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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 that’s 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.
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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.
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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 patient’s 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
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Patient’s Data
A. Personal Data
Name: Ms. P
Age: 14 years old
Sex: Female
Weight: Pre-Op - 72 kg
Post- Op - 42 kg
Height: 5’2
BMI: Pre-Op – 29.2 (malnourish/overweight)
Post-Op – 17 (malnourish/underweight)
Address: Barangiran, Alamada, North Cotabato
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Occupation: Student
B. Clinical Data
Room: OB Ward Room A Pre-Op; Room C Post-Op
Date of Admission: September 09, 2012
Time of Admission: 8:30 PM
Attending Physician: Dr. Malik/ Dr. Kamensa/ Dr. Gaurana
Chief Complaint: Pelvic Pain
Admitting Diagnosis: G0, Ovarian New Growth with Complications, Probably Malignant
Final Diagnosis: G0, Ovarian New Growth Left, Pending Biopsy Result
Initial Vital Signs
Temperature: 36°C
Pulse Rate: 90 bpm
Respiratory Rate: 19 bpm
Cardiac Rate: 94 bpm
Blood Pressure: 160/110 mmHg
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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
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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 family’s 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 P’s 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.
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GENERAL PHYSICAL SURVEY
Behavior: Cooperative; answers question promptly
Feeling: Calm and assured
Appearance: Dressed inappropriately wearing violet malong and a white short, appears weak
Posture and gait: Slouched posture; slow and unsteady gait
Hygiene and grooming: Proper hygiene and grooming noted, nails properly trimmed, hair properly fixed
Body and Breath odor: No foul body and breath odor noted
Body built: Skinny, bony outlines are prominent with lower extremity edema
Body movements: Coordinated but slow
Speech: Slow but comprehensible
Thought Process: Coordinated; answers are related to the questions asked
Affect: Appropriate
Mood: Irritable during painful episodes
Integument: Skin is relatively pale in color, hair color is black, hair is properly distributed, skin is dry, capillary refill is 2 seconds.
Skin: Warm and dry, skin turgor springs back springs back to its previous state in 2-3 seconds.
Hair: Wavy, black in color, not extremely oily, evenly distributed, negative for lice.
Head: Without masses, proportion to the body
Face: No pimples, no masses, asymmetrical face
Eyes: Eyelashes are black in color and well curved, pupils are equally round and reactive to light, smooth, poor hearing ability.
Nose: 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
Mouth: 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
Neck: 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
Chest: 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
Heart: 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
Upper extremities: Equally grip, low strength, warm to touch, both have five fingers, good skin turgor
Lower extremities: Edema noted on both feet, lesions noted,
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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, it’s 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 Pre- Op 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.
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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.
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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.
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PATHOPHYSIOLOGY
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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
Formation of cysts and genetic changes
Irregular menstrual period
Pain or pressure with urination or bowel movement
Increase in abdominal girth
Lower abdominal or pelvic pain
OVARIAN NEW GROWTH
COURSE IN THE HOSPITAL
Date/Time Order Rationale9-9-12
8:30 pm Please admit patient with consent
under the service of Dr. Napoles/ Malik/ Kamensa/ Gaurana
General liquid, NPO post-midnight
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
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
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Additional Labs: TPA
Alkaline Phosphatase
Meds: Cefuroxime 750mg IVTT
q8° ANST( )
For ExLap possible Salpingo-Oophoretomy fertility sparing surgery
Pls. secure signed consent
Pls. inform OR/ AOD
Pls. inform medicine dept. for CP evaluation
Monitor VS q30min and record
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
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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
BT= ”A”Hgb= 110Hct= 0.36Plt= 182
WBC= 0.3
To secure 4 ‘u’ of FWB of patient’s blood type; for OR standby use
Refer. Thank you
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
10:25 pm Internal MedicineThank you for this referral (CP evaluation) Pt. seen and examined
History reviewed and PE doneS:
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
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ECG (+)Depressed T waves
III, AVF, V3
pitting, bipedal A:
Massive ascites secondary to ovarian new growth prob-malignant
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
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
To obtain present health history to support data
To obtain present health history to support data
To create a collaborative treatment within the health care providers
9-19-127:30 am
S/O: awake,afebrile120/80
A: still for OR
NPO
Cont. IVF D5LR 1L @ 30 gtts/min
Pls. follow up labs: U/A
TPA
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
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Alkaline Phosphatase
X-ray official result
For ExLap; possible Salpingo-Oophorectomy fertility sparing surgery
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.
