Colegio De San Juan De Letran- Calamba

School of Nursing
Bucal, Calamba City

A Case Study on

CESAREAN DELIVERY

Prepared and presented by

Padua, Jhaylyne Panganiban, Danica Pea, Norianne Sael, Joshua Salcedo, Gleis Taccad, Tanya

Level II- Section 1 GROUP 3

Presented and Submitted to:

Maam Cecilia Dilag, RN, MAN

Clinical Instructor

I.

INTRODUCTION

A. Background of the Study A cesarean section is the delivery of a baby through a cut or incision in the mothers abdomen and uterus. It is often called a C-section. The term cesarean is derived from the Latin word caedore, which means to cut. C-section may be planned or unplanned. Reasons you might need an unplanned C-section include: Labor is slow and hard or stops completely. The baby shows signs of distress, such as a very fast or slow heart rate. A problem with the placenta or umbilical cord puts the baby at risk. The baby is too big to be delivered vaginally. Reasons you might have a planned C-section include:

The baby is not in a cephalic presentation close to your due date. You have a problem such as heart disease that could be made worse by the stress of labor. You are carrying more than one baby (multiple pregnancies). You had a C-section before, and have the same problems like before.

B. Rationale for choosing the case o To gain more knowledge about Cesarean Section. o To know what are the medical and surgical treatments done. o To identify the factors why women undergo cesarean birth.

C. Significance of the study The importance of this study is to help us gain more knowledge about the proper ways of handling and caring Cesarean section patients. We can educate and inform people on how to handle the said delivery and to increase their awareness and knowledge about the case.

D. Scope and Limitation of the study This study covers and focuses on the following: o o o o A brief discussion of the procedure. Anatomy and Physiology Drug study for the medication Nursing care plans

II.

CLINICAL SUMMARY
A. General Data

Name of Patient: Patient Z Age and Sex: 21, Female Birth date: December 6, 1990 Birthplace: San. Pedro, Laguna Civil status: Single Nationality: Filipino Religion: Roman Catholic

Date Admitted: August 5, 2011 Time Admitted: 9:25 am Attending Physician: Dra. Grace V. Mendoza

B. Chief Complaint On the 5th of August the client was brought to hospital because of dry labor.

C. History of Present Illness 2 weeks prior to admission patient Z experienced cough and abdominal pain. The patients age of gestation is

D. Past Medical History Patient Z doesnt have any history of illnesses like hypertension, diabetes, asthma, kidney disease, and doesnt have allergies. She did not also experience any operations before. For her childhood illness she had chicken pox and measles.

Menstrual History Menarche 13 years old, lasting for 4 to 5 days Experiencing dysmenorrhea LMP: November 6, 2010 Obstetrical Hisory G2P1 A. Familial history

Father Mother (-) hypertension (-) hypertension (-) Diabetes Mellitus (-) Diabetes (+) Anemia

Mellitus

Patient Z (-) hypertension (-) Diabetes Mellitus

F. Physical Assessment
AREA 1. Size, shape and symmetry TECHNIQUE Inspection NORMS SKULL rounded (normocephalic and symmetrical with frontal, parietal and occipital prominences), smooth skull contour smooth, uniform consistence, absence of nodules and masses no edema HAIR Evenly distributed and covers the whole scalp; Thick or thin Silky; resilient hair No infection and infestation FACE Symmetric. No palpated nodules or mass. FINDINGS Rounded (normocephalic); Smooth skull contour ANALYSIS Normal

2.

3.

Presence of nodules, masses and depression Presence of Edema

Inspection and Palpation Inspection and Palpation Inspection and Palpation Inspection and Palpation Inspection and Palpation Inspection and Palpation

Has no tenderness; no masses nor nodules No edema

Normal

Normal

1.

