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Chapter I

INTRODUCTION Endometrial Polyp is a condition by which a mass is formed in the lining of the uterine endometrium simultaneous to the growth of uterine lining influenced by the hormone estrogen. It is considered a complication in pregnancy because it may cause a severe harm due to bleeding to the mother and to her fetus and can even initiate miscarriage. A. RATIONALE Our group decided to choose the case, endometrial polyps as a complication during pregnancy because we know that there is just a rare number of its occurrences in our country even in Oriental Mindoro Provincial Hospital which is our training ground. We also wanted to be familiarized and oriented with the rare diseases/complications that will cause a terrifying and complicated effects to mother especially to her fetus. Our goal is also to enhance our knowledge, skills and attitude toward the management of this said complication. B. LEARNING OBJECTIVES 1. Cognitive To have further learning and comprehension about endometrial polyp. To define its meaning. To identify the risk factors that have been linked to this health problem, the signs and symptoms, and its clinical manifestations To learn the treatment and other related management regarding the case.

2. Psychomotor To become practiced in handling the said condition. To use our skills in performing the nursing process To develop skills in caring endometrial polyp patient. To practiced the application of nursing care plan. 3. Behavioral To develop understanding and appreciation with the clients condition. To provide rapport and interact client utilizing therapeutic communication.

Chapter II
CLINICAL SUMMARY

A.

GENERAL DATA Name: Unit assignment: Age: Birthdate: Birth place: Gender: Religion: Address: Civil status: Occupation: Educational Background: Date of Admission: Time of Admission: Admitting Physician: Admitting Diagnosis: J.L.T. Labor room 41yrs old April 3, 1970 Victoria, Oriental Mindoro Female Born Again Christian Victoria, Oriental Mindoro Married Teacher Tertiary August 12, 2011 10:59am Dra. Tabudlo Abortion, incomplete 11 weeks AOG induced NS1 G3P2(2001) Previous CS1 2 Transverse

B. CHIEF COMPLAINT Vaginal Bleeding + passage of abortion 7 days ago. C.HISTORY OF PRESENT ILLNESS A 43 year old mother was admitted in Oriental Mindoro Hospital on August 16,2010 at 4:00 am ambulatory, accompanied by her relatives with chief complaint of vaginal bleeding 5 days prior to admission. Nurse I have sudden hypogastric pain that start intermittently in 3 hours sharp character profuse causing 4 pads/days aggravated with activity relieve by rest and putting tampons to stop or minimize the bleeding as verbalized by the client. D. PAST MEDICAL HISTORY

Client states that she has chicken fox and mumps during her childhood years. Two years ago, she was hospitalized during her previous pregnancy, in her 7th month. She attending pre-natal check up in Oriental Mindoro Provincial Hospital , done diagnostic examinations especially complete blood count reveals that the patient suffering from anemia. The Doctors order was blood transfusion. She was confined for 24 hours for observation. She doesnt take any medication during her sicknesses.

C. FAMILIAL HISTORY The father and eldest brother of the client have both a history of asthma and patient and her fifth sibling have urinary tract infection, but her mother, husband and other siblings do not have any disease..

ASTHMA

60 y/o

59y/o

ASTHMA

ENDOMETRIAL POLYPS

LEGEND:

Male

Female

A. PHYSICAL ASSESSMENT VITAL SIGNS: August 16, 2010 BP:90/70mmHg PR: 108 bpm RR: 19 cpm TEMP:37.5 C

NORMAL FINDINGS

SIGNIFICANT FINDINGS

INTERPRETATION

INTEGUMENTARY SYSTEM HAIR Evenly distributed, silky, resilient hair, no infection No deviation

SKULL AND FACE

Rounded, normocephalic, absence of nodules or masses, symmetric nasolabial folds, symmetric facial movements

Expressionless face Frequently yawning

Due to sleepiness

EYES AND VISION

Eyebrows skin contact, hair evenly distributed, eyebrows symmetrically aligned, equal movement, skin intact, no discharge, white sclera, pinkish conjunctiva, no orbital edema, PERRLA Color same as facial skin, symmetrical, auricle aligned with outer canthus of eye, pinna recoils after folded, minimal amount of dry cerumen, able to hear on both ears clearly.