Pls. follow up blood procurement( 2 more units of whole blood/ PRBC)
Refer for unusualities
Refer, Thank you
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.
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
To create a collaborative treatment within the health care providers
To create a collaborative treatment within the health care providers
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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 Hydralazine- treatment of hypertension
9-10-122 pm
Start with Nicardipine drip (10mL/amp + 90cc PNSS) to run @ 10 mgtts/min via solu set
Nicardipine- For hypertensive emergencies; pre-op and post op hypertension and hypertensive states of NPO patients
9-10-123 pm
BP = 120/80PR = 104RR = 20
T = 36.3°C
(+) bipedal edema
2 years. History of enlarging
abdomenNo consultation
done to the problem
Pt. seen
History and PE reviewed
Pls. follow up availability of blood
To OR via stretcher on call
Refer
To obtain present health history to support data
To obtain present health history to support data
To follow up previous order
To consider the proper transferring of the patient
To create a collaborative treatment within the health care providers
Pls. give Hydrocortisone 250mg IVTT now
Refer. Thank You
Hydrocortisone- to prevent allergic reaction pre-BT
To create a collaborative treatment within the health care providers
9-10-124:15 pm
BP = 150/100
Increase Nicardipine drip into 12 mgtts/min
Refer
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
8 pm On Gen. liquid diet
NPO post-midnight
To prepare the GIT prior to surgical procedure
To prevent aspiration pneumonia especially those who will undergo
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a general anesthesia
9-11-127:30am
NPO
IVF D5LR 1L @ 30gtts/min
Continue Cefuroxime 750mg IVTT q8°
For ExLap possible Salpingo-Oopherectomy fertility sparing surgery on call
Pls. inform OR personnel/AOD
Return IFC and monitor I & O q hourly
Monitor VS q4° and record
Refer accordingly
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.
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
9-11-125:35 pm
Post Op Order S/P ExLap, Peritoneal Fluid
Ontology, Salpingo-Oophorectomy (L)
To PACU then back to ward
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,
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NPO temporarily
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.
vital signs are monitored and management of pain.
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 Cefuroxime-treatment of infections of the urinary and lower respiratory tracts, and skin and skin-structure infections
Ketorolac-short term management of pain
To continue Ranitidine-treatment 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
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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
Additional Orders: Pls. transfuse another 1 ‘u’ of
Whole Blood as settled RBC
For rpt. CBC with Pt. Ct. 6 hr post BT (2’u’) 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!
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
May have tea and crackers at 12 MN with strict aspiration precaution
Refer. Thank you
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
Resume Aminoleban IV
Refer. Thank You!
Aminoleban-a parenteral nutrition for the treatment of Hepatic Encephalopathy in patients with acute and chronic liver disease
To create a collaborative
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treatment within the health care providers
9-12-125:30 am
S/O: awake 110/8092 bpm18 cpm
36 C
(+) IFCA: SIP SO (L)
Cont. Meds
General liquids and crackers
Soft diet once with flatus
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
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
21 | P a g e
Pls. insert Bisacodyl suppository at rectum now
Pls. remove IFC now refer if unable to void 6hr after
Encourage ambulation
Monitor VS q4 and record pls.
Refer for unusualities
Refer. Thank you!
acidify the urine
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
9-13-127:10 am
S/O: awake Afebrile120/80
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
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
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 Nursing Diagnosis Manifestations Pathophysiology Client outcome Interventions Rationale Evaluation
EXCHANGING
Ineffective peripheral tissue perfusion r/t pitting edema on both leg
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
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.
Within the shift the patient will maintaintissue perfusion as evidenced by decreased edema, warm skin and normal vital signs.
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
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
Goal met. Patient maintained perfusion as evidenced by decreased edema and BP of 120/80 mmHg.
24 | P a g e
HRP Nursing Diagnosis Manifestations Pathophysiology Client outcome Interventions Rationale Evaluation
MOVING
Activity intolerance level 2 r/t decrease muscle strength
Subjective: “Minsan nanghihina ako kaya 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
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.
Within the shift the patient will be able to exhibit increase muscle strength as evidence by ability to tolerate performing ADL’s with minimal assistance.
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
Encourage the patient to take adequate intake of fluids and nutritious foods.
Implement
To protect client from injury
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
Goal met. Patient was able to tolerate activities with minimal assistance.
