Está en la página 1de 66

INTRODUCTION Attitude is a little thing that makes a big difference by Winston Churchill.

As the quotation suggests, we are all going through this upside down and unpredictable world but our attitude will help us survive or lose to it. We do not mean having a good or bad attitude because that is of another topic but what we mean is that on how one deals with the good thing and bad things happening in his life. In life, we show dissatisfaction by complaining and we complain more often that we can notice. It is indeed inevitable not to nag on certain things in our life, not to fully accede in everything thats coming and not to fantasize a perfect life but to be pleased to what is in the plate is way more pessimistic. By this, we do not intend to say that when you are diagnosed of a disease, you jump to joy of having it, we mean is that deal with it positively that you can overcome it and treated with it. In the span of our duty, we can notice how one differs from the other, how one exerts effort from the other and how one loses from the other. For the sick, it is hardly imagine the pain they are going through and for the significant others, their hardships are imaginable because we all had experienced a loved one being sick but everyone varies in dealing with problems. The severity of the problem greatly affects ones attitude towards it but if one has a positive disposition in life, no matter how heavy the loads you give and no matter how deep it will reach, it will be handled as though nothing bad will going to happen. Honestly, this case is what our group chose in particular because our attention was caught especially by the physical appearance of the patient. Patient Ms. P appears to be a happy person that smiles even to strangers but her being seriously sick is not hidden to many due to the large mass in her abdomen that is even bigger to that of a pregnant mother. We can say that her attitude towards her condition is always positive and she deals with it very well. Patient Ms. P was diagnosed with Ovarian New Growth with left pending biopsy result to determine if it is malignant or benign. Ovarian new growth is sac filled with liquid or semiliquid material that arises in an ovary. They often become very large and can extend up into the abdomen. The diagnoses of the disease require a widespread implementation of physical examination and ultrasonography technology. It is divided into three categories: benign, borderline, and malignant. Survival is largely dependent on the histology of the tumor, with a 10 year survival rate of 100% for benign tumors, 60% for borderline tumors, and only 34% for the malignant subtype. There is some difference in ages of the peak incidence for the different subtypes with considerable overlap as described below. In general, benign tumors tend to present earlier, while malignant tumors are often seen later in life. Women diagnosed of such have anxiety and fear of it being malignant but vast majority are benign. It is developed in women at any stage of life from neonatal period to post menopause. However, most occur during infancy and adolescence, which are hormonally active periods of development. According to Wikipedia, in US ovarian cyst are found in nearly premenopausal women and in up to 14.8% of post-menopausal. About 95% are benign, meaning they are not cancerous. According to the statistics conducted by the Department of Health in Selected causes of death by Region in the Philippines, year 2006, about 743 deaths under Malignant Neoplasm in Region 12 was noted and a total of 28, 556 deaths in the entire Philippines. On the same year, the category Malignant Neoplasm ranked 3rd among the 12 selected cause of death. It increased from the previous year, 2005, to almost 1,000 deaths which was 27, 604 deaths under malignant neoplasm. It is a bit alarming because as the year goes by, it never fail to increase as how the year increases. Our awareness to the case is not developed very well in which if it had; cases might lower down as to know what precautionary measures we have done.

1|Page

Significance of the study On the present, we are learning, adopting and enjoying the benefits of the advanced technologies that we have especially in the medical field. There are new machines that help in diagnosing and treating certain diseases. There is also new equipment that is very useful in the daily routine of healthcare professionals. Yet, with all this advancements it is still hard to beat the will of the Almighty because some fatal diseases are still left without any means of diagnostic procedure and before you know it, you already have it. In this study, we will dig deeper on what are the factors that contributes to the disease for prevention in our self and to determine if this factors are already enough to justify the result. It will help us to know the proper managements for our future patients. It will give us additional knowledge that will help us manage it in our patients of the same diseasein the future. Scope and Limitations This case study is focused on the ovarian new growth with complications and its probability of being malignant. As a case study, this discussion is centered to a certain client in Cotabato Regional and Medical Center. All data utilized in this study come from her course of stay in the hospital. It has served as a basis of instruction to present more realistic overview of the disease. Reasons why you chose the case As a nurses, we are exposed to different areas, different people, and different diseases that some are communicable and some are not and with that, we see lots of unfamiliar cases. As something new to us, we want to learn more about this disease and hopefully to be knowledgeable about the disease for in the future, we can deal with it properly and correctly.

2|Page

General Objectives Within the span of our clinical exposure at Cotabato Regional and Medical Center, our aim is to gain a comprehensive case study concerning the patients state of health and all aspects contributing to and affect her condition. Specific Objectives Acquire pertinent data of the client which are relevant to the case study To identify factors affecting the disease To determine the health history of the client by obtaining the present health history and past present health history To be able to conduct a cephalocaudal assessment To be able to discuss the involved system of the disease in the Human Anatomy and Physiology To be able to trace the Pathophysiology of the disease To be able to explain and interpret the laboratories undergone by the patient and the different drugs taken by the patient To be able to for formulate a specific, measurable, attainable, realistic, time-bound nursing care plans To be able to formulate recommendation and health teaching

3|Page

Patients Data A. Name: Age: Sex: Weight: Personal Data Ms. P 14 years old Female Pre-Op - 72 kg Post- Op - 42 kg Height: BMI: 52 Pre-Op 29.2 (malnourish/overweight) Post-Op 17 (malnourish/underweight) Address: Nationality: Religion: Civil Status: Occupation: Barangiran, Alamada, North Cotabato Filipino Roman Catholic Single Student

B. Room:

Clinical Data OB Ward Room A Pre-Op; Room C Post-Op September 09, 2012 8:30 PM Dr. Malik/ Dr. Kamensa/ Dr. Gaurana Pelvic Pain G0, Ovarian New Growth with Complications, Probably Malignant G0, Ovarian New Growth Left, Pending Biopsy Result

Date of Admission: Time of Admission: Attending Physician: Chief Complaint: Admitting Diagnosis: Final Diagnosis:

Initial Vital Signs Temperature: Pulse Rate: Respiratory Rate: Cardiac Rate: Blood Pressure:
4|Page

36C 90 bpm 19 bpm 94 bpm 160/110 mmHg

Chest X-Ray Lung fields are clear Heart is not enlarged Haziness is seen in the abdominal cavity with consequent elevation of both hemidiaphragms Bony thorax is unremarkable IMPRESSION: Consider Ascites

Pelvic Ultrasound Abdominal pelvic mass consider ovarian new growth probably malignant by Sassone=8 benign by Lerner=2

5|Page

HEALTH HISTORY

A. Family Health History It was been said that the cousin of Miss P in paternal side has a history of Ovarian New Growth but cured on early stage thus she recovered and had her offspring. On the other hand, her maternal grand side has no record of any tumors or cyst that is in relation to the present chief complaint of the patient. Both paternal and maternal lineages have no history of hypertension, diabetes and heart disease. The common sicknesses of the family are cough, colds and fever. The father of the patient work as a truck driver whom he is renting, sometimes in a day, if he have not rented a truck he had no income, while the mother is just a housewife. Since only the father work, all of the familys expenses depended on him. They are seven children in the family, five of them got married and had their own family, and the remaining last two children are still living and dependent with their parent, Miss P as the youngest.

B. History of Present Illness Miss P is 14 years old girl, nulligravida and a student from Alamada. But later she stopped studying due to present condition. The ovarian new growth of Miss P started to grow 2 years and 9 months from now and that time she was 11 years old. According to Miss P she started menstruation at an early age and experiencing dysmenorrhea and irregularities. She had her last menstruation period last December 2011. During the growth of the mass, Miss P did not feel anything strange in her body or experience any signs and symptoms except for the enlargement of the abdomen. That is according to her doctor her ovarian new growth is asymptomatic, mucinous, borderline ovarian new growth. With the presence of the mass, Miss P is still able to ambulate, turn and position herself but with a slow pacing. The mother verbalized that they manipulated the mass through hilot. Upon measuring Miss Ps abdominal girth it was 122 cm and she weighted 72 kg and with grade 3 pitting edema of both lower extremities and is warm to touch. According to her doctor the hilot had not do any effect to the mass. So upon admission, her doctor scheduled her for emergency exploratory laparotomy since the patient already complains of pelvic pain.

C. Past Medical History Miss P had a complete immunization during her childhood. She experiences common colds, cough and fever and because of it she usually takes over- the-counter drug like the Paracetamol. She is also taking and using herbal medicines when in sick, like the leaves of guava and star apple. As a young lady, at the time she is having a menstruation, she is takes ferrous sulfate as a nutritional supplements. About her diet, she eats three times a day, without skipping meals. Their usual viand consists of vegetables and fish. She likes spaghetti and drinking coffee and no allergies to foods or substances. She has an enough rest periods with 10 hours number of sleep. During her childhood when she was 7 years old, she experienced dengue fever and admitted to Alamada Community Hospital. When she was 8 years old she is diagnosed with Urinary Tract Infection and admitted to the same hospital. At time when Miss P was 11 years old the ovarian new growth started to form or grow but the family did not give a prompt attention to it until it reaches to its largest size.

