Nursing Report: Cynthia Jones' Case Study and Interdisciplinary Care

This nursing report presents a comprehensive analysis of Cynthia Jones' case, focusing on uterine fibroids, their aetiology, and the associated pathophysiology. The report details the functional changes experienced by Cynthia Jones due to the growth of fibroids, including increased menstrual bleeding, pressure on the urinary bladder, and changes in abdominal contour. It also examines the pathophysiology of her post-operative deterioration following a total abdominal hysterectomy, including potential risks and necessary nursing management. Furthermore, the report emphasizes the importance of an interdisciplinary healthcare team, including psychologists, social workers, and dieticians, in providing holistic care to Cynthia Jones, addressing her physical, mental, and social needs. The report concludes by referencing relevant literature and highlighting the critical role of nurses in effectively managing post-operative care and preventing potential complications.

NURSING

TABLE OF CONTENTS
QUESTION 1 ..................................................................................................................................1
Aetiology and pathophysiology of Cynthia Jones .....................................................................1
QUESTION 2...................................................................................................................................2
Pathophysiology of Cynthia Jones post operative deterioration ................................................2
QUESTION 3...................................................................................................................................3
Interdisciplinary healthcare team................................................................................................3
REFERENCES ...............................................................................................................................6

QUESTION 1
Aetiology and pathophysiology of Cynthia Jones
Uterine fibroid is the form of a tumour which is developed in the uterus (womb). This
tumour does not grow like cancerous tumour. This tumour gets developed in smooth muscles of
uterus wall.
Aetiology: The possible causes which have resulted in uterine fibroid in Cynthia Jones are as
follows:
 It is observed that genes in fibroid containing muscles are different from the genes which
are present in ordinary uterine. Thus, it can be concluded that genetic changes or
alterations in gene structure can lead to uterine fibroid.
 The growth of fibroid is also affected by the factors such as insulin. These factors are
responsible for maintaining the growth of body tissues. So any imbalance or deviation in
these factors can affect the fibroid (Khan, Shehmar and Gupta, 2014).
 Cynthia Jones is a 49 years old woman; thus hormonal changes are common practice for
people of this age group. The hormones which promote the development of linings in
uterus during menstrual cycle are also responsible for promoting this fibroid growth. It is
also observed that uterine fibroids tumours contain higher level of progesterone and
estrogen hormone. However, when fibroids are grown due to these hormones then it
tends to shrink as menopause cycle begins. It is also possible that Cynthia Jones may have developed fibroids as a result of her
family history or from other members of her family who may have suffered from it in the
past. Obesity and commencement of menstrual period before the age of 10 years are also
among the causes for this sort of growth.
Pathophysiology of uterine fibroids: Cynthia Jones has observed the following functional
changes in her body which accompanied her gradually, due to the growth of fibroids in her
uterus walls.
 It is observed that Cynthia Jones experienced an increase and irregular menstrual
bleeding and extra pressure on urinary bladder. This pressure led to frequent urination
and sometimes difficulty to urinate.
1

 Fibroid also caused an expansion in waist size and changed the abdominal contour of
Cynthia Jones. It is also observed that it also increased the pelvic pressure and pressure
on rectum which steered to excessive pain in lower abdominal and constipation
(Carranza-Mamane and et.al., 2015).
 The uterine fibroid also commanded an excessive generation of hormones such as
estrogen, progesterone, insulin, cytokines and other hormones which are involved in the
growth of such tissues. These fibroids also guided a transformation of estradiol from
circulating androstenedione.
 Uterine fibroid also caused the functional changes in respiratory mechanism and
metabolism (Stewart and et.al., 2017). Thus, Cynthia Jones also experienced the
difficulty in breathing, heaviness in chest and light-headedness.
QUESTION 2
Pathophysiology of Cynthia Jones post-operative deterioration
Cynthia Jones had undergone through Total Abdominal Hysterectomy procedure in
which her entire uterus as well as cervix were removed. The operation headed to several risks
such as blood clots, blood loss, early onset of the menopause and damage to her urinary tract.
Thus, it is very essential to monitor and manage her post-operative deterioration to avoid these
risks. Post operation, Cynthia Jones was not be able to perform any strenuous activities which
require physical effort or stress for at least 8 weeks. Thus, she was not incompetent to lift
weights or use stairs. She also experienced vaginal bleeding for few weeks (Stewart and et.al.,
2017).
The heavy doses of medicines and inactive routine for around 6 to 8 weeks led to
constipation. To get relieve from constipation, the doctors advised her to include plenty of fluids,
vegetables and fruits in her diet and also gave her stool softener. The pain level of Cynthia Jones
was 0/10, so initially, pain killers were not required but on her request, when she was suffering
from nausea, vomiting or discomfort then pain killers were given to her.
Post-surgery she suffered from great pain and fever. She might have also experienced
abdominal bloating or burning sensation during urination. Chest pain and breath shortness are
also common functional changes after total abdominal hysterectomy (Uterine Fibroids, 2018).
2

