compre to drug 1

XI. TREATMENT/ MANAGEMENT

A. Drug Study

Trade and Generic Name Drug Classification

Mechanism of Action Side Effect Nursing Consideration

Celecoxib200mg/cap 1 cap BID x 5 days (8am-6pm)

Analgesics (nonopiod)

NSAID

The patient had undergone surgery in which there is traumatized skin and this drugs serves as a treatment if patient experince acute pain, specifically its action serves as an analgesics and anti-inflammatory activities related to inhibition of the COX-2 enzyme, which is activated in inflammation to cause the signs and symptoms associated with inflammation.

The patient manifest skin rash

Administer drug with food or after meals if GI upset occurs

Emphasized to the patient to keep the affected area clean and dry and if available put calamine lotion

Advised the patient to report if severity occurs

Tramadol 50mg IVTT q6h 6am-12nn-6pm-12mn)

Ordered as PRN when patient experience severe pain, specifically binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin.

The patient claimed that she had loss her appetite as the only side effect experienced by the patient

Instruct the patient to eat frequent small meals

Ceftriaxone1g IVTT q8h x 3 days(8am-4pm-12NN)

AntibioticCephalosporin (third generation)

Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death, since the patient had undergone surgery and there’s a presence of incision in which it is possible for bacterial invasion resulting to risk for infection.

Ketorolac30mg IVTTq8h ANST(-)

Analgesic and anti-inflammatory

This serves a short term management when the patient experience pain. Anti-inflammatory and analgesic activity; inhibits prostaglandins and leukotriene synthesis.

Dizziness headache

Advise patient to report worsening pain.

Closely monitor blood pressure before administration if hypotensive do not administer

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B. IV FLUIDS

NAME COMPONENT CLASSIFICATION OF THE FLUID

EFFECTS OR USE SIGNIFICANCE

D5LR’s The ratio of electrolytes and water in Lactated Ringer's is carefully balanced so that it can be used efficiently by the body. In every 100 mL of Lactated Ringer's, there are 600 mg of sodium chloride, 20 mg of calcium chloride, 30 mg of potassium chloride and 310 mg of sodium lactate. The pH of Lactated Ringer's is adjusted to be 6.6, and a liter of this solution has 9 calories.

Hypertonic 1. UseThe patient was given D5LRs intravenously purposively to replace fluids and electrolytes lost from the surgery. This solution maintains acid base balance and moderately neutralizing metabolic acidosis occurring during abdominal surgery. This solution may be prescribed along with a sugar solution (typically dextrose) to provide a source of calories.

2. Side EffectsThe patient did not manifest any side effects such as irritation at the administration site, overhydration, pulmonary edema and fever.

Rehydration from the water in a Lactated Ringer's solution is vital, as the total weight of the body is about 70 percent water. A significant loss of water, and the ions contained in it, will result in an extreme upset to every major system in the body. In the event that too much water is lost, the pH of the body may become too acidic, a condition called acidosis. The lactate contained in Lactated Ringer's helps the body combat acidosis.

PNSS Each 100 mL contains dextrose, hydrous 5 g, sodium chloride, 234 mg, potassium acetate, 128 mg and magnesium acetate, anhydrous 21 mg. May contain hydrochloric acid for pH adjustment.

Isotonic solution 1. Use The patient ws given PNSS intravenously The solution is administered by intravenous infusion for parenteral maintenance of routine daily fluid and electrolyte requirements with minimal carbohydrate calories.

When administered intravenously, Normosol-M and 5% Dextrose Injection provides water and electrolytes (with dextrose as a readily available source of carbohydrate) for maintenance of daily fluid and electrolyte requirements, plus minimal carbohydrate calories. The electrolyte composition approaches that of the principal ions of normal plasma (extracellular fluid). The electrolyte concentration is hypotonic (112 mOsmol/liter) in relation to the extracellular fluid (280 mOsmol/liter). One liter provides approximately one-third of theaverage adult daily requirement for water and principal electrolytes in balanced proportions, with acetate as a bicarbonate alternate, plus 170 calories from dextrose.

C. SURGERIES

15

NAME OF SURGERY DATE AND TIME OF

THE SURGICAL

PROCEDURE

CONDUCTED

DESCRIPTION OF THE SURGICAL PROCEDURE RESULTS

TAHBSO (Total Abdominal

Hysterectomy with Bilateral

Salphingo-Oophorectomy)

December 15, 2009

Removal of the uterus including the cervix as well as the fallopian tubes

and ovaries using an incision in the abdomen. Intended for obstetrical

conditions of which the normal functions of these organs involve are

compromised and necessitate.

