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I.

INTRODUCTION
The purpose of this case study is to be familiar with Molar Preg a cy! "ow it is start# what are the causes a d what are the sig s a d symptoms! especially how to pre$e t# treat a d ma age the patie t by gi$i g medicatio for treatme t a d pro$idi g rapport. .%e chose this case study because this is the first time we&$e e cou tered i the e tire rotatio a d because some of the patie t i O' (emale semi)pri$ate room *(+PR, are Normal +po ta eous Deli$ery *N+D,. My group is also fo d to - ow about the importa t thi gs to co sider a d word to discuss about this case. .estatio al Trophoblastic Disease is proliferatio a d dege eratio of the trophoblastic $illi. /s the cells dege erate #they become filled with fluid ..rape 0 si1ed $esicles #diag ostic of multiple preg a cy or a miscalculated .No fetal heart sou d are heard because there is o $iable fetus. This fact must be e$aluated carefully

II. P/TI2NT "2/3T" "I+TOR4


A. PERSONAL DATA O or about +ept. 56# 7889 at :;68 pm# <.=. was admitted at +a <ua Medical Ce ter with chief complai t of $agi al bleedi g. +he was placed o Deli$ery Room# with D>% 53 ? @A was admi istered. Routi e laboratory wor-)up was do e li-e ultrasou d# chest ?)ray# a d 2C.. Placed o moderate high bac- rest# the Prior to admissio she the e?perie ce high 'P ele$atio a d the doctor gi$e him Catapres as relief to her co ditio . The after the doctor has see that she ha$e relief from her co ditio # she was the placed o (emale +emi) Pri$ate 'ed B. I=&s a d oral meds were co ti ued gi$e to her due to her high 'P results. The doctors of +<MC ma-e a pla that <= must u dergo to a operatio called "4+T2R2CTOM4# were i the patie t will u dergo to a certai operatio / surgical operatio to remo$e the uterus a d# sometimes# the cer$i?. Remo$al of the e tire uterus a d the cer$i? is referred to as a total hysterectomy. Remo$al of

the body of the uterus without remo$i g the cer$i? is referred to as a subtotal hysterectomy. B. PRESENT ILLNESS OR PRESENT HEALTH STATUS 7 Days PT/ 0 *C, $agi al bleedi g with hypogastric pai # co sulted at 2ast /$e ue Medical Ce ter. *C, cough# o )producti$e *C, dysp ea +he was diag osed with Molar Preg a cy# 56)5> wee-s /O.# .9P> TP/3 *>)8)5)>, C. PAST MEDICAL HISTORY The clie t stated that she had measles whe she was 57 yDo. +he does &t ha$e a y allergies a d past i Euries# a d ha$e complete immu i1atio s whe she was a child. +he does &t smo-e a d dri - alcohol. D. FAMILY HEALTH HISTORY The patie t stated that her family has a history of "yperte sio . +he also stated that they do &t ha$e history of Diabetes# Tuberculosis a d other hereditary disease. E. PHYSICAL ASSESSMENT +-i U iform color with warm temperature# dry a d smooth. No scars a d hairs are e$e ly distributed. Nails 3o g a d slightly dirty "ead a d (ace The s-ull is proportio ate to body si1e# o te der ess. "air is oily# thica d e$e ly distributed. (ace is symmetrical a d symmetrical facial mo$eme t.

2yes The clie t has straight ormal eye co ditio ! pupil is blac- i color a d eFual i si1e. "as thi eyebrows. Nose The ose is i septum is i midli e# mucosa is pale! both pate t but ha$e watery secretio . Mouth The lips are pale# symmetrical# pale mucosa# to gue is i midli e. NecThe s-i is u iform i color. Nec- muscles are eFual i si1e a d o te der ess. 'reast a d /?illa No masses# te der ess upo palpatio /bdome U iform i color. +ymmetrical mo$eme t. There is prese ce of scar a d masses# pai # te der ess upo palpatio . It is because she is sufferi g ")mole preg a cy. /bdome has a u lil-e o ormal preg a cy. Upper 2?tremities There is resista ce for muscle stre gth. The s-i has scar. 3ower 2?tremities There is resista ce for muscle stre gth. The s-i has scar. irregular e largeme t

III. /N/TOM4 /ND P"4+IO3O.4


The uterus is a hollow muscular orga betwee located i the female pel$is the bladder a d rectum. The o$aries produce the eggs that tra$el

through the fallopia tubes. O ce the egg has left the o$ary it ca be fertili1ed a d impla t itself i the li i g of the uterus. The mai fu ctio of the uterus is to ourish the de$elopi g fetus prior to birth.

