Republic of the Philippines

MARIANO MARCOS STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES
Batac, Ilocos Norte

Surgery: CHOLECYSTECTOMY

Francis John Dancel

Vander John Doctor
Irma Claire Gregorio
Cristine Mae Hipolito
Monica Francine Jose
Thea Grizzelle Joy Leaño
Vanessa Paguirigan
Aleli Chris Florah Paguyo
Krystle Kaye Pascua
Blessica Grace Pasion

July 2010
I. Personal Data

Name of the Patient: Nino Jesus Padilla Visitacion

Address: Santo Cristo 1 (Pob.), Bacarra, Ilocos Norte
Hospital Number: 588445
Sex: Male
Age: 41 years old
Date of Birth: December 25, 1968
Place of Birth: Bacarra, Ilocos Norte
Civil Status: Married
Religion: Aglipayan
Educational Attainment: High School undergraduate
Occupation: Farmer
Chief Complaint: RUQ pain
Admitting Diagnosis: CHOLECYSTOLITHIASIS
Date and Time of Admission: July 13, 2010 @ 11:27 AM
Attending Physician: Rommel Rasos, M.D.
Final Diagnosis: CHRONIC CALCULUS CHOLECYSTITIS
Date and Time of Discharge: July 16, 2010
MEDICAL MANAGEMENT

Treatment

1. Laparoscopic Cholecystectomy
Date Ordered: July 13, 2010

Laparoscopic Cholecystectomy is a surgical management for symptomatic gallbladder

disease.The surgeon usually approaches the gallbladder through a through a laser cautery to
remove the gallbladder. With the client under general anesthesia, carbon dioxide is used to
create pneumoperitoneum through a needle inserted near the umbilicus. Near the umbilicus,
an endoscope is inserted through a small incision to view the gallbladder and to determine
the feasibility of success associated with this procedure. Three other small incision are
created: one for grasping the gallbladder, one for suction and irrigation and one for dissection
instruments and applying clips.

Indication: Laparoscopic Cholecystectomy was done to our client to remove the formed
gallstones in the gallbladder thus treating his disease and also to prevent further complication.

Preoperative Nursing Responsibilities:

1. Prepare client psychologically to promote client’s peace of mind and lessen anxiety felt
so as to gain cooperation.
 Inform client about the reason or purpose of the procedure.
 Explain the procedures that will be performed before, during and after the
surgery.
 Emphasize probable outcome of the operation.
2. Prepare client regarding legal aspects.
 Obtain and witness signature of the client or the significant other on operation and
anesthesia consent form to guard client against invasive procedures, to ensure
patient’s understanding of the nature of the treatment, indicates decision, protect
patient from unauthorized procedure and also to protect health care facility and
the health care providers.
3. Give pre-operative teachings to the client.
  Teach client to do deep breathing and coughing exercises and proper way of
expectorating secretions and to perform leg exercises that are necessary after
surgery
 Teach repositioning and ambulation techniques after surgery for faster recovery of
the client.
4. Prepare client physically by means of proper hygiene.

On the eve of the surgery:

 Do skin preparation (below the nipple line down to proximal leg) to lessen presence
of microorganisms on the incision site that may cause infection.
 Place client on NPO post-midnight as ordered to reduce possibility of vomiting and
aspiration during the effect of the anesthesia.
 Promote rest and sleep of the client.
 Assist in bath or shower and oral hygiene of the client.
 Ask client to void and take the vital signs of the client before administering the
preoperative medications.

On the day of the Surgery:

 Assist the client in bath or shower and oral hygiene and changing hospital gowns.
 Remove jewelries, dentures, and colored nail polish if present.
 Empty bladder.
 Reinforce health teachings.
 Check gadgets and get vital signs for baseline data.
 Administer pre-operative medications like tranquilizers, sedatives, analgesics and
anticholinergics.
 Do proper documentation.
 Transfer the client to OR safely.
Post-operative Nursing Responsibilities:

Immediate
1. Maintain patency of airway to prevent respiratory complications by:
 Turn client’s head to side and chin extended forward.
 Placing client on moderate high backrest to prevent aspiration since effect of the
anesthesia is still present.
 Suctioning if there are secretions in the mouth.
 Observe for abnormalities on respiration and absence of air movement.
2. Assess or monitor circulation status by:
 Monitoring vital signs every 15 minutes until stable, then every 30 minutes for 2 hours
then after 4 hours.
 Check dressing for signs of bleeding which is supported by the vital signs.
3. Maintain renal function by:
 Monitoring and recording intake and output so as to identify post-operative bleeding
and dehydration.
 Monitor blood pressure and pulse.
4. Maintain body temperature by providing warm blanket.
5. Prevent injury by raising side rails and staying with the client.
6. Provide comfort by administering analgesic as prescribed.
7. Promote proper positioning to the client.