Indication: Removal as the last recourse of management; in this case,

Myoma.

RESULT fibroids will

never come back

because the uterus and

fallopian tube is

removed.

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A. ACTUAL NURSING CARE PLAN

19

ASSESSMENT SCIENTIFIC EXPLANATION

PLANNING NURSING IMPLEMENTATION

RATIONALE EVALUATION

O> Pale looking> Restless and irritable at times> Pulse Rate: 96bpm>Dozing>Dizziness>Respiratory rate: 26cpm> delayed capillary refill: 4-5 sec

A> Ineffective tissue perfusion related to excessive blood loss.

Altered tissue perfusion is a condition wherein there is decrease inOxygen resulting in thefailure to nourish thetissues at the capillary level because of excessive blood loss the hearts ability to pumpblood compensates with what is left with the body to utilize, therefore decrease in cardiac output then results to decrease pulse rate, decrease respiratory rate, increased blood pressure and increasedtemperature; thus, the lumen of the blood vessels become narrowed, there is a decrease in the amount of oxygen circulating thebody, leading to ineffective tissue perfusion.

STO:After 30 minutes of medical and nursing intervention the patient will manifest an increase in oxygenation as evidenced of normal skin color, pinkish mucosa, good capillary refill and good breathing pattern.

LTO:After 3 days of nursing and medical intervention the patient will be able to demonstrate increased perfusion as individually appropriate AEB patient’s skin warm and peripheral pulses present. V/s withinnormal range, oriented, balance I and O, free of pain and discomfort.

Dx> Monitored and recorded vital signs.

> Checked capillary refill and conjunctiva for paleness

> Assessed patient general condition

Tx> Regulated IVF as ordered

>Elevated head of bed to 30° as ordered

> Provided and maintain oxygenas ordered

> Administered medications asordered

Edx> Advised patient to have enough rest

>Instructed to avoid neckflexion and extreme hip/kneeextension

>For comparative baseline data.

> To determine blood circulation

>to note any abnormal findings

> To maintain hydration

>To promote circulation

> Aids in difficulty ofbreathing

> To address the condition and continue course of treatment.

> Enough rest is needed to conserve energy

> To avoid obstruction of arterial and venous blood flow

> To conserve energy/lower tissue oxygen demands

STO: After 30 minutes of medical and nursingintervention the client manifested an increase in oxygenation as evidenced of normal skin color, pinkish mucosa, good capillary refill and good breathing pattern. Therefore, the plan was met.

LTO:The pt. shall have demonstrated increased perfusion as individually appropriate AEB patient’s skin warm and peripheral pulses present. V/s within normal range, oriented, balance I and O, free of pain and discomfort.

20

Reference: Medical-Surgical Nursing by Brunner and Suddarth 11th edition

> Encouraged quiet, restful atmosphere

>Instructed patient’s SO about food rich in iron

> To increase hemoglobin count

ASSESSMENT SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION

21

EXPLANATION IMPLEMENTATIONO >poor skin turgor> Dry lips>Weak inappearance> Pale looking>decreased urine output >concentrated urine>Hypotension

A> Fluid volumedeficit related topostoperativehemorrhage asmanifested bypoor skin turgor and pallor.

Due to operation that the patient had which is TAHBSO, bleeding can become severe. Blood contains plasma; the liquid and does would lead to hypotension, and shock. In severe case it can lead to death.

Reference: Medical-Surgical Nursing by Brunner and Suddarth 11th edition

STO: After 2 hour of medical and nursing interventions the patient will experience decrease weakness and good capillary refill.

LTO:After 2 days of medical and nursing interventions the patient will be free from s/sx of dehydration such as:

Urine out put greater than 30ml/hr

Good skin turgor


>Obtained history to ascertain the probable cause of the fluid disturbances

>Evaluated fluid status in relation to dietary intake

>Assessed skin turgor and mucous membrane for signs of dehydration

>Monitored BP for orthostatic change

>Assessed color and amount of urine

>Assessed level of weakness

Tx>provided oral hygiene

>Administered blood products as prescribed


>this help in guiding interventions caused include trauma and prolonged bleeding

>determined if patient has been on a fluid restriction

>the skin losses elasticity

>Hypotension is evident in hypovolemia

>concentrated urine denotes fluid deficit

>this aids in defining what patient is capable of, which is necessary before setting realistic goal

>to prevent dryness of mucous membrane

>this is required to replace blood loss

STO: Goal met, since the patient was able to decrease weakness and showed good capillary refill.