6|Page

GENERAL PHYSICAL SURVEY Behavior: Feeling: Appearance: Posture and gait: Hygiene and grooming: Body and Breath odor: Body built: Body movements: Speech: Thought Process: Affect: Mood: Integument: Cooperative; answers question promptly Calm and assured Dressed inappropriately wearing violet malong and a white short, appears weak Slouched posture; slow and unsteady gait Proper hygiene and grooming noted, nails properly trimmed, hair properly fixed No foul body and breath odor noted Skinny, bony outlines are prominent with lower extremity edema Coordinated but slow Slow but comprehensible Coordinated; answers are related to the questions asked Appropriate Irritable during painful episodes Skin is relatively pale in color, hair color is black, hair is properly distributed, skin is dry, capillary refill is 2 seconds. Warm and dry, skin turgor springs back springs back to its previous state in 2-3 seconds. Wavy, black in color, not extremely oily, evenly distributed, negative for lice. Without masses, proportion to the body No pimples, no masses, asymmetrical face Eyelashes are black in color and well curved, pupils are equally round and reactive to light, smooth, poor hearing ability. Symmetrical to the midline of the face, no lesions or swelling noted, no discharges, airways are free from obstructions, nasal mucosa is free from inflammation Teeth are incomplete, slightly yellow in color with no indication of any tooth decay or other tooth problems, pinkish gums with no bleeding, lips is pinkish in color Patient was able to hold the neck erect at midline with symmetrical muscles, no inflammation noted on thyroid glands, masses noted in the general area of the neck, no bounding of jugular vein No lesions noted, equal chest expansion and negative on clear breath sound, absence of adventitious sounds upon auscultation, respiratory rate of 20 cycles per minute from the normal rate of 12-20 cycles per minute, no cough of any condition was present With normal heart sound, has a regular rhythm of 66 beats per minute from the normal rate of 60-100 beats per minute, no visible pulsation Equally grip, low strength, warm to touch, both have five fingers, good skin turgor Edema noted on both feet, lesions noted,

Skin: Hair: Head: Face: Eyes: Nose:

Mouth:

Neck:

Chest:

Heart:

Upper extremities: Lower extremities:


7|Page

FOCUS ASSESSMENT ABDOMINAL ASSESSMENT Inspection 1. Skin: Upon inspection of the skin, its color is pale pink and appears lighter than the other parts of the body such as arms and legs. With fine veins noted with small scar on the left lower quadrant. 2. Umbilicus: Upon inspection of the umbilicus, it is located at the center of the abdomen, its color is the same with the surrounding skin. 3. Contour: Upon inspection, the abdominal contour of the patient from the rib margin to the pubic bone upon standing at her side, when done in a supine position is enlarged. 4. Symmetry: Patients abdomen is symmetrical and her abdominal girth measures 122 cm PreOp and 82 cm Post-Op. 5. Enlarged organs: No enlarged organs are noted 6. Peristalsis: Movement is not visible upon inspection 7. Pulsations: Pulsation is not visible Auscultation 1. Bowel sounds As I auscultated, there are irregular gurgle (15 times/min). In the right upper quadrant, 18 times/min. In the left upper quadrant, 23 times/min. In the left lower quadrant, 21 times/min.

8|Page

ANATOMY

Fig.1.Female Reproductive System

The main external structures of the female reproductive system include: Labia majora: The labia majora enclose and protect the other external reproductive organs. Literally translated as "large lips," the labia majora are relatively large and fleshy, and are comparable to the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with hair. Labia minora: Literally translated as "small lips," the labia minora can be very small or up to 2 inches wide. They lie just inside the labia majora, and surround the openings to the vagina (the canal that joins the lower part of the uterus to the outside of the body) and urethra (the tube that carries urine from the bladder to the outside of the body). Bartholin's glands: These glands are located beside the vaginal opening and produce a fluid (mucus) secretion. Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable to the penis in males. The clitoris is covered by a fold of skin, called the prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive to stimulation and can become erect.

9|Page

The internal parts include: Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal. Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developing fetus. The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit. Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs and hormones. Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants into the lining of the uterine wall.

10 | P a g e

PATHOPHYSIOLOGY

PREDISPOSING FACTORS: Nulliparity Infertility Hereditary Early Menarche

PRECIPITATING FACTOR: Unknown

Hyperstimulation of FSH, LH and Estrogen

Follicle to proliferate

Follicles continue to ovulate and continue to grow


Irregular menstrual period

Formation of cysts and genetic changes

Pain or pressure with urination or bowel movement

Increase in abdominal girth


OVARIAN NEW GROWTH

Lower abdominal or pelvic pain

11 | P a g e

COURSE IN THE HOSPITAL Date/Time 9-9-12 8:30 pm Order Please admit patient with consent under the service of Dr. Napoles/ Malik/ Kamensa/ Gaurana General liquid, NPO postmidnight Rationale For proper monitoring,management and evaluation. To prevent aspiration pneumoniaespecially those who willundergo a general anesthesia. To screen for alteration and serve as baseline data for future comparison: CBC with Plt. Ct. - determines thequantity of bloodcell in a given specimen of blood,often including the amount of hemoglobin, hematocrit, and the proportion of various white bloodcells. To know any deviations or abnormalities in the blood BT-to treat severe anemia or thrombocytopenia U/A-to detect and measures various compounds that pass through the pt.s urine CXR-for internal visualization of the chest to check for any unusualities and to see if other vital organs has already been affected CA 125-is a serum antigen defined by a monoclonalantibody found in ovarian and pelvic organ malignancies as well as in breast and pancreatic malignancies. The test is undertaken to monitor surgical removal of malignant ovarian tumor for recurrence and metastasis UTZ- use of high-frequency sound waves to create images of organs and systems within the body. To correct cellular fluid losses; mild to moderate acidosis. 30gtts/min is appropriate rate computed by physician Aminoleban-for the treatment
12 | P a g e

Labs: CBC, BT, Plt. Ct - STAT

U/A Chest X-ray (APL)

CA 125

Pelvic UTZ

IVF D5LR 1L @ 30gtts/min

Start with Aminoleban 500cc OD to run x 6 hours x 3days

Additional Labs: TPA

of Hepatic Encephalopathy in patients with acute and chronic liver disease TPA- amarker identified in serum and tissue in those witha variety of malignancies in relation to the extent ofthe disease and subsequent recurrence or regressionafter surgical removal of the tumor Alk Phosphate-to measure the alkaline phosphate present in human body Cefuroxime-treatment of infections of the urinary and lower respiratory tracts, and skin and skin-structure infections ExLap-to assess disease in the abdomen. The procedure is done to find out how far cancer has spread; to determine the cause of an acute problem in the abdomen Salpingo-Oophoretomy - this surgery is performed to treat ovarian or other gynecological cancers, or infections caused by pelvic inflammatory disease.If only one fallopian tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term. If both are removed, however, the woman is rendered permanently infertile. Patient has the right to beconsented in all procedures to bedone To create a collaborative treatment within the health care providers To create a collaborative treatment within the health care providers

Alkaline Phosphatase

Meds: Cefuroxime 750mg IVTT q8 ANST( )

For ExLap possible SalpingoOophoretomy fertility sparing surgery

Pls. secure signed consent

Pls. inform OR/ AOD

Pls. inform medicine dept. for CP evaluation Monitor VS q30min and record

13 | P a g e

Refer for unusualities

Refer. Thank You.