2. 3.

evenness of growth, thickness or thinness of hair Texture and oiliness over the scalp Presence of infection and infestation

Evenly distributed, covers the scalp, thick Oily hair No infection

Normal

Normal Normal

Facial Features, symmetry of facial movements

Symmetric, No palpated nodules or mass

Normal

AREA

TECHNIQUE

Hair distribution, alignment, skin quality and movement

Inspection

Evenness of distribution and direction of curl

Inspection

NORMS EYES Eyebrows Symmetrical and in line with each other; maybe black, brown, or blond depending on the race; evenly distributed Eyelashes Evenly distributed

FINDINGS

ANALYSIS

Symmetrically aligned with each other. Black in color. Evenly distributed

Normal

Turned outward eyelashes, Evenly distributed

Normal

Surface characteristics and position (in relation to the

Inspection

Eyelids Upper eyelids covers the small portion of

Symmetrical when the

Normal

cornea, ability to blink, and frequency of blinking)

the iris, cornea and sclera when eyes are open; eyelids meet completely when the eyes are closed; symmetrical Conjunctiva Pinkish, or red in color No tenderness and palpable lesions. Sclera White in color, clear, no yellowish discoloration: some capillaries may be visible

eyes are closed.

Color, texture and the presence of lesions

Inspection

Pinkish in color

Normal

Color and Clarity

Inspection

White in color. Capillaries visible

Normal

AREA

TECHNIQUE

NORMS Cornea No irregularities on the surface, Looks smooth Iris Anterior chamber is transparent, no noted visible materials Pupils Color depends on the persons race, equal in size and equally round Constrict briskly when light is directed to the eye Visual Acuity Able to read newsprint Lacrimal Gland No edema or tenderness over

FINDINGS

ANALYSIS

Clarity and texture

Inspection

Transparent in color

Normal

Shape and color

Inspection

Black in color, transparent anterior chamber

Normal

1.

Color, shape and symmetry of size

Inspection

Black in color

Normal

2.

Light reaction and accommodation

Inspection

Constrict briskly when light is directed to the eye

Normal

Near vision

Inspection

Able to read newsprint

Normal

Palpability and tenderness of the lacrimal gland

Palpation

No tenderness, No edema

Normal

lacrimal gland Visual Fields When Looking straight ahead, client can see objects in the periphery

Peripheral visual fields

Inspection

Client can see objects in periphery

Normal

AREA

TECHNIQUE

Color, symmetry of size and position

Inspection

NORMS EARS Auricles Color same as facial skin; symmetrical; auricle aligned with outer cantus of the eye. Firm, not tender; pinna recoils after it is folded Hearing Acuity Test Normal voice tones audible

FINDINGS

ANALYSIS

Same color as of the facial skin; tip of auricle aligned at the outer cantus of the eye. Smooth in texture, pinna recoils easily; no tenderness

Normal

Texture, elasticity areas of tenderness

and

Palpation

Normal

Clients response to normal voice tones

Inspection

Can hear normal volume tones or words.

Normal

Any deviation in shape, size or color and flaring or discharge from the nares.

Inspection

NOSE Symmetric and straight: no discharge or flaring: uniform color Nasal spectrum intact and in midline Air moves freely as the client breathes through the nose No tenderness, no lesions

Can smell normally

Normal

Nasal septum (between the nasal chambers) Patency of cavities Both nasal

Inspection

Nasal spectrum intact and in midline Can breath freely through the nose

Normal

Inspection

Normal

Tenderness, masses ,and displacements of bone and cartilage

Palpation

No tenderness or lesions

Normal

Identification of the sinuses and for tenderness AREA

Palpation

Sinuses Not Tenderness

No Tenderness

Normal

TECHNIQUE

NORMS

FINDINGS

ANALYSIS

Symmetry of contour, color and texture

Inspection and Palpation

MOUTH Lips Uniform pink color, soft, moist, symmetry of contour Buccal Mucosa Uniform pink color; moist,

Dry and pale

Normal

Color, moisture and texture and presence of lesions

Inspection

Pink in color, Moist

Normal

Color, number and condition and presence of dentures

Inspection

Teeth 32 adult teeth, smooth, white.

Teeth is complete, white in color

Normal

Color and condition

Inspection

Gums Pink gums; no retraction Tongue/Floor of the mouth Pink color, moist, slightly rough; thin whitish coating, moves freely Oropharynx and Tonsils

Pinkish gums

Normal

1.

Color and texture of the mouth floor and frenulum.

Inspection

White in color

Normal

1.