LTO: Goal met, if after 2 days of medical and nursing interventions the patient will be free from s/sx of dehydration such as:

Urine out put greater than 30ml/hr

Good skin turgor

22

>Cleaned, dried and moisturized skin

>Assisted in urinating and performing ADLs

>Edx>Explained causes of fluid losses

>Reinforced rationale and intended effect of treatment program

>Encouraged to maintain functional body alignment

>Encouraged verbalization of feelings, strength, weakness and concerns

>to helps in maintaining normal skin and tissue integrity

>to conserve energy

>give knowledge to the patient so as to increase awareness regarding her present condition

>to gain cooperation and for betterment of the whole treatment course

>to b e able to move quickly and efficiently

>for the betterment of nursing intervention

23

ASSESSMENT SCIENTIFIC EXPLANATION

PLANNING NURSING IMPLEMENTATION

RATIONALE EVALUATION

O > S/P TAHBSO with surgical

incision at lowerabdominal area

with dry intact dressing on the surgical site

Elevated levels of vita signs such asRR: 24 cpm.

A > Impaired Skin Integrity related toskin/tissue trauma secondary to TAHBSO

Uterine Myoma↓

Prolonged bleeding↓

TAHBSO↓

Dissection ofLower abdominal

tissues↓

Disruption ofskin surface anddestruction of

skin layers↓

Impairedskin/tissueintegrity

Reference: Medical-Surgical

STO:Within 8 hours of nursing and medicalintervention the patient will be able to manifest the following:a.) intact suturesb.) dry and intact wound dressing

LTO:After 3 days of medical and nursing intervention the patient will be able to display timely healing of skin lesions/ wounds without complication.


>Assessed operative site for redness, swelling, loose sutures, or soaked dressing

>Assessed blood supply and sensation of affected area.

Tx>Assisted in passivemovements(while 8hrs. flat on bed) such as bed turning and passive ROM exerciseand active exercise thereafter movements such as bed position, sitting

>Inspected skin on daily basis.

>Periodically remeasured wound and observed for complications such as infection.

>Keep area clean/dry,Carefully dress wounds, support incision, prevent infection and stimulate


>to check skin integrity, monitor progress of healing

>To determine signs of bleeding and impaired sensation.

>to promote circulation to the surgical site fortimely healing

>To observe for changes

>To monitor progress on wound healing.

>To reduce pressureon/enhance circulation to compromisedtissues

STO: Goal met. Within 8 hours of effective nursingand medical intervention the patient was be ablemanifest the following:a.) intact suturesb.) dry and intact wound dressing.

LTO: Goal met, if after effective nursing and medical intervention the patient is able to display timely healing of skin lesions/wounds without complication.

24

Nursing by Brunner and Suddarth 11th edition

circulation to surrounding tissues.

> Supported incision as in splinting when coughing andduring movement

Edx>Instructed and encouraged strict compliance of medication regimen.

>Emphasized importance of proper fit of clothing.

>Instructed patient and SO’s to immediately report when dressing are soaked

>Instructed patient and SO’s to refrain from touching/scratching operative site

>Encouraged patient to verbalized any untoward feelings especially pain, discomfort as well as changes noted on operative site.

>to reduce pressure on the operative site

>To achieve wellness and prevent further complications

>Helps in presence of reduced sensation/ circulation.

>for immediatereplacement to prevent skin breakdown andcontamination ofoperative site

>to prevent bacteria harbor in operative site

>to allow continuous monitoring and assessment of pt.condition

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B. POTENTIAL NURSING CARE PLANS

ASSESSMENT EXPLANATION OF THE PROBLEM

OBJECTIVES NURSING INTERVENTION RATIONALE EVALUATION

O redness notes in the

wound

swelling noted at incision site

soiled abdominal dressing

with odorous discharges

increased pain

elevated temperature of 38oC and above

with IFC

A Risk for infection

related to post surgical incison

Patient recently had undergone TAHBSO in which the surgical wound site and the presence of IFC are the possible risk for invasion of microorganism. These microorganisms will breaks in the integument, the body’s first line defense leading to signs and symptoms of infection such as fever, redness, inflammation, etc. Infection prolongs healing and may result in death if untreated.