External Female Reproductive System 2scutcheo mo s $e erisDpubis clitoris s-e e&s gla d *para urethral gla d, $estibule bartholi s gla d *$ul$o $agi al gla d, hyme fourchette fre ulum labia mi ora labia maEora peri eum a us Internal Female Reproductive System (u dus Corpus Isthmus o$aria ligame t fallopia tube 4 parts of fallopian tube I terstitial)5 Isthmus)7 *tubal ligatio , /mpulla)> *site of fertili1atio I fa dibulum)7 Uterus "ead) fu dus 'ody) corpus Nec-) isthmus

Corpus- 3 layers 2 dometrium Myometrium Perimetrium Isthmus- 3 parts I ter al os Cer$ical ca al 2?ter al os

I=. DI/.NO+I+
A. DEFINITION "ydatidiform mole is a rare mass or growth which arise from fetal tissue that may form i side the uterus at the begi i g of a preg a cy. (reFue tly there is o fetus at all. I the complete or classic mole# there is mar-ed edema a d e largeme t of the $illi with disappeara ce of the $illous blood $essels. There is proliferatio of the trophoblastic li i g of the $illi. The fetus# cord a d am iotic membra e are abse t! -aryotype is ormal. The i complete or partial mole is characteri1ed by mar-ed swelli g of the $illi a d atrophic trophoblastic cha ges. U li-e the classic mole# the fetus# cord a d am iotic membra e are prese t a d -aryotype is ab or al# e.g.# triploidy or trisomy. The cause is ot completely u derstood although pote tial causes# e.g.# defects of the o$um *egg,# ab ormalities withi the uterus# a dDor utritio al deficie cies# ha$e bee suggested. The i cide ce is i creased i wome u der 78 or o$er 68 years old. Ris- factors implicated i clude low socioeco omic status a d diets low i protei # folic acid# a d carote e B. RISK & PRE-DISPOSING FACTOR The co ditio te ds to occur most ofte i wome who ha$e a low protei i ta-e i you g wome *u der age of 5@ years,#i wome years a d i wome of /sia heritage. %ith a complete mole#all trophoblastic $illi swell a d become cystic. If a embryo forms#it dies early at o ly 5 to 7mm i si1e with o fetal blood prese t i the $illi.O chromosomal a alysis #although the -aryotype is ormal 6B?? or 6B?y#this chromosome compo e t was co tributed o ly by the father or a Hempty o$umI was fertili1ed a d the chromosome material was duplicated with a partial mole# some of the $illi from ormally .The sy cytio)trophoblastic layer of $illi#howe$er #is swolle a d misshaper. /lthough o embryo is prese t fetal blood may be prese t i the $illi./ macerate embryo of appro?imately : wee-s gestatio may be prese t./ partial mole has B: chromosomes *a triploid older tha age of G>

