142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study

8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study

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Wesleyan University- Philippines

Mabini Extension, Cabanatuan City

Case Study

In NCM 10! Care o" Clients #ith proble$s in

%xy&enation-Cardiovas'ular syste$ (isorder


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Sub$itted by!

)enilyn *aye M+ %rpilla

sn-./

Sub$itted o!

Pro"+ euben 2+ I&na'io, N M3N

Con'ept Instru'tor


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Abnormal Uterine Bleeding,

Iron deficiency Anemia Secondary Case Study

Table of Contents

I+ INTRODUCTIONError Boo!mar! not defined"

3+ rie" history o" the 'ase Error Boo!mar! not defined"

+ (e"inition o" related ter$s Error Boo!mar! not defined"

II" #ATIENT$S %ISTOR& 4

3+ io&raphi' data 4

+ Chie" 'o$plaints

C+ 5istory o" present illness

(+ Past $edi'al 6 health history

E+ *a$ily $edi'al 6 illness history

*+ evie# o" syste$


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7+ 8i"estyle and health pra'ti'es .

h+ (evelop$ental level 9

III" CO''ECTIN( OB)ECTI*E DATA 9

a+ Course o" 'on"ine$ent 9

i+ Medi'ation ad$inistered sin'e date o" ad$ission 9

ii+ I:* , and other parenteral $edi'ation in"used6 ad$inistered sin'e date o" ad$ission ;

iii+ 3ll dia&nosti' test $ade to pt sin'e date o" ad$ission ;

b+ Physi'al assess$ent ;

I*" 'IST O+ NANDA BASED OR (ORDON BASED NURSIN( D- 1<

*" #AT%O#%&SIO'O(& Error Boo!mar! not defined"=

*I" NURSIN( CARE #'AN Error Boo!mar! not defined";

e"eren'es 4=


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INTRODUCTION a" O.er.ie/

Patient 3 has been ad$itted in 3u&ust 44, 4014 9!0s pre&nant and

has been reported #ith a heavy va&inal bleedin&+ 5er "inal dia&nosis is 3bnor$al Uterine

leedin&, Iron (e"i'ien'y 3ne$ia Se'ondary+

Iron de"i'ien'y is the $ost 'o$$on de"i'ien'y disorder in the #orld, a""e'tin& $ore than t#o

billion people #orld#ide, #ith pre&nant #o$en at parti'ular ris>+ World 5ealth %r&ani?ation

W5%/ data sho# that iron de"i'ien'y anae$ia I(3/ in pre&nan'y is a si&ni"i'ant proble$

throu&hout the #orld #ith a prevalen'e ran&in& "ro$ an avera&e o" 1.@ o" pre&nant #o$en in

industriali?ed 'ountries to an avera&e o" 9no#n and 'onsiderable ris> "a'tor "or both $other and

"etus+ *etal 'onseuen'es are an in'reased ris> o" &ro#th retardation, pre$aturity, intrauterine

death, a$nion rupture and in"e'tion+ Pre$aturity is a 'onseuen'e o" early anae$ia durin&

Maternal 'onseuen'es o" anae$ia are also #ell >no#n and in'lude 'ardiovas'ular sy$pto$s,

redu'ed physi'al and $ental per"or$an'e, redu'ed i$$une "un'tion, tiredness, redu'ed

peripartal blood reserves and "inally in'reased ris> "or blood trans"usion in the postpartu$

period+

Definition of Related terms

Anemia/ Anaemia- is a de'rease in nu$ber o" red blood 'ells Cs/ or less than the nor$al uantity o" he$o&lobin

in the blood+

Iron deficiency anemia-(IDA) is an ail$ent #hen there is not enou&h he$o&lobin produ'ed by the body to $eet its

reuire$ent+

Iron- he total body iron in a B0->& $an is about .

Abnormal Uterine Bleeding (AUB) or Dysfunctional uterine bleeding (DUB) is abnor$al bleedin& "ro$ the va&ina

that is due to 'han&es in hor$one levels+


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Anemia - a de'rease in red blood 'ell C/ $ass+

Red blood cell (RBC)/ Erytrocyte- deliver oxy&en "ro$ the lun&s to the tissues and 'arbon dioxide "ro$ the tissues

to the lun&s

Cesarean !ection- is a sur&i'al pro'edure in #hi'h one or $ore in'isionsare $ade throu&h a

$otherDs abdo$en laparoto$y/ and uterus hysteroto$y/ to deliver one or $ore babies, or,

rarely, to re$ove a dead "etus+ 3 Caesarean se'tion is usually per"or$ed #hen a va&inal delivery

#ould put the babyDs or $otherDs li"e or health at ris>, althou&h in re'ent ti$es it has also been

per"or$ed upon

reuest "or 'hildbirths that 'ould other#ise have been natural+

"ocia rubra (or cruenta/ is the "irst dis'har&e, red in 'olor be'ause o" the lar&e a$ount o" blood it 'ontains+ It

typi'ally lasts no lon&er than to 9 days a"ter birth+

#ematocrit - 5t or 5C/ or pa'>ed 'ell volu$e PC:/ or erythro'yte volu$e

"ra'tion E:*/ is the volu$e per'enta&e @/ o" red blood 'ells inblood+ It is nor$ally about .9@"or $en and .0@ "or #o$en+

1F It is 'onsidered an inte&ral part o" a personDs 'o$plete blood

'ount results, alon& #ith

he$o&lobin 'on'entration, #hite blood 'ell 'ount, and platelet 'ount+

#emoglobin- tetra$er protein 'o$posed o" he$e and &lobin+ Is the iron-'ontainin& oxy&en-transport$etalloprotein

in the red blood 'ells


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$C#- %mean cell emoglobinG is the avera&e $ass o" he$o&lobin per red blood 'ell in a sa$ple o"

blood+ It is reported as part o" a standard 'o$plete blood 'ount+ MC5 value is di$inished in

hypo'hro$i' ane$ias+

$C#C- mean cor&uscular emoglobin concentration, a $easure o" the 'on'entration o"he$o&lobin in a &iven volu$e o" pa'>ed red blood 'ells+ It is reported as part o" a standard

'o$plete blood 'ount+ It is 'al'ulated by dividin& the he$o&lobin by the he$ato'rit+

$C'- mean cor&uscular olume, or G$ean 'ell volu$eG MC:/, is a $easure o" the avera&e red

blood 'ell si?e that is reported as part o" a standard 'o$plete blood 'ount+ he MC: is