For monitoring so that all unusualities will be referred as follows To create a collaborative treatment within the health care providers To create a collaborative treatment within the health care providers Transfusion is indicated in patients with documented coagulation factor deficiencies and active bleeding, or who are about to undergo an invasive procedure. To create a collaborative treatment within the health care providers

BT= A Hgb= 110 Hct= 0.36 Plt= 182 WBC= 0.3

To secure 4 u of FWB of patients blood type; for OR standby use

Refer. Thank you

10:25 pm

Internal Medicine Thank you for this referral (CP evaluation) Pt. seen and examined History reviewed and PE done S: With gradual swelling of abdomen. Consult done and was diagnosed with ONG. Advised for surgery but did not comply. No further consult done. Persistence of signs and symptoms. With DOB orthopnea prompted consult @ OPD. Last admission was 2009 2 snake bite Not known with heart disease / bronchial asthma Unremarkable family history Not known smoker/ alcoholic drinks O: Ambulatory with assist, conscious, coherent, oriented; 130/ 90, 112 bpm, 24 cpm. (+) tachycardia @ 112bpm, (-) mammary distended, firm, 122 cm (+) edema Gr. III pitting,

To obtain present health history to support data To obtain present health history to support data To note for supportive past health history

To note for supportive past health history To note for supportive past health history To note for supportive past health history To note for supportive past health history To obtain present health history to support data

14 | P a g e

pitting, bipedal A: Massive ascites secondary to ovarian new growth probmalignant P: ECG done Pt. is CP cleared as High risk patient, avoid over hydration of pt. Avoid over fluctuation of BP and other VS Maintain UO 50cc/hr. or 200cc/hr. Will standby for any intraop referral Refer. Thank You! To identify the appropriate interventions on the current problem ECG-to evaluate the functionality of the heart Cardio-pulmonary clearance-done by the physician to determine if patient will be able to undergo a surgery To prevent arising of complication to the current condition To prevent fluid and electrolytes imbalance To create a collaborative treatment within the health care providers To create a collaborative treatment within the health care providers To obtain present health history to support data

ECG (+) Depressed T waves III, AVF, V3

11 pm

Pt. seen and examined, History reviewed. No known abnormalities. Inquiring referring services regarding the need to do CP evaluation in this patient. Assessment: Malignant Ovarian Cancer Refer for unusualities NPO

To obtain present health history to support data To create a collaborative treatment within the health care providers To prevent aspiration pneumonia especially those who will undergo a general anesthesia. To maintain fluid and electrolyte balance.30gtts/min is appropriate rate computed by physician U/A-to detect and measures various compounds that pass through the pt.s urine TPA- a marker identified in serum and tissue in those with a variety of malignancies in relation to the extent of the

9-19-12 7:30 am S/O: awake, afebrile 120/80

Cont. IVF D5LR 1L @ 30 gtts/min Pls. follow up labs: U/A

A: still for OR TPA

15 | P a g e

Alkaline Phosphatase X-ray official result For ExLap; possible SalpingoOophorectomy fertility sparing surgery

disease and subsequent recurrence or regression after surgical removal of the tumor Alk Phosphate-to measure the alkaline phosphate present in human body To follow up previous order ExLap-to assess disease in the abdomen. The procedure is done to find out how far cancer has spread; to determine the cause of an acute problem in the abdomen Salpingo-Oophoretomy - this surgery is performed to treat ovarian or other gynecological cancers, or infections caused by pelvic inflammatory disease. If only one fallopian tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term. If both are removed, however, the woman is rendered permanently infertile.

Pls. inform OR personnel and AOD Pls. insert IFC and attached to urobag c/o OR Monitor I & O q hourly and record pls. Pls. give Ranitidine 50 mg IVTT now then q8 Monitor VS q4 and record pls.

To create a collaborative treatment within the health care providers To facilitate urination until pt. is able to void on her own To gaugefluid balance and give valuableinformation about clientson condition Ranitidine-treatment and prevention of heartburn For monitoring so that all unusualities will be referred as follows To follow up previous order

Pls. follow up blood procurement( 2 more units of whole blood/ PRBC) Refer for unusualities Refer, Thank you

To create a collaborative treatment within the health care providers To create a collaborative treatment within the health care providers

16 | P a g e

Pls. insert BT line with PNSS 1L @ KVO rate Refer. Thank you

In preparation for possible blood transfusion To create a collaborative treatment within the health care providers

9-10-12

Hydralazine 5 mg IVTT now Start with Nicardipine drip (10mL/amp + 90cc PNSS) to run @ 10 mgtts/min via solu set Pt. seen History and PE reviewed Pls. follow up availability of blood

Hydralazine- treatment of hypertension Nicardipine- For hypertensive emergencies; pre-op and post op hypertension and hypertensive states of NPO patients To obtain present health history to support data To obtain present health history to support data To follow up previous order

9-10-12 2 pm

9-10-12 3 pm BP = 120/80 PR = 104 RR = 20 T = 36.3C

(+) bipedal edema 2 years. History of enlarging To OR via stretcher on call abdomen No consultation done to the Refer problem

To consider the proper transferring of the patient To create a collaborative treatment within the health care providers Hydrocortisone- to prevent allergic reaction pre-BT To create a collaborative treatment within the health care providers Nicardipine- indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. To create a collaborative treatment within the health care providers To prepare the GIT prior to surgical procedure To prevent aspiration pneumonia especially those who will undergo

Pls. give Hydrocortisone 250mg IVTT now Refer. Thank You

9-10-12 4:15 pm BP = 150/100

Increase Nicardipine drip into 12 mgtts/min

Refer

8 pm

On Gen. liquid diet NPO post-midnight

17 | P a g e

a general anesthesia 9-11-12 7:30am NPO To prevent aspiration pneumonia especially those who will undergo a general anesthesia To maintain fluid and electrolyte balance.30gtts/min is appropriate rate computed by physician Compliance to medication may avert further complications ExLap-to assess disease in the abdomen. The procedure is done to find out how far cancer has spread; to determine the cause of an acute problem in the abdomen Salpingo-Oophoretomy - this surgery is performed to treat ovarian or other gynecological cancers, or infections caused by pelvic inflammatory disease. If only one fallopian tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term. If both are removed, however, the woman is rendered permanently infertile. Pls. inform OR personnel/AOD Return IFC and monitor I & O q hourly To create a collaborative treatment within the health care providers To facilitate urination until pt. is able to void in his own and to gauge fluid balance and give valuable information about clients on condition For monitoring so that all unusualities will be referred as follows To create a collaborative treatment within the health care providers To consider in the interventions that patient has undergone a surgery. Post Anesthesia Care Unit- where patient will recover from anesthesia after a surgery. In this,

IVF D5LR 1L @ 30gtts/min

Continue Cefuroxime 750mg IVTT q8 For ExLap possible SalpingoOopherectomy fertility sparing surgery on call

Monitor VS q4 and record

Refer accordingly

9-11-12 5:35 pm

Post Op Order S/P ExLap, Peritoneal Fluid Ontology, SalpingoOophorectomy (L) To PACU then back to ward

18 | P a g e

vital signs are monitored and management of pain. NPO temporarily To prevent aspiration pneumonia especially that the movement of the GIT has not resumed yet due to anesthesia HBR-To prevent aspiration and promote circulatory processes. Ambulate for easy return peristalsis and mobilization. For monitoring so that all unusualities will be referred as follows For essential tissue oxygenation in which essential for all physiologic functioning To continue Cefuroximetreatment of infections of the urinary and lower respiratory tracts, and skin and skinstructure infections Ketorolac-short term management of pain To continue Ranitidinetreatment and prevention of heartburn Hydralazine- indicated for heart failure To maintain fluid and electrolyte balance.30gtts/min is appropriate rate computed by physician To create a collaborative treatment within the health care providers To maintain fluid and electrolyte balance.30gtts/min is appropriate rate computed by physician To screen for, diagnose, and monitor conditions that affects blood cells and to determine effectivity of treatment To prevent fluid and electrolytes imbalance and to create a

High back rest and advise early ambulation

Monitor VS q15 min until stable then q 30 min x 2 hr. & q 4 and pls. record O2 inhalation @ 3-4 LPM via nasal cannula Meds: Cont. Cefuroxime 750 mg IVTT q8

Start Ketorolac 300 mg OD Cont. Ranitidine 50 mg IVTT q8 hr. Hydralazine 50 mg IVTT q 6 hr for BP 140/90 mmHg IVF D5LR @ 30 gtts/min

IVF TF: c/o OB on duty

PNSS @ KVO rate

For rpt. Hgb, Hct, Plt. Ct. post BT and pls. refer result

Refer for UO 30cc/hr.

19 | P a g e

collaborative treatment within the health care providers Tramadol 50mg IVTT q 8 hr for pain Bisacodyl 2 suppository on rectum at 10 am Tranexamic Acid 1 IVTT x2 more days q 8 hr. (12mn-8am) Tramadol- to manage moderate to moderately severe pain Bisacodyl- for temporarily relief of constipation Tranexamic acid- treatment of hemorrhage associated with excessive fibrinolysis in various surgical procedures BT-to treat severe anemia or thrombocytopenia To screen for, diagnose, and monitor conditions that affects blood cells and to determine effectivity of treatment Furosemide- post-blood transfusion to prevent fluid overload Hydrocortisone- to prevent allergic reaction prior to BT To create a collaborative treatment within the health care providers To create a collaborative treatment within the health care providers To prevent nausea and vomiting since the patient was previously NPO. Abrupt resuming of the regular diet may cause complications To create a collaborative treatment within the health care providers Aminoleban-a parenteral nutrition for the treatment of Hepatic Encephalopathy in patients with acute and chronic liver disease To create a collaborative

Additional Orders: Pls. transfuse another 1 u of Whole Blood as settled RBC For rpt. CBC with Pt. Ct. 6 hr post BT (2u) refer

Furosemide 30 mg IVTT after 2nd u of BT with strict BP precaution Pls. give Hydrocortisone 100mg IVTT now then AT 12mn Refer for unsualities

Refer. Thank you!