formatio i which there are G chromosomes i stead of 7 for e$ery pair o e set supplied by a o$um that appare tly was fertili1ed by 7 sperm or a o$um fertili1ed by o e sperm i which meiosis or reductio di$isio did ot occur,.this could also occur if o e set of 7G chromosomes was supplied by o e sperm a d a o$um that did ot u dergo reductio di$isio supplied 6B. The cause os ot completely u derstood .Pote tial causes may i clude defects i the egg#problems withi the uterus# or utritio al deficie cies. %ome u der 78 or o$er 68 years of age ha$e a higher ris-. Other ris- factors may i clude diets low protei #folic acid a d carote e. C. SIGNS AND SYMPTOMS +ymptoms occur i co Eu ctio with a pote tial# suspected# or co firmed preg a cy! $agi al bleedi g i preg a cy *first or seco d trimester,! ausea a d $omiti g# se$ere e ough to reFuire hospitali1atio i 58J of cases! ab ormal si1e i uteri e growth for stage of preg a cy with >8J of cases with e?cessi$e i growth a d appro?imately 5DG of cases with smaller tha e?pected! symptoms of hyperthyroidism# e.g.# rapid heart rate# restless ess# a d more moist tha usual i er$ous ess heat i tolera ce u e?plai ed weight loss# loose stools# trembli g ha ds# s-i warmer about 58J of cases! symptoms co siste t with preeclampsia# e.g.# high blood pressure swelli g i feet# a -les# legs protei uria# that occur i the 5st or early i the 7 d trimester! abdomi al pai due to theca lutei cysts. "ydatidiform moles ca e?aggerate the usual symptoms of preg a cy. Ma y of the symptoms are similar to those associated with miscarriage# a d most wome with molar preg a cies first belie$e they ha$e miscarried. I $asi$e moles a d choriocarci omas ca cause symptoms duri g or after preg a cy# a d symptoms ca de$elop after a hydatidiform mole has bee remo$ed. The most commo symptom is $agi al bleedi g# especially betwee the Bth a d 5Bth wee-s of preg a cy. / other symptom is bleedi g that co ti ues for a lo g time after deli$ery. +mall amou ts of bleedi g ca show up as a watery brow discharge from the $agi a. +ometimes# a piece of tissue co tai i g

grapeli-e shapes will pass through the $agi a# though this is ot commo . It is importa t to remember that most $agi al bleedi g duri g or after preg a cy is ot associated with a molar preg a cy. "owe$er# you should report a y bleedi g duri g preg a cy to your health care professio al. / mole or choriocarci oma also ca cause the followi g symptoms; /bdomi al swelli g# caused by the uterus becomi g larger# which occurs more rapidly tha e?pected for the first trimester of preg a cy 2?cessi$e $omiti g duri g preg a cy (atigue# ofte caused by a emia from hea$y bleedi g +udde se$ere abdomi al pai caused by i ter al bleedi g Pel$ic crampi g or $agi al discharge +hort ess of breath# coughi g or blood i coughed)up secretio s because choriocarci oma $ery rarely spreads to the lu gs before it is diag osed There are ma y other causes for these symptoms# so if you ha$e such problems do Kt assume you ha$e a molar preg a cy. /lways spea- with your health care professio al. Usually# these symptoms are associated with a ormal preg a cy.

D. DIAGNOSTIC AND LABORATORY 3/'OR/TOR4 2L/MIN/TION 5., COMP32T2 '3OOD COUNT; 7., P3/T232T+ COUNT M /deFuate E!"#$%$&' "2MO.3O'IN "2M/TOCRIT R2D '3OOD C233 %"IT2 '3OOD C233 +IFFERE(#I"% C$U(#, N2UTROP"I3+ 34MP"OC4T2+ 2O+INOP"I3+ MONOC4T2+ '/+OP"I3+ +T/'+ 8.9> 8.5> 8.8@ NOT DON2 NOT DON2 NOT DON2 8.G@ ) 8.B@ 8.77 ) 8.>G 8.85 ) 8.89 8.8> ) 8.57 8.887 ) 8.85 8.8 ) 8.8> I creased because of %'C ele$atio Decreased because immu e system is affected I creased due to parasitic i fectio NOT DON2 NOT DON2 NOT DON2 RESU%# @B 8.7> 7.@9 55.7 ($R!"% )"%UES 578 ) 598 gD3 8.G9 ) 8.>6 6.8 ) B.8 ? 5857 3 6.> ) 58 ? 58: 3 I(#ER*RE#"#I$( Decrease protei productio causi g a emia Decreased because the patie t has +ig ifica t with hemorrhage Decrease O7 productio due to =agi al bleedi g that cause a emia +lightly i creased because i fectio started