Color and texture

Inspection

Pinkish and smooth posterior wall Pink and smooth, no discharge; of normal size

Pink in color and has a smooth posterior wall Pink in color, no discharge

Normal

2.

Size, color, and discharge of the tonsils.

Inspection

Normal

AREA

TECHNIQUE

1.

Breathing patterns

Inspection

NORMS THORAX Anterior Thorax Quiet, rhythmic, and effortless respirations Skin intact, uniform temperature, chest wall intact, no tenderness, no masses Breath sounds

FINDINGS

ANALYSIS

Quiet, rhythmic respiration Has intact skin , No tenderness

Normal

2.

Temperature, tenderness, masses

Palpation

Normal

3.

Anterior thorax

Auscultation

Has normal breath

Normal

auscultation Posterior Thorax Vertically aligned

sounds

1.

Spinal Alignment

Inspection

Has a vertical alignment No tenderness; has equal warmth on each side

Normal

2.

Temperature, tenderness, and masses

Palpation

Skin intact; uniform temperature; chest wall intact; no tenderness; no masses CARDIOVASCULAR Has pulsations

Normal

1.

Aortic and Pulmonic Area Tricuspid Area Apical Area

Auscultation

Has Pulsations

Normal

2. 3.

Auscultation Auscultation

Has pulsations Pulsations in the fifth LICS at or medial to Midclavicular line ABDOMEN

Has Pulsations Pulsations heard in the 5th 9 intercostals space left Midclavicular line

Normal Normal

1.

Skin Integrity

Inspection

Unblemished skin; uniform color

Has an open wound on the mid region of the abdomen with puss inside Rounded

Because the client didnt take antibiotics therefore it causes Infection Normal

2.

Abdominal contour

Inspection

Flat, Rounded, or scaphoid Symmetric Contour

3. Symmetry of contour

Inspection

Has asymmetrical abdominal contour

Because of the surgical wound the abdomen becomes asymmetrical

4.

Abdominal movements associated with respirations

Inspection

Symmetric movements

Abdomen moves during inspiration.

Normal

MUSCULOSKELETAL Muscles Proportionate to the body

1.

Muscle size and comparison on the other side No tremors in the muscles Muscle Tone

Inspection

Proportionate to the body ; even in both sides No tremor Has some bruises in left hands

Normal

2. 3.

Inspection Palpation

No tremors Even and firm tone

Normal Because of the injection of intravenous fluids in the clients blood vessels. Normal

4.

Muscle strength

Palpation

Has equal muscular strength on both sides

Has equal muscle strength

CATEGORY Mental status Level of Consciousness

NORMAL FINDINGS

ACTUAL FINDINGS

ANALYSIS AND INTERPRETATION

Orientation

Alert Conscious Coherent Oriented

conscious alert Coherent

Patient is stimulate and responsive to stimuli from the environment. Patient is able to quickly and impulsively state their name, location, and the date or time are said to be oriented to self, place, and time. Patient has an comprehensible and clear thought in telling and describing information or situation that enable both of them with the nurse to have a good statement Patient has the ability to remember precedent situation and information that being said or happened.

Language test

Logical sequence Makes sense Has a sense of reality

client was able to answer question regarding on her situation and identification

Recall

Understandable Moderate pace Clear tone and inflection Exhibits thought association ability to store, retain and recall information

client has an understandable, clear thought

has the ability to evoke information and events

Cranial Nerves CN I Olfactory

Able to identify different odors

client identified the different odors/ aromas

Patient was able to distinguish and recognize unlike odors because the neurons of the olfactory bulb were able to transmit olfactory information along the olfactory

tract to the olfactory cortex of the cerebrum. CN II Optic 20/20 vision able to read newsprint, client can see objects in the periphery pupil is black in color, equal in size, normally 3 to 7 mm, round, smooth border, iris flat and round illuminated pupil constricts nonilluminated pupil constricts simultaneously with the illuminated pupil both eyes coordinated, move in unison, with parallel alignment Equality of strength of the masseter muscles when the teeth are clenched and unclenched Ability to correctly distinguish dull and sharp sensations Ability to correctly distinguish light touch Ability to sense hot and cold sensations Presence of blinking of the eye Normal vision Patient was able to comprehend her books accordingly and in normal vision.