May have tea and crackers at 12 MN with strict aspiration precaution

Refer. Thank you

Resume Aminoleban IV

Refer. Thank You!


20 | P a g e

treatment within the health care providers 9-12-12 5:30 am S/O: awake 110/80 92 bpm 18 cpm 36 C General liquids and crackers To prevent upset of the GIT after a surgical procedure and to prevent nausea and vomiting since the patient was previously NPO. Abrupt resuming of the regular diet may cause complications Soft diet is one where all the food are mashed, pureed or placed in a sauce for easy swallowing. Flatus is a sign of the return of peristalsis. A regular diet. BM is a sign that the patient has fully recovered from anesthesia and the GIT has resumed movement. To follow up previous order. To stop giving Aminoleban since the patient has resumed her regular diet. To expands the extracellular fluid volume. Only solution that can be administered in blood products. To stop giving Hydrocortisone since BT is already done. To continue giving Cefuroxime To consume and shift the available IVTT meds: Mefenamic acid- for treatment of pain Celecoxib- for treatment of acute pain and to prevent inflammation FeSO4- a dietary supplement for iron and to prevent and treat iron deficiency anemia CaCO3- for treatment of heartburn Ascorbic Acid- for prevention and treatment of scurvy and to

Soft diet once with flatus (+) IFC A: SIP SO (L) Cont. Meds DAT once with BM

Pls. follow up rpt. CBC with Plt. Ct. q 6 post BT and refer D/C Aminoleban IVTT

BT line PNSS 1L @ 20 q hourly

D/C Hydrocortisone IVTT Cont. Cefuroxime IVTT Other IVTT medication to consume then shift to: Mefenamic Acid 500 mg 1cap q6 RTC for pain with meals Celecoxib 200mg 1tab BID FeSO4 1tab TID

CaCO3 1tab OD Ascorbic Acid 500mg 1tab OD


21 | P a g e

acidify the urine Pls. insert Bisacodyl suppository at rectum now Pls. remove IFC now refer if unable to void 6hr after Encourage ambulation Bisacodyl- for temporarily relief of constipation To evaluate if patient is able to void on her own To promote mobilization and prevent pressure sores if constantly lying For monitoring so that all unusualities will be referred as follows To create a collaborative treatment within the health care providers To create a collaborative treatment within the health care providers To allow patient to eat her regular diet To terminate IVF To terminate BT line To stop giving IVTT medication Patient can be discharge once cleared Cefuroxime-treatment of infections of the urinary and lower respiratory tracts, and skin and skin-structure infections Celecoxib- for treatment of acute pain and to prevent inflammation Mefenamic acid- for treatment of pain FeSO4- a dietary supplement for iron and to prevent and treat iron deficiency anemia CaCO3- for treatment of heartburn Ascorbic Acid- for prevention

Monitor VS q4 and record pls.

Refer for unusualities

Refer. Thank you!

9-13-12 7:10 am S/O: awake Afebrile 120/80 A: S/P SO (L) Exlap

DAT D/C IVF D/C BT line D/C IVTT medication May go home today Home medication: Cefuroxime 500mg 1tab TID x 7 days

Celecoxib 200mg 1cap BID PRN for pain with meals Mefenamic Acid 500mg 1tab TID for pain with meals FeSO4 1tab TID x 30 days

CaCO3 1 tab OD x 30 days Ascorbic Acid 500mg 1 tab


22 | P a g e

OD x 30 days OPD follow up on 9-19-12 To secure blood bank clearance prior to discharge Advised Refer. Thank you

and treatment of scurvy and to acidify the urine To note for date of return for check up To be cleared from blood bank for all the blood used before discharge Given health teaching for continuing care at home To create a collaborative treatment within the health care providers

23 | P a g e

HRP E X C H A N G I N G

Nursing Diagnosis Ineffective peripheral tissue perfusion r/t pitting edema on both leg

Manifestations Pitting edema on both legs Weakness noted Difficulty moving or positioning on bed Edema site is shiny, and scaly Clammy skin BP of 160/140 mmHg

Pathophysiology With hypertension the cardiac system can become overwhelmed because the heart is forced to pump against rising peripheral assistance. This reduces blood supply to organs particularly the kidneys. Vasospasm in the kidney increase blood flow resistance leading to decreased glomerular filtration. Thus sodium reabsorption and fluid retention takes place, due to an increase permeability, fluid shifting occur from intravascular to interstitial spaces causing edema.

Client outcome Within the shift the patient will maintaintissue perfusion as evidenced by decreased edema, warm skin and normal vital signs.

Interventions Instruct to elevate both legs. Instruct not to stand and sit for long periods and do not wear constricting clothing. Monitor intake and output Instruct to elevate the head of bed at night. Encourage early ambulation Instruct to do ROM exercises

Rationale To promote circulation. To minimize causative factors and to maximize tissue perfusion. To monitor fluid balance. To increase gravitational blood flow. To enhance venous return To prevent venous stasis and further circulatory

Evaluation Goal met. Patient maintained perfusion as evidenced by decreased edema and BP of 120/80 mmHg.

24 | P a g e

HRP M O V I N G

Nursing Diagnosis

Manifestations

Pathophysiology The patient has weakness on both legs in which she cannot move it freely because of weakness, patient has insufficient energy to endure or do desired activities like standing or sitting on bed because of enlargement of abdomen due to ovarian cyst and developing of edema on both legs.

Client outcome Within the shift the patient will be able to exhibit increase muscle strength as evidence by ability to tolerate performing ADLs with minimal assistance.

Interventions Assist with activities and provide use of assistive devices Instruct to limit physical activities and avoid overexertion. Provide adequate rest periods between activities Place patient on position of comfort

Rationale To protect client from injury

Evaluation Goal met. Patient was able to tolerate activities with minimal assistance.

Activity Subjective: intolerance level 2 Minsan nanghihina r/t decrease muscle ako kaya strength tinutulungan ako ni mama. as verbalized by patient Objective: Body weakness noted Unable to stand or sit on bed without assistance Difficulty moving or turning on bed Edema on both legs

To prevent fatigue and muscle strain. To reduce fatigue and to conserve energy To aid in relaxation and it will improve blood circulation To promote well-being and maximize energy production To conserve

Encourage the patient to take adequate intake of fluids and nutritious foods. Implement
25 | P a g e

energy saving technique like sitting while doing a task. Increase activities gradually Encourage active ROM exercises

limited energy and preventing fatigue. To conserve energy To maintain muscle strength

26 | P a g e

HRP F E E L I N G

Nursing Diagnosis Acute pain r/t post op surgical incision secondary to removal of ovarian cyst

Manifestations Subjective: Masakit ang tahi ko lalo pag gumagalaw ako. as verbalized by the patient Objective: Pain scale of 6/10 Facial grimace Guarding behaviour Appears weak Limited activities Needs assistance in doing ADLs

Pathophysiology The client is experiencing pain due to removal of cyst in the ovary, pain is a typical sensory experienced that may be described as the unpleasant awareness of a noxious stimulus or bodily harm, individual is experience pain by various daily hurts and aches and occasionally through more serious injuries or illness.

Client outcome Within the shift, patient will be able to verbalize decreased in pain as evidenced by pain scale of 3/10.

Interventions Monitor for vital signs.

Rationale Vital signs are usually altered when patient is in pain. Pain is not always present, but if present should be compared with patients previous pain symptoms. This comparison may assist in diagnosis of etiology of bleeding and development of complicatio n

Evaluation Goal met. Patient verbalized, Medyo nabawasan na ang sakit. Pain scale of 3/10.

Note reports of pain, including location, duration, intensity (010 scale)

Encourage to verbalize feelings and


27 | P a g e

To explore methods for alleviation

concerns especially if in pain. Provide comfort measures such as assisting to change position every now and then. Encourage to increase intake of protein rich foods. Encourage to participate in diversional activities like listening to music. Instruct to do deep breathing exercises

or control of pain For patients comfort and to minimize the pain.

To hasten wound healing and tissue repair To distract attention and reduce tension.

To aid in relaxation.

28 | P a g e

HRP F E E L I N G

Nursing Diagnosis Risk for infection r/t post-operative surgical procedure

Manifestations Subjective: Patient verbalized Kahapon lang ako inoperahan. Objective: - Clean and intact abdominal dressing

Pathophysiology Bacteria can colonize wounds at later stages of care being introduced into the wound at subsequent dressing changes prior to definitive wound closure.