G., R2D C233 MORP"O3O.4 MC= *M2/N CORPU+CU3/R =O3., M :8 3 (5 I=.U *@8 0 :B f5, 6., P2RIP"2R/3 +M2/R MC" *M2/N CORPU+CU3/R "2MO.3O'IN, M G8.8 pg I=.U *79 0 GG pg, MC"C *CORPU+CU3/R "2MO.3O'IN CONC2NTR/TION, M GG 3 :D3 I=.U *G78 0 GB8 :D3, D2(INITION O( T2RM+ INDIC/T2D IN T"2 3/'OR/TOR4 2L/MIN/TION COMP32T2 '3OOD COUNT *C'C, ) / complete blood cou t *C'C,# also - ow as full blood cou t *('C, or full blood e?am *('2, or blood pa el# is a test reFuested by a doctor or other medical professio al that gi$es i formatio about the cells i a patie tKs blood. / Medical tech ologist performs the reFuested testi g a d pro$ides the reFuesti g Medical Professio al with the results of the C'C. / C'C is also - ow as a NhemogramN. ) The cells that circulate i the bloodstream are ge erally di$ided i to three types; white blood cells *leu-ocytes,# red blood cells *erythrocytes,# a d platelets or thrombocytes. /b ormally high or low cou ts may i dicate the prese ce of ma y forms of disease# a d he ce blood cou ts are amo gst the most commo ly performed blood tests i medici e.

R2D '3OOD C233+ *2R4T"ROC4T2+, ) ) /re the most commo type of blood cells a d the $ertebrate body&s pri cipal mea s of deli$eri g o?yge from the The umber of red cells is gi$e as a absolute umber per litre. lu gs or grills to body tissue $ia blood.

"2MO.3O'IN ) ) Is a protei that is carried by the red cells. It pic-s up o?yge i the lu gs a d deli$ers it to the peripheral tissues to The amou t of hemoglobi i the blood# e?pressed i grams per litre. *3ow hemoglobi is called a emia., mai tai the $iabilty of the cells.

"2M/TOCRIT OR P/CO2D C233 =O3. *PC=, ) This is the fractio of whole blood $olume that co sists of red blood cells.

M2/N CORPU+CU3/R =O3. *MC=, ) the a$erage $olume of the red cells# measured i femtolitres. / emia is classified as microcytic or macrocytic based o whether this $alue is abo$e or below the e?pected ormal ra ge. Other co ditio s that ca affect MC= i clude thalassemia a d reticulocytosis. M2/N CORPU+CU3/R "2MO.3O'IN *MC", ) ) the a$erage amou t of hemoglobi per red blood cell# i picograms. It is dimi ished i microcytic a emias# a d i creased i macroa emias.

It is calculated by di$idi g the total mass of hemoglobi by the R'C cou t.

M2/N CORPU+CU3/R "2MO.3O'IN CONC2NTR/TION *MC"C, ) ) the a$erage co ce tratio of hemoglobi i the cells. It is dimi ished *HhypochromicI, i microcytic a emias# a d ormal *H ormochromicI, i macro a emias *due to

large cell si1e# though the hemoglobim amou t or MC" is high# the co ce tratio remai s ormal,. %"IT2 '3OOD C233+ *32UOOC4T2+, ) ) /re cells of the immu e system which defe d the body agai st both i fectious disease a d foreig materials. /ll the white cell types are gi$e as a perce tage a d as a absolute umber per litre.

/ complete blood cou t with differe tial will also i clude; N2UTROP"I3+ ) ) This is the mai defe der of the body agai st i fectio a d a tige s. "igh le$els may i dicate a acti$e i fectio . May i dicate bacterial i fectio . May also be raised i acute $iral i fectio s.

34MP"OC4T2+ ) ) Is a type of blood cell i the $ertebrate immu e system. 2le$ated le$els may i dicate a acti$e $iral i fectio s.

"igher with some $iral i fectio s such as gla dular fe$er a d. /lso raised i lymphocytic leu-aemia C33.

MONOC4T2+ ) ) ) May be raised i bacterial i fectio Is a leu-ocyte# part of the immu e system that protects agai st bloodbor e pathoge s a d mo$es Fuic-ly to sites 2le$ated le$els may i dicate a allergic reactio s or parasites.

of i fectio s i the tissue.

2O+INOP"I3+ ) ) ) /re white blood cells of the immu e system that are respo sible for combati g i fectio by parasites i $ertebrates. I creased i parasitic i fectio s. "igh le$els are fou d i allergic reactio s. They are gra ulocytes that de$elop i the bo e marrow before migrati g i to blood.

