
• Continuing care. The responsibilities of the home care include assessing the home environment, suggesting
modifications at home or in care to help the patient and the family address the patient’s physical needs.
 Health teaching
Home care after surgery
• Here’s what to do at home following surgery for ovarian cancer.
• Activity
• Ask others to help with chores and errands while you recover.
• To avoid straining your incisions, don’t lift anything heavier than 10 pounds for at least 6 weeks after surgery.
• Don’t vacuum or do other strenuous housework until the healthcare provider says it’s OK.
• Limit stair climbing for the first 2 weeks after surgery. Climb stairs slowly and pause after every few steps.
• Walk as often as you feel able. While this may seem hard to do, it's important to move as much as you can as you
recover from surgery. 
• Shower as usual.
• Don’t drive for at least 3 weeks after surgery unless it is OK with your healthcare provider. Don’t drive if you are
still taking pain medicine.
• Ask your healthcare provider when you can expect to return to work.
• Speak to your healthcare provider if you have questions about your care.
• Ask your surgeon for specific instructions about your care after surgery.
Incision care
• Wash the incision site with soap and water. Pat it dry. Do not scrub or rub the incision.
• Don’t use oils, powders, lotions, or creams on your incision.
• Inspect the incision site every day for increased redness, drainage, swelling, or separation of
the skin.
• Be sure you have an appointment set up to have the sutures or staples removed. 
Other home care
• Take your medicines exactly as directed. Use your pain medicine if you need it so
you can be up and moving around—do not stay in bed. 
• Continue the coughing and deep breathing exercises you learned in the hospital.
• Don’t put anything in your vagina until your healthcare provider says it’s safe to do
so. Don’t use tampons or douches. Don’t have sexual intercourse.
• Report hot flashes, mood swings, or irritability to your healthcare provider. There
may be medicines that can help you.
• Return to your diet as tolerated. Eat a healthy well-balanced diet.
• Avoid constipation:
• Eat fruits, vegetables, and whole grains.
• Drink 6 to 8 glasses of water a day, unless directed otherwise.
• Use a laxative or a mild stool softener if your healthcare provider says it’s OK.
 Home care after chemotherapy
• Prevent mouth sores
• Many people get mouth sores during chemotherapy. So, don’t be discouraged if you do, even if you are following
all your healthcare provider’s instructions. Do the following to help prevent mouth sores or to ease discomfort:
• Brush your teeth with a soft-bristle toothbrush after every meal.
• Don’t use dental floss unless your healthcare provider or nurse says it's OK.
• Use an oral swab or special soft toothbrush if your gums bleed during regular brushing.
• Use any mouthwashes given to you as directed.
• Use salt and baking soda to clean your mouth. Mix 1 teaspoon of salt and 1 teaspoon of baking soda into an 8-
ounce glass of warm water. Swish and spit as often as you like.
• Watch your mouth and tongue for white patches. This is a sign of fungal infection, a common side effect of
chemotherapy. Be sure to tell your healthcare provider about these patches. Medicine can be prescribed to help
you fight the fungal infection.
• Talk to your healthcare provider or nurse about mouth dryness, pain, or sores. There are often things that can be
done to help with these problems and keep them from getting worse. 
Manage other side effects
• Try to exercise, which keeps you strong and your heart and lungs active. Walk as much as you can without
becoming dizzy or weak.
• Don’t be surprised if your treatment causes rashes on your hands and feet. Some medicines can cause this to
happen. Ask your healthcare provider or nurse what you can do to help prevent or relieve these changes and
protect your skin.
• Let your healthcare provider know if your throat is sore. You may have an infection that needs treatment.
• Remember, many patients feel sick and lose their appetites during treatment. Eat small meals several times a
day to keep your strength up:
• Choose bland foods with little taste or smell if you are reacting strongly to food.
• Be sure to cook all food thoroughly. This kills bacteria and helps you avoid infection.
• Eat foods that are soft. They are less likely to cause stomach irritation.
• Talk to your healthcare provider. There are many ways to help prevent or relieve nausea and vomiting. 