Ptosis of eyelid

Due to sleepiness

EARS AND HEARING

No deviation

NOSE AND SINUSES

Symmetric and straight nose, no discharge, no lesions, nose bridge intact, air moves freely as the client breathes through the nares, maxillary and frontal sinus not tender.

No deviation

MOUTH AND Without dentures OROPHARYNX Tongue freely moves, gag reflex present Lips pallor and dry Due to blood loss

NECK

Head centered, no palpable lymph nodes, coordinated movement without discomforts, presence of carotid pulse, trachea in midline

No deviation

UPPER EXTREMITIES

SKIN AND NAILS Brown complexion, no edema, no lesions, good skin turgor, smooth nails Generalized pallor Due to blood loss

Pallor nail beds 4 seconds capillary refill

Indication of poor circulatory impairment due to excessive blood loss.

MUSCLE STRENGHT

Muscles equal size on both sides, no contractures, AND presence of brachial and radial pulse

Flaccidity or weakness

Due to excessive blood loss 5

CHEST AND BACK SPINAL COLUMN Chest symmetric, spinal column straight, skin intact, no masses No deviation

LUNGS

Effortless respirations No rales

No deviation

BREAST AND AXILLAE

Symmetric , no masses, no lesions, rounded, skin uniform in color, nipple round, equal in size, similar in color, no discharge, axilla no tenderness, masses or nodules. With palpitations

No deviation

HEART

Because of excessive bleeding, the body compensates resulting to increase contraction of the heart to supply the whole body.

ABDOMEN

SKIN Brown complexion, flat, symmetric movements caused by respiration, no tenderness, relaxed, soft abdomen. No deviation

GENITALS Pubic skin intact, no lesions, presence of pubic hair, darkercomplexion of vulva.

IE: (+) bleeding (240 mL per day)

Due to irritation of polyp

ANUS AND RECTUM Brown color No deviation

LOWER EXTREMITIES SKIN AND TOENAILS Brown complexion, with cuticle. No deviation

MUSCLE Equal in size and length, symmetrical, no lesions, no masses. PULSE Presence of popliteal and pedal pulse. No deviation

No deviation

B. REVIEW OF SYSTEMS
LEVEL INTEGUMENTARY SYSTEM RESPIRATORY SYSTEM FINDINGS THE CLIENT VERBALIZED OF FEELING COLD NO DIFFICULTY IN BREATHING NO FEELING OF PALPITATIONS, NO HEART BURN, NO CARDIOVASCULAR SYSTEM CHEST PAIN. LOSS OF APPETITE, DEFECATES AND URINATES GASTROINTESTINAL/DIGESTIVE/METABOLIC GENITOREPRODUCTIVE SYSTEM MUSCULOSKELETAL SYSTEM NEUROLOGIC SYSTEM REGULARLY NO PAIN IN THE GENITAL AREA THE PATIENT HAS NO FEELING OF MUSCLE WEAKNESS. ORIENTED WITH TIME AND PLACE, ANXIETY

C. PATTERNS OF FUNCTIONING Functional Health Patterns Prior to Hospitalization During Hospitalization Day 1 Day 2 Day 3 Analysis& Interpretation

*Health PerceptionHealth Management Pattern

*The client does not rely on doctors when her feelings of sickness are not too serious.

*The client relies on the care given by the health care personnel or doctor .

*The client still seeks the medical assistance of the doctors.

*The client trust doctors and nurses regarding her health care.

*Prior to hospitalization, the client do not manage her health seriously and does not seek doctor`s assistance but when hospitalized, the client really seek on doctors and relied her health unto them.

*Nutritional Metabolic Pattern

*The client eats a lot, as long as she wanted and her favorite dish was vegetables.

*The client can`t eat because she was under NPO.

