Ovarian New Growth

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


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Refer for unusualities

Refer. Thank You.

For monitoring so that all unusualities will be referred as follows



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.


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





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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



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





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, 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


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 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





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

Refer. Thank you

In preparation for possible blood transfusion


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 consider the proper transferring of the patient


Pls. give Hydrocortisone 250mg IVTT now

Refer. Thank You

Hydrocortisone- to prevent allergic reaction pre-BT


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.


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


Compliance to medication may avert further complications


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 facilitate urination until pt. is able to void in his own and to gauge fluid balance and give valuable information about clients on condition



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 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 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



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


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

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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. 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




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


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


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


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.


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


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


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


USUAL DOSE

ACTUAL DOSE


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


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


USUAL DOSE

ACTUAL DOSE

SIDE EFFECT


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.


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


USUAL DOSE

ACTUAL DOSE


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


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


USUAL DOSE

ACTUAL DOSE

SIDE EFFECT


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



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


USUAL DOSE

ACTUAL DOSE

SIDE EFFECT


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


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


USUAL DOSE

ACTUAL DOSE

SIDE EFFECT


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



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


USUAL DOSE

ACTUAL DOSE


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


USUAL DOSE

ACTUAL DOSE


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,


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


USUAL DOSE

ACTUAL DOSE


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


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


USUAL DOSE

ACTUAL DOSE


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


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


USUAL DOSE

ACTUAL DOSE


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


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

49 | P a g e

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


USUAL DOSE

ACTUAL DOSE

SIDE EFFECT


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



Patients with asthma, aspirin-induced allergy are at increased risk of developing hypersensitivity reaction

Assess the characteristic,

50 | P a g e

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

51 | P a g e

demonstrated by verbalization of decreased in severity of pain.

GENERIC

NAME

BRAND

NAME

GENERAL CLASSIFIC

ATION

MODE OF ACTION


USUAL DOSE

ACTUAL DOSE

SIDE EFFECT


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



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,

52 | P a g e

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


USUAL DOSE

ACTUAL DOSE

SIDE EFFECT


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



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 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


Apply manual pressure and dressings over puncture site.



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.




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.



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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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Documents

Ovarian New Growth