'/+OP"I3+ ) ) Circulates $hite blood cells. 'asophils degra ulate to release histami e# proteoglyca s *e.g. hepari a d cho droiti ,# a d proteolytic e 1ymes

*e.g. elastase a d lysophospholipase,. They also secrete lipid mediators li-e leu-otrie es# a d se$eral cyto-i es. P3/T232T COUNT

Platelets or thrombocytes are the cell fragme ts circulati g i the blood that are i $ol$ed i the cellular

mecha isms of primary hemostasis leadi g to the formatio of blood clots. Dysfu ctio or low le$els of platelets predisposes to bleedi g# while high le$els# although usually asymptomatic# may i crease the ris- of thrombosis. ) ) (u ctio s of Platelets ca be ge eralised i to a umber of categories; /dhesio # /ggregatio # Clot retractio # Pro) / ormal platelet cou t i a healthy perso is betwee 5>8#888 a d 688#888 per mmP of blood *5>80688 ? 58:D3,. Coagulatio # Cyto-i e sig alli g# Phagocytosis. :>J of healthy people will ha$e platelet cou ts i this ra ge. +ome will ha$e statistically ab ormal platelet cou ts while ha$i g o ab ormality# although the li-elihood i creases if the platelet cou t is either $ery low or $ery high. ) 3ow platelet cou ts are ge erally ot corrected by tra sfusio u less the patie t is bleedi g or the cou t has falle below > ? 58:D3! it is co trai dicated i thrombotic thrombocytope ic purpura *TTP, as it fuels the coagulopathy. I patie ts ha$i g surgery# a le$el below >8 ? 58:D3, is associated with ab ormal surgical bleedi g# a d regio al a aesthetic procedures such as epidurals are a$oided for le$els below @8)588. R2D '3OOD C233 MORP"O3O.4 ) ) /lso - ow as 'lood +mear# a d Ma ual differe tial. %as o ce prepared o early e$eryo e who had a complete blood cou t *C'C, performed. %ith the automated

blood cell cou ti g i strume ts curre tly used# a automated differe tial is also pro$ided. "owe$er# if the prese ce of ab ormal %'Cs# R'Cs# or platelets is suspected# a blood smear e?ami ed by a trai ed eye is still the best method for defi iti$ely e$aluati g a d ide tifyi g immature a d ab ormal cells.

(i di gs from the blood smear e$aluatio are ot always diag ostic i themsel$es a d more ofte i dicate the

prese ce of a u derlyi g co ditio a d its se$erity a d suggest the eed for further diag ostic testi g. 'lood smear fi di gs may i clude; R'C# %'C a d differe tial cou t. P2RIP"2R/3 +M2/R ) / Peripheral smear is a blood test that gi$es i formatio about the umber a d shape of blood cells.

DI/.NO+TIC 2L/MIN/TION .4N2CO3O.4 M HP23=IC U3TR/+OUNDI is the e?ami atio do e to the patie t I. UT2RU+ /'NORM/3ITI2+ The uterus is e larged with a dilated e dometrial ca$ity as measured co tai i g comple? structure with multiple cystic spaces of $aried si1es i terspersed withi suggesti$e of a molar gestatio . II. 2NDOM2TRIUM Thic- 0 9.:B CM "yper)echoic

III. /DN2L/2 %ithi the left o$ary is a cystic structure# u ilocullar# thi )walled# a echoic# measuri g 7.B ? 7.8 cm# suggesti$e of cystic follicle. IMPR2++ION; ) ) ) ) ) 2 larged / te$erted Uterus 0 whe we say a te$erted# it is a ab ormality of the uterus. %here the uterus lea s I tra)e dometrial co te t as described# suggesti$e of molar preg a cy Cystic follicle right o$ary 0 cystic mea s there is a tumor li-e spaces i the o$ary of a female Normal left o$ary Please correlate cli ically forward o$er the top of the bladder.