*The client was in the Gyne-Ward so she can eat what she wants.

*The client can freely eat what she wants.

*When the client was at home, she can eat what she wants w/out limitations unlike when hospitalized. *When the client was at home, she defecates and voids regularly, because of the regular work of the body and so promoting peristalsis. *The client has a lot of work when at home but all of them disappears when she was hospitalized. *The client has a regular sleep pattern at home but disturbed when hospitalized.
*The client has no problem at home but a little bit anxious when brought at the hospital but then easily adapted.

*Elimination

*The client defecate and void every day.

*The client did not defecate this day.

*The client defecate once.

*The client defecates regularly.

*ActivityExercise Pattern

*The client was doing her regular work like washing of clothes, cooking, and vegetable farming and copra`s.

*The client can`t do her work.

*The client can`t still do her work because she`s far at home.

*The client was ready to do work but she`s still at the hospital.

*Sleep Rest Pattern

*The client has a regular sleep at 9pm to 4 am and at noon.

*The client can`t sleep good

*The client can`t sleep good

*The client had adjusted to her environment but still can`t sleep good. * The client feels a lot better.

*Cognitive Perceptual Pattern

*The client responds clearly.

*The client was moderately anxious.

*The client feels better.

*Self PerceptionSelf Concept

*The client was not sensitive of others situation when they are sick, ``Basta gumaleng. *The client was a mother and with her husband strived hard for their children.

*The client was confident that she will recover immediately.

*The client feels better.

*The client feels a lot better.

* The client was not aware of having an illness until she became on that position.

*Role Relationship Pattern

*The client has no ability to do her obligations as a mother because she was sick and confined.

*The client feels that she can do her obligations but she was confined.

*Sexuality Reproductive

*The client says that their relationship was good and they enjoyed sexual relationship.

*The client wanted to go home and do her responsibilities as a good provider with her husband and she was thinking of her children *The client can`t make love but her husband has been so supportive and sweet to her.

*The client was doing her very best to be a good mother and a provider to her children but since her husband was with her, they can`t do their responsibilities.

*The client says that they can`t make sexual relationship because she was confined. *Now, the client was confident that she can overcome this problem because her husband has been with her.

*The client still can`t make love.

*Coping-Stress Tolerance Pattern

*Whenever the client has problem and stressed, she was not alone because her husband has been with her so she feels okay.

*The client and her husband has been so sweet and supportive with each other. They enjoyed being with each other.

*The client was relaxed.

*The client was excited to go home to do her responsibilities Her husband has been always comforting her so she feels a good.

*The client could always cope with her problems by the support of her husband.

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*Value Belief Pattern

*The client believes on GOD. She can`t afford to go every Sunday to Church because they are too far from the Church.

*The client believes that GOD is the most powerful of all.

*The client trust on GOD and verbalizes that she prays.

*The client told that GOD is merciful and when she got home, she will visit the church.

*The client seldom go to church because they are too far from the Church but she says that she knows GOD and trust in Him.

D. ACTIVITIES OF DAILY LIVING PRIOR TO HOSPITALIZATION Maaga akong nagigising kasi ako lahat gumagawa ng gawaing-bahay, naglalaba, nagluluto, naglilinis tapos naggagamas pa. Buong araw nga may ginagawa ako. Gabi lang at pagkakain pahinga ko, as verbalized by the patient. DURING HOSPITALIZATION Nakakapanibago pala kapag nasa ospital. Nakakainip! Lagi na lang nakahiga, paupo-upo, patayu-tayo. Parang ngang napakabagal ng oras. Minsan lang ako nakakalabas dito. Hindi ko na nagagawa mga ginagawa ko dati. Hindi rin ako makatulog kasi maiingay sila minsan,as verbalized by the patient. ANALYSIS Hospitalization affects the daily activities of the patient. It gives a big change in her living. She cannot perform her usual activities. There was also a sleep pattern disturbance. She also felt boredom because of the long stay in the hospital.

E.