CN III, IV, VI Occulomotor Trochlear Abducens

pupil is black in color, equal in size, 2- 3 mm in diameter, round pupil constricts both eyes coordinated and with parallel alignment

Patient has a accurate movement of the eye for visual tracking or fascination on an object.

CN V Trigeminal

can clenched teeth on equal strength able to distinguish dull and sharp sensation able to distinguish light touch able to distinguish hot and cold (+) blinking reflex

Patient was able to tell between different sensory information and can also achieve muscle mastication or chewing.

CN VII Facial

Equality of muscle strength when raising the eyebrows, frowning, showing both the upper and lower teeth, smiling, puffing out the cheeks, and closing the eyes tightly

client can smile, can raise eyebrows, can puff cheeks, (-) lateralization, close eyes tightly

Patient was able to manage most facial expression, secretions of tears and saliva taste.

CNVIII Vestibulocochlear

Ability to correctly repeat the whispered word Vibrating sound is heard equally well in both ears; no lateralization AC of the vibrating sound is heard twice as long as BC of the vibrating sound

heard equally the vibrating sound AC>BC

Patient was able to conclude hear information through cochlear nerve and balance information through the vestibular part of the nerve.

CN IX, X Glossopharyngeal, Vagus

CN XI Accessory (Spinal)

Symmetrical rise of the soft palate and uvula when ah is said Presence of gagging Absence of hoarseness or nasal quality of the voice Symmetrical strength and contraction of the trapezii muscles as the shoulders are shrugged upward against resistance Symmetrical strength and contraction of these

(-) gag reflex Patient was able to intellect absence of hoarseness of flavor information the voice symmetrical rise of the soft palate and uvula

equal strength and contraction of the trapezii and sternocleidomastoid muscle

Patient was able to swallow and execute muscle movement for the upper shoulders, head and neck.

sternocleidomastoid muscles as the head is turned against resistance CN XII Hypoglossal Symmetry Absence of atrophy Midline position of the tongue Inability to push the tip of the tongue into the mouth can move tongue side to side (-) atrophy midline positon of the tongue can move tongue side to side

Patient was able to execute tongue movement

Muscle Strength Left Arm Normal (3,4,5) strength of muscle contraction Absence of fasiculations or tremors Normal (3,4,5) strength of muscle contraction Absence of fasiculations or tremors 100% of normal strength (-) tremors

Patient has a normal strength and normal full movement against gravity and against full resistance Patient has a normal strength and normal full movement against gravity and against full resistance

Right Arm

100% of normal strength (-) tremors

Left leg

Normal (3,4,5) strength of muscle contraction Absence of fasiculations or tremors Normal (3,4,5) strength of muscle contraction Absence of fasiculations or tremors.

100% of normal strength (-) tremors

Patient has a normal movement against gravity

Right leg

100% of normal strength (-) tremors

Patient has a normal movement against gravity

G. Patterns of Functioning
Functional Health Pattern Prior to Hospitalization Health Perception-Health Management The patient has a good health status, though she is drinking alcohol. Nutritional Metabolic Pattern The patient has a balanced diet. She eats three times a day but admits that she loves eating street foods. Elimination The patient doesnt experience any pain during bowel movements, and urinates in a normal way. Activity and Exercise The patient considered her daily chores as her daily exercise. Sleep and Rest The patient has a sleep habit of 8 hours per night. She doesnt have any difficulty of going to sleep. She also takes naps. Self-Perception The patient view herself in a positive way. Norms and Standards Health is a state of health being, it involves hygiene, cleanliness of self and environment, wellness and absence of diseases. Nutrition of the patient involves a balanced diet manifested by food and fluid intake. Junk food, soft drinks and street foods such as fish balls, kikiams, and chips are not good for the health. No pain in bowel in bowel movements, urinate in a normal way are the normal excretory functions. She said that everyday fecal elimination is a good way to eliminate toxins. Daily activity in the house like fixing your room, sweeping and washing dishes are a form of exercise. Exercise is important to maintain good posture and metabolism. We usually need about 8 hours of sleep to fuel wakefulness for the next 16 hours. Our patient has a normal sleep for about 6-8 hours or even extend.

