RELATED TREATMENT MEDICAL TREATMENT 1.

Blood Transfusion

PRE-OP April 17, 2012 Time Started: 2:30pm April 18, 2012

POST-OP

Time Started: 3:30 pm (right after The operation is done)

Order: 1pack RBC (250 ml) 10-15 gtts/min To run for 4 hours Time Ended: 6:30 pm

Order: 1pack (250 ml) 10-15 gtts/min To run for 4 hours 3:30-5:30 @ Recovery Room 5:30-6:00 Transport patient to Room 6:00 Received patient @ Room 303 Time Ended: 7:30pm

2. Intravenous Fluid Plain Normal Saline Solution 1liter @ 20 gtts/min Significance: Normal Saline Solution is used frequently in intravenous drips (IVs) for patients who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia. 3. Medications Pre Op Generic Name: Ferrous Sulfate Brand Name: ( Hemarate FA)

Classification: Anti-anemia Dosage/Route/Timing: 1 tab po BID Indication: Ferrous sulfate is used to treat iron deficiency anemia. Mechanism of Action: Ferrous sulfate facilitates O2 transport via hemoglobin. It is used as iron source as it replaces iron found in hemoglobin, myoglobin and other enzymes. Side Effects/ Adverse Effects: Constipation, upset stomach, temporary staining of the teeth, black or dark-colored stools. Nursing Considerations: General: Observe the 10 rights of drug administration Before: Assess patients condition and any allergy to drug. During: Tell patient to take drug with orange juice or water but not milk. After: Advise patient to report constipation and change in stool color or consistency. On Call for OR 1. Generic Name: Monobasic Sodium Phosphate Dibasic Sodium Phosphate Brand Name: Phosphosoda Classification: Laxative Dosage/Route/Timing: 45cc po OD (one dose) Indications: For bowel cleansing prior to medical procedure such as surgery Mechanism of Action: Increasing stool volume and distention of the gut walls leads to enhanced peristalsis and bowel evacuation. Side Effects and Adverse Effects: Transient Hypophosphatemia Nursing Considerations: General: Observe the 10 rights of drug administration. During: Let the patient take the drug with juice to cover the taste of the drug. After: Assess patient for signs of dehydration. 2. Generic Name: Co- Amoxiclav Brand Name: Augmentin

Classification: Bactericidal Dosage/Route/Timing: 625mg IVTT every 8 hours Indications: pre& post-surgical procedures Mechanism of Action: Inhibits enzymes involved information of peptidoglycan layer of bacterial cell wall No effect on human cell walls Bactericidal; only works on dividing bacteria Well absorbed enterally Clavulanic acid inhibits bacterial -lactamase Side Effects and Adverse Effects: Hypersensitivity reactions, GI upset, mucocutaneous candidiasis. Rarely hepatitis, cholestatic jaundice, interstitial nephritis, toxic epidermal necrolysis, blood dyscrasias, CNS effects, antibiotic associated colitis. Nursing Considerations: General: Observe the 10 rights of drug administration. Before: Ask patient if she is allergic to penicillin. During: Ask patient to take drug with food to prevent GI upset. After: Tell patient to take drug exactly as prescribed even after she feels better. 3. Generic Name: Omeprazole Brand Name: Zefton Classification: Anti- Ulcer Drugs Dosage/Route/Timing: 40mg IVTT OD Indications: heartburn Mechanism of Action: Inhibits activity of acid pump and binds to hydrogen-potassium adenosine triphosphatase at secretory surface of gastric parietal cells to block formation of gastric acid. Side Effects and Adverse Effects: headache, dizziness, diarrhea, abdominal pain, nausea, vomiting, constipation, flatulence, back pain, cough, rash Nursing Considerations: General: Observe the 10 rights of drug administration. Before: Check doctors order. During: Reconstitute with Normal Saline Solution, D5W or Lactated Ringers Solution. After: Watch for signs and symptoms of side/ adverse effects. 4. Generic Name: Promethazine

Brand Name: Promacot Classification: Antihistamine Dosage/Route/Timing: 0.5mg IM on call to OR Indications: For routine preoperative or postoperative sedation. Mechanism of Action: Phenothiazine derivative that competes with histamine for H1 receptor sites on effector cells. Prevents, but doesnt reverse, histamine-mediated responses. At high doses, drug also has local anesthetic effects. Side Effects and Adverse Effects: sedation, sleepiness, dizziness, drowsiness, disorientation, hypotension, hypertension, blurred vision, nausea, vomiting, dry mouth, urine retention, hyperglycemia, respiratory depression, apnea, photosensitivity, rash Nursing Considerations: General: Observe the 10 rights of drug administration. Before: Check doctors order. During: Inject deep IM into large muscle mass. Dont give SQ. After: Monitor patient for altered mental status. 5. Generic Name: Parecoxib Brand Name: Dynastat Classification: NSAIDS Dosage/Route/Timing: 40mg slow IVTT every 12 hours Indications: post op pain Mechanism of Action: Parecoxib is the prodrug of valdecoxib. It has a very high selectivity for inhibiting cyclo-oxygenase-2 (COX-2) mediated prostaglandin synthesis to reduce mediators of pain and inflammation. The selective inhibition of COX-2 is coupled with reduced GI toxicity, but associated increased risk for thrombotic events and renal impairment have been noted. Side Effects and Adverse Effects: Rash, ulcerations or any other signs of an allergic reaction; GI disturbances and bleeding; hypotension; hypertension; back pain; edema; numbness; agitation or sleeping difficulties; anemia; sore throat or difficulty breathing; pruritus; decreased