Client outcome Within 8 hours of nursing intervention, the client will be able to remain free of infection as evidenced by normal VS and absence of purulent drainage from incision.

Interventions Assess for localized signs of infection at surgical incision Note sign and symptoms of sepsis such as fever, chill, diaphoresis, altered level of consciousness Cleanse incision sites daily or PRN

Rationale To monitor for the condition of the surgical incision To check for any onset of infection

Evaluation Goal met. Patient is free of infection as evidenced by normal VS and absence of purulent drainage from incision.

To aid in preventing infection

Wash hands To prevent before contact to crosspatient contamination Encourage early ambulation To help in the returning of the peristalsis of the abdomen and prevent adhesion To aid in relaxation

Encouraged deep breathing and coughing exercise


29 | P a g e

Encourage on position changes with time interval

To prevent bed sore and to promote mobilization

30 | P a g e

HRP E X C H A N G I N G

Nursing Diagnosis Imbalanced nutrition: Less than body requirement r/t inability to digest food secondary to compression of the stomach

Manifestations Subjective: Minsan wala akong ganang kumain.

Pathophysiology

Client outcome Within the shift, the patient will participate in activities to help attain proper nutrition

Interventions Monitor and record VS

Rationale To asses for any abnormalities as manifested by an increased or decreased in VS To establish baseline parameters To quantify nourishment intake To enhance food satisfaction and stimulate appetite To enhance intake

Evaluation Goal met, the patient was able to participate in activities involving how to attain proper nutrition

The enlarged ovarian new growth compresses abdominal organs Objective: such as stomach and Post-op BMI small and large of 17 kg/m intestines. It affects (underweight) the ability of Pale gastrointestinal tract conjunctiva to digest and absorb and mucous food needed by the membranes body. Compressed Body stomach causes client weakness to decrease food Decreased intake because of tolerance to feeling of fullness. activity This led to Loss of imbalanced nutrition: muscle tone less than body requirement.

Assess and record weight Assess for caloric intake Encourage to choose foods which are appealing Promote pleasant, relaxing environment

31 | P a g e

GENERI C NAME C E F U R O X I M E

BRAND NAME

GENERAL CLASSIFICA TION 2nd Generation Cephalosporin ; Antibiotic

MODE OF ACTION

INDICATION

CONTRAINDIC ATION Hypersensitivity to cephalosporin group of antibiotics Use cautiously to patients with hypersensitivity to penicillins

USUAL DOSE

ACTUAL DOSE

SIDE EFFECT

NURSING RESPONSIBILITY

C E F T I N

Inhibits cell wall synthesis; promoting osmotic instability; bactericidal

Infection of the urinary to lower respiratory tract Skin to skin structure infection Urinary tract infection Pharyngitis or tonsillitis Acute bacterial otitis media Impetigo Acute bacterial exacerbations of chronic bronchitis and secondary bacterial infection of acute bronchitis

250 mg q 12 hour for 10 days

750 mg IVTT ANST (-)

Diarrhea/loo Observe the se stools patients 10Rs in administering Nausea and medication. vomiting Assess VS, CBC, Abdominal Chemistry profile pain Assess for anemia, Phlebitis renal dysfunction. Thrombophl Reduce dose with ebitis impaired renal function Before the initial dose, make sure that has negative result of skin test Absorption is enhanced when taken with meals Instruct the patient that high fat meal increases drug bioavailability If therapy is prolonged, monitor patient for signs of infection

32 | P a g e

GENERIC NAME

BRAN D NAME A M I N O L E B A N

GENERAL CLASSIFIC ATION Parenteral nutrition

MODE OF ACTION

INDICATION

CONTRAINDICA TION Severe renal impairment Abnormal amino acid metabolism Hepatic disorders

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY Observe patients 10Rs upon administering the medication. Assess patients condition before starting the therapy. Be alert to adverse reactions. Monitor patient temperature. If GI reaction occur monitor patient hydration.

A M I N O L E B A N

Formula containing amino acids, carbohydrates, fats, vitamins and minerals as a dietary supplement especially for patients with liver impairmen t. The preparation has an amino acid composition consisting of high concentrations of branchedchain amino acids and low concentrations of aromatic amino acids.

For treatment of Hepatic Encephalopat hy in patients with acute and chronic liver disease Beneficial inpatients under hypercataboli cstate such as, surgery

500-1000 mL/dose by drip IV infusion

500 cc OD to run for 6H X 3 days

Nausea and vomiting Chest discomfort and palpitation Large and acute administration: acidosis was reported Occasional chills Fever Headache Vascular pain.

33 | P a g e

GENERI C NAME

BRAN D NAME Z A N T A C

GENERAL CLASSIFIC ATION

MODE OF ACTION

INDICATION

CONTRAINDICA TION

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY Observe patients 10Rs upon administering the medication. Assess for history of allergy to Ranitidine, impaired renal or hepatic function. Inform the pt. about the side effects of the drug such as and diarrhea, nausea and vomiting, and headache. Do not stop taking without consulting your physician Inform patients to take the drug 30-60 minutes before having foods or drinks to prevent heartburn. If symptoms persist, contact health care provider as early as possible to prevent further complications.

R A N I T I D I N E

Anti-ulcer Inhibits the agents; action of Histamine H2 histamine at the antagonist H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori.

Treatment and prevention of heartburn Acid indigestion Duodenal ulcer disease Gastric ulcer Gastroesopha geal reflux disease

Hypersensitivity 50 mg IM or IV. to Ranitidine Cross-sensitivity may occur Some oral liquids contain alcohol and should be avoided in patients with known intolerance Renal impairment

Ranitidin e 500 mg IVTT now then q8

Dizziness Drowsiness Hallucinations Headache Arrhythmias Dark stools Diarrhea Nausea Thrombocytopen ia

34 | P a g e

GENERIC NAME

BRAN D NAME A P R S O L I N E

GENERAL CLASSIFIC ATION Antihyperten sive; Vasodilator

MODE OF ACTION

INDICATION

CONTRAINDIC ATION Hypersensitivit y to drug Severe tachycardia Dissecting aortic aneurysm Heart failure with high cardiac output Cor pulmonale Myocardial insufficiency due to mechanical obstruction Coronary artery disease

USUAL DOSE

ACTUAL DOSE

SIDE EFFECT Nausea and vomiting Headache Angina Arrythmias Edema Orthostatic hypertensio n Diarrhea Rashes Sodium retention

NURSING RESPONSIBILITY Observe the patients 10Rs in administering medication. Assess VS, CBC, Chemistry profile Monitor blood pressure and pulse frequently during initial doses adjustments and periodically throughout therapy. Prior to and periodically during prolonged therapy, monitor the following labs: CBC and electrolytes IM or IV route should be used only when the drug cannot be given orally Hydralazine may be administered concurrently with diuretics or beta blockers to permit lower doses and minimize side effects Inform patient to take

H Y D R A L A Z I N E

Relaxes the muscle in the blood vessel to help them dilate. This lowers blood pressure and allows blood to flow more easily through the vein and arteries.

Moderate to severe hypertension Lowering high blood pressure To help prevent strokes and heart attacks

Slow IV 5-10 mg

5 mg IVTT q6 for BP 140/90

35 | P a g e

the drug with food or a snack Instruct patient to take

this drug as prescribed by the doctor. It should not be taken in larger amounts or for longer than recommended. Inform patient to use hydralazine as directed because high blood pressure often has no symptoms. Instruct patient to report immediately if he/she feels: Fainting Joint or muscle pain Unexplained fever Rapid heartbeat Chest pain Swollen ankles or feet Numbness and tingling in hands or feet

36 | P a g e

GENERI C NAME

BRAN D NAME C A R D E P I N E

GENERAL CLASSIFIC ATION Anti-angina Drugs / Calcium Antagonists

MODE OF ACTION

INDICATION

CONTRAINDICA TION Hypersensitivity to Nicardipine Cardiogenic shock Recent MI or acute unstable angina Severe aortic stenosis

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY Observe patients 10Rs upon administering the medication. Monitor closely for orthostasis; ampule must be diluted before use; to assess adequacy of blood pressure response, measure blood pressure 8 hours after dosing Instruct the patient to change position slowly to prevent orthostatic events. Patient should avoid activities requiring coordination until drug effects are realized as drug may cause dizziness Instruct patient to rise slowly from a sitting position/supine position as drug may cause symptomatic hypotension

N I C A R D E P I N E H C l

It inhibits calcium ion from entering the slow channels or select voltagesensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilatation. It also increases myocardial oxygen delivery in patients with vasospastic angina.