Post operation before discharge, an appropriate nursing management is required so that
Cynthia does not suffer from possible risks which may rise after operation. For at least eight
hours’, the nurse must monitor the pain and respiratory status along with the body temperature to
deal with possible hypothermic conditions. It is essential for the nurse to monitor the frequency
of urination. Nurses also must monitor the vital signs in duration of 4-8 hours if Cynthia is stable
for the initial 24 hours of surgery. Nurse must also check out the drainage amount and regularly
examine that there are no signs of infections. The dressing can be changed with sterile technique
(Leanza and et.al., 2016).
The nurses always play a crucial role in effectively providing the post operation care to
patients like Cynthia Jones. The post-operative care approaches help the patients to minimise the
risk and can inspect their health deterioration due to surgery. The infections and weakness are the
most common factors after surgery which must be treated properly otherwise it can lead to
several other major health concerns (Ono and et.al., 2018).
Nurses can diagnose the condition of Cynthia by continuous monitoring of health
parameters. Based on the observations, they can plan suitable control strategies along with the
consent of patient. Nurses and health professionals must also evaluate that their care strategies
are giving positive results and Cynthia Jones is comfortable.
QUESTION 3
Interdisciplinary healthcare team
Interdisciplinary teams involve professionals from various disciplines who work
collaboratively with similar goals and share responsibilities and resources. These teams play an
effective role in creating a care plan for the patients during treatment and after discharging the
patient from hospital. The interdisciplinary healthcare teams eliminate the traditional boundaries
of healthcare professionals in providing more effective care. Cynthia Jones must be provided
with the following team members in interdisciplinary healthcare team.
3

Psychologist:
Cynthia Jones had a history of depression. The diagnosis and treatment of uterine fibroids
may have caused mental and financial stress to her. These factors might have given rise to her
depression issue again. Thus, it is essential that before her discharge, she must be provided with
more care by psychologists who could understand her mental state. It is essential for Cynthia
Jones to remain calm and to avoid all such mental stress. The mental stability will help her to
recover from the treatment soon and also to avoid it, which may arise due to anxiety or
depression (Sirkeci, Belli and Manyonda, 201). The support of psychologist will motivate
Cynthia Jones to share her feelings and concerns with the professionals.
It will also help her to describe her fear, misconceptions and queries regarding the
treatment process and possible healthcare issues which may again rise in the future. Thus, the
role of psychologist is very important in planning the care for Cynthia Jones as it will help her to
improve knowledge regarding health practices as well as to recover soon. When she will have
regular discussions with psychologist regarding treatment and healthcare practices, it will give
her motivation to accept the changes after getting discharge from the hospital. Post operation
effect may cause severe pain and discomfort to Cynthia Jones, thus psychological help will allow
her to collect her strength to stay strong without getting depressed.
Social workers:
Cynthia Jones lives with her 13-year-old son. Thus, it may be difficult for his son to
manage and handle the regulations of healthcare centre. This issue can also cause stress to
Cynthia as she was in hospital and in that situation, her children were alone and had to manage
everything. In such situations, support from social workers could be of great relief to her. The
social workers can help her family to fulfil all requirements of health professionals accurately.
These social activists also ensure that if a patient requires some emotional and financial
support then they can be provided to them. Most of the people are not able to access healthcare
services due to unavailability of resources. The social workers ensure that Cynthia Jones and
other patients can access and use these healthcare services without any discrimination or barriers
and with proper concern from the healthcare providers.
1

Dieticians:
Interdisciplinary team must also include dietician. The nutritionists have key role in
sustaining the health status of the patients. Cynthia Jones can recover quickly from the treatment
and can continue her routine as early as possible by involving the diet which is rich in nutrition
and can provide her enough strength to adopt the treatment positively.
The dietician will guide Cynthia Jones about the nutrition value and she must include this
in her routine and how she can adopt healthy approaches for maintaining her health. The
dietician will also provide her guidelines to follow after she get discharges from the hospital so
that she does not encounter any weakness or side effects of the treatment (Pritts and et.al., 2015).
The involvement of these members in interdisciplinary team will ensure that Cynthia Jones can
get effective healthcare services by providing her strong emotional, psychological support along
with proper guidance from these professionals.
1

REFERENCES
Books and Journals
Carranza-Mamane, B., Havelock, J., and et.al., 2015. The management of uterine fibroids in
women with otherwise unexplained infertility. Journal of Obstetrics and Gynaecology
Canada. 37(3). pp.277-285.
Khan, A.T., Shehmar, M. and Gupta, J.K., 2014. Uterine fibroids: current perspectives.
International journal of women's health. 6. p.95.
Leanza, V., Castronovo, G., and et.al., 2016. The impact of hysterectomy as uterine fibroid
therapy on personality traits and psychological symptoms of patients. GIORNALE
ITALIANO DI OSTETRICIA E GINECOLOGIA. 38(2). pp.253-259.
Ono, M., Maruyama, T., and et.al., 2018. Stem Cells and Uterine Fibroids. In Uterine Fibroids
and Adenomyosis (pp. 59-67). Springer, Singapore.
Pritts, E.A., Parker, W.H., and et.al., 2015. Outcome of occult uterine leiomyosarcoma after
surgery for presumed uterine fibroids: a systematic review. Journal of minimally invasive
gynecology. 22(1). pp.26-33.
Sirkeci, R.F., Belli, A.M. and Manyonda, I.T., 2017. Treating symptomatic uterine fibroids with
myomectomy: current practice and views of UK consultants. Gynecological surgery.
14(1). p.11.
Stewart, E.A., Cookson, and et.al., 2017. Epidemiology of uterine fibroids: a systematic review.
BJOG: An International Journal of Obstetrics & Gynaecology. 124(10). pp.1501-1512.
Online
Uterine Fibroids, 2018. [Online] Accessed through
<https://www.emedicinehealth.com/uterine_fibroids/article_em.htm#what_are_uterine_fi
broids>
2