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 Nursing Diagnosis Manifestations Pathophysiology Client outcome Interventions Rationale Evaluation
FEELING
Acute pain r/t post op surgical incision secondary to removal of ovarian cyst
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
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.
Within the shift, patient will be able to verbalize decreased in pain as evidenced by pain scale of 3/10.
Monitor for vital signs.
Note reports of pain, including location, duration, intensity (0–10 scale)
Encourage to verbalize feelings and
Vital signs are usually altered when patient is in pain.
Pain is not always present, but if present should be compared with patient’s previous pain symptoms. This comparison may assist in diagnosis of etiology of bleeding and development of complication
To explore methods for alleviation
Goal met. Patient verbalized, “Medyo nabawasan na ang sakit.” Pain scale of 3/10.
27 | P a g e
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 patient’s comfort and to minimize the pain.
To hasten wound healing and tissue repair
To distract attention and reduce tension.
To aid in relaxation.
HRP Nursing Diagnosis Manifestations Pathophysiology Client outcome Interventions Rationale Evaluation
28 | P a g e
FEELING
Risk for infection r/t post-operative surgical procedure
Subjective:Patient verbalized “Kahapon lang ako inoperahan.”
Objective:- Clean and
intact abdominal dressing
Bacteria can colonize wounds at later stages of care being introduced into the wound at subsequent dressing changes prior to definitive wound closure.
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.
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
Wash hands before contact to patient
Encourage early ambulation
Encouraged deep breathing and coughing exercise
Encourage on
To monitor for the condition of the surgical incision
To check for any onset of infection
To aid in preventing infection
To prevent cross-contamination
To help in the returning of the peristalsis of the abdomen and prevent adhesion
To aid in relaxation
To prevent bed
Goal met. Patient is free of infection as evidenced by normal VS and absence of purulent drainage from incision.
29 | P a g e
position changes with time interval
sore and to promote mobilization
HRP Nursing Diagnosis Manifestations Pathophysiology Client outcome Interventions Rationale Evaluation
EXCHAN
Imbalanced nutrition: Less than body requirement r/t inability to digest food secondary to compression of the
Subjective:“Minsan wala akong ganang kumain.”
Objective: Post-op BMI
The enlarged ovarian new growth compresses abdominal organs such as stomach and small and large
Within the shift, the patient will participate in activities to help attain proper nutrition
Monitor and record VS
To asses for any abnormalities as manifested by an increased or
Goal met, the patient was able to participate in activities involving
30 | P a g e
GING
stomach of 17 kg/m² (underweight)
Pale conjunctiva and mucous membranes
Body weakness
Decreased tolerance to activity
Loss of muscle tone
intestines. It affects the ability of gastrointestinal tract to digest and absorb food needed by the body. Compressed stomach causes client to decrease food intake because of feeling of fullness. This led to imbalanced nutrition: less than body requirement.
Assess and record weight
Assess for caloric intake
Encourage to choose foods which are appealing
Promote pleasant, relaxing environment
decreased in VS
To establish baseline parameters
To quantify nourishment intake
To enhance food satisfaction and stimulate appetite
To enhance intake
how to attain proper nutrition
GENERIC
NAME
BRAND NAME
GENERAL CLASSIFICA
TION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
31 | P a g e
CEFUROXI
ME
CEFTIN
2nd Generation Cephalosporin; Antibiotic
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
Hypersensitivity to cephalosporin group of antibiotics
Use cautiously to patients with hypersensitivity to penicillins
250 mg q 12 hour for 10 days
750 mg IVTT ANST (-)
Diarrhea/loose stools
Nausea and vomiting
Abdominal pain
Phlebitis Thrombophl
ebitis
Observe the patients 10R’s in administering medication.
Assess VS, CBC, Chemistry profile
Assess for anemia, renal dysfunction. Reduce dose with 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
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
32 | P a g e
AMINOLEBAN
AMINOLEBAN
Parenteral nutrition
Formula containing amino acids, carbohydrates, fats, vitamins and minerals as a dietary supplement especially for patients with liver impairment. The preparation has an amino acid composition consisting of high concentrations of branched-chain amino acids and low concentrations of aromatic amino acids.
For treatment of Hepatic Encephalopathy in patients with acute and chronic liver disease
Beneficial inpatients under hypercatabolicstate such as, surgery
Severe renal impairment
Abnormal amino acid metabolism
Hepatic disorders
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.
Observe patient’s 10R’s upon administering the medication.