Short-term treatment of hypertension For prolonged control of blood pressure Stable angina

IV infusion dilute to 1020mg/100 ml at an initial rate of 5mg/hr.

Nicardip ine 10mg/10 ml + 90cc PNSS

Dizziness Flushing Headache Hypotension Peripheral edema Tachycardia, palpitations Nausea Ischemic chest pain Cerebral or myocardial ischemia Fever Abnormal LFTs Thrombocytopen ia

37 | P a g e

Advised patient to report: Swelling Difficulty breathing or new cough Unresolved fatigue Unusual weight gain or unresolved dizziness

38 | P a g e

GENERIC NAME

BRAN D NAME H Y D R O C O R T I S O N E

GENERAL CLASSIFIC ATION Corticosteroi d

MODE OF ACTION

INDICATION

CONTRAINDIC ATION Hypersensitivit y to corticosteroids Cured or manifest TB Renal insufficiency Liver disease, cirrhosis, hypothyroidis m Ulcerative colitis with impending perforation Convulsive disorders Metastatic carcinoma Diabetes mellitus

USUAL DOSE

ACTUAL DOSE

SIDE EFFECT Headache, insomnia, convulsions , psychosis Hypotensio n, shock Cardiac arrhythmias secondary to electrolyte disturbance s Thin, fragile skin, petechiae, striae Nausea and vomiting Increased appetite and weight gain (long-term therapy) Muscle weakness

NURSING RESPONSIBILITY Observe the patients 10Rs in administering medication. Assess VS, CBC, Chemistry profile Report any worsening of condition, any fever, sore throat, muscle aches, slow healing, sudden weight gain, swelling extremities Use minimal doses for minimal duration to minimize adverse effects. May be taken with food to minimize GI upset Patient on long term therapy should report onset of the following: Signs of infection Hyperglycemia Blurred vision

H Y D R O C O R T I S O N E

A C E T A T E

Enters target cells Acute and binds to hypersensitivity cytoplasmic reaction receptors; Short-term initiates many inflammatory complex reactions and allergic that are disorders, such responsible for its as rheumatoid antiarthritis, collagen inflammatory, diseases (SLE), immunosuppressi dermatologic ve diseases (glucocorticoid), (pemphigus), and salt-retaining status (mineralocorticoi asthmaticus, and d) actions autoimmune disorders Hematologic disorders-thrombocytopeni c purpura, erythroblastopeni a Replacement therapy in adrenal cortical insufficiency

100-500 200 mg mg IM/IV IVTT every 2, 4, or 6 hours

39 | P a g e

GENERIC NAME

BRAN D NAME D U L C O L A X

GENERAL CLASSIFIC ATION Stimulant Laxative

MODE OF ACTION

INDICATION

CONTRAINDIC ATION Acute surgical abdomen Nausea and vomiting Abdominal cramps Intestinal obstruction Fecal impaction Use of rectal suppository in presence of anal or rectal fissures Appendicitis Gastroenteritis

USUAL DOSE

ACTUAL DOSE

SIDE EFFECT Mild cramping Nausea Diarrhea Fluid and electrolyte disturbance s( Potassium and Calcium)

NURSING RESPONSIBILITY Observe the patients 10Rs in administering medication. Administer in the evening or before breakfast because of action time required Encouraged to add high-fiber foods to the regular diet Instruct that the drug my cause diarrhea or abdominal pain, discomfort and cramping. If the suppositories are used, it may cause proctitis. Patient should expect to have a bowel movement within 1560 minutes after administration if suppository is used. It should not be given within 1 hour of antacids, milk and milk products.

B I S A C O D Y L

Induces peristaltic Temporarily contraction by relief of direct stimulation constipation of sensory nerve For evacuation ending in the of colon before colonic wall surgery Use to cleanse colon before delivery Relieve constipation in patient with spinal cord damage

10 mg supposito ry rectally once daily

2 supposito ry per rectum

40 | P a g e

GENERIC NAME

BRAN D NAME L A S I X

GENERAL CLASSIFIC ATION Loop Diuretics

MODE OF ACTION

INDICATION

CONTRAINDI CATION

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY Observe the patients 10Rs in administering medication. Assess VS, CBC, Chemistry profile Assess closely for sign of vascular thrombosis and embolism. With history of gout, monitor uric acid levels Monitor BP, edema, breath sounds, I & O. Observe for hypokalemia. With rapid diuresis, observe for dehydration and symptoms of respiratory collapse With chronic use, assess for thiamine deficiency. Taken in the morning on an empty stomach to enhance absorption and to avoid interruption of sleep for frequent urination.

F U R O S E M I D E

Inhibits the reabsorption of sodium and chloride in the proximal and distal tubules as well as the ascending loop of Henle

Edema associated with Congestive Heart Failure Hypertension in conjunction to spironolactone Pulmonary edema Post-Blood transfusion

Hypersensitivit 20-40 mg twice a y to day IVTT furosemide Never use with ethacrynic acid Patients with anuria

20 mg Jaundice IVTT Tinnitus after 2 u Hearing BT impairment Hypotensio n Water/elect rolyte depletion Pancreatitis Abdominal pain Dizziness Anemia

41 | P a g e

Monitor BP for it may cause drop of BP.

42 | P a g e

GENERI C NAME

BRAN D NAME P O N S T E L

GENERAL CLASSIFIC ATION Analgesics, non-narcotic, non-steroidal

MODE OF ACTION

INDICATION

CONTRAINDICA TION Hypersensitivity in aspirin, iodides, or any NSAID Preexisting renal disease Active ulceration or chronic inflammation of GI tract Diarrhea Dyspepsia GI bleeding Mild elevations in LFT results

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY

M E F E N A M I C A C I D

Inhibits Relief of prostaglandin moderate synthesis; pain lasting Reduces less than 1 inflammatory week response and intensity of pain stimulus reaching sensory nerve endings.

PO 500 mg then 250 mg every 6 h as needed. Usually not used more than 1 wk.

500 mg 1cap q6 RTC for pain with meals

Upset stomach

Take the medication and nausea with meals Heartburn Inform patient not to use drug for longer Dizziness than 1 wk. drowsiness, Report if any of Warn patient about the following has potential for bleeding. occur: Advise patient to fainting discontinue persistent/sever medication if rash e headache develops and to hearing contact health care changes provider. fast/pounding Instruct patient to heartbeat report the following mental/mood symptoms to health changes care provider: difficult/painfu rash l swallowing visual problems swelling of the dark stools ankles/feet/han ds decreased urinary sudden/unexpl output ained weight persistent headache gain or stomach pain unusual bruising or bleeding

43 | P a g e

Advise patient to avoid intake of alcoholic beverages. Advice patient not to do activities that require mental alertness as the drug causes dizziness. Caution patient to avoid prolonged exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.

44 | P a g e

GENERI C NAME

BRAN D NAME C E L E B R E X

GENERAL CLASSIFIC ATION Nonsteroidal AntiInflammatory Drugs (NSAIDs)

MODE OF ACTION

INDICATION

CONTRAINDICA TION

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY Observe patients 10Rs upon administering the medication. Assess patients range of motion, degree of swelling, and pain in affected joints before and periodically throughout therapy. May be administered without regard to meals. Instruct patient to take celecoxib exactly as directed. Do not take more than prescribed dose. Increasing doses does not appear to increase effectiveness. Advise patient to notify health care professional promptly if signs or symptoms of GI toxicity occurs: abdominal pain black stools skin rash unexplained weight gain edema

C E L E C O X I B

Thought to inhibit prostaglandin synthesis, impending cyclooxygenase 2 to produce antiinflammatory, analgesic and anti-pyretic effects

Acute pain Juvenile arthritis Ankylosing spondylitis Rheumatoid arthritis

Hypersensitivity
to NSAIDs Severe hepatic impairment Heart failure Inflammatory bowel disease Peptic ulcer Renal impairment Asthma Urticaria

100 to 200 mg once or twice a day

200 mg 1 tab BID

Diarrhea Nausea Excessive tiredness Unusual bleeding or bruising Pain in the upper right part of the stomach Fever Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs Difficulty swallowing or breathing Difficult or painful urination Frequent urination, especially at night

45 | P a g e

Patient should discontinue celecoxib and notify health care professional if signs and symptoms of hepatotoxicity occur: Nausea Fatigue Lethargy Pruritus Jaundice Upper right quadrant tenderness Flu-like Instruct patient that it may take several days before he feels consistent pain relief

46 | P a g e

GENERI C NAME

BRAN D NAME S O R B I F E R

GENERAL CLASSIFIC ATION Iron Preparation

MODE OF ACTION

INDICATION

CONTRAINDICA TION

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY

F E R R O U S S U L F A T E

Iron is absorbed Prevention from the and duodenum and treatment of upper jejunum iron by active deficiency mechanism anemia through the Dietary mucosal cells supplement where it for iron combines with the protein transferring. Iron is stored in the body as hemosiderin or aggregated ferritin which is found in reticuloendothel ial cells of the liver, spleen and bone marrow. About two thirds of total body iron is in the circulating RBCs in hemoglobin.