PATIENTS CONCEPT OF HEALTH, ILLNESS AND HOSPITALIZATION Kapag nagkakasakit ako o kaya yung mga anak ko at asawa ko sa albularyo muna ako pumupunta. Mahal kasi pag ospital agad tsaka baka nanununo lang o kaya nadawdaw. Nagpapatapal muna kami o kaya nagpapatawas, minsan pag may mga bali nagpapahilot kami sa mga hilot. Kapag walang nangyari sa ginawa ng albularyo tsaka lang kami pumupunta sa center. Kapag walang gamot sa center tsaka pa sa ospital, as verbalized by the patient. Our patient still believes that the cause of the illness of their family is some extraordinary creatures or superstitious actions. They always tend to go first to quack doctors instead of going straight to hospitals or rural health centers because according to them they cant afford doing so. They believe that their illnesses can be cured by the quack doctors. They used to utilize the things that a quack doctor uses when treating them like taking in herbal plants, using tawas or tapal. If the albularyo didnt treat their disease, this is the time that they will go to the hospital and seek the doctors help.

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F. LABORATORY AND DIAGNOSTIC EXAM August 16, 2010 Complete Blood Count Diagnostic Exam Normal Value Hemoglobin 120-160 g/l Hematocrit Leukocyte Ct. Neutrophils Lymphocytes Eosinophils Blood type = B+ HBsAG non-reactive August 16, 2010 Urinalysis Examination Color Character Specific gravity pH RBC WBC Albumin 0.36-0.48 4.0-11.0x10L 0.40-0.60 0.20-0.40 0.01-0.03

Significant Findings 120 0.35 11.7 0.79 0.20 0.01

Analysis Normal Slightly decrease. Possible to anemia. Renal (kidney) failure Possible to infection Normal Normal

Normal Values Pale yellow to amber clear 1.010-1.025 4.5-8.0 Negative or rare Negative or rare Negative

Findings Yellow Clear 1.010 6.5 10-15 6-8 Trace

Analysis
Excess sweating could result in the urine becoming a deeper yellow. Also, it is a sign that you have not been drinking enough liquids

Sugar Negative Negative Crystals amorphous Negative Few PREGNANCY TEST: Positive August 16, 2010 Ultrasound Result Normal anteverted with 7.9 x 4.8 x 4.4 cm with thick endometrium 1.66 to consider hyperplasia August 17, 2010 Diagnostic exam Hemoglobin Hematocrit

Normal Possible to renal failure Normal The patient has vaginal bleeding Urinary Tract Infection Possible to glomerular damage Normal Deviation