Assess patient’s condition before starting the therapy.
Be alert to adverse reactions.
Monitor patient temperature.
If GI reaction occur monitor patient hydration.
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
33 | P a g e
RANITIDINE
ZANTAC
Anti-ulcer agents;Histamine H2 antagonist
Inhibits the action of histamine at the 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 to Ranitidine
Cross-sensitivity may occur
Some oral liquids contain alcohol and should be avoided in patients with known intolerance
Renal impairment
50 mg IM or IV.
Ranitidine 500 mg IVTT now then q8°
Dizziness Drowsiness Hallucinations Headache Arrhythmias Dark stools Diarrhea Nausea Thrombocytopen
ia
Observe patient’s 10R’s 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.
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
HY
AP
Antihypertensive;
Relaxes the muscle in the
Moderate to severe
Hypersensitivity to drug
Slow IV 5-10 mg
5 mg IVTT q6°
Nausea and vomiting
Observe the patients
10R’s in 34 | P a g e
DRALAZINE
RSOLINE
Vasodilator blood vessel to help them dilate. This lowers blood pressure and allows blood to flow more easily through the vein and arteries.
hypertension Lowering high
blood pressure To help prevent
strokes and heart attacks
Severe tachycardia
Dissecting aortic aneurysm
Heart failure with high cardiac output
Cor pulmonale Myocardial
insufficiency due to mechanical obstruction
Coronary artery disease
for BP ≥ 140/90
Headache Angina Arrythmias Edema Orthostatic
hypertension
Diarrhea Rashes Sodium
retention
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 the drug with food or a snack
Instruct patient to take
this drug as 35 | P a g e
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
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
NICA
CARD
Anti-angina Drugs / Calcium Antagonists
It inhibits calcium ion from entering the slow
Short-term treatment of hypertension
Hypersensitivity to Nicardipine
Cardiogenic shock
IV infusion dilute to 10-
Nicardipine 10mg/10ml +
Dizziness Flushing Headache Hypotension
Observe patient’s 10R’s upon administering the medication.
36 | P a g e
RDEPINE
HCl
EPINE
channels or select voltage-sensitive 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.
For prolonged control of blood pressure
Stable angina
Recent MI or acute unstable angina
Severe aortic stenosis
20mg/100ml at an initial rate of 5mg/hr.
90cc PNSS
Peripheral edema Tachycardia,
palpitations Nausea Ischemic chest
pain Cerebral or
myocardial ischemia
Fever Abnormal LFTs Thrombocytopen
ia
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
Advised patient to report:
Swelling Difficulty breathing
or new cough
Unresolved fatigue37 | P a g e
Unusual weight gain or unresolved dizziness
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
HYDROC
HYDROC
Corticosteroid
Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions
Acute hypersensitivity reaction
Short-term inflammatory and allergic
Hypersensitivity to corticosteroids
Cured or manifest TB
Renal
100-500 mg IM/IV every 2, 4, or 6 hours
200 mg IVTT
Headache, insomnia, convulsions, psychosis
Hypotension, shock
Observe the patients 10R’s in administering medication.
Assess VS, CBC, Chemistry profile
Report any worsening
38 | P a g e
ORTISONE
ORTISONE
ACETATE
that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions
disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
Hematologic disorders--thrombocytopenic purpura, erythroblastopenia
Replacement therapy in adrenal cortical insufficiency
insufficiency Liver disease,
cirrhosis, hypothyroidism
Ulcerative colitis with impending perforation
Convulsive disorders
Metastatic carcinoma
Diabetes mellitus
Cardiac arrhythmias secondary to electrolyte disturbances
Thin, fragile skin, petechiae, striae
Nausea and vomiting
Increased appetite and weight gain (long-term therapy)
Muscle weakness
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
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
BISACO
DULCOL
Stimulant Laxative
Induces peristaltic contraction by direct stimulation of sensory nerve ending in the colonic wall
Temporarily relief of constipation
For evacuation of colon before surgery
Acute surgical abdomen
Nausea and vomiting
Abdominal cramps
10 mg suppository rectally once daily
2 suppository per rectum
Mild cramping
Nausea Diarrhea Fluid and
electrolyte
Observe the patients 10R’s in administering medication.