Hemosiderosis Hemochromato sis Peptic ulcer Regional enteritis and ulcerative colitis Hemolytic anemia Pyridoxine responsive anemia Severe hypotension Cirrhosis of the liver.

300 to 325 mg of regularrelease ferrous sulfate orally once a day.

1 tab TID

Diarrhea Stomach cramps or upset stomach May cause your stools to turn black, an effect that is not harmful Seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: Rash Itching/swell ing (especially of the face/tongue/t hroat) Severe dizziness Trouble breathing

Observe patients 10Rs upon administering the medication. Caution patient to make position changes slowly to minimize orhtostatic hypotension. Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and feet and hypotension occurs Encourage patient to comply with additional intervention for hypertension like proper diet, regular exercise, lifestyle changes and stress management. Instruct patient to avoid OTC medicine without consulting the physician.

47 | P a g e

GENERI C NAME

BRAN D NAME C A L C I A I D

GENERAL CLASSIFIC ATION Electrolyte s / Antacid s, Antireflux Agents & Antiulcer ants Dietary/ Nutritional drugs Vitamins and Minerals

MODE OF ACTION

INDICATION

CONTRAINDICA TION Nephrolithiasis Zollinger-ellison syndrome Hyperthyroidism Hypercalcaemia Hypercalciuria

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY Observe patients 10Rs upon administering the medication. Do not continue this medication beyond 1 2 week, since it may cause acid rebound, which generally occurs after repeated use for 1 or 2 weeks and leads to chronic use. Do not take antacids longer than 2 weeks without medical supervision. Instruct to avoid taking calcium carbonate with cereals or other foods high in oxalates. Oxalates combine with calcium carbonate to form insoluble, nonabsorbable compounds. Instruct not to use calcium carbonate repeatedly with foods high in vitamin D (such as milk) or

C A L C I U M C A R B O N A T E

Neutralize gastric acid rapidly and effectively. However, it may adversely activate Ca dependent processes, leading to secretion of gastric & hydrochloric acid. It can induce rebound acid secretion and, prolonged high doses may cause hypercalcemia, alkalosis and milk-alkali syndrome.

Flatulence Heartburn Hypocalcaem ia Peptic ulcer Upset stomach Hypophospha temia Renal failure

1 to 2 tab daily

1 tab OD

Nausea Headache Abdominal pain Acid rebound Vomiting Constipation Dizziness Flatulence Dizziness Belching

48 | P a g e

sodium bicarbonate,

as it may cause milkalkali syndrome: Hypercalcemia Distaste for food Headache Confusion Nausea and vomiting Abdominal pain Metabolic alkalosis Soft tissue calcification (calcinosis) Hypophosphate mia and renal insufficiency

49 | P a g e

GENERI C NAME

BRAN D NAME C E C O N

GENERAL CLASSIFIC ATION Vitamin C

MODE OF ACTION

INDICATION

CONTRAINDICA TION

USUAL DOSE

ACTUA L DOSE

SIDE EFFECT

NURSING RESPONSIBILITY Observe patients 10Rs upon administering the medication. Instruct to take large doses of vitamin C in divided amounts because the body uses only what is needed at a particular time and excretes the rest in urine. Inform that large doses can interfere with absorption of vitamin B12 Inform that large doses may cause diarrhea or nephrolithiasis Instruct patient should preferably take the oral formulation with a meal.

A S C O R B I C A C I D

Water-soluble Prevention vitamin and essential for treatment of synthesis and scurvy and maintenance of to acidify collagen and the urine intercellular ground substance of body tissue cells, blood vessels, cartilage, bones, teeth, skin, and tendons. Unlike most mammals, humans are unable to synthesize ascorbic acid in the body; therefore it must be consumed daily.

Hypersensitivity PO 150 500 mg Nausea and vomiting 500 mg in 1 tab OD to any 12 doses Heartburn component of the preparation Diarrhea, or abdominal cramps Patients on (high doses) sodium Acute hemolytic restriction anemia Use of calcium Sickle cell crisis ascorbate in Headache or patients insomnia (high receiving doses) digitalis. Urethritis Dysuria,
crystalluria, hyperoxaluria, or hyperuricemia (high doses) Dizziness

50 | P a g e

GENERI C NAME K E T O R O L A C

BRAN D NAME T O R A D O L

GENERAL CLASSIFIC ATION Non-steroidal Inflammatory Agents

MODE OF ACTION

INDICATION

CONTRAINDIC ATION Hypersensitivit y to drug Cross sensitivity with other NSAIDs Known alcohol intolerance Active peptic ulcer disease Recent GI bleeding or perforation Advanced renal failure or in those at risk for renal failure due to volume depletion

USUAL DOSE

ACTUAL DOSE

SIDE EFFECT Headache Dizziness Drowsiness Diarrhea Nausea Dyspepsia/in digestion Epigastria/G I pain Edema

NURSING RESPONSIBILITY Observe the patients 10Rs in administering medication. Assess VS, CBC, Chemistry profile Patients with asthma, aspirin-induced allergy are at increased risk of developing hypersensitivity reaction Assess the characteristic, location, intensity and frequency of pain prior to administration Instruct patient to avoid use of alcohol, NSAIDs, aspirin, acetaminophen without consulting the physician. Instruct to take only as directed; do not exceed prescribed dosage Drug may cause drowsiness and dizziness; instruct to

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia;

Short term management of pain Seasonal allergic conjunctivitis Inflammatory disorder of the eye

30 mg/am 1 amp IVTT

30 mg IVTT q 6 hours

51 | P a g e

avoid activities that

require mental alertness until drug effects realized. Advise patient to consult if the following are manifested: Rash Itchiness Visual disturbances Tinnitus Weight gain Edema Black stools Persistent headache Effectiveness of the therapy can be demonstrated by verbalization of decreased in severity of pain.

52 | P a g e

GENERI C NAME T R A N E X A M I C A C I D

BRAN D NAME H E M O S T A N

GENERAL CLASSIFIC ATION Antifibrinolytic; Antihemorrh agic

MODE OF ACTION

INDICATION

CONTRAINDI CATION Renal function impairment Hematuria of upper urinary tract origin Lactation

USUAL DOSE

ACTUAL DOSE

SIDE EFFECT Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent headache Shortness of breath

NURSING RESPONSIBILITY Observe the patients 10Rs in administering medication. Assess VS, CBC, Chemistry profile Unusual change in bleeding pattern should be immediately reported to the physician. The medication can be taken with or without meals. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once. Inform the client that he/she should inform the physician immediately if the side effects occur

Synthetic Epistaxis; derivative of the hemoptysis; amino acid lysine. hematuria It exerts its Peptic ulcer antifibrinolytic with effect through the hemorrhage reversible and blood blockade of lysinedyscrasias with binding sites on hemorrhage plasminogen Treatment of molecules. Antihemorrhage fibrinolytic drug associated with inhibits excessive endometrial fibrinolysis in plasminogen various activator and thus surgical prevents procedures fibrinolysis and the breakdown of blood clots. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis

Inj 0.5-1 gm/kg body weight TID

1 gm IVTT x 2 doses q 8 hours

53 | P a g e

GENERIC NAME

BRAN D NAME U L T R A M

GENERAL CLASSIFIC ATION Analgesics (centrally acting)

MODE OF ACTION

INDICATION

CONTRAINDIC ATION Hypersensitivit y to tramadol Cured or manifest TB

USUAL DOSE

ACTUAL DOSE

SIDE EFFECT Flushing Pruritus Constipati on Nausea and vomiting Dizziness Headache Insomnia

NURSING RESPONSIBILITY Observe the patients 10Rs in administering medication. Assess VS, CBC, Chemistry profile Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids.

T R A M A D O L

Inhibits reuptake of serotonin and norepinephrine in the CNS

Moderate to moderately severe pain

50-100 mg IV every 4-6 hours

50 mg IVTT q 8 hours for pain

54 | P a g e

This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrease the seizure threshold. Overdose may cause respiratory depression and seizures.

55 | P a g e

Hematology (September. 09,2012)


DETERMINATION White Blood Cells ACTUAL VALUE 6.3 4-10 x 10^9/L Red Blood Cells 4.39 4.5-5.4 x 10^12/L DECREASED NORMAL NORMAL VALUE INTERPRETATION SIGNIFICANCE NURSING RESPONSIBLITY

Decreased in anemia hemorrhage and leukemia; this may due to bone marrow suppression because of infection. Decreased in anemia and hemorrhage; anemia results from a decrease in the number, size, or function of RBCs

Explain test procedure. Explain that slight discomfort may be felt when the skin is punctured. Encourage to avoid stress if possible because altered physiologic status influences and changes normal hematologic values. Explain that fasting is not necessary. However, fatty meals may alter some test results as a result of lipidemia.