STO Within the shift,

patient will able to identify ways on reducing risk for infection such as:

a. Verbalization of understanding why she is at risk for infection

b. Demonstration of precautionary measures being implemented to prevent its risk

Dx Review laboratory studies

for possibility of systemic infection

Assess for presence existence of history of risk factors such as the incision site and presence of IFC

Monitor the following signs of infection

a. redness, swelling, increased pain or purulent drainage at incisions, injured sites, existence of tubes, drains or catheter

b. Elevated temperature

c. Appearance of urine

Tx Provide wound care and

change dressing regularly Administer antimicrobial as

ordered

decreased WBC count may indicate ongoing infection

These examples represent a breakdown in the body’s first line of defense

Any suspicious drainage should be cultured, antibiotic therapy is determined by pathogens identified at culture, for proper medication and treatment

this symptoms are sign of growth of microorganisms

Cloudy, foul-smelling urine with visible sediments is indicative of urinary

STOGoal met if the patient able to identify ways on reducing risk for infection such as:

a. Verbalizes that the precipitating factor that leads her at risk for infection is due to her incision site and presence of IFC

b. Demonstrates precautionary measures such as having regular wound care and changing of dressings, antimicrobial therapy, and proper hand washing.

26

LTO After 3 days of

nursing intervention patient remains free of infection as evidenced by

a. Normal body temperature from 38oC to 37.5oC

b. absence of purelent drainage from the incision site and indwelling catheter

EDx Instruct client and

caregivers of proper handwashing, especially after toileting, before meals, and after administering self-care

Educate patient the signs and symptoms of infection and to report a health care provider

Emphasize necessity of taking anti microbial drugs as ordered

Encouraged patient of keeping the area around the dressing and wound clean and dry

Encourage of taking in vitamin C rich foods such as mangoes and oranges

or bladder infection

To prevent the growth of microorganism

Antimicrobial drugs are agents that is toxic to the pathogens or reduce growth microorganism

To avoid spread of microorganism

For early detection and immediate treatment

Premature discontinuation of treatment when client begins to feel well may result in return of infection

Wet area can be lodge area of bacteria

Vitamin C helps boost immunity and

LTO Goal met if the patient

remains free of infection as evidenced by

a. normal body temperature of 36.5oC to 37.5oC

b. absence of purelent drainage from the incision site and indwelling catheter

27

promotes healing\

ASSESSMENTSCIENTIFIC

EXPLANATIONPLANNING NURSING

IMPLEMENTATIONRATIONALE EVALUATION

O> Emotionally stressed.> Facial grimace> Narrowed focus>Negative feelingsabout self in situation

A> Risk for situational Low Self-Esteem may be related to changes in femininity

Self-esteem plays a role in almost everything you do. Feeling of inadequacy, self doubt, and reduces confidence in your abilities. Self-esteem may be triggered by treated poorly, especially those who experience depression, anxiety, phobias,or who have an illness or a disability.

Reference: Reasons of Low Self-Esteem, Review What are the Reasons for Low Self-Esteem

by Adele M. Hayes, Melanie S. Harris and Charles Carver

General objectives:After 2 days of nursing interventions the client will be able to express positive self-appraisal.

Dx> Assess emotional stress the patient is experiencing. Identify meaning of loss for patient/SO.

> Ascertain individual strengths and identify previous positive coping behaviors.

> Provide open environment for patient to discuss concerns about sexuality.

Tx- Independent:>Provide time to listen to concerns and fears of patient and SO. Discuss patient’s perceptions of self related to anticipated changes and her specific lifestyle

> Provide accurate information, reinforcing

> Nurses need to be aware of what this operation means to the patient to avoid inadvertent casualness or over solicitude.

> Helpful to build on strengths already available for patient to use in coping with current situation.

> Promotes sharing of beliefs about sensitivesubject, and identifies misconceptions that mayinterfere with adjustment to situation.

> Conveys interest and concern; provides opportunity tocorrect misconceptions, e.g., women may fear loss of femininity and sexuality

> Provides opportunity

Goal met, if after 2 days of nursing interventions the client will be able to express positive self-appraisal.

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information previously given

COLLABORATIVERefer to professional counseling as necessary

Edx>Encourage patient to vent feelings appropriately

for patient to question and assimilate information

> May need additional help to resolve feelings about loss.

> She may fear inability to fulfill her reproductive role and may experience grief over loss.

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compre to drug 1

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