Administer in the evening or before breakfast because of
39 | P a g e
DYL
AX
Use to cleanse colon before delivery
Relieve constipation in patient with spinal cord damage
Intestinal obstruction
Fecal impaction
Use of rectal suppository in presence of anal or rectal fissures
Appendicitis Gastroenteritis
disturbances( Potassium and Calcium)
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 15-60 minutes after administration if suppository is used.
It should not be given within 1 hour of antacids, milk and milk products.
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
FUROSEMI
LASIX
Loop Diuretics
Inhibits the reabsorption of sodium and chloride in the proximal and distal tubules as well as the ascending loop of
Edema associated with Congestive Heart Failure
Hypertension in conjunction to spironolactone
Pulmonary
Hypersensitivity to furosemide
Never use with ethacrynic acid
Patients with anuria
20-40 mg twice a day IVTT
20 mg IVTT after 2 ‘u’ BT
Jaundice Tinnitus Hearing
impairment Hypotensio
n Water/
electrolyte
Observe the patients 10R’s in administering medication.
Assess VS, CBC, Chemistry profile
Assess closely for sign of vascular
40 | P a g e
DE
Henle edema Post-Blood
transfusion
depletion Pancreatitis Abdominal
pain Dizziness Anemia
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.
Monitor BP for it may cause drop of BP.
41 | P a g e
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
MEFENAMIC
PONSTEL
Analgesics, non-narcotic, non-steroidal
Inhibits prostaglandin synthesis; Reduces inflammatory response and intensity of pain stimulus reaching
Relief of moderate pain lasting less than 1 week
Hypersensitivity in aspirin, iodides, or any NSAID
Preexisting renal disease
Active ulceration or chronic inflammation of GI tract
PO 500 mg then 250 mg every 6 h as needed. Usually not used more than
500 mg 1cap q6° RTC for pain with meals
Upset stomach and nausea
Heartburn Dizziness drowsiness, Report if any of
the following has occur: fainting
Take the medication with meals
Inform patient not to use drug for longer than 1 wk.
Warn patient about potential for bleeding.
Advise patient to
42 | P a g e
ACID
sensory nerve endings.
Diarrhea Dyspepsia GI bleeding Mild elevations in
LFT results
1 wk. persistent/severe headache
hearing changes
fast/pounding heartbeat
mental/mood changes
difficult/painful swallowing
swelling of the ankles/feet/hands
sudden/unexplained weight gain
discontinue medication if rash develops and to contact health care provider.
Instruct patient to report the following symptoms to health care provider: rash visual problems dark stools decreased urinary
output persistent headache
or stomach pain unusual bruising or
bleeding
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
43 | P a g e
exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
CELECOXIB
CELEBREX
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Thought to inhibit prostaglandin synthesis, impending cyclooxygenase – 2 to produce anti-inflammatory, analgesic and anti-pyretic
Acute pain Juvenile
arthritis Ankylosing
spondylitis Rheumatoid
arthritis
Hypersensitivity to NSAIDs
Severe hepatic impairment
Heart failure Inflammatory
bowel disease Peptic ulcer Renal impairment Asthma
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,
Observe patient’s 10R’s upon administering the medication.
Assess patient’s range of motion, degree of swelling, and pain in affected joints before and periodically throughout therapy.
May be administered
44 | P a g e
effects Urticaria tongue, lips, eyes, hands, feet, ankles, or lower legs
Difficulty swallowing or breathing
Difficult or painful urination
Frequent urination, especially at night
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
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
45 | P a g e
Instruct patient that it may take several days before he feels consistent pain relief
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
FERROUS
SULFA
SORBIFER
Iron Preparation
Iron is absorbed from the duodenum and upper jejunum by active mechanism through the mucosal cells where it combines with the protein transferring. Iron is stored in
Prevention and treatment of iron deficiency anemia
Dietary supplement for iron
Hemosiderosis Hemochromato
sis Peptic ulcer Regional
enteritis and ulcerative colitis
Hemolytic anemia
Pyridoxine responsive anemia
300 to 325 mg of regular-release 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
Observe patient’s 10R’s 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
46 | P a g e
TE
the body as hemosiderin or aggregated ferritin which is found in reticuloendothelial cells of the liver, spleen and bone marrow. About two thirds of total body iron is in the circulating RBCs in hemoglobin.
Severe hypotension
Cirrhosis of the liver.
the following symptoms of a serious allergic reaction: Rash Itching/
swelling (especially of the face/tongue/throat)
Severe dizziness
Trouble breathing
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.
