DRUG STUDY

DRUG ORDER

MECHANISM OF ACTION - Inhibits bacterial cell wall synthesis, rendering the cell wall osmotically unstable, leading to cell death

INDICATIONS

CONTRAINDICATIONS

ADVERSE EFFECT - Anaphylaxis - Leukopenia - Diarrhea

Generic Name: Brand name:

Cephalexin

Keflex

Classification: Antimicrobial and Antiparasitic Route: Oral

1. Treatment of LRTI 2. Skin and soft tissue infections 3. Pre-operative prophylaxis to reduce chance of post-operative surgical infections

- Hypersensitivity to cephalosporins - Hyperbilirubemic neonates

NURSING RESPONSIBILTY PRECAUTION - Instruct the patient to take the medication as prescribed by the doctor even if she feels better

Dosage:

250-500 mg

Frequency:

250 mg q 6

NURSING CARE PLAN Cesarean Section

ASSESSMENT NURSING DIAGNOSIS - Risk for fluid volume deficit, may be related to excessive vascular loss possibly evidenced by hypotension, tachycardia and tachypnea. SCIENTIFIC ANALYSIS - Cesarean delivery is the surgical removal of the infant from the uterus through an incision made in the abdominal wall. Due to this the patients skin and tissue were mechanically interrupted. OBJECTIVE INTERVENTION RATIONALE EVALUATION

Subjective cues: none Objective cues: - V/s taken as follows: T- 36.3 P- 73 R- 20 BP- 100/70

Short Term: After 2 hours of nursing interventions the patient will: - Demonstrate adequate perfusion and stable vital signs

Independent: - Monitor V/S

- Inspect dressing for blood and weigh - Instruct the mother in relaxation or visualization excersises

- To obtain baseline data to determine if the patient is showing signs of shock - To measure the amount of blood loss - Promotes relaxation and may enhance the patients coping abilities by refocusing attention

After the nursing interventions the goals were met: - Patient has adequate perfusion and stable vital signs

DRUG STUDY
DRUG ORDER MECHANISM OF ACTION Methergine Stimulates uterine smooth muscles producing sustained contractions thereby shortens the third stage of labor INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT Hypertension Dizziness Headache Nausea/vomiting tinnitus NURSING RESPONSIBILTY PRECAUTION - Obtain v/s before adm. the drug - Monitor uterine contractions - Be alert for adverse reactions and drug interactions

Generic Name: Brand name:

Methylergonovine maleate Methergine

Classification: Anti-ulcer agent

1. Prevention and treatment of postpartum hemorrhage caused by uterine atony or subinvolution

- Hypertensive patients - Hypersensitivity to the drug

Route:

IV

Dosage:

50 mg IV q 12 x 4 doses

Frequency:

DRUG STUDY

DRUG ORDER

MECHANISM OF ACTION - Ponstan has analgesic, antiinflammatory and antipyretic properties. It inhibits the synthesis of prostaglandins

INDICATIONS

CONTRAINDICATIONS

ADVERSE EFFECT Dizziness Flushing Headache Visual Disturbances - Tachycardia - Palpations - pancreatitis

Generic Name: Brand name:

Mefenamic Acid Ponstan

1. Relief of pain - Presence of including post-op hypersensitivity to the and postpartum drug pain, headache as - Ulceration in the GI well as relief of tract. primary dysmenorrhea

NURSING RESPONSIBILTY PRECAUTION - Educate patient about common side effects after taking the drug

Classification: Antiinflmmatory; Analgesic Route: Oral

Dosage:

Frequency:

DRUG STUDY

DRUG ORDER

MECHANISM OF ACTION - Stimulates peristalsis. Also alters the fluid and electrolyte transport producing fluid accumulation in the colon

INDICATIONS

CONTRAINDICATIONS

ADVERSE EFFECT Abdominal pain Nausea Vomiting headache

Generic Name: Brand name:

Bisacodyl

Dulcolax

1. Treatment of constipation 2. Promote normal bowel movement after surgery

- Presence of hypersensitivity to the drug - Abdominal pain - Nausea - Vomiting

Classification: Stimulant laxative Route: Oral

NURSING RESPONSIBILTY PRECAUTION - Assess for abdominal distention, bowel sounds, and usual pattern of bowel elimination - Assess amount, consistency and color of stool produced

Dosage:

5 mg

Frequency:

NURSING CARE PLAN Cesarean Section

ASSESSMENT NURSING DIAGNOSIS - Risk for infection related to inadequate primary defenses secondary to surgical incision SCIENTIFIC ANALYSIS - Cesarean delivery is the surgical removal of the infant from the uterus through an incision made in the abdominal wall. Due to this the patients skin and tissue were mechanically interrupted. Thus, the wound is at risk of developing infection. OBJECTIVE INTERVENTION RATIONALE EVALUATION

Subjective cues: none Objective cues: - V/s taken as follows: T- 36.3 P- 73 R- 20 BP- 100/70

Short Term: After 2 hours of nursing interventions the patient will: - Be able to understand the causative factors, identify signs of infection and report them to the health care provider accordingly.

Independent: - Monitor V/S

- Inspect dressing and perform wound care - Monitor for elevated temperature, redness, swelling, increased pain, or purulent drainage at incisions. - Wash hands and teach other caregivers and relatives to wash hands before contact with the patient and between procedures as well.

- To obtain baseline data to determine if the patient is showing signs of infection. - Moist from drainage can be a source of infection as well as an unclean wound - These are signs of infection

After the nursing interventions the goals were met: - Patient is expected to be free of infection, as evidenced by normal vital signs and absence of drainage from the wound.