The patient perceives herself in a very positive way.

Role-Relationship The patient has a good relationship with her husband. She clearly understands her role for being a wife.

Has a good relationship pattern, she has a clear understanding of her role being a wife.

Coping-Stress The patient rates her usual handling of stress as average. She deal with her stress by crying. Value-Belief The patient is a Roman Catholic and is knowledgeable about God.

Has an effective coping pattern. Her standard relies on her perception regarding illness, health and values of life.

Has a good value-belief pattern. Believes in the teachings of Jesus Christ as a role model in her life. She also believes in the teachings of Our God as a Savior. Prayer as a good form of relationship to God.

H. Activities of Daily Living

ASPECT PRIOR TO HOSPITALIZATION Healthy No pain. Daily chores serve as exercise. Taking a bath daily. Complete sleep. Active DURING HOSPITALIZATION Low appetite No pain. No exercise INTERPRETATION AND ANALYSIS Due to hospitalization, her nutrition was affected. She cant perform exercise, selfcare recreational activities, sleep well all because of the previous CS.

1. Nutrition 2. Elimination 3. Exercise

4. Hygiene 5. Sleep and Rest 6. Sexal Activity

Improper hygiene. Cannot sleep well. Inactive

I. Patients Concept about Health, Illness, and Hospitalization

HEALTH According to the patient, as long as you have a proper hygiene and no diseases, you are healthy.

ILLNESS According to the patient, being ill is a problem that she doesnt want to happen in her family.

HOSPITALIZATION According to the patient, being hospitalize is their last option if they have illness.

J. Laboratory and Diagnosis Examination HEMATOLOGY

Date August 5, 2011 9 Procedure Norms Result Interpretation and Analysis
A high white blood count indicates not a specific disease by itself but indicates infection, systemic illness, inflammation, allergy, leukemia and tissue injury caused due to burns. A high neutrophil count indicates bacterial infections , primarily , viral and fungal infections, others are acute stress and white blood cell cancers A low lymphocyte indicates acute infection, that the body's resistance to fight infection has been substantially lost A low hemoglobin count indicates a low red blood cell count is called as Anemia. The low hemoglobin level indicates nutritional deficiency A normal platelet count indicates normal range of platelet count and is negative for occurrence of excessive bleeding and thrombosis A low hematocrit indicates anemia, such as that caused by iron deficiency or other deficiencies.

WBC

5-10 x 10

/L

17

Neutrophils

0.51 0.67

.87

Lymphocytes

0.21 0.35

.13

M 130 180 Hemoglobin F 120 - 160 110

Platelet Count

150 400 x 10 /L

393

M 39 54 Hematocrit F 36 - 48 34

Date AUGUST 11, 2011

Procedure

Norms

Result

Interpretation and Analysis

A high white blood count indicates not a specific disease by itself but indicates infection, systemic illness, inflammation, allergy, leukemia and tissue injury caused due to burns. A normal count of neutrophils indicates low risk for infections and/ or no bacterial or other infections are present An increase in lymphocyte concentration is usually a sign of a viral infection A low hemoglobin count indicates a low red blood cell count is called as Anemia. The low hemoglobin level indicates nutritional deficiency A high platelet count Indicates a tendency to bleed due to the lack of stickiness of the platelets most seen in patient with chronic inflammation

WBC

5-10 x 10

/L

13.2

Neutrophils

0.51 0.67

.63

Lymphocytes

0.21 0.35

.37

M 130 180 Hemoglobin F 120 - 160 90

Platelet Count

150 400 x 10 /L

844

M 39 54 Hematocrit F 36 - 48 27

A low hematocrit indicates anemia, such as that caused by iron deficiency or other deficiencies.

K. Impression/Diagnosis G3P2 2012 PUFT Cephalic in presentation in 1 degree LTCS

III.