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
CALCIUM
CARB
CALCI-AID
Electrolytes / Antacids, Antireflux Agents & Antiulcer ants
Dietary/ Nutritional drugs – Vitamins
Neutralize gastric acid rapidly and effectively. However, it may adversely activate Ca dependent processes, leading to secretion of gastric &
Flatulence Heartburn Hypocalcaem
ia Peptic ulcer Upset
stomach Hypophospha
temia Renal failure
Nephrolithiasis Zollinger-ellison
syndrome Hyperthyroidism Hypercalcaemia Hypercalciuria
1 to 2 tab daily
1 tab OD
Nausea Headache Abdominal pain Acid rebound Vomiting Constipation Dizziness Flatulence Dizziness Belching
Observe patient’s 10R’s 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
47 | P a g e
ONATE
and Minerals
hydrochloric acid. It can induce rebound acid secretion and, prolonged high doses may cause hypercalcemia, alkalosis and milk-alkali syndrome.
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, non-absorbable compounds.
Instruct not to use calcium carbonate repeatedly with foods high in vitamin D (such as milk) or sodium bicarbonate,
as it may cause milk-alkali syndrome: Hypercalcemia Distaste for food Headache Confusion Nausea and
vomiting Abdominal pain Metabolic
alkalosis Soft tissue
calcification 48 | P a g e
(calcinosis) Hypophosphate
mia and renal insufficiency
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT NURSING RESPONSIBILITY
ASCORBIC
ACID
CECON
Vitamin C Water-soluble vitamin essential for synthesis and maintenance of collagen and intercellular ground substance of body tissue cells, blood vessels, cartilage, bones, teeth, skin, and tendons. Unlike most mammals,
Prevention and treatment of scurvy and to acidify the urine
Hypersensitivity to any component of the preparation
Patients on sodium restriction
Use of calcium ascorbate in patients receiving digitalis.
PO 150–500 mg in 1–2 doses
500 mg 1 tab OD
Nausea and vomiting
Heartburn Diarrhea, or
abdominal cramps (high doses)
Acute hemolytic anemia
Sickle cell crisis Headache or
insomnia (high doses)
Urethritis Dysuria,
crystalluria, hyperoxaluria, or hyperuricemia
Observe patient’s 10R’s 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
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humans are unable to synthesize ascorbic acid in the body; therefore it must be consumed daily.
(high doses) Dizziness
Inform that large doses may cause diarrhea or nephrolithiasis
Instruct patient should preferably take the oral formulation with a meal.
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
KETOROLAC
TORADOL
Non-steroidal Inflammatory Agents
Inhibits prostaglandin synthesis, producing peripherally mediated analgesia;
Short term management of pain
Seasonal allergic conjunctivitis
Inflammatory disorder of the eye
Hypersensitivity 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
30 mg/am 1 amp IVTT
30 mg IVTT q 6 hours
Headache Dizziness Drowsiness Diarrhea Nausea Dyspepsia/
indigestion Epigastria/
GI pain Edema
Observe the patients 10R’s 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,
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renal failure due to volume depletion
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 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
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demonstrated by verbalization of decreased in severity of pain.
GENERIC
NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
TRANEXAMIC
ACID
HEMOSTAN
Anti-fibrinolytic;Antihemorrhagic
Synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen
Epistaxis; hemoptysis; hematuria
Peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage
Treatment of hemorrhage associated with excessive fibrinolysis in various
Renal function impairment
Hematuria of upper urinary tract origin
Lactation
Inj 0.5-1 gm/kg body weight TID
1 gm IVTT x 2 doses q 8 hours
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
Observe the patients 10R’s 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,
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activator and thus prevents 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
surgical procedures
tenderness Chest pain Confusion Coughing up
blood Decreased
urination Severe or
persistent headache
Shortness of breath
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
GENERIC NAME
BRAND
NAME
GENERAL CLASSIFIC
ATION
MODE OF ACTION
INDICATION CONTRAINDICATION
USUAL DOSE
ACTUAL DOSE
SIDE EFFECT
NURSING RESPONSIBILITY
TRAMADOL
ULTRAM
Analgesics (centrally acting)
Inhibits reuptake of serotonin and norepinephrine in the CNS
Moderate to moderately severe pain
Hypersensitivity to tramadol
Cured or manifest TB
50-100 mg IV every 4-6 hours
50 mg IVTT q 8 hours for pain
Flushing Pruritus Constipati
on Nausea
and vomiting
Dizziness Headache Insomnia
Observe the patients 10R’s 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
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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.