'al'ulated by dividin& the total volu$e o" pa'>ed red blood 'ells also >no#n as he$ato'rit/ by

the total nu$ber o" red blood 'ells+

!erum ferritin- *erritin is a protein "ound inside 'ells that stores iron so your body 'an use it later+ 3

"erritin test indire'tly $easures the a$ount o" iron in your blood+

Total Iron Binding Ca&acity in te Blood (TIBC)-/ is a $edi'al laboratory test

that $easures the bloodDs 'apa'ity to bind iron #ith trans"errin+ It is per"or$ed by dra#in& blood

and $easurin& the $axi$u$ a$ount o" iron that it 'an 'arry, #hi'h indire'tly $easures

trans"errin sin'e trans"errin is the $ost dyna$i' 'arrier+

Transferrin- are iron-bindin& blood plas$a &ly'oproteins that 'ontrol the level o" "ree iron in

biolo&i'al "luids+ rans"errin saturation! 19 A90@ $ales/, 14A.9@ "e$ales/

Erytro&oiesis- is the pro'ess by #hi'h red blood 'ells erythro'ytes/ are produ'ed+ It is sti$ulated by

de'reased %4 in 'ir'ulation, #hi'h is dete'ted by the >idneys, #hi'h then se'rete the hor$one erythropoietin+

#ATIENT$S %ISTOR&

A" Biogra01ical Information


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Na$e! Patient 3

3&e! . years old

7ender! *e$ale

irthday! Mar'h 4, 1; 1, 8aur, Nueva E'iHa

Phone Nu$ber! 0;4B-.B44-99;

Edu'ational 8evel! 5i&h s'hool 7raduate

%''upation! None

a'e6 Ethni' 7roup! a&alo&

eli&ion! o$an Catholi'

Nationality! *ilipino

xiv+ Citi?enship! *ilipino 'iti?en

8an&ua&e spo>en! a&alo&

Sour'e o" in"or$ation! Patient 3

eliability! ;;@


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b" C1ief Com0laints2 :a&inal leedin&

i+ Initial dia&nosis! 3bnor$al Uterine leedin& /

*inal (ia&nosis! 3bnor$al Uterine leedin&, Iron (e"i'ien'y 3ne$ia Se'ondary c" %istory

of #resent Illness2

1 $onth prior to ad$ission- Junusual bleedin&K des'ribed as $essy lastin& only "or B days,

'onsu$in& 4 pads+

19 days prior to ad$ission- va&inal bleedin& noted to be pro"use, 'onsu$in& = pads "ully

soa>ed

days prior to ad$ission- va&inal bleedin& noted to be pro"use, 'onsu$in& ; pads "ully and

#ith pain in lu$bosa'ral re&ion

4 days prior to ad$ission- still #ith bleedin&, #ith lu$bosa'ral pain and heada'he

#ast 3edical4 %ealt1 %istory

Proble$s at birth- none

Childhood illnesses-

1;B=! Measles

1;=1! Mu$ps

I$$uni?ation to date A

Patient 3 'annot re$e$ber iv+ 3dult illnesses


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4000-4014! 5ypotension v+ 3''idents! None

vi+ 3ller&ies! None

vii+ Previous 5ospitali?ation, Medi'al and Sur&i'al

(ia&nosis

Lear

Cause

3bdo$inal

1;;=

Pre&nan'y o her *irst Child

Caesarean Se'tion

e" +amily 3edical4 Illness %istory i+ 5eredo"a$ilial

In her "ather side, her "ather is re'ently been dia&nosed #ith diabetes and an al'oholi' drin>er+

5er 7rand$other had uber'ulosis o" the bone and also asth$ati'+ In her $other side her

$other has a history o" hypotension, and ane$ia+ 5er &rand$other had a history o" hepatitis

and diabetes+

Re.ie/ of System

S>in, 5air Nails-

S>in A Pallor


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5air- la'>

Nails- Pin>ish

5ead and Ne'>

5ead- No heada'he reported

Ne'>- No sti""ness o" ne'> "elt, #ith $elas$a at ba'> o" ne'>

EEN Sinuses


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Ears- No draina&e or rin&in& ears reported

Eyes- lurred :ision #hen readin& *arsi&hted/

Nose- No dis'har&es

hroat- No pain or hoarseness o" voi'e "elt

Chest and 8un&s

Chest- No pain reported

8un&s- No shortness o" breath or pain reported

reast e&ional 8y$phati's

reast- #ith Mil> dis'har&es

*eelin& o" tenderness, and dar> areola

e&ional 8y$phati's- 8y$ph nodes are not enlar&ed nor tender

5eart, Ne'> :essels Central C:S

5eart- No pain, distress or palpitations "elt

Ne'> vessels- are not distended+

Cardiovas'ular Syste$- No ti&htness, ede$a, or orthopnea reported

P:S

With :ari'osities in i&ht 8e&


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3bdo$en

No abdo$inal pain, bo#el $ove$ents are &ood, #ith linea ni&ra

7enitalia and eprodu'tive Syste$

With :a&inal dis'har&e 8o'hia rubra/

No pain durin& sexual inter'ourse reported

3nus, e'tu$ Prostate

3nus- No it'hiness or lesion reported

e'tu$- No it'hiness or lesion reported

Mus'ulos>eletal Syste$ and Extre$ities

No $us'le pain, sti""ness or s#ellin& "elt

Neurolo&i'

With di??iness and #ea>ness as reported

'ifestyle and %ealt1 #ractices5 67% day Descri0tion

Nutrition, diet and Wei&ht $ana&e$ent

She pre"ers ve&etables, ri'e and a &lass o" #ater in her $eal+

3'tivity Exer'ise

She does household 'hores as her exer'ise+ She usually at ho$e #ith her dau&hter+


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est and Sleep

he 'lient ta>es a 9-


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Spiritual, Cultural, :alues and elie" Syste$

he patient 7oes to Chur'h every Sunday and prays at ni&ht and be"ore $eals+ She believes that everythin& happens"or a reason+

Edu'ation and #or>

3 hi&h s'hool &raduate and #ith no #or>+ Patients 3 stays at ho$e and do household 'hores+

Stress 8evel and Mana&e$ent6 Copin& Stress

Patient 3 is havin& a heada'he and "eels di??y #hen she is stress or an&ry at her 'hild+ SheOs #at'hin&

television at ni&ht be"ore sleep, and tal>in& #ith her peer &roup at $ornin& as a #ay o" relievin&

stress+

Environ$ent Nei&hborhood

Patient 3 lives in a rural area in a bedroo$-house, #ith a ba'>yard and a &arden+ he houses in their

to#n are 9 $eters apart+ With a uiet nei&hborhood and "ar "ro$ hi&h#ay+

De.elo0mental Stage

heory! Eri> Eri'>sonOs Psy'hoso'ial (evelop$ent

ii+ 7enerativity vs+ Sta&nation Middle adulthood .0-


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'on"ident o" raisin& her pre$ature 'hild and her "irst 'hild so that so$eday, her 'hildren #ill do

the sa$e to her+ She believes that all o" their sa'ri"i'es he 'lient and her husband/ are #orth it

"or their "a$ily+

iii" Co$parison o" Nor$al and 3bnor$al develop$ental para$eter!