• Keep clean. During treatment your body can’t fight germs very well:
• Take short baths or showers with warm water. Avoid very hot or cold water.
• Use moisturizing soap. Treatment can make your skin dry.
• Apply moisturizing lotion several times a day to help relieve dry skin.
 When to call your healthcare provider

• Call your healthcare provider right away if you have any of the • Ongoing fatigue
following:
• Shortness of breath
• Fever of 100.4°F (38°C) or higher, or chills
• Rapid, irregular heartbeat; chest pain
• Bright red vaginal bleeding or bleeding that soaks more than 1 pad
• Dizziness or lightheadedness
per hour
• Smelly discharge from a surgical site (incision) or the vagina
• Constant feeling of being cold

• Trouble urinating or burning when you urinate

• New or unusual lumps, bumps, or swelling

• Severe pain or bloating in your belly

• Easy bruising or bleeding 

• Signs of infection around the incision (redness, drainage, warmth,

• Persistent nausea, vomiting, or diarrhea
pain) • Ask your healthcare provider who you should call and what number
you should use if you have problems at home. Be sure you know how
• Incision that opens up or pulls apart
to get help anytime, including after office hours and on weekends
• Trouble concentrating and holidays.
 Talking with your healthcare team

Talking with your healthcare team

• Getting treatment for ovarian cancer can be tough on the mind and body.
Keep talking with your healthcare team about ways to make the process
easier. Work together to ease the affect of symptoms on your daily life.
There are often things that can be done to help you manage treatment-
related problems. Talk to your healthcare provider and/or nurse to get the
help you need
POLYCYSTIC OVARY
SYNDROME
WHAT IS POLYCYSTIC OVARY SYNDROME?

POLYCYSTIC OVARY SYNDROME (PCOS) IS A HORMONAL DISORDER

COMMON AMONG WOMEN OF REPRODUCTIVE AGE. WOMEN WITH PCOS
MAY HAVE INFREQUENT OR PROLONGED MENSTRUAL PERIODS OR
EXCESS MALE HORMONE (ANDROGEN) LEVELS. THE OVARIES MAY
DEVELOP NUMEROUS SMALL COLLECTIONS OF FLUID (FOLLICLES) AND
FAIL TO REGULARLY RELEASE EGGS.
SIGNS AND SYMPTOMS IF POCS

• THE MOST COMMON PCOS SYMPTOMS ARE MISSED, IRREGULAR,

INFREQUENT, OR PROLONGED PERIODS. EXCESS ANDROGENS CAN
CAUSE HAIR LOSS, HAIR IN PLACES YOU DON’T WANT IT (LIKE ON
YOUR FACE), AND ACNE. OTHER SYMPTOMS INCLUDE:
• DARKENED SKIN OR EXCESS SKIN (SKIN TAGS) ON THE NECK OR IN
THE ARMPITS
• MOOD CHANGES
• PELVIC PAIN
• WEIGHT GAIN
TREATMENTS:

• LIFESTYLE CHANGE-YOUR DOCTOR MAY RECOMMEND

WEIGHT LOSS THROUGH A LOW-CALORIE DIET COMBINED WITH
MODERATE EXERCISE ACTIVITIES. EVEN A MODEST REDUCTION
IN YOUR WEIGHT — FOR EXAMPLE, LOSING 5 PERCENT OF YOUR
BODY WEIGHT — MIGHT IMPROVE YOUR CONDITION. LOSING
WEIGHT MAY ALSO INCREASE THE EFFECTIVENESS OF
MEDICATIONS YOUR DOCTOR RECOMMENDS FOR PCOS, AND CAN
HELP WITH INFERTILITY.
• MEDICATIONS TO REGULATE YOUR MENSTRUAL CYCLE, YOUR
DOCTOR MIGHT RECOMMEND:
• COMBINATION BIRTH CONTROL PILLS. PILLS THAT CONTAIN
ESTROGEN AND PROGESTIN DECREASE ANDROGEN PRODUCTION
AND REGULATE ESTROGEN. REGULATING YOUR HORMONES CAN
LOWER YOUR RISK OF ENDOMETRIAL CANCER AND CORRECT
ABNORMAL BLEEDING, EXCESS HAIR GROWTH AND ACNE. INSTEAD
OF PILLS, YOU MIGHT USE A SKIN PATCH OR VAGINAL RING THAT
CONTAINS A COMBINATION OF ESTROGEN AND PROGESTIN.
• PROGESTIN THERAPY. TAKING PROGESTIN FOR 10 TO 14 DAYS
EVERY ONE TO TWO MONTHS CAN REGULATE YOUR PERIODS AND
PROTECT AGAINST ENDOMETRIAL CANCER. PROGESTIN THERAPY
DOESN'T IMPROVE ANDROGEN LEVELS AND WON'T PREVENT
PREGNANCY. THE PROGESTIN-ONLY MINIPILL OR PROGESTIN-
CONTAINING INTRAUTERINE DEVICE IS A BETTER CHOICE IF YOU
ALSO WISH TO AVOID PREGNANCY.
• TO HELP YOU OVULATE, YOUR DOCTOR MIGHT RECOMMEND
• CLOMIPHENE (CLOMID). THIS ORAL ANTI-ESTROGEN
MEDICATION IS TAKEN DURING THE FIRST PART OF YOUR
MENSTRUAL CYCLE.
• LETROZOLE (FEMARA). THIS BREAST CANCER TREATMENT CAN
WORK TO STIMULATE THE OVARIES.
• METFORMIN (GLUCOPHAGE, FORTAMET, OTHERS). THIS ORAL
MEDICATION FOR TYPE 2 DIABETES IMPROVES INSULIN
RESISTANCE AND LOWERS INSULIN LEVELS. IF YOU DON'T
BECOME PREGNANT USING CLOMIPHENE, YOUR DOCTOR MIGHT
RECOMMEND ADDING METFORMIN. IF YOU HAVE PREDIABETES,
METFORMIN CAN ALSO SLOW THE PROGRESSION TO TYPE 2
DIABETES AND HELP WITH WEIGHT LOSS.
• GONADOTROPINS. THESE HORMONE MEDICATIONS ARE GIVEN
BY INJECTION.
• TO REDUCE EXCESSIVE HAIR GROWTH, YOUR DOCTOR MIGHT
RECOMMEND:
• BIRTH CONTROL PILLS. THESE PILLS DECREASE ANDROGEN
PRODUCTION THAT CAN CAUSE EXCESSIVE HAIR GROWTH.
• SPIRONOLACTONE (ALDACTONE). THIS MEDICATION BLOCKS THE
EFFECTS OF ANDROGEN ON THE SKIN. SPIRONOLACTONE CAN
CAUSE BIRTH DEFECT, SO EFFECTIVE CONTRACEPTION IS
REQUIRED WHILE TAKING THIS MEDICATION. IT ISN'T
RECOMMENDED IF YOU'RE PREGNANT OR PLANNING TO BECOME
PREGNANT.
• EFLORNITHINE (VANIQA). THIS CREAM CAN SLOW FACIAL HAIR
GROWTH IN WOMEN.
• ELECTROLYSIS. A TINY NEEDLE IS INSERTED INTO EACH HAIR
FOLLICLE. THE NEEDLE EMITS A PULSE OF ELECTRIC CURRENT TO
DAMAGE AND EVENTUALLY DESTROY THE FOLLICLE. YOU MIGHT
NEED MULTIPLE TREATMENTS.
NURSING MANAGAMENT
FOR PCOS PATIENT
First-line management of PCOS includes diet modification, weight loss, and stress management.
First-line treatment for androgen excess is estrogen therapy, the combination of estrogen and
progesterone being the drugs of choice. Uncomplicated amenorrhea in PCOS is managed with
monthly or bimonthly administration of medroxyprogesterone. The antiestrogen clomiphene
citrate has been the drug of choice for inducing ovulation. The success of any treatment plan will
depend largely on the client's ability to reduce body weight.
HEALTH TEACHING FOR PCIS
PATIENTS

• PCOS IS COMMON TO WOMEN WHO ARE OBESE SO I

RECOMMEND TO START TO LOSE WEIGHT
• BE PHYSICALLY FIT
• EAT HEALTHY DIET
• GO MONTHLY CHECK UPS