Late post-operative Care

1. Encourage ambulation and deep breathing and coughing exercises to prevent post-
operative complications and for the promotion of cardiovascular function.
2. Provide comfort and rest by proper positioning and straightening bed linens.
3. Promote relief of pain by administering analgesics.
4. Observe aseptic technique in wound dressing to prevent nosocomial infection.
5. Give antibiotics as prescribed as prophylaxis for infection.
6. Resume to normal diet gradually as ordered to promote adequate nutrition and
elimination.
 NPO to prevent paralytic ileus.
  General Liquid
 Soft diet
 Diet as tolerated (DAT)

2. GENERAL ANESTHESIA
Anesthesia is an artificially state of partial or total loss of sensation with or without loss
of consciousness. Anesthetic agents can produce muscle relaxations, block transmission of pain
nerve impulses and suppress reflexes. It can also temporarily decrease memory retrieval and
recall. The depth and effects of anesthesia are monitored by observing changes in respiration,
oxygen saturation and end tidal CO2 levels, heart rate, urine output and blood pressure.
General anesthesia is the state of analgesia, amnesia and unconsciousness. Types of
general anesthesia include inhalation and intravenous anesthesia.
General anesthesia has four stages: the stage of analgesia, stage of delirium or
excitement, state of surgical anesthesia and the stage of danger or medullary.
Indication: General anesthesia was ordered because Mrs. Visitacion will undergo laparoscopic
cholecystectomy and it was administered intravenously.
Nursing Responsibilities
1. Before operation
o Inform anesthesia department the day before the operation for proper instructions.
2. During Administration
o Close operating room doors, keep room quite, stand by to assist client.
o Assist anesthetist if needed.
o Let the client sleep and do not leave him alone because the client fells dizzy and
drowsy.
o Restrain the client to prevent the risk for fall.
3. After operation
o Maintain client’s airway to prevent respiratory complications by:
 Turn client’s head to side and chin extended forward.
 Placing client on moderate high backrest to prevent aspiration since effect of the
anesthesia is still present.
  Observe for abnormalities on respiration and absence of air movement.
o Maintain renal function by:
 Monitoring and recording intake and output so as to identify post-operative
bleeding and dehydration.
 Monitor blood pressure and pulse.
o Prevent injury by raising side rails and staying with the client.

3. IVF THERAPY
Generally, IV fluids are administered to maintain/replace body water, electrolyte,
vitamins, proteins to meet daily requirement.
Indication: It serves as calories and nitrogen in the patient who cannot maintain adequate intake
per orem. It is also used to restore acid base balance and avenue for drug administration.
It is an efficient and effective method of supplying fluid directly into the intravascular
fluid compartments.

The IVF infused to client are the following:

a. D5LR 1 Liter regulated to 31-32 gtts/min (Date Ordered: July 13, 2010)

This solution is hypertonic which contains calorie (50 mg/100 ml glucose) and
electrolytes such as Na, Cl, and K. It is given to our client to replace body fluids since the
client is prone to fluid volume deficit due to the surgical procedure done.

Purpose:

The choice of an IV solution depends on the purpose of administration. Generally, fluids are
administered to achieve one or more of the following goals:

1. To provide water, electrolytes and nutrients to meet the daily requirements.

2. To replace water and correct electrolyte imbalances.

3. To administer medications.
Nursing Responsibilities

1. Explain the purpose of the IVF therapy as well as about the procedure to the patient.
Inform also the patient how long the process will last to gain his cooperation.

2. Observe aseptic technique in assembling the infusion and during the insertion to prevent
nosocomial infection.
3. Ensure appropriate flow rate of IVF and regulate well basing in the order of the physician
to meet the necessary fluid and electrolytes needed by the body within the specified
length of infusion as well as to prevent circulatory overload.

4. Check the pathway of the IV site to prevent infiltration.

5. Change the solution container before it emptied to prevent embolism.

6. Document the type, flow rate, date, time and the amount consumed for
record purposes.

4. OXYGEN INHALATION (Date Ordered: July 14, 2010)

> Oxygen inhalation at 5LPM per facial mask.

Oxygen therapy is a procedure in which oxygen is administered to relieve hypoxia.

Indication: This was indicated to our client during the surgery due to the relaxation of the lungs
as an effect of the general anesthesia. Administration of oxygen inhalation will help maintain the
supply of oxygen to the client thus preventing hypoxia and other further complications.

Nursing Responsibilities

1. Prepare the equipments needed.

2. Disinfect the facial mask before administering auto inhalation.
3. Regulate oxygen to desired flow rate.
4. Ensure proper positioning.
 Moderate high backrest for proper/good lung expansion as well as to prevent
aspiration.
 5. Ensure observance of oxygen therapy safety precautions such as:
 Check electrical appliances before use to avoid-short-circuit sparks.
 Place NO SMOKING sign at the bedside.
 Avoid use of alcohol near the client.
 Avoid use of material that generates static electricity.
6. Assess the client regularly. Assess effectiveness of oxygen therapy.
 15 to 30 minutes after starting the therapy and regularly thereafter, depending on
the client’s condition.
7. Make relevant documentation.