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
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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.
Hematology(September. 09,2012)
DETERMINATIONACTUAL VALUE
NORMAL VALUE
INTERPRETATIONSIGNIFICANCE
NURSING RESPONSIBLITY
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White Blood Cells
Red Blood Cells
Hemoglobin
Hematocrit
Platelet
MCV
MCH
MCHC
RDW
6.3
4.39
110
0.36
182
83
25
304
16.3
4-10 x 10^9/L
4.5-5.4 x 10^12/L
115-155 g/L
0.36-0.47
150-400 x 10^9/uL
86-100 fL
26-31 pg
310-370 g/L
11.6-13.7 %
NORMAL
DECREASED
DECREASED
NORMAL
NORMAL
DECREASED
DECREASED
DECREASED
INCREASED
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 microcytic anemia
Decreased in microcytic anemia
Decreased in severe hypochromic anemiaIncreased with any condition stimulatingincrease in bone marrow activity
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 on removal of dinner.
Monitor the puncture site for oozing or hematoma formation.
Instruct to resume normal activities and diet.
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Differential count:
Neutrophils
Lymphocyte
Monocyte
Eosinophils
Basophil
Blood Type
54
30
8
6
2
“A”
40-70%
19-42%
3-9%
2.0-8.0%
0-5%
NORMAL
NORMAL
NORMAL
NORMAL
NORMAL
Clinical Chemistry
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(September. 09, 2012)
DETERMINANTS ACTUAL VALUE NORMAL VALUE INTERPRETATION SIGNIFICANCE NURSING RESPONSIBILITIES
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
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
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IMMUNOLOGY
(July. 31, 2012)
DETERMINANTS ACTUAL VALUE NORMAL VALUE INTERPRETATION SIGNIFICANCE NURSING RESPONSIBILITIES
CA 12-5 85.8 0-35U/mL INCREASED Increased in colon, upper gastrointestinal(GI),ovarian, and other gynecologic cancers: pregnancy, peritonitis
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.
Hematology(September. 12,2012)
DETERMINATIONACTUAL VALUE
NORMAL VALUE
INTERPRETATIONSIGNIFICANCE
NURSING RESPONSIBLITY
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White Blood Cells
Red Blood Cells
Hemoglobin
Hematocrit
Platelet
MCV
MCH
MCHC
7.7
3.63
96
0.30
116
82.4
26.4
321
4-10 x 10^9/L
4.5-5.4 x 10^12/L
115-155 g/L
0.36-0.47
150-400 x 10^9/uL
85.0-95.0 fL
28.0-32.0 pg
320-350g/L
NORMAL
DECREASED
DECREASED
DECREASED
DECREASED
DECREASED
DECREASED
NORMAL
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
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.
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RDW-SD
Differential count:
Neutrophils
Lymphocyte
Monocyte
Eosinophils
Basophil
43.9
75.4
13.2
0.0
11.3
0.1
37-46fL
40-70%
19.0-48.0%
3-9%
2.0-8.0%
0-5%
NORMAL
INCREASED
DECREASED
DECREASED
INCREASED
NORMAL
Increased with acute infections,trauma or surgery, leukemia, malignant disease,necrosis;
Decreasedwith aplastic anemia, SLE, immunodeficiencyincluding AIDS
Decreased withuse of corticosteroids, RA, HIV infection
Increased in allergy, parasitic disease, collagen disease, subacute infections;
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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 medicationsExercise
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
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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.
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PROGNOSIS
DETERMINATION
GOOD(3)
FAIR(2)
POOR(1)
JUSTIFICATION
AgeOnset of Illness
Since the patient is experiencing the disease when she was still 11 years old.
Duration of Illness
Since the patient is experiencing the gradual enlargement of the abdomen for the past 2 years.
Present Health Status
Since the patient has high blood pressure, bipedal edema and an abdominal girth of 122 cm Pre-OP and abdominal girth of 82 cm Post-Op.
Financial Status
The patient is under social service that helped her comply to different diagnostics and medications.
Support System
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.
Attitude toward treatment
The patient has been cooperating very well, is taking her medication, and cooperates in nursing interventions.
Justification
Using the criteria provided, our patient’s 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.
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BIBLIOGRAPHY
Books
2010 Edition Delmar Nurses Drug Handbook Jeorge R. Sprato and Adrienne L. Woods
MIMS 2012
12 Edition Nurse’s 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
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