- Hand washing reduces the risk of transmitting pathogens from infecting the wound

NURSING CARE PLAN Cesarean Section

ASSESSMENT NURSING DIAGNOSIS - Acute pain related to abdominal incision as evidenced by verbal reports SCIENTIFIC ANALYSIS - Acute pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage. It is due to the abdominal incision done for her cesarean section delivery OBJECTIVE INTERVENTION RATIONALE EVALUATION

Subjective cues: masakit ang tahi sa tyan ko.. as verbalized by the patient Objective cues: - Guarded/protective movement - Facial grimace - Irritable

Short Term: After 1 hour of nursing interventions the patient will: - Be able to verbalize management of pain or pain tolerance - Decrease facial grimace - Have little or no guarded/protectiv e movement

Independent: - Monitor V/S

- Accept clients description of pain - Perform comfort measures such as arranging bed linens - Educate the mother about performing relaxation techniques such as deep breathing Collaborative: - Give analgesics as ordered by the physician

- To obtain baseline data to determine if the patient is showing signs of infection. - Pain is subjective and cant be felt by others. - To promote comfort and safety - To distract the patients mind from pain.

After the nursing interventions the goals were met: - The patient was able to verbalize management of pain, has decreased facial grimace and little or no guarded/protecti ve movement.

- To reduce sensation of pain and inflammation

NURSING CARE PLAN CORD PROLAPSE

ASSESSMENT NURSING DIAGNOSIS - Impaired gas exchange (fetal) related to interruption of blood flow from placenta to fetus SCIENTIFIC ANALYSIS - Prolapsed umbilical cord occurs when the babys umbilical cord falls in to the birth canal ahead of the babys head or other parts of the babys body. Malpresentatio n is one of the factors that contribute to this OBJECTIVE INTERVENTION RATIONALE EVALUATION

Objective cues: - The cord is visible and palpable - Membranes are ruptures - Changes in FHR

Short Term: After 30 minutes of nursing interventions the patient will: - FHR will return to normal

Independent: - Change maternal position into kneechest position.

- To reliev pressure of the presenting part so that the oxygen can get through the fetus - To prevent drying of cord - Expedite termination of threat to infant

- Cover cord with a gauss soaked in saline solution - Prepare for immediate cesarean birth Collaborative: - Give terbutaline as per doctors order

After the nursing interventions the goals were met: - FHR returned to normal - Uncomplicated birth of the viable child

- To stop the contractions relieving pressure on the cord

NURSING CARE PLAN Placenta Previa

ASSESSMENT NURSING DIAGNOSIS - Impaired fetal gas exchange related to altered blood flow and decreased surface area of gas exchange at site of placental detachment SCIENTIFIC ANALYSIS
- The

OBJECTIVE

INTERVENTION

RATIONALE

EVALUATION

Subjective cues: I am bleeding and I am getting worried about it as verbalized by the patient Objective cues: - Changes in fetal heart rate - V/s taken as follows: T- 36.9 P- 95 R- 20 BP- 110/60

Short Term: After 8 hours of nursing interventions the patient will: - Be able to understand the causative factors and perform appropriate interventions to be done

development of the placenta in the lower uterine segment, partially or completely covering the internal cervical os.

Independent: - Monitor vital signs closely

- Monitor amount and type of bleeding - Promote bed rest and maintain a quite environment - Position mother in left side lying position Collaborative: - Administer oxygen as indicated

- To obtain baseline data for comparison to detect any anomalies as well as a rough estimate of blood loss - Provide objective evidence for prompt intervention - Prevents fatigue and improves strength of the patient - To promote placenta perfusion

After 8 hours of nursing interventions the: - Patient was able to understand the causative factors and perform the appropriate interventions.

- Provides adequate

fetal oxygenation to compensate for lowered maternal blood volume.

NURSING CARE PLAN Premature Rupture of Membranes

ASSESSMENT NURSING DIAGNOSIS - Risk for infection related to loss of protective barrier SCIENTIFIC ANALYSIS
- Premature

OBJECTIVE

INTERVENTION

RATIONALE

EVALUATION

Subjective cues: I experienced a sudden gush of water and I havent felt any labor contractions as verbalized by the patient Objective cues: - Changes in fetal heart rate - V/s taken as follows: T- 37.0 P- 85 R- 18 BP- 130/80

Short Term: After 8 hours of nursing interventions the patient will: - Be free from any signs and symptoms of infections such as foul smelling vaginal secretions and elevated temperatures

rupture of membrane is the spontaneous rupturing of the amniotic membranes before the onset of true labor. PROM can result in two major complications, cord prolapse and the fetus and the mother can develop an infection

Independent: - Monitor vital signs closely

- Monitor Fetal Heart tone - Promote bed rest and maintain a quite environment - Position mother in left lateral position

- To obtain baseline data for comparison to detect any signs of infection like rising temperature - To determine whether or not the fetus is in distress - Prevents fatigue and improves strength of the patient - To help in the circulation and avoid compressing the vena cava to supply the fetus with oxygen

After 8 hours of nursing interventions the: - Patient is free from signs and symptoms of infection

Physiology of Breech Presentation: Fetus moves and tends to seek the most comfortable position in the uterus Non-Modifiable Factors: - Multiple foetuses - Uterine abnormalities - Placenta Previa - Polyhydramnios

Modifiable Factors: - Number of Pregnancies

Overtime the fetus will fidget and maneuver around the head gravitates to the largest space of the uterus which is the lower uterine space.

In this case the mothers lower uterine space is not the largest due to factors like placenta previa, congenital abnormalities and many others Diagnostic Test: - Ultrasound - Leopolds maneuver - FHT is located at the upper quadrants of the mothers abdomen

The fetus presentation is breech position, at about 32 weeks this position will be permanent.

Treatment: - External version

Breech position = C-Section