People extend their 'on'ern "ro$ the$selves and their "a$ilies to the 'o$$unity and to the

#orld+ hey $ay be'o$e politi'ally a'tive, #or> to solve proble$s, or to parti'ipate in "ar-

rea'hin&-'o$$unity or #orld based de'isions+ People #ith sense o" &enerativity are sel"-

'on"ident and better able to Hu&&le their various lives as a $other and 'hur'h $e$ber+ People

#ithout this sense be'o$e sta&nated or sel"-absorbed+ hose #ho have devoted the$selves to only

one role are $ore li>ely to "ind the$selves at the end o" $iddle a&e #ith a narro# perspe'tive and

la'> o" ability to 'ope #ith 'han&e+ Wo$en #ithout a sense o" &enerativity $ay have $oredi""i'ulty than others a''eptin& a late-in-li"e pre&nan'y and a ne# role o" 'hildbearin&+

CO''ECTIN( OB)ECTI*E DATA a" Course of Confinement

3edications Administered since date of admission

ysician*s +rder

3s'orbi' a'id 1'ap I( P+%+

,eneric ame

3s'orbi' 3'id

Brand ame

3po-C, 3s'orbi'ap, Cebid, Ce'on,

Cenolate, Ce$ill, C-Span, Cetane,


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Cevalin, Cevi-id, Ce-:i-Sol, Cevita,


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*lavor'ee, edoxon, S'hi"" E""erves'ent

:ita$in C, :ita-C+

Classification

:ita$in

$ecanism of Action

:ita$in C or 8-as'orbi' a'id, or

si$ply as'orbate the anion o" as'orbi'

a'id/, is an essential

nutrient "or hu$ans and 'ertain other

ani$al spe'ies+ :ita$in C re"ers to a

nu$ber o" vita$ers that have vita$in C

a'tivity in ani$als, in'ludin& as'orbi'

a'id and its salts, and so$e oxidi?ed

"or$s o" the $ole'ule

li>e dehydroas'orbi' a'id+ 3s'orbate and


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as'orbi' a'id are both naturally present in

the body #hen either o" these is

introdu'ed into 'ells, sin'e the "or$s

inter'onvert a''ordin& to p5+

:ita$in C is a 'o"a'tor in at least

ei&ht en?y$ati' rea'tions in'ludin&

several 'olla&en synthesis rea'tions that,

#hen dys"un'tional, 'ause the $ost

severe sy$pto$s o" s'urvy+

!ide Effects

ursing $anagement

7I disturban'es in hi&h doses nausea,

Instru't Client to ta>e the $edi'ation

vo$itin&, and diarrhea/+

a"ter $eals to avoid 7I upset+


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Instru't 'lient to $easure and "ollo#

the pres'ribed dosa&e o" the

$edi'ation to avoid overdosin&+

ri&ht yello# dis'oloration o" urine

3dvise the 'lient that yello#

dis'oloration o" urine is nor$al

Aderse Effects

ursing $anagement

arely, hypersensitivity rea'tion

Instru't the 'lient to dis'ontinue the

$edi'ation, and re"er to the do'tor+

*latulen'e, 'onstipation


$edi'ation, and re"er to the do'tor+

5eartburn,

Instru't the 'lient to ta>e the

$edi'ation a"ter $eals to avoid


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adverse rea'tions+

ysician*s +rder

ranexa$i' a'id 900$&, 1'ap I( P+%+

,eneric ame

ranexa$i' a'id

Brand ame

5e$ostan, *ibrinon, Cy>lo>apron,

8ysteda, ransa$in

Classification

3nti-"ibrinolyti', antihe$orrha&i'+

5ae$ostati's

$ecanism of Action

ranexa$i' a'id is a syntheti' derivative

o" the a$ino a'id lysine+ It exerts its


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anti"ibrinolyti' e""e't throu&h the

reversible blo'>ade o" lysine-bindin&

sites on plas$ino&en $ole'ules+ 3nti-

"ibrinolyti' dru& inhibits endo$etrial

plas$ino&en a'tivator and thus prevents

"ibrinolysis and the brea>do#n o" blood

'lots+ he plas$ino&en-plas$in en?y$e

syste$ is >no#n to 'ause 'oa&ulation

de"e'ts throu&h lyti' a'tivity on

"ibrino&en, "ibrin and other 'lottin&

"a'tors+ y inhibitin& the a'tion o"

plas$in "inronolysin/ the anti-

"ibrinolyti' a&ents redu'e ex'essive


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brea>do#n o" "ibrin and e""e't

physiolo&i'al he$ostasis+

!ide Effects

ursing $anagement

7I disturban'es Nausea, vo$itin&,


diarrhea/


Aderse Effects

ursing $anagement

5ypotension

a>e the 'lient lood pressure

be"ore and a"ter ta>in& the

$edi'ation to identi"y i" hypotension

o''urs as adverse e""e'ts, i" so,

dis'ontinue the $edi'ation and re"er

to the do'tor+

5eada'he


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Monitor the 'lient a"ter ta>in& the