=. M2DIC/3D+UR.IC/3 NUR+IN. C/R2 M/N/.2M2NT


!edical mana-ement
Prostagla di s are the most commo ly used age ts# owi g to their ability to i duce uteri e co tractio s a d thus e?pel the products of co ceptio . Prostagla di s ca be gi$e orally# $agi ally# or rectally# a d admi istratio is ofte preceded by oral mifepristo e# which primes the uterus by allowi g local productio of prostagla di s * ormally suppressed by progestero e,. Misoprostol useful to help uterus e?pel products of co ceptio adhere t to the uteri e wall such as blood clots. that are ot

Sur-ical mana-ement
Suction Curetta-e "bortion / commo first trimester abortio procedure is the suctio a d curettage method. The abortio ist begi s by dilati g the momKs cer$i? u til it is large e ough to allow a ca ula to be i serted i to her uterus. The ca ula is a hollow plastic tube that is co ected to a $acuum)type pump by a fle?ible hose. The abortio ist ula alo g the surface of the uterus causi g the baby to be

ru s the tip of the ca

dislodged a d suc-ed i to the tube ) either whole or i pieces. /m iotic fluid a d the place ta are li-ewise suctio ed through the tube a d# together with the other body parts# e d up i a collectio Ear. / y remai i g parts are scraped out of the uterus with a surgical i strume t called a curette. (ollowi g that# a other pass is made through the momKs uterus with the suctio o e of the babyKs body parts ha$e bee machi e to help i sure that left behi d. The co te ts of the

collectio Ear are e?ami ed to assure that all fetal parts a d a adeFuate amou t of tissue comme surate with gestatio al age are prese t

"ysterectomy; / surgical operatio to remo$e the uterus a d# sometimes# the cervix. Remo$al of the e tire uterus a d the cer$i? is referred to as a total hysterectomy. Remo$al of the body of the uterus without remo$i g the cer$i? is referred to as a partial hysterectomy

(ursin- Care !ana-ement


5. /ssess the ff; - $Ds amou t a d character of $agi al bleedi g uteri e fu dus

7. /ssess emotio al distress G. /ssess for ausea a d $omiti g 6. /ssess for ability to wor>. Report to health care pro$ider ab ormal $Ds 'P Q:8 "R R578 RR Q57 or R76 acute abdomi al pai ausea a d $omiti g e?cessi$e emotio al distress passi g of large clots of blood D tissue

B. /dmi ister I= fluids as ordered 9. Pro$ide emotio al support! e courage Fuestio a d e?pressio of feeli gs @. /llow o e support perso at bedside followi g procedure if desired by patie t :. Pro$ide writte discharge a d follow)up i structio s 58. Pro$ide a d re$iew i formatio about a y ewly prescribed medicatio s

=II. DRU. +TUD4


(ame of dru-, Clo idi e *hil. /rand0s, Catapres# Drug Ma-er&s 'iotech Clo idi e "Cl# Mel1i US /rand0s, Catapres# Catapres)TT+# Clo idi e "Cl# Duraclo Canada /rand0s, Di?arit #herapeutic Classification, =asodilati g age t Indication, Ma ageme t of all grades of hyperte sio *"PN, with the e?ceptio of "PN due to phaeochromocytoma. Prophylactic treatme t of migrai e or recurre t $ascular treatme t of migrai e. (or relief of ca cer pai # i combi atio with opiates for epidural use. Contraindication, "yperse siti$ity to clo idi e. +ic- si us sy drome "dverse Reation, 3ocal s-i irritatio # /llergic co tact dermatitis# hypo 0 a d hyperpigme tatio of the s-i drowsi ess# dry mouth# di11i ess# headache. Co stipatio # depressio # a ?iety# fatigue# ausea# a ore?ia# parotid pai # sleep disturba ces# $i$id dream# impote ce# uri ary rete tio # slight orthostatic hypote sio # bur i g a d itchi g se satio of the eye. Route of "dministration, PO Route; .i$e last dose at bedtime Tra sdermal Route; /pply patch wee-ly! remo$e old patch a d wash off residue! apply to site without hair! best absorptio o$er chest or upper arm! rotate sites with each applicatio ! apply firmly# especially arou d edges. (ursin- Responsibilities, I struct patie t ot to disco ti ue drug abruptly# or withdrawal symptoms may occur a ?iety# i creased 'DP# headache# i som ia# i creased pulse# tremors# ausea# sweati g! Cautio patie t ot to ta-e OTC *cough# cold# allergy, remedies u less directed by physicia ! Teach patie t ot to s-ip or disco ti ue medicatio without co sulti g physicia ! I form patie t that drug may impair ability to dri$e or operate machi ery# thus should be a$oided i tas-s that reFuire me tal alert ess. Drug may cause di11i ess# fai ti g# light headache! I struct patie t to otify physicia of mouth sores# sore throat# fe$er#