CLINICAL DISCUSSION OF THE DISEASE

A. Anatomy and Physiology

EXTERNAL STRUCTURE Vulva which runs from the pubic area downward to the rectum. Two folds of fatty, fleshy tissue surround the entrance to the vagina and the urinary. The labia majora, or outer folds, and the labia minora, or inner folds, located under the labia majora. The clitoris, is a relatively short organ (less than one inch long), shielded by a hood of flesh. When stimulated sexually, the clitoris can become erect like a man's penis. The hymen, a thin membrane protecting the entrance of the vagina, stretches when you insert a tampon or have intercourse.

 INTERNAL STRUCTURE The vagina is a muscular, ridged sheath connecting the external genitals to the uterus, where the embryo grows into a fetus during pregnancy. In the reproductive process, the vagina functions as a two-way street, accepting the penis and sperm during intercourse and roughly nine months later, serving as the avenue of birth through which the new baby enters the world. Cervix, the lower portion or neck of the uterus. After intercourse, sperm ejaculated in the vagina pass through the cervix, and then proceed through the uterus to the fallopian tubes where, if a sperm encounters an ovum (egg), conception occurs. The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes. The uterus mostly consists of muscle, known as myometrium. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus. On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy. The ovaries are the place inside the female body where ova or eggs are produced. The process by which the ovum is released is called ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle. After ovulation, the ovum is captured by the oviduct, where it travelled down the oviduct to the uterus, occasionally being fertilized on its way by an incoming sperm, leading to pregnancy and the eventual birth of a new human being. The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.

B. Drug Study

Brand name Ampicillin

Classification Anti-infective

Indication Treatment of infections caused by susceptible strains of the designated organisms

Contraindication Patient with allergic reaction to penicillin. Patient with hypersensitivity to drug.

Action Inhibits cellwall synthesis during bacterial multiplication

Side effects Skin rashes, nausea, vomiting and diarrhea

Nursing Interventions Before giving the drug ask the patient about allergic reactions to penicillin or a negative history of penicillin allergy. Watch for signs and symptoms of hypersensitivity.

Brand name
Gentamicin

Classification anti-infective, aminoglycoside antibiotic

Indication Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated

Contraindication History of hypersensitivity or toxic reaction with any aminoglycoside antibiotic

Action Broad-spectrum aminoglycoside antibiotic derived from Micromonospo ra purpurea. Actio n is usually bacteriocidal.

Side effects Ototoxicity (vestibular disturbances, impaired hearing)

Nursing Interventions . Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity. Repeat C&S if improvement does not occur in 35 d; reevaluate therapy. Note: Dosages are generally adjusted

. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertensio n. GI: Nausea, vomiting

to maintain peak serum gentamicin concentrations of 4 10 g/mL, and trough concentrations of 12 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity. Draw blood specimens for peak serum gentamicin concentration 30 min 1h after IM administration, and 30 min after completion of a 3060 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose.

Brand name

Classification Anti-infectives, Anti-protozoals

Indication Amebicide in the management of amebic dysentery

Contraindication hypersensitivity

Action Disrupts DNA and protein synthesis in susceptible organismsBact ericidal, or amebicidal action

Side effects CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic:

Nursing Interventions Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if

Metronidaz ole

leukopenia Skin: rashes, urticaria

feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose. May cause dizziness or light-headedness. Caution patient or other activities requiring alertness until response to medication is known. Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark. Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foulsmelling stools develop)

Brand name Ranitidine

Classification

Indication Treatment and prevention of heartburn, acid indigestion, and sour stomach

Contraindication Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impairment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation

Action Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori.

Side effects CNS: Confusion, dizziness, drowsiness, hallucinatio ns, headache CV: Arrhythmia s GI: Altered taste, black tongue, constipatio n, dark stools, diarrhea, druginduced hepatitis, nausea LOCAL: Pain at IM site

Nursing Interventions Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists

IV.

NURSING PROCESS

D. Discharge Planning

Medications Exercise or economic factor Treatment Health teaching

Take home medication as prescribed by the physician Light exercises, participate in ADL Clean the incision site regularly. Have a follow-up check up Informed patient to avoid lifting heavy objects, proper breastfeeding. Instructed patient to report to the physician any signs of infection. DAT(Diet As Tolerated) Can participate in spiritual activities.

Out patient follow-up Diet Spiritual/ sexual activities