$edi'ation and Instru't to ta>e bed

rest to avoid inHury

5ypersensitivity s>in rea'tions6


aller&i' rea'tions

$edi'ation, and re"er to the do'tor

(isturban'es in 'olor vision


$edi'ation, and re"er to the do'tor

ysician*s +rder

*errous *u$erate 1'ap, I( P+%+

,eneric ame

*errous *u$erate

Brand ame

*e$iron, *erretts, *erro-Seuels,

*erro'ite, 5e$o'yte, Ir'on

Classification

3ntiane$i'6 Supple$ent


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$ecanism of Action

Iron is an essential 'o$ponent in the

physiolo&i'al "or$ation o" he$o&lobin,

adeuate a$ounts o" #hi'h are ne'essary

"or e""e'tive erythropoiesis and the

resultant oxy&en transport 'apa'ity o" the

blood+ 3 si$ilar "un'tion is provided by

iron in $yo&lobin produ'tion+ Iron also

serves as a 'o"a'tor o" several essential

en?y$es, in'ludin& 'yto'hro$es that are


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involved in ele'tron transport+ Iron is

ne'essary "or 'ate'hola$ine

$etabolis$ and the proper "un'tionin& o"

neutrophils+

!ide Effects

ursing $anagement

•

sto$a'h upset,



•

diarrhea,

Instru't 'lient not to ta>e #ith $il>


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or anta'ids

• bla'> or dar>er than nor$al

In"or$ patient the 'olor stool bla'>

appearin& stools, or

$ay be bla'>

• te$porary stainin& o" the teeth+

In"or$ patient that te$porary

stainin& o" the teeth is nor$al

3dverse E""e'ts

Nursin& Mana&e$ent

nausea or vo$itin&,

Instru't 'lient to ta>e the $edi'ation

a"ter sna'> or $eal

epi-&astri' pain+

Instru't 'lient to ta>e the $edi'ation


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4 hours prior to or . hours a"ter

anta'ids

Physi'ianOs %rder

Me"ena$i' a'id 900$& 1'apsule, I(

P+%+

7eneri' Na$e

Me"ena$i' a'id

rand Na$e

Pharex, Me"ene$ax, *ena$ax, *e$a'id

Classi"i'ation

Nonsteroidal 3nti-In"la$$atory (ru&s

NS3I(s/

Me'hanis$ o" 3'tion

Me"ena$i' a'id binds the prosta&landin

synthetase re'eptors C%-1 and C%-4,


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inhibitin& the a'tion o" prosta&landin

synthetase+ 3s these re'eptors have a role

as a $aHor $ediator o" in"la$$ation

and6or a role "or prostanoid si&nalin& in

a'tivity-dependent plasti'ity, the

sy$pto$s o" pain are te$porarily

redu'ed+

Side e""e'ts!

sto$a'h pain or 'ra$ps

Instru't patient to avoid al'ohol inta>e


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vo$itin& or upset sto$a'h

#hen ta>in& this $edi'ine sin'e it 'an

'ause in'reases in sto$a'h irritation+

in'reased shortness o" breath

Use 'aution i" the patient has a

#ea>ened heart+ It $ay 'ause in'reased

shortness o" breath or #ei&ht &ain+

di??iness and dro#siness

(o not drive or en&a&e in potentially

ha?ardous a'tivities until response to

dru& is >no#n+ It $ay 'ause di??iness

and dro#siness+


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3dverse E""e'ts

Nursin& Mana&e$ent

sto$a'h ul'er or bleedin&

Instru't 'lient to i$$ediately tell the

health provider about bleedin& or

sto$a'h ul'er

dar> stools, he$ate$esis,

Instru't 'lient to (is'ontinue the dru&

e''hy$oses

pro$ptly, do not use a&ain and

Conta't the physi'ian+

diarrhea, epistaxis, or rash

Instru't 'lient to (is'ontinue the dru&

pro$ptly, do not use a&ain and

Conta't the physi'ian+

ii" I*+, BT and ot1er #arenteral 3edication infused4administered since date of

admission


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INTRA*ENOUS +'UID OREDERED

reious I'.

Rationale his pulls the "luid into the

8S 18iter Q RCl .0 $e68

vas'ular by os$osis resultin& in an

in'rease vas'ular volu$e+ It raises

intravas'ular os$oti' pressure and

provides "luid, ele'trolytes and 'alories

"or ener&y+ Potassiu$ 'hloride is used to

prevent or to treat lo# blood levels o"

potassiu$ hypo>ale$ia/+

Current I'.


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Rationale only I: "luid #hi'h is

Plain NSS 18iter "or 4.hours

'o$patible to lood rans"usion

To follo0 I'.

Rationale o "a'ilitate another lood

Plain NSS 18iter "or 4.hours

rans"usion

OT%ERS

lood rans"usion

Rationale o restore blood volu$e a"ter

severe he$orrha&e and to restore the

oxy&en-'arryin& 'apa'ity o" the blood


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%xytoxin

Rationale Sti$ulatin& labor #hen the

'ontra'tions are 'onsidered too #ea>+

Preventin& or 'ontrollin& heavy bleedin&

"ollo#in& delivery o" the 'hild post-

partu$ he$orrha&e/+

iii" Diagnostic Test since Date of Admission

Na$e o"

esult

Nor$al

Unit o"

I$pli'ation

(ia&nosti'

:alues

Measure$ent


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est

Co$plete CC

5e$o&lobi

100

*e$ale! 110 A

&6dl

Indi'ates a de'rease in

n $ass

19=

ed blood 'ell

Male! 1= to 1=4

5e$ato'rit

0+4

0+B A 0+9.


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8eu>o'yte

;

.+9 A 10

Count

Platelet

.


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Seru$ Iron

.0

*e$ale! 90

'on'entration

to 1B0

Male!


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underlyin& 'ondition

that is 'ausin& the

disorder+

p&

(e'rease in redness is

due to a

disproportionate

redu'tion o" red 'ell

he$o&lobin+

"8

(e'rease in red blood

'ell si?e

(e'rease in he$o&lobin 'on'entration+

U68

Indi'ate a nu$ber o"

$edi'al 'onditions su'h

as tissue da$a&e due to

trau$a or disease/,

he$olyti' ane$ia an

abnor$al brea>do#n o"

red blood 'ells/

T&6d8

Indi'ates poor

absorption o" Iron,

Chroni' heavy

$enstrual bleedin&,


40/133

Poor absorption o" iron,

Not enou&h dietary iron

or Pre&nan'y

T&68

here is a ris> "or la'>

o" iron


41/133

Male! 0A

00

otal Iron

B9

490AB0

T&68

In pre&nant, the liver

indin&

in'reases the produ'tion

Capa'ity in the

o" trans"errin& thus

lood IC/


42/133

raisin& IC+ When

IC is hi&h, it

indi'ates iron de"i'ien'y

ane$ia+

iv+ %ther relevant events durin& hospitali?ation - none+

b" #1ysical Assessment

7eneral I$pression

5y&iene- Clean and 7roo$ed appropriately


43/133

Intera'tion6behavior- Cooperative attitude as her 'ondition per$its

Posture- edridden and #ea>

"a'ial Expression- Sy$$etri' #ith $ove$ent

5ei&ht, #ei&ht and :ital Si&ns

5ei&ht! 9 "eet and in'hes

Wei&ht! 14< lbs

:ital si&ns!

e$perature! B+O C

Pulse rate! == 'p$

lood Pressure! 1106B0 $$65&

espiratory ate! 4 bp$

S>in

Color o" s>in- Pallor

Color o" hair- la'> Nor$al/

%dor- No odor

8esion- No lesion


44/133

Moisture- Moist

e$perature- War$

exture- S$ooth So"t

ur&or- Pin'hed up s>in returns i$$ediately to ori&inal position

Ede$a- No s#ellin&, pittin& or ede$a

Nails- 5as a 'onvex 'urvature o" "in&ernail plate, 1


45/133

Mental Status! 3#a>e 3lert oriented to person, pla'e ti$e

Cranial Nerves!

