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Case Study 1: Janet Jackson

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Case Study 1: Janet JacksonJanet Jacksonis a 40yearoldwoman. She is a single parent with three teenage children. She has been experiencing symptomswhich has led to a diagnosis ofuterine fibroids (leiomyomas). Janet has a history of depressionand is a heavysmoker.Janet was admitted to hospital for a vaginal hysterectomy via spinal anaesthesia. After 2 hours in the post-anaesthetic recovery room (PARU) shewas transferred to the ward.She has an indwelling urinary catheter insitu and patient controlled analgesia.PRESENTATION TO THE WARD:On return to the ward Janet’s observations are as follows:
Respirationrate30 per minute•BP 90/50mmHg•Pulse 130bpm•Temperature 36.5oC•Pain 0/10•Indwelling urinary catheter insitu with 10mls of urine output for the last hourIt is planned for Janetto be discharged after two days on the ward.QUESTIONS TO BE ADDRESSED:In relation to Janet Jackson:•Discuss theaetiology and pathophysiologyof thepatient’s presenting condition(LO1; LO3).•Critically discuss the underlying pathophysiologyof the patient’s post-operative deterioration.Prioritize, outlineand justifythe appropriate nursing management of the patient during this time (LO1; LO2; LO3; LO5: LO6)
Identify three (3) members of the interdisciplinary healthcare team, apart from the primary medical and nursing team, who you would involve in the care of the patient before their discharge and provide justification for their involvement. (LO1; LO4: LO5; LO6).

 

Introduction

Janet Jackson diagnosed with Uterine fibroids is currently in a ward. These are tumors found in the uterus. The cause of uterine fibroids is unknown though there is evidence progestogen and estrogens aggravate the growth of tumors as in most cases they regress after menopause. However, this is not the case in Janet’s case as she is a 40-year-old woman a few years shy of menopause.

Etiology and Pathophysiology

The etiology of fibroids highlights a wide prospect of theories. Fibroids are usually made up of smooth muscle cells. Organs of the body like the stomach and the uterus are made of smooth muscles cells. It is why in women with fibroids, the endometrium looks normal under a microscope. In some instances however, an abnormality referred to as the glandular functionalis is the first clinical clue for doctors to examine a patient closely for submucosal fibroid (Tinelli et al., 2015). Janet has leiomyomas usually referred to as clonal, result from alterations of a single myoma cell. Estrogen promotes the growth of Leiomyomas but sometimes they may be triggered by low absence of estrogen. It is possible to have some scenario where ovarian and adrenal androgens are transformed to estrogen by aromatase activity in the myoma cells (Tinelli et al., 2015).

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