Normal Value 120-160g/l 0.36-0.48

Significant finding 95 0.28

Analysis Decreased. Anemia Decreased. Anemia

The patient was given packed blood, type B on August 17 2010, 3 am


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III. CLINICAL DISCUSSION OF THE DISEASE A. ANATOMY AND PHYSIOLOGY

GENERAL The organs of the reproductive systems are concerned with the general process of reproduction, and each is adapted for specialized tasks. These organs are unique in that their functions are not necessary for the survival of each individual. Instead, their functions are vital to the continuation of the human species. In providing maternity gynecologic health care to women, you will find that it is vital to your career as a practical nurse and to the patient that you will require a greater depth and breadth of knowledge of the female anatomy and physiology than usual. The female reproductive system consists of internal organs and external organs. The internal organs are located in the pelvic cavity and are supported by the pelvic floor. The external organs are located from the lower margin of the pubis to the perineum. The appearance of the external genitals varies greatly from woman to woman, since age, heredity, race, and the number of children a woman has borne determines the size, shape, and color. See figure 1-1 for the female reproductive organs. TERMS AND DEFINITIONS 1. Corpus Luteum. The yellow mass found in the graafian follicle after the ovum has been expelled.
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2. Estrogen. The generic term for the female sex hormones. It is a steroid hormone produced primarily by the ovaries but also by the adrenal cortex. 3. Fimbriae. Fringes; especially the finger-like ends of the fallopian tube. 4. Follicle. A pouch like depression or cavity. 5. Follicle Stimulating Hormone. The follicle stimulating hormone (FSH) is a hormone produced by the anterior pituitary during the first half of the menstrual cycle. It stimulates development of the graafian follicle. 6. Graafian Follicle. A mature, fully developed ovarian cyst containing the ripe ovum. 7. Hormone. A chemical substance produced in an organ, which, being carried to an associated organ by the bloodstream excites in the latter organ, a functional activity. 8. Lactation. The production of milk by the mammary glands. 9. Luteinizing Hormone. A hormone produced by the anterior pituitary that stimulates ovulation and the development of the corpus luteum. 10. Ovum. The female reproductive cell. 11. Progesterone. The pure hormone contained in the corpora lutea whose function is to prepare the endometrium for the reception and development of the fertilized ovum. 12. Reproduction. The process by which an offspring is formed. INTERNAL FEMALE ORGANS The internal organs of the female consist of the uterus, vagina, fallopian tubes, and the ovaries. a. Uterus. The uterus is a hollow organ about the size and shape of a pear. It serves two important functions: 1. it is the organ of menstruation and during pregnancy it receives the fertilized ovum 2. retains and nourishes it until it expels the fetus during labor. (1)Location: Between the urinary bladder and the rectum. It is suspended in the pelvis by broad ligaments. (2)Divisions of the uterus. The uterus consists of the body or corpus, fundus, cervix, and the isthmus. The major portion of the uterus is called the body or corpus. The fundus is the superior, rounded region above the entrance of the fallopian tubes. The cervix is the narrow, inferior outlet that protrudes into the vagina. The isthmus is the slightly constricted portion that joins the corpus to the cervix. (3)Walls of the uterus. The walls are thick and are composed of three layers: 1. the endometrium, 2. the myometrium, 3. the perimetrium. The endometrium is the inner layer or mucosa. A fertilized egg burrows into the endometrium (implantation) and resides there for the rest of its development. When the female is not pregnant, the endometrial lining sloughs off about every 28 days in response to changes in levels of hormones in the blood. This process is called menses. The myometrium is the smooth muscle component of the wall. These smooth muscle fibers are arranged.
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In longitudinal, circular, and spiral patterns, and are interlaced with connective tissues. During the monthly female cycles and during pregnancy, these layers undergo extensive changes. The perimetrium is a strong, serous membrane that coats the entire uterine corpus except the lower one fourth and anterior surface where the bladder is attached. b. Vagina. (1) Location. The vagina is the thin in walled muscular tube about 6 inches long leading from the uterus to the external genitalia. It is located between the bladder and the rectum. (2) Function. The vagina provides the passageway for childbirth and menstrual flow; it receives the penis and semen during sexual intercourse. c. Fallopian Tubes (Two). (1) Location. Each tube is about 4 inches long and extends medially from each ovary to empty into the superior region of the uterus. (2) Function. The fallopian tubes transport ovum from the ovaries to the uterus. There is no contact of fallopian tubes with the ovaries. (3) Description. The distal end of each fallopian tube is expanded and has finger-like projections called fimbriae, which partially surround each ovary. When an oocyte is expelled from the ovary, fimbriae create fluid currents that act to carry the oocyte into the fallopian tube. Oocyte is carried toward the uterus by combination of tube peristalsis and cilia, which propel the oocyte forward. The most desirable place for fertilization is the fallopian tube. d. Ovaries (1) Functions. The ovaries are for oogenesis-the production of eggs (female sex cells) and for hormone production (estrogen and progesterone). (2) Location and gross anatomy. The ovaries are about the size and shape of almonds. They lie against the lateral walls of the pelvis, one on each side. They are enclosed and held in place by the broad ligament. There are compact like tissues on the ovaries, which are called ovarian follicles. The follicles are tiny sac-like structures that consist of an immature egg surrounded by one or more layers of follicle cells. As the developing egg begins to ripen or mature, follicle enlarges and develops a fluid filled central region. When the egg is matured, it is called a graafian follicle, and is ready to be ejected from the ovary. (3) Process of hormone production by the ovaries. (a) Estrogen is produced by the follicle cells, which are responsible secondary sex characteristics and for the maintenance of these traits. These secondary sex characteristics include the enlargement of fallopian tubes, uterus, vagina, and external genitals; breast development; increased deposits of fat in hips and breasts; widening of the pelvis; and onset of menses or menstrual cycle. (b) Progesterone is produced by the corpus luteum in presence of in the blood. It works with estrogen to produce a normal menstrual cycle. Progesterone is important during pregnancy and in preparing the breasts for milk production.