swelli g of ha ds or feet# irregular heartbeat# chest pai # sig s of a gioedema# i creased weight. (ame of dru-, (errous +ulfate *hil. /rand0s, /M)2uropharma (errous +ulfate# 'rofesol# (eosol +pa sule (er) I )+ol# (erglobi # Rhea (errous +ulfate# U ited "ome (ersulfate Iro US /rand0s, 2d)I )+oul# (eosol# (er).e )+ol# (er Iro Drops# (ero).rad# Mol) Iro #herapeutic Classification, "emati ic age t Indication, Pre$e tio a d co trol of treatme t of iro ) deficie cy a emia! a form of the mi eral Iro # Iro is for ma y fu ctio s i the body. Contraindication, "yperse siti$ity to a y i gredie t# hemosiderosis# hemolytic a emia. "dverse Reaction, .I irritatio # a ore?ia# ausea# $omiti g# diarrhea# co stipatio # dar- stool. Teeth stai i g with liFuid formulatio . Route of "dministration, Through oral admi istratio ) Me ; 58 mg 0%ome ; 5> mg 0%ome greater tha >5 yrs; 58 mg 0 Preg a cy; G8 mg 0lactatio ; 5> mg. Iro replaceme t i deficie cy states 0 /dults; 588 to 788 mg G?Dday. Childre *7) 57 yrs old,; G mgD-gDday i G to 6 di$ided doses. Childre *B mo s)7 yrs,; up to B mgD-gDday i G to 6 di$ided doses. I fa ts; 58 to 7> mg e$ery day i G to 6 di$ided doses. (ursin- Responsibilities, I struct patie t ot to substitute o e iro salt for a other because they ha$e differe t eleme tal iro co te t. +wallow the whole tablet# do ot crush or chew# do ot double the dose if missed# but ta-e it as soo as remembered a d a$oid ta-i g the drug with certai foods that may impair oral iro absorptio li-e yogurt# cheese# eggs# mil-# cereals tea a d coffee. (ame of dru-, Cefuro?ime /rand (ame, Cefti #herapeutic Classification, Is a semisy thetic cephalospori a tibiotic# chemically similar to pe icilli .

Indication, Is effecti$e agai st susceptible bacteria&s causi g i fectio s of the middle ear# to sillitis# throat i fectio s# lary gitis# bro chitis# a d p eumo ia. It is also used i treati g uri ary tract i fectio s# s-i i fectio s# a d go orrhea. /dditio ally# it is useful i treati g acute bacterial bro chitis i patie ts with chro ic pulmo ary disease *COPD,. Contraindication, "yperse siti$ity or with - ow allergy to cephalospori e type a tibiotics. "dverse Reaction, +hoc-# +te$e s)<oh so sy drome# erythema multiform# 3yell&s sy drome# hyperse siti$ity# re al i sufficie cy# hematological effects# hepatic disorders. Route of "dministration, Through oral admi istratio (ursin- Responsibilities, I struct patie t that cefuro?ime is ge erally well tolerated a d side effects are usually tra sie t. Reported side effects i clude diarrhea# ausea# $omiti g# abdomi al pai # headache# rashes# hi$es# $agi itis# a d mouth ulcers.

1$SE RI2"% U(I)ERSI#' C$%%E&E $F (URSI(& / case study of a patie t with MO3/R PR2.N/NC4 / partial fulfillme t of the reFuireme ts i Nursi g Care Ma ageme t 585 Related 3ear i g 2?perie ce +a <ua Medical Ce ter Obstetrics ) .y ecology %ard

+ubmitted by; .roup II 0 /)G56 3eader; .ocela# (rit1 /dria e Members; Coo# Ro ald Cubelo# Marycarl De =era# .aude cio Dela Cru1# Ia Dwight Delfi # +arah De$era# Mar- / tho y Doro ila# <e y Du-a# Moses 2 osario# Mary 'laise 2sFuierdo# Cathri a Pia

+ubmitted to; Maria 'lesilda 3lagu o *Cli ical I structor,

5st +emester 7889