:isual 3'uity- 40640 #ith po'>et s'reener, both eyes

:isual *ields- inta't in all "ields

II and III! Pupillary ea'tion to 8i&ht- dire't 'onsensual nor$al 3''o$$odation-

nor$al

PE83, pupils, eual, round, rea'tive to li&ht, and a''o$$odation "or both/

III, I:, :I! E%M- inta't

:! 8i&ht ou'h *a'e- nor$al in all divisions

:II! Wrin>le *orehead, Close Eyes, Sho# eeth- nor$al :III! 5earin&- nor$al by rou&h

testin&

! Cou&h- nor$al able to 'ou&h/

I! Shru& Shoulders and 'he'> sterno'leido$astoid $us'les - nor$al II! Protrude

on&ue- $idline protrusion

Motor Syste$! Nor$al tone

Sensory! 3ble to "eel !


46/133

8i&ht ou'h- nor$al

Position Sense- nor$al :ibration- nor$al

Sharp- nor$al

e"lexes! (eep tendon

O i'eps C9-le S1/- esponsive

Patholo&i'al - Plantar e"lex- none bilateral do#n &oin& toes/

Coordination! 7ait and alan'e- nor$al

*in&er to Nose- nor$al

apid "in&er $ove$ents- nor$al

5EEN, Sinuses and Ne'>

5ead2

Si?e6Shape- Sy$$etri', round, ere't in $idline

%M6 5ead 'ontrol- Ne'> $ove$ent is s$ooth 'ontrolled #ith .9 de&ree "lexion, 99

de&ree extension, .0 de&ree lateral abdu'tion, B0 de&ree rotation


47/133


48/133

S'lera6ConHu'tiva- No s#ellin&, dis'har&es, lesions or la'eration are noted

Iris6Pupils A Color la'>, round, "lat and 'onstri'ted #hen dire't to li&ht

:isual 3'uity est- 40640 vision Can di""erentiate 'olors

Ears!

External!

Pla'e$ent- 3li&n$ent o" pinna #ith 'orner o" eye #ithin 10 de&ree an&le o" verti'al position

No s#ellin&, dis'har&es and lesions+

Internal!

No dis'har&es, lesion, ex'oriation or presen'e o" "orei&n body+

Mouth!

8ips- S$ooth $oist, #ithout lesions or s#ellin&

Palates- 5ard palate is pale or #hitish #ith "ir$, transverse ru&ae #rin>le li>e "olds/

on&ue- Pin>, $oist, a $oderate si?e #ith papillae

u''al Mu'osa- S$ooth $oist #ithout lesion

7u$s- Pin>, $oist and "ir$

eeth- 1 adult teeth, #hite to yello#ish in 'olor, shiny tooth ena$el, no inta't dentures

Uvula- Positioned in $idline o" so"t palate

hroat6tonsils- Pin> and sy$$etri'


49/133

Nose6sinuses!

Stru'ture and paten'y o" nares- 3ble to sni"" throu&h ea'h nostril #hile other is o''luded

Color and proble$ o" turbinates - Color is the sa$e as the rest o" the "a'e

No dis'har&es or tenderness

Ne'>!

Mobility- Sy$$etri'

Cervi'al 8y$ph Nodes- No enlar&e$ent or tenderness

e$perature- War$

No s#ellin& or tenderness

C6 8 and 5eart

reasts and Nipples- sy$$etri'al--nipples sy$$etri'al and everted

No $asses, #ith $il>y dis'har&es

3reola- Eual, round, sy$$etri', dar> bro#n, s$ooth,has no lesions

horax-

Posterior thorax-


50/133

o Sy$$etri', ribs are sloped do#n#ard at .9 relative to the spine, $us'le

develop$ent is eual, anteroposterior to transverse dia$eter in ratio o" 1!4

o Spinal ali&n$ent- Sli&htly

o Uni"or$ in te$perature, no tenderness and $asses

o espiratory ex'ursion- *ull and sy$$etri' 'hest expansion

o :o'al "re$itus- ilaterally eual, heard $ostly at the apex o" the lun&s

Sounds- Per'ussion notes resonant ex'ept over the s'apula, bron'hovesi'ular and

vesi'ular

3nterior thorax


51/133

o reathin& patterns- 2uiet, rhyth$i' e""ortless

e$perature, tenderness, $asses- War$, no tenderness or $asses

espiratory ex'ursion- *ull and sy$$etri' 'hest expansion

:o'al "re$itus- ilaterally eual, $ostly heard at the apex o" the lun&s

Sounds- *lat sound on the part #ith heavy $us'les and bony pro$inen'es, ty$pani on

the sto$a'h, dullness on the liver and spleen, bron'hovesi'ular, vesi'ular

ra'hea- ron'hial sound

3xillary, sub'lavi'ular and supra'vi'alar ly$ph nodes- 3bsen'e o" $asses or lu$ps

Cardiovas'ular

Pre'ordiu$-

3orti', pul$oni', tri'uspid area- No pulsation

3pi'al area- With palpable pulsation point o" $axi$al i$pulse/

Sounds o" tri'uspid and api'al- S4 is louder than S1

Sounds o" ri'uspid and api'al area- S1 is lauder than S4

Carotid arteries- Sy$$etri' pulse volu$es, "ull pulsation, no sound

:isibility- Not visible

8un&s-

respiratory e""ort! Even, 4bp$, unlabored


52/133

Per'ussion and Palpation o" 8un& *ields- nor$al resonant per'ussion

3us'ultation- 'lear, nor$al vesi'ular breath sounds

3bdo$inal

Unble$ished s>in, uni"or$ in 'olor, no si&ns o" enlar&e$ent o" the liver and spleen, sy$$etri'al 'ontour