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B. PATHOPHYSIOLOGY

Predisposing factors *age 40-50 *premenopausal

Precipitating factors * estrogen

ENDOMETRIUM

Growth of uterine lining after menstruation

Interference to egg and sperm

POLYPS AREAS

Difficult pregnancy

Remained and attached to small stalks

Increase chance of miscarriage

S/SX *pale lips *generalized pallor *cold, clammy skin

Rubbing off of tissues

Exposure of capillaries Anemia Excessive vaginal bleeding or spotting 16

Endometrial Polyps
The uterus is mostly composed of muscle. However, the inside lining of the uterus is made of fluffy endometrial tissue that grows and shrinks during the menstrual cycle. If a woman does not become pregnant, this lining sheds, causing a menstrual period. After a period, the lining grows rapidly under the influence of hormones like estrogen. Polyps are areas that grow a little too much. As they grow, they usually fan out but remain attached to a small stalk, kind of similar to a bush or a tree. The stalk is like the trunk of a tree, while the larger part of the polyp is like the branches (see photo below). They are usually about the size of a pencil eraser, although they can be even smaller. Rarely, polyps can grow to the size of an orange! Since most polyps are small, they probably do not often cause symptoms. However, when symptoms do occur, they usually include excessive bleeding during a menstrual period, or bleeding in between periods, or even spotting after intercourse. Some women report a few days of brown blood after a normal menstrual period. Polyps cause these symptoms because they dangle from their stalksand irritate the surrounding tissue, which causes the tissue to rub off, exposing tiny blood vessels These blood vessels bleed, leading to spotting or vaginal bleeding. If the polyp interferes with the egg and sperm, it may make it hard to get pregnant. Nobody knows how common this is. It is also possible that they may lead to a slightly higher chance of miscarriage, but this is also unknown. Most gynecologists will remove polyps, as discussed below, if they are found in women with a history of miscarriage. If a woman goes to her doctor complaining of spotting between periods or after intercourse, or very heavy bleeding during a menstrual period, her doctor will usually think of polyps as one of the many possible causes. Diagnosing endometrial polyps involves looking inside the uterine cavity. A regular ultrasound (also called a sonogram) usually does not diagnose polyps, because the pressure inside the uterus flattens the polyps, making them very hard to see. Finally, gynecologists are becoming more skilled at using the hysteroscope to look inside the uterus. This is a small, lighted tube that goes into the vagina then the uterus, to look around inside the uterus. Hysteroscopy using small tubes can be performed in the office, but larger tubes (used to remove large polyps or fibroids) usually require anesthesia in the hospital. If a polyp is diagnosed one of the first questions is could this be cancer? Fortunately, polyps only rarely turn cancerous. The risk does increase, but only slightly, as a patient passes age 50. The next question is often how do you remove the polyp? The old-fashioned way was to perform a D & C (dilatation and curettage). This involves a gentle scraping of the uterine lining. Unfortunately, this may miss the polyp completely, since this procedure is done solely by feel. Imagine a polyp dangling by a little stalk. As the scraping instrument goes by, it will likely just push the polyp out of the way without grabbing it.

