VII. THERAPEUTIC MANAGEMENT

LIST OF PROBLEMSTHERAPEUTIC OBJECTIVES

1. Pain (Right Lower Quadrant Pain)2. Tender Palpable mass 10x10cm1. To treat the underlying cause of the pain3. To maintain vital signs within normal range4. To prevent further complications

ADVICE AND INFORMATIONNON-PHARMACOLOGIC MANAGEMENT

1. Educate the patient and her family about her disease condition, its symptoms, risk factors, and its potential harmful effects if not treated.2. Educate the patient as well as her family regarding the different benefits of the drugs taken and to watch out for its possible side effects or adverse reactions.3. Advice the patient to strictly follow her diet regimen.4. Advice patient to do deep breathing exercises, follow a healthy diet plan (such as high fiber diet), and observe proper hygiene, adequate rest and sleep to promote well being.

Pre-Operative Management:1. Admit patient for surgical management.2. Secure patients/parents consent.3. Start venoclysis Plain LR 1L @ 10gtts/min. 4. Monitor vital signs every 4 hours.5. Diet: NPO initially until cleared by Surgery and OB-Gynecology.Intra-Operative (Surgical Management):Due to the low frequency of malignancy in the pubertal age group, OVARIAN SPARING SURGERY is the goal. The treatment consists of OPEN LAPAROTOMY and CYSTECTOMY since the patient presented with 10cmx10cm mass and pain which may indicate torsion. 1. Open Laparotomy Inspect the contralateral ovary. The current treatment involves preservation of the contralateral overy without biopsy if it grossly appears normal.2. Cystectomy is the operative treatment of choice, with preservation of the remaining portion of the ovary. Scalpel incision is made in ovary at intersection of dermoid and normal ovary. Dermoid will be separated from the ovary. Reconstruction of the normal ovary.

PHARMACOLOGIC MANAGEMENT

DRUG NAMEEFFICACYSAFETYSUITABILITY

NONSTEROIDAL ANTI-INFLAMMATORY DRUG

Ketorolac (KETERO)1mg/kg IV every 6 hours for 2 days

Preparation: Ketero in 30mg/ml vialKetorolac inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which results in decreased formation of prostaglandin precursors.Administration: Inject over 15 seconds.

Contraindications: Hypersensitivity to NSAIDS, history of asthma and GI bleeding.For short-term management of mild to moderate post-op pain.

NARCOTIC ANALGESICS

Morphine (MST CONTINUS) 20mg every 12hrs

Preparation:MST Continus MR tab 10mgNarcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation; suppresses cough by acting centrally in medullaAdministration: May be taken with or without food. Swallow whole, do not break/chew/crush.

Contraindications:Hypersensitivity, paralytic ileus.Prolonged relief moderate to severe post-op pain.

P-DRUGS

Ketorolac (KETERO)1mg/kg IV every 6 hours for 2 days

FOLLOW-UP

1. OPD Follow-up:7 days after the patient was discharge, patient should have hER follow up check up on the nearest health center or hospital.2. 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 family3. Proper hygiene.4. Diet: Proper diet such as eating nutritional foods that are rich in protein, fiber and Vit. C to promote well-being. Increase oral fluid intake.

Rosheil Mae C. de los Santos, M.DSilliman Medical Center(035) 422-1333Patient:X,Y Date: 07/23/2015Address: Mabinay, Neg. Or. Age/Sex: 12y.o./FemaleKetorolac (KETERO) 30mg/ml vial#12Sig:Administer 40mg IV every 6 hours for 2 daysROSHEIL MAE C. DE LOS SANTOS, MDLic. No. 0123459