Peristalsis $ove$ent not visible

vas'ular patterns not visible

3udible bo#el sounds, not audible vas'ular and peritoneal "ri'tion rubs

With suture in

Urinary Syste$

No Pain or dis'o$"ort in response to pressure on the lo#er ba'>, abdo$en, or the area above the pelvi'

bone,

No&ro#ths, or abnor$alities dete'ted

No dis'har&e "ro$ the urethra

7enitalia and eprodu'tive


53/133

External 7enitalia- labia, 'litoris, urethral ori"i'e introitus A all nor$al no s#eelin, pus, #arts or

in"la$$ation/

i$anual Exa$- uterus is anterior, $idline, s$ooth, enlar&ed and tender

*undus in $idline, about hal" #ay to 46 #ay bet#een u$bili'us and sy$physis pubis

Inspe'tion o" Cervix and :a&ina- bul&in& #ith strainin&, nor$al va&ina $u'osa, 'ervix- pin>,

#ith lo'hia rubra, 'ervix! Spongy and flabby

3nus


54/133

Nor$al re'tal sphin'ter tone no re'tal $asses or tenderness+ 0 stool "or days+

no "issures, no he$orrhoids

Mus'ulos>eletal, upper and lo#er extre$ities and P:S

Mus'ulos>eletal syste$

Mus'les-

Si?e, 'ontra'tures, tre$ors- ilaterally sy$$etri', no 'ontra'tures and tre$ors

oni'ity, stren&th ne'>, upper, lo#er extre$ities/- Nor$al $us'le tension, adeuate

stren&th o" the$us'les

ones- Uni"or$ in stru'ture, no de"or$ities, tenderness or ede$a

)oints- 3bsen'e o" tenderness and s#ellin&, has s$ooth $ove$ent, no nodules

an&e o" $otion shoulder and s'apula, elbo#s, hands, a'etabulu$, popliteal, an>les/- 3ble

to per"or$ the exer'ises in "ull ran&e o" $otion, no tenderness, $oves s$oothly

Upper Extre$ities

VNails- no 'yanosis, or 'lubbin&

pal$s- pale

$us'les- si?e is proportional

Hoints in'ludin& ro$/

-interphalan&eal- nor$al an&e o" $otion #ithout de"or$ities


55/133

#rists- "lexion ;0X, extention B0X, radial deviation 40X, ulnar deviation 90X

elbo#s- "lexion 1le- dorsi"lex 40X, plantar "lexion .0X, eversion 40X, inversion 40X

Rnee- "lexion 10X

5ip- "lexion 100X, internal rotation .0X, ext rotation .0X Pulses!

Posterior ibial- . 6 . bilateral eual (orsalis Pedis- . 6 . . bilateral eual

V Capillary e"ill test! 4 se'onds nor$al/


56/133

I*" 'IST O+ NANDA5BASED OR (ORDON5BASED NURSIN( DIA(NOSIS

'IST O+


57/133

#RIORITI8ED

BASIS O+ #RIORITI8ATION

)USTI+I

NURSIN(

DIA(NOSIS


58/133

Circulation

$aslo0

Actual/

+ert/

atient*s

1Air0ay1

&otential

coert

erbali2ation

Breating


59/133

1+ *ati&ue related to the

*ati&ue or #ea>nes

bloodOs de'reased

'hie" 'o$plaint re&

he$o&lobin and


60/133

a"ter her 'esarean d

di$inished oxy&en-

also one o" the si&n

'arryin& 'apa'ity

Iron de"i'ien'y ane

4+ *luid volu$e de"i'it


61/133

hereOs a severe he

related to blood loss

delivery, blood loss

se'ondary to ane$ia

intravas'ular volu$


62/133

repla'e i$$ediatel

hypovole$ia and s

+ is> "or in"e'tion


63/133

5e$o&lobin served

related to de'reased

de"ense, a de'rease

he$o&lobin se'ondary

also $eans thereOs

to iron-de"i'ien'y


64/133

patho&ens to in"e't

3ne$ia+

espe'ially durin& h


65/133

hospital+

.+ (isturbed sleep

pattern related to

hospital noise and


66/133

li&htnin& se'ondary to

3ne$ia

9+ I$balan'ed nutrition!


67/133

8ess than body

reuire$ent related to


68/133

inadeuate inta>e o"

essential nutrients


69/133

se'ondary to 3ne$ia

"or Ine""e'tive

tissue per"usion related


70/133

to inadeuate blood

volu$e se'ondary to

ane$ia


71/133

B+ 3'tivity intoleran'e

related to i$balan'e

bet#een oxy&en supply


72/133

and de$and in the blood

related to &enerali?ed

#ea>ness se'ondary to

3ne$ia


73/133

=+ is> "or Constipation

related to insu""i'ient

physi'al a'tivity


74/133

se'ondary to 3ne$ia

;+ is> "or "all related to


75/133

&enerali?ed #ea>ness

se'ondary to 3ne$ia

10+ Sedentary li"estyle


76/133

related to de"i'ient

>no#led&e o" health

bene"its o" proper diet


77/133


78/133

In Wei&ht edu'in& pro&ra$ Preter$ irth Y=

#ee>s/

irth delivery via Cesarean se'tion

+- $+DIAB"E .ACT+R!

3&e! 3dult . years old/ 7ender! *Pre&nant/ 5eavy Menstruation 5is

havin& 3ne$ia

Preter$ irth

lood loss6 5e$orrha&e

(e'reased intravas'ular volu$e

(epletion o" iron stores in bone $arro#

Seru$ "erritin #ill be'o$e lo# Y 40-0 $'&68/

he 'o$pensatory in'rease in iron absorption 'auses an in'rease in iron-bindin& 'apa'ity IC6rans"errin le

Seru$ iron "alls to Y 90 T&6d8 and trans"errin saturation to Y

1


79/133

Erythropoiesis is i$paired

8o# 5e$o&lobin belo# 14$&6d8/

8o# 5e$ato'rit elo# @/

edu'tion in oxy&en-'arryin& 'apa'ity o" ed lood 'ell

S$all ed lood 'ell Mi'ro'yti'/ 8ess 5e$o&lobin than 3vera&lood 'ell 5ypo'hro$i'/

Si&ns and Sy$pto$s! *ati&ue6 7enerali?ed #ea>ness 5eada'he6 (i??iness

Pale s>in 'olor or Pallor Sore ton&ue 8i&ht-headedness #hen you


80/133

*I" NURSIN( CARE #'AN

Na$e! Patient 3

(ia&nosis! 3bnor$al Uterine leedin&, 3ne$ia Se'ondary

(ate and ti$e! 3u&ust 44, 4014 11p$-Ba$/

Assessment

Diagnosis

Scientific


81/133

#lanning

Im0lementation

Scientific Rationale

rationale

!ub3ectie

*ati&ue

Iron-

"ong term

Inde&endent

Data

related to

de"i'ien'y

,oal

Interention

JNan&hihina


82/133

the bloodOs

ane$ia is

3"ter 1<

Explain to the 'lient

o redu'e anxiety o"