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C. DRUG STUDY Generic Brand Action


Classification

Indication

Contraindica tion

Side Effects/ Adverse Effects

Nursing Responsibilities

Augmentin

Amoxicil lin Clavulan ate acid

Amoxicillin prevents cross-linking of bacterial cell wall and leading to cell death. Addition of clavulanate (a betalactam) increases drug's resistance to betalactamase (an enzyme produced by bacteria that may inactivate amoxicillin).

a penicillintype antibiotic

Upper & lower resp tract, skin & soft tissue, *Coamoxiclav GUT, is used to bone & joint treat infections infections caused by bacteria.

*Hypersensit anxiety, confusion, , *Monitor ivity to drug dizziness, fatigue, patient or any carefully for penicillin signs and * symptoms of Phenylketon hypersensitivit uria (some y reaction. products) * Monitor for *History of seizures when cholestatic giving high jaundice or doses. hepatic Check dysfunction patient's associated temperature with this and watch for other signs drug and symptoms of superinfection , *Instruct patient to immediately report signs or symptoms of hypersensitivit y reaction, such as rash, fever, or chills.

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Generic

Brand

Action

Classification

Indication

Contraindication

Side Effects/ Adverse Effects -upset stomach; -headache; or

Nursing Responsibilities *watch for symptoms of overdosage *assess for proper dosage

Multivitamins

Vitamins are the building blocks of the body. They are used to prevent or treat a vitamin deficiency due to poor nutrition, certain illnesses or during pregnancy .

antioxidant *multivitami vitamins with n deficiencies minerals; boron; calcium; calcium carbonate; copper; essential fatty acids; folic acid; magnesium; magnesium oxide; magnesium sulfate; manganese; multiple vitamins; multiple vitamins with minerals; pyridoxine hydrochloride ; vitamin B complex with C and zinc; vitamin C; vitamin D; vitamin D3; vitamin E (as tocopherol acetate); vitamin K1; zinc

Avoid taking more than one multivitamin product at the same time unless your doctor tells you to. Taking similar vitamin products together can result in a vitamin overdose or serious side effects

-unusual or unpleasant taste in your mouth.

* Do not take this medication with milk, other dairy products, calcium supplements,or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin.

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Generic

Brand

Action

Classification

Indication

Contraindication

Side Effects/ Adverse Effects

Nursing Responsibilities

Folic Acid

Folic acid is used to treat or prevent certain anemias caused by poor diet, pregnancy, alcoholism, liver disease, certain stomach/intestinal problems, kidney dialysis, or other conditions. This medication helps to relieve symptoms such as unusual tiredness and diarrhea that can occur with these types of anemias. Women of childbearing age should maintain adequate amounts of folic acid either through diet or supplements to prevent infant spinal cord birth defects. Folic acid is a B-complex vitamin needed to form healthy cells, especially red blood cells.

B-complex vitamin

Folic acid deficiency can have many causes. Inadequate diet, some malabsorption symptoms can lead to manifestations of megaloblastic anemias. Several drugs cause folic acid deficiency, particularly phenytoin, possibly also other antiepileptic agents, and methotrexate. During pregnancy folic acid deficiency is particularly acute, so that regular folic acid supplements are recommended.In general it is desirable that women who wish to have children start taking a daily dose of at least 400 g of folic acid even before pregnancy. It has now been safely established that this precaution significantly reduces the incidence of neural tube defects (cleft spine, myelomeningocele, anencephaly) Women whohave given birth to a child with one of the above-mentioned anomalies should constantly take relatively high doses of folic acid in view of future pregnancies

Hypersens dizziness,. itivity to the drug or compone nts

*assess for rash or itching *assess trouble breathing for

*assess for the proper dosage

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IV. NURSING PROCESS

A. PROBLEM LISTS

Date of onset Aug. 16,2010

Nursing problem Ineffective tissue perfusion related to blood loss Self-care deficit related to weakness and environmental barriers Disturbed sleep pattern related to environmental factors

Date identified Aug. 16, 2010

Date resolve Aug. 17,2010

Date inactive Aug. 18,2010

Aug. 17,2010 Aug. 16, 2010

Aug. 18,2010

Aug 17, 2010

Deficient knowledge related to information Aug.17, 2010 misinterpretation (inaccurate/incomplete information presented)

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