urine output; jaundice, abnormal liver function; low platelet count; skin swelling, blistering or peeling; kidney failure; heart failure, heart attack, bradycardia, arrhythmia. Nursing Considerations: General: Observe the 10 rights of drug administration. Before: Dont use in children. During: Caution should be exercised in patients with history of dehydration, hypertension, liver or kidney disease, ulcer, elderly and pregnant patients. After: Tell patient that drug may cause dizziness or drowsiness. She should not drive a car. Post Op 1. Generic Name: Metoclopramide Brand Name: Plasil Classification: Anitemitics Dosage/Route/Timing: 10mg IVTT at 2 am Indications: Treatment and prevention of postoperative nausea and vomiting Mechanism of Action: Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying. Side Effects and Adverse Effects: restlessness, anxiety, drowsiness, fatigue, depression, insomnia, confusion, seizures, hallucinations, headache, dizziness, transient hypertension, hypotension, nausea, diarrhea, urinary frequency, rash, urticarial, loss of libido. Nursing Considerations: General: Observe the 10 rights of drug administration. Before: Make sure patient is not allergic to drug. During: Give doses of 10mg or less by direct injection over 12 minutes. Dilute doses larger than 10mg in 50 ml of compatible diluent and infuse over at least 15 minutes. After: Closely monitor blood pressure. Urge patient to report persistent or serious adverse reactions promptly. 2. Generic Name: Co- Amoxiclav Brand Name: Augmentin Classification: Bactericidal

Dosage/Route/Timing: 625 mg tab 1 tab po BID Indications: pre& post-surgical procedures Mechanism of Action: Inhibits enzymes involved information of peptidoglycan layer of bacterial cell wall No effect on human cell walls Bactericidal; only works on dividing bacteria Well absorbed enterally Clavulanic acid inhibits bacterial -lactamase Side Effects and Adverse Effects: Hypersensitivity reactions, GI upset, mucocutaneous candidiasis. Rarely hepatitis, cholestatic jaundice, interstitial nephritis, toxic epidermal necrolysis, blood dyscrasias, CNS effects, antibiotic associated colitis. Nursing Considerations: General: Observe the 10 rights of drug administration. Before: Ask patient if she is allergic to penicillin. During: Ask patient to take drug with food to prevent GI upset. After: Tell patient to take drug exactly as prescribed even after she feels better. 3. Generic Name: Etoricoxib Brand Name: Arcoxia Classification: NSAIDS Dosage/Route/Timing: 120 mg tab 1 tab po OD Indications: to relieve short term pain, including cramp-like pain or discomfort before or during a menstrual period Mechanism of Action: Etoricoxib selectively inhibits cyclooxygenase 2 (COX-2). Side Effects and Adverse Effects: GI disorders; ischemic cardiac events; hypersensitivity reactions, headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, tinnitus, photosensitivity; blood disorders, fluid retention, hypertension; dry mouth, taste disturbance, mouth ulcers; appetite and wt changes; chest pain, fatigue, paraesthesia, influenza-like syndrome, myalgia. Renal toxicity. Nursing Consideration: General: Observe the 10 rights of drug administration. Before: 5. Ferrous Sulfate (see above information)

SURGICAL TREATMENT Dilatation and Curettage with frozen section + Total Abdominal Hysterectomy Purpose of the procedure: Dilatation and Curettage is a surgical procedure usually performed under local anesthesia in which the cervix is dilated and the endometrial lining of the uterus is scraped with a curet; performed to obtain tissue samples or to stop prolonged bleeding or to remove small tumors. Frozen Section is a specimen cut by microtome from tissue that has been frozen. It is done to know if the lesion present is malignant lesion or non-neoplastic lesion. Total Abdominal Hysterectomy is the removal of the uterus and the cervix. It may be recommended over other surgical approaches if you have a large uterus or if your doctor wants to check other pelvic organs for signs of disease.t may be Date and Time of the procedure: April 18, 2012 / 11:00am Nursing Considerations: Re-assessed patients understanding on the physicians explanation on the surgical procedure. Encouraged verbalization of feelings, doubts, confusion and discomforts. Provided support system (e.g presence of family members and significant others) Facilitated pre-operative preparations (e.g removal of dentures, metallic objects and etc.)