a>o $ula

de'reased

a

5ours o" duty

the pro'edures and its

patient+

>a&abi, sobra

he$o&lobi

'o$$on a

he patient

purpose

o prepare the patie

ata >asi

n and

ne$ia lo

#ill be able


83/133

the Pro'edure+

pa&duru&o n&

di$inished

# red

o enhan'e

puson >o >aya

oxy&en-

blood 'ell

her

3ssess vital si&ns+

o evaluate "luid sta

si&uro a>o

'arryin&

level/

>no#led&e

and 'ardiopul$onar

nan&hihina+

'apa'ity

'aused by


84/133

about her

response to a'tivity+

Matanda na

se'ondary

insu""i'ien

disease, and

rin >asi a>o

to 3ne$ia

t dietary

to "a'ilitate

Evaluate need "or

o deter$ine the nee

nan&

inta>e and

health

individual assistan'e

"or doin& a'tivities o

nabuntisK as


85/133

absorption

pro$otion+

or assistive devi'e+

$ove$ent+

$ani"ested by

o" iron+

the $other+

!ort Term

%ne o" the

,oal

En'oura&e 'lient to do


86/133

o in'rease a'tivity

+b3ectie

Sy$pto$s

3"ter 1< hours

#hatever possible

as tolerated

Data

o" ane$ia

o" duty,

Pallor,

is

he patient

En'oura&e use o"

o 'onserve ener&y

&enerali?ed


87/133

&enerali?e

#ill be able to

assistive devi'es li>e

other tas>

#ea>ness,

d

verbali?e the

#heel'hair

With heavy

Wea>ness

understandin&

lo'hia rubra

and

o" individual

Instru't patient to sit


88/133


89/133


90/133

he patient

Iron ri'h "oods e+&+

#ill be able to

liver or ani$al

identi"y "oods

or&ans, e&&, "ish,

ri'h in iron

poultry, lea"y

and the

ve&etables and dried

patient #ill be

"ruits/

able to

verbali?e the

Instru't patien

dosa&e o" her

in'rease her "lu

$edi'ation+

inta>e+


91/133

!ort term

%bserve and $easure

+b3ectie

"luid losses e+&+

3"ter . hours

bleedin&/

o" health

tea'hin&, the

Provide %ral 'are

patient #ill be

able enhan'e

her a'tivities

o" daily livin&

Instru't the *a

as eviden'ed

bathe the patien


92/133

by report o"

other day+

i$proved

sense o"

7ive6ad$inister

ener&y+

$edi'ations as

Pleasurable a'ti

re"o'us ener&y

di$inish "eelin&

unhappiness an

slu&&ishness+

o In'rease the

ody iron o" the prevent ane$ia

in produ'in& $ r

blood 'ells+

o rehydrate the

o deter$ine repla

needs


93/133

*or patientOs 'o$"or to prevent dryness o $u'ous $e$brane+

o provide opti$

'are and to prev

dryness o" s>in+

o *ollo# patientO

therapeuti' re&i$e

instru'ted by the do'tor+

3d$inister lood trans"usion as ordered by the (o'tor+

epla'e ele'trolytes as ordered Insertin& I: "l

ordered/

Collaboratie

Interention!

e"er patient to adiolo&y e'hni'ian "or -ray

ordered by the do'tor+


94/133

stabili?e her #ellnes health+

o repla'e lood vo loss+

o repla'e ele'trolyt prevent dehydration "urthe

'o$pli'ation

*or "urther evaluatio and analysis o" the patient

disease+


95/133

Na$e! Patient 3

(ia&nosis! 3bnor$al Uterine leedin&, 3ne$ia Se'ondary

(ate and ti$e! 3u&ust 4, 4014 11p$-Ba$/

Assessment

Diagnosis

Scientific

#lanning

Im0lementation


96/133


rationale

!ub3ectie

*luid

Iron

"ong term

Inde&endent

Cues

volu$e

de"i'ien'y

,oal

Interention

JMedyo

de"i'it

durin& the

3"ter 1< hours


o redu'e anxiety o


97/133

nan&hihina pa

related to

pre&nan'y is

o" duty, the

the pro'edures and

patient+

rin a>o pero

blood loss

the 'ause o"

patient #ill be

its purpose

o prepare the patie

din na tulad

se'ondary

abnor$al

able to enhan'e

"or the Pro'edure+

n& >ahapon,

to ane$ia

uterine

her >no#led&e

na>a>atayo


98/133


99/133

heavy blood

"urther disease

a>o uha#K as

loss+

prevention+

Esti$ate pro'edural

o $onitor and obs

$ani"ested by

"luid losses and ta>e

other routes o" "luid

the $other+

Massive

!ort Term

note possible routes

losses

*luid


100/133

,oal

o" insensible loss+

+b3ectie

volu$e is

3"ter 1< hours

Cues

loss durin&

o" duty, he

Note 'o$plaints and

%ther si&n and

&enerali?ed

the delivery

patient #ill be

physi'al si&ns

sy$pto$s $ay indi

#ea>ness,

as a result

able to


101/133

asso'iated #ith

serious 'o$pli'atio

#ith lo'hia

the patient

verbali?e the

dehydration s'anty,

rubra

"elt #ea>

understandin&

'on'entrated urine,

and thirsty+

o" individual

'on"usion, $us'le

:ital si&ns!

therapeuti'

#ea>ness, li&ht


102/133


103/133

$$65&

"luid repla'e$ent

"ong term

needs+

ob3ectie

3"ter . hours

Instru't patie

o" health

in'rease her "l

tea'hin&, the

inta>e+

patient #ill be


104/133

able to

Maintain a''urate I

de$onstrate

%

behavior to

'orre't de"i'it+

Provide %ral

!ort term

+b3ectie

3"ter . hours

o" health

Instru't the *

tea'hin&,


105/133

to bathe the patient

he patient

every other day+

#ill able o

$aintain

Chan&e position

adeuate "luid

"reuently

volu$e as

eviden'ed by

Chan&e dres

adeuate

"reuently

urinary output

7ive6ad$ini


106/133

$edi'ations as

instru'ted by the

do'tor+

3d$inister lood

trans"usion as

ordered by the

valleys in "luid

o rehydrate t


107/133

o observe the pro& o" the 'urrent status the patient

*or patientOs 'o$"o and to prevent dryn o" $u'ous $e$bra

o provide opti$al 'are and to prevent dryness o" s>in+

o redu'e pressure "ra&ile s>in and tiss

o prote't s>in a

$onitor losses+

o *ollo# pati

therapeuti' re&

stabili?e her #

health+

o repla'e lood

loss+


108/133

(o'tor+


109/133

3d$inister I: "luids

o repla'e ele'troly

as indi'ated

to prevent dehydrat

and "urther

'o$pli'ations+


110/133

Collaboratie

Interention!