Hemoglobin

110 115-155 g/L DECREASED

Hematocrit

0.36 0.36-0.47 NORMAL Decreased in microcytic anemia

Platelet

182 150-400 x 10^9/uL NORMAL

Apply manual pressure and dressings over puncture site on removal of dinner. Monitor the puncture site for oozing or hematoma formation. Instruct to resume normal activities and diet.

MCV

83 86-100 fL DECREASED Decreased in microcytic anemia

MCH

25 26-31 pg DECREASED Decreased in severe hypochromic anemia Increased with any

56 | P a g e

MCHC

304 310-370 g/L DECREASED

condition stimulating increase in bone marrow activity

RDW

16.3

11.6-13.7 %

INCREASED

Differential count: Neutrophils 54 40-70% NORMAL

Lymphocyte

30

19-42%

NORMAL

Monocyte

3-9%

NORMAL

Eosinophils

2.0-8.0%

NORMAL

Basophil

2 A

0-5%

NORMAL

Blood Type

57 | P a g e

Clinical Chemistry (September. 09, 2012) DETERMINANTS ACTUAL VALUE NORMAL VALUE INTERPRETATION SIGNIFICANCE NURSING RESPONSIBILITIES Obtain medication history before the test because numerous drugs give falsely elevated results although it always depends on the one ordering the test Withheld drugs that alters the result 12 hours before the test Instruct the patient to abstain from alcohol 24 hours before the test and abstain from eating 12 hours before the test Resume the withheld drugs and food after the test Monitor VS specially the cardiac rate Provide rest and energy consuming techniques Encouraged to eat a healthy diet
58 | P a g e

ALP Total Protein Albumin Globulin A/G Ratio

76 7.6 3.7 3.9 1.0

42-98U/L 6.4-8.3g/dL 3.5-5.2g/dL

NORMAL NORMAL NORMAL

IMMUNOLOGY (July. 31, 2012) DETERMINANTS ACTUAL VALUE NORMAL VALUE INTERPRETATION SIGNIFICANCE NURSING RESPONSIBILITIES Explain test procedure. Explain that slight discomfort may be felt when the skin is punctured. Apply manual pressure and dressings over puncture site. Monitor the puncture site for oozing or hematoma formation. Instruct to resume normal activities and diet.

CA 12-5

85.8

0-35U/mL

INCREASED

Increased in colon, upper gastrointestinal(GI),ovarian, and other gynecologic cancers: pregnancy, peritonitis

59 | P a g e

Hematology (September. 12,2012) DETERMINATION ACTUAL VALUE NORMAL VALUE INTERPRETATION SIGNIFICANCE NURSING RESPONSIBLITY

White Blood Cells

7.7

4-10 x 10^9/L

NORMAL

Red Blood Cells

3.63

4.5-5.4 x 10^12/L

DECREASED

Decreased in anemia hemorrhage and leukemia; this may due to bone marrow suppression because of infection. Decreased in anemia and hemorrhage; anemia results from a decrease in the number, size, or function of RBCs Decreased in severe anemias, anemia of pregnancy, acute massive blood loss Decreased in thrombocytopenic purpura,acute leukemia, aplastic anemia,and during cancer chemotherapy. Decreased in microcytic anemia

Explain test procedure. Explain that slight discomfort may be felt when the skin is punctured. Encourage to avoid stress if possible because altered physiologic status influences and changes normal hematologic values. Explain that fasting is not necessary. However, fatty meals may alter some test results as a result of lipidemia. Apply manual pressure and dressings over puncture site. Monitor the puncture site for oozing or hematoma formation. Instruct to resume normal activities and diet.

Hemoglobin

96

115-155 g/L

DECREASED

Hematocrit

0.30

0.36-0.47

DECREASED

Platelet

116

150-400 x 10^9/uL

DECREASED

MCV

82.4

85.0-95.0 fL

DECREASED

60 | P a g e

MCH

26.4

28.0-32.0 pg

DECREASED

Decreased in microcytic anemia

MCHC

321

320-350g/L

NORMAL

RDW-SD

43.9

37-46fL

NORMAL

Differential count: Neutrophils 75.4 40-70% INCREASED Increased with acute infections,trauma or surgery, leukemia, malignant disease,necrosis;

Lymphocyte

13.2

19.0-48.0%

DECREASED

Decreased with aplastic anemia, SLE, immunodeficiency including AIDS Decreased with use of corticosteroids, RA, HIV infection Increased in allergy, parasitic disease, collagen disease, subacute infections;

Monocyte

0.0

3-9%

DECREASED

Eosinophils

11.3

2.0-8.0%

INCREASED

Basophil

0.1

0-5%

NORMAL

61 | P a g e

DISHARGE PLANNING

Medications Instruct to take home meds. Explain how to take the meds, its precise dose and time to be taken to ensure efficiency and to avoid overdose or under dose. Emphasize the importance of the drugs to prevent further complication Continue on prescribe maintenance medications Exercise Range of motion exercises as tolerated to prevent muscle atrophy Advice to refrain from strenuous activity Treatment Inform to avoid lifting heavy objects for 1-2 weeks Discourage to participate in strenuous activities that night precipitate stress and trauma to the wound Maintain good abdominal support. Using a pillow against the abdomen will help with pain when sneezing or coughing Observe for signs of dehiscence and evisceration Instruct to report any signs of infection Instruct to report any case of hemorrhage or abnormal bleeding Hygiene Compliance to diet and medical regimen Stress the importance of perineal cleanliness Instruct to stay in calm, quiet environment. Home environment must be free from slipping or accident hazards. Out-patient Visit Inform to have a follow-up check up. (September 19, 2012) Diet Instruct to eat foods rich in protein and green leafy vegetables to promote faster recovery Encourage to increase fiber and fluid intake to avoid constipation Spiritual Encourage to derive strength from God and maintain a close relationship to the family and community

62 | P a g e

Recommendation
TO THE PATIENT: Quarterly check-up since ovarian new growth has a tendency of recurring.

TO THE FAMILY: The significant others to be supportive and understanding to reduce possible stress producing situations. (Stress is a contributing factor in worsening the condition of the patient.) To supervise the medical and diet regimen compliance of the patient even at home.

TO THE COMMUNITY That the community be educated about ovarian new gowth; its causes, signs and symptoms, prevention, management, and complications.

TO THE NDU-BSN STUDENTS As future health practitioner, we should be aware to the disease namely to its contributing factors, manifestation, how it occurred from the normal function in our body and especially to its appropriate management. This study should not just for our requirement purposes and forget it afterwards. Being a rational person, we should not stop from learning and we should always keep in mind everything that we learn in order for us to apply it not just in the clinical area but as well in every place possible.

63 | P a g e

PROGNOSIS DETERMINATION GOOD (3) FAIR (2) POOR (1) JUSTIFICATION Since the patient is experiencing the disease when she was still 11 years old. Since the patient is experiencing the gradual enlargement of the abdomen for the past 2 years. Since the patient has high blood pressure, bipedal edema and an abdominal girth of 122 cm Pre-OP and abdominal girth of 82 cm PostOp. The patient is under social service that helped her comply to different diagnostics and medications. It has been observed that the family is assisting the patient in her movement, does not leave the patient and diligently complying with the orders. The patient has been cooperating very well, is taking her medication, and cooperates in nursing interventions.

Age Onset of Illness

Duration of Illness

Present Health Status

Financial Status

Support System

Attitude toward treatment

Justification Using the criteria provided, our patients prognosis is poor as evidenced by 3 out of 6 determinants are poor, those are onset of illness, duration of illness and financial status. Our patient got 1 fair which is present health status while 2 good results and those are support system and attitude towards the treatment.

64 | P a g e

BIBLIOGRAPHY
Books 2010 Edition Delmar Nurses Drug Handbook Jeorge R. Sprato and Adrienne L. Woods MIMS 2012 12 Edition Nurses Pocket Guide Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr 12 Edition Medical-Surgical Nursing Suzanne Brunner and Suddarth Second Edition 2009 Medical-Surgical Nursing Josie Quiambao-Udan, RN, MAN Fifth Edition Essentials of Anatomy and Physiology Valerie C. Scanlon Tina Sanders Edition 6 Maternal and Child Health Nursing Care of the children and childbearing family Pillitteri, PhD, RN, PNP Physical Assessment Manual Website www.scribd.com www.wikipedia.co

65 | P a g e

66 | P a g e

También podría gustarte