NURS 6521 Week 5 Practicum Journal Entry Ovarian Cyst

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NURS 6521 Week 5 Practicum Journal Entry Ovarian Cyst

Practicum Journal Entry: Ovarian Cysts 

Introduction 

An ovarian cyst is a sac that arises in the ovary containing liquid or semiliquid material. Most ovarian cysts are usually benign (Zahidy & Abdulkareem, 2018). Cysts can occur throughout the lifespan from neonatal to postmenopausal period. Most ovarian cysts develop during infancy and adolescence when there is active hormonal development. Most cysts are functional and resolve with no treatment. However, large, painful, and persistent ovarian cysts may require surgery and in some cases, the removal of the ovary (Zahidy & Abdulkareem, 2018). Symptoms include lower abdominal pain, severe pain in cases of torsion and rupture, dyspareunia, menstrual irregularities, abdominal bloating and fullness, and altered bowel movements. 

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NURS 6521 Week 8 Pharmacology for Psychological Disorders Tasks

Patient’s History 

In the gynecologic clinic rotation, I clerked a 24-year-old female patient who presented with complaints of mild discomfort in the lower abdominal, and abdominal bloating. She reported that the symptoms began two weeks ago when she started perceiving abdominal fullness, which was accompanied by heartburn, indigestion, and early satiety. She had abdominal fullness most of the day, and this progressed to lower abdominal discomfort. She described the abdominal discomfort as dull and constant pain felt in the left lower quadrant. The pain had no aggravating factors but was moderately relieved by Tylenol. The patient denied having abnormal vaginal discharge, pain during micturition or intercourse, abnormal vaginal bleeding, or changes in the bowel movements.  

The patient’s menarche was at 14 years old, and she reported mild abdominal cramping, which she managed with Tylenol to relieve the pain. The menstrual cycles were 30 days apart and last 5 days. She was a Para 0+0 Gravida 0.  She reported having one sexual partner and was on COCs, which she had used for four months.  

The vital signs were within the normal range, and the patient had a normal BMI. On physical examination, there was no abdominal tenderness, and the perineum was normal. A palpable cyst was felt on abdominal exam. The cervix was pink with no discharge or bleeding, and there was no adnexal mass tenderness.  A pelvic ultrasound was conducted, which revealed a multilocular left ovarian cyst with a diameter of 10 cm.    

Treatment 

We made an impression of Ovarian Cyst and recommended a laparoscopy to confirm the diagnosis, assess if the cyst was malignant, and to remove the cyst. A laparoscopy was done which confirmed a left ovarian cyst which was removed. The right ovary and adjacent pelvic organs were assessed, and no abnormalities were detected. The cyst was taken for histology, which confirmed that it was benign. 

Medications: The patient was administered with Naproxen 500 mg BD before and after the laparoscopy to relieve abdominal pain.  

Follow-up Care: A follow-up was scheduled after two weeks, and the patient reported that the symptoms had resolved after discharge. 

Differences in Treatment Modalities for Ovarian Cysts, Endometriosis, and Amenorrhea 

Ovarian cysts are treated depending on a patient’s age, pregnancy status, and CA125 value. A majority of patients with simple ovarian cysts of less than 5 cm do not need treatment. However, in a postmenopausal woman, a persistent simple cyst of less than 10 cm diameter, with a normal CA125 value, requires monitoring with consecutive ultrasonography examinations (Zahidy & Abdulkareem, 2018). In pregnant women, asymptomatic ovarian cysts are managed by conservative management, but in symptomatic cysts and those with rapid growth, surgical removal is recommended. Surgical procedures for symptomatic ovarian cysts more than 5-10 cm include laparotomy and laparoscopy (Eltabbakh, 2016). Bilateral oophorectomy and hysterectomy are recommended in postmenopausal patients since there is a high chance of neoplasm (Eltabbakh, 2016). Laparoscopy and laparotomy are useful in making a diagnosis of ovarian cyst, determining if the cysts are malignant and in assessing other pelvic organs for abnormalities (Eltabbakh, 2016). If the laparoscopy is performed without caution, a cyst rupture and bleeding are likely to occur. 

The treatment modality for endometriosis is similar to ovarian cysts, where laparoscopy is used to remove endometrial implants in pelvic organs (Duffy et al., 2014). Laparoscopy is also used in making a diagnosis. However, alternative approaches are used in the treatment of endometriosis, such as hormonal therapy using combined or contraceptives, progestin agents, gonadotropin-releasing hormone analogs, and Danazol (Berlanda et al., 2017). Hormonal therapy is the mainstay of medical treatment in endometriosis. It is indicated to interrupt the normal cyclic secretion of reproductive hormones and to alleviate dysmenorrhea associated with endometriosis (Berlanda et al., 2017). Hormonal therapy is associated with side effects such as irregular menstrual flow and weight gain, while treatment with laparoscopy has a high chance of recurrence. 

Treatment of amenorrhea is dependent on the causative factor and is tailored to treating the underlying pathology. Surgical interventions are indicated in abnormalities of the outflow tract, such as imperforate hymen. For causes other related to the Hypothalamic-Pituitary-Ovarian axis, hormonal therapy is the mainstay of therapy, similar to the treatment of endometriosis (Berga, 2019). In primary amenorrhea, hormone therapy is indicated involving estrogen and progestin to correct estrogen deficiency. Transdermal or vagina patches are preferred to avoid first-pass liver metabolism (Berga, 2019). The recommended medical therapy for secondary amenorrhea is dopamine agonists, which reverse the underlying pathology that causes amenorrhea. In addition, gonadotrophin-realizing hormone is recommended for women who are anovulatory due to unresolved hypothalamic or pituitary disorders but desire fertility (Berga, 2019). Amenorrhea related to thyroid dysfunction such as hyperthyroidism and hypothyroidism, anti-thyroid, or thyroid products is prescribed. Nevertheless, hormonal therapy may have side effects, including irregular uterine bleeding, increased vaginal discharge, and weight gain. 

 

References 

Berga, S. L. (2019). Hypothalamic Amenorrhea. In Menstrual Cycle Related Disorders (pp. 15-26). Springer, Cham. 

Berlanda, N., Somigliana, E., Frattaruolo, M. P., Buggio, L., Dridi, D., & Vercellini, P. (2017). Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? European Journal of Obstetrics & Gynecology and Reproductive Biology, 209, 67-71. 

Duffy, J. M., Arambage, K., Correa, F. J., Olive, D., Farquhar, C., Garry, R., Barlow, D.H., & Jacobson, T. Z. (2014). Laparoscopic surgery for endometriosis. Cochrane Database of Systematic Reviews, (4). 

Eltabbakh, G. (2016). Laparoscopic surgery for large ovarian cysts-review. Trends Gynecol Oncol, 1(109), 2. 

Zahidy, A., & Abdulkareem, Z. (2018). Causes and Management of Ovarian Cysts. Egyptian Journal of Hospital Medicine, 70(10). 

 

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Title: NURS 6521 Week 5 Practicum Journal Entry Ovarian Cyst