e"er patient to

*or "urther evaluati

adiolo&y

and analysis o" the

e'hni'ian "or -ray


111/133

patientOs disease+

as ordered by the

do'tor+


112/133


113/133


rationale

!ub3ectie

Iron

"ong term ,oal

Inde&endent

cues

de"i'ien'y

3"ter 1< hours o"

Interention

JEto $edyo

is> "or

durin& the

duty, the patient


o redu'e anxiety o"


114/133

nan&hihina

In"e'tion

pre&nan'y

#ill be able to

the pro'edures and

patient+

at

related to

is the

enhan'e her

its purpose

o prepare the patien

na&duru&o

de'reased

'ause o"

>no#led&e about

the Pro'edure+

pa rin an&

he$o&lobi

abnor$al

her disease, and

puson >o,


115/133

n

uterine

to "a'ilitate

3ssess vital si&ns

Chan&es in vital si&n

pero di na

se'ondary

bleedin&

health pro$otion

notin& blood pressure

asso'iated #ith "luid

>asin& la>as

to iron-

durin& the

and "urther

volu$e loss or other

n& >ahaponK

de"i'ien'y

labor and

disease

'o$pli'ations+

as


116/133

ane$ia+

resultin&

prevention+

$ani"ested

in heavy

%bserve "or lo'ali?ed

o deter$ine possibl

by the

blood loss+

!ort Term

si&ns o" in"e'tion at

in"e'tion and to avoid

$other+

,oal

insertion sites o"

"urther 'o$pli'ation


117/133

5e$o&lob

3"ter 1< hours o"

invasive sites or I:*

+b3ectie

in served

duty, the patient

insertion sites/ and

Data

as a

#ill able to

#ound site+

&enerali?ed

se'ondary

i$prove #ound

#ea>ness,

de"ense, a


118/133

healin& and #ill

Stress proper hy&iene

3 "irst line o" de"ens

va&inal

de'reased

not $ani"est any

by all 'are&ivers

a&ainst health'are

bleedin&

in

si&n o" in"e'tion+

bet#een therapies and

asso'iated in"e'tions

lo'hia

he$o&lobi

'lients

53Is/

rubra/

n also

"ong term


119/133

$eans

ob3ectie

E$phasi?e proper use

*or personal prote'tio

:ital si&ns!

thereOs an

3"ter . hours o"

o" personal prote'tive

yoursel" and the patie

!


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P! ;0 'p$

the

able to

the a&en'yOs proto'ol

P! 1106B0

patho&ens

de$onstrate

$$65&

to in"e't

te'hniues in

Maintain steril

the patient

li"estyle 'han&e

te'hniue "or al

espe'ially

to pro$ote sa"e

invasive pro'ed

durin& her

environ$ent


121/133

stay in the

e'o$$end routine

hospital+

!ort term

sho#er or s'rubs+

+b3ectie

3"ter . hours o"

Instru't the patient

health tea'hin&,

and her relative about

the patient and

proper hand #a

her relative #ill

be able to

Chan&e #ound

de$onstrate

dressin&s usin&

behavior to

proper te'hniu


122/133

prevent and

'han&in& and

redu'e ris> in

disposin& o"

in"e'tion e+&+

'onta$inated

hand #ashin&

$aterials+

and 'han&e o"

dressin&/

Cover perineal

pelvi' re&ion #

usin& a bedpan+

En'oura&e e

a$bulation, dee


123/133

breathin&, and

'ou&hin& and position

'han&es+

Maintain adeuate

hydration, stand or sit

o redu'e 'onta$

o redu'e ba'terial

'oloni?ation+

asi' in"e'tion and

'onta$ination 'ont


124/133

o prevent 'onta$ina and redu'in& the o''urren'e o" in"e'tio

o prevent 'onta$ina

*or $obili?ationrespiratory, and

prevention o" asp

respiratory in"e'

o avoid bladder d

and urinary


125/133

to void+

stasis


126/133

Provide perineal 'are

o redu'es ris> o"

as'endin& urinary tra

in"e'tion

Provide %ral 'are

*or patientOs 'o$"ort


127/133

to prevent dryness o"

$u'ous $e$brane+

7ive6ad$inister

o *ollo# patientOs

$edi'ations as

therapeuti' re&i$en t


128/133

instru'ted by the

stabili?e her #ellness

do'tor+

health+

3d$inister lood

o repla'e lood vol

trans"usion as ordered

loss+


129/133

by the (o'tor+

3d$inister I: "luids

o repla'e ele'trolyte

as indi'ated

prevent dehydration a

"urther 'o$pli'ations

Collaboratie


130/133

Interention!

%btain appropriate

*or "urther evaluation

tissue or "luid

analysis o" the patient

spe'i$ens "or

disease+


131/133

observation and

'ulture and sensitivity

test


132/133

RE.ERECE!

NurseOs Po'>et 7uide by E+3+ (avis/

Maternal Child 5ealth Nursin& ipedia+or& "or (e"inition o" ter$s/

http!66###+n'bi+nl$+nih+&ov6pub$edhealth6PM500016pre&nan'y6$edi'ines6synto'inon+ht$l

http!66###+s'ribd+'o$6do'6BB101;063ne$ia-NCP

ato&ysiology references

5andboo> o" Medi'al-Sur&i'al Nursin& 11th

Edition by runner Suddhart/

Maternal Child 5ealth Nursin& <th

Edition :olu$e 14 8ippin'ott-Willia$s Wil>ins/

http!66###+$er'>$anuals+'o$6pro"essional6he$atolo&yZandZon'olo&y6ane$iasZ'ausedZby

Zde"i'ientZerythropoiesis6ironZde"i'ien'yZane$ia+ht$l http!66nursin&'rib+'o$6nursin&-notes-

revie#er6$aternal-'hild-health6iron-de"i'ien'y-ane$ia6 http!66###+na$rata+'o6'ase-study-iron-

de"i'ien'y-ane$ia6

5andboo> o" Medi'al-Sur&i'al Nursin& 11th

Edition by runner Suddhart/


133/133

Maternal Child 5ealth Nursin& <th

Edition :olu$e 14 8ippin'ott-Willia$s Wil>ins/

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