5. MONITORING VITAL SIGNS EVERY 15 MINUTES

(Date Ordered: July 14, 2010 post-op order)
Indication: Assessment of vital signs provides information about the progress or deterioration of
patient’s condition.
Nursing Responsibilities:

1. Explain the purpose to gain cooperation.

2. Monitor vital signs like respiratory rate and pulse rate for a full minute.
3. Record vital signs and refer for abnormalities especially an elevated BP.

6. DIET
a.NPO – Nothing per orem
July 13, 2010 (prior to operation)

Indication: This is ordered to prevent vomiting and aspiration of food particles and fluids in
case the patient’s level of consciousness is altered.

Nursing Responsibilities:

1. Explain to the patient the purpose of these diets to gain cooperation.

2. Monitor and ensure that patient takes only the prescribed diet to prevent any
complications.
b. DAT- Diet as Tolerated is a kind of diet given to the patient without any restrictions.
Date ordered: July 14, 2010 (after operation when fully awake)
Indication: This was ordered because the patient does not have special diet since there is no

imbalance in his nutritional need.

Nursing Responsibilities:

1. Explain to the patient the purpose of these diets to gain cooperation.

2. Write the ordered or prescribed diet of the patient in the diet list. This serves as a
basis for the dietary section in preparing the food to be given to the patient.
3. Monitor and ensure that patient takes only the prescribed diet.
Laboratory studies and Diagnostic procedures
1. URINALYSIS
Date Ordered: June 29, 2010
Requesting Physician: Dr. Rasos
Urinalysis is done as a general screening test for a variety of diseases.
Indication: To determine the genitourinary disturbances brought about by a suspected acute
infectious illness. It detects the presence of normally unfound concentrates particularly
infectious microorganisms in the genitourinary system as well as urine characteristics that
contribute to the confirmation of the diagnosis.
a. Color
The urine normally ranges from pale yellow to deep amber, depending on its concentration.
b. Clarity
Freshly voided urine is normally transparent.
c. Specific gravity
It indicates the concentration of the urine. This can be used to estimate the person’s general
fluid status.
d. pH
It reflects the plasma pH, with alkalinization or additional acidification occurring in order to
maintain the body’s acid-base balance.
e. Casts
They are formed elements organized in the nephrons by agglutination of protein.
Requested by: Dr. Gilbeys
Result Normal Significance
Physical Exam Color Yellow Amber yellow Normal
Clarity Slightly Turbid Clear Abnormal
Specific Gravity 1.020 1.010-1.025 Normal
pH alkaline 4.6-8 Normal
Chemical
CHON Negative Negative Normal
Exam
Glucose Negative Negative Normal
Hgb Negative Negative Normal
Ketone Negative Negative Normal
Nitrite Negative Negative Normal
 Bilirubin Negative Negative Normal
Urobilinogen Negative Negative Normal
Leukocyte Negative Negative Normal
Esterase Negative Negative Normal
Microscopic Cells:
Exam WBC/HPF 3-5 2-4 Increased
RBC/HPF 0-2 0-2 Normal
Epithelial Cells Numerous Occasional Normal
Bacteria Few Negative Abnormal
Mucus threads Few Negative Normal
Renal cells Negative Negative Normal
Yeast Cells Negative Negative Normal
Cast:
Negative
Hyaline Cast Negative Normal
Fine Granular
Negative Negative Normal
Cast
Coarse Granular
Negative Negative Normal
Cast
Waxy Cast Negative Negative Normal
WBC Negative Negative Normal
RBC Negative Negative Normal
Epithelial Negative Negative Normal
Crystals:
Amorphous Few None Abnormal
Urates
Analysis: Increases in the opacity of the urine may denote a pathologic condition
usually results from the presence of bacteria and crystals. An increase in the WBC, usually
designates an infectious process. The amorphous urates are indicative for infectious process.

Nursing Responsibilities
1. Explain that this test is to look for problems with the urine and the organs that help form
it.

2. Advise the client to wash the perineal area prior to collecting the specimen to avoid
contamination with secretions or stool.

3. Inform the client that a specimen from the first morning urination is preferred since it is
usually concentrated and more likely to reveal abnormalities and formed substances.
 4. Describe the procedure for collecting a clean catch or midstream specimen if indicated.

5. Collect approximately 50 mL of urine, freshly voided into a clean, dry container. A fresh
specimen may be taken from a urinary catheter according to agency policy to prevent
decomposition

6. Ask the watcher to send the specimen to the laboratory with label indicating contents,
client’s name and date to avoid mistakes.

7. Attach result to chart for the physician to evaluate the condition.

2. HEMATOLOGY
Date ordered: June 29, 2010
Requested by: Dr. Rasos
Found Value Normal Value Significance
Hgb 144g/L 110-160 g/L Normal
Hct 0.43g/L 0.38-0.54 Normal
RBC 4.800g/L 4.5-5.5 Normal
MCV 89.40 80-100 Normal
MCH 30 27-32 Normal
MCHC 33.60 31-35 Normal
WBC 6.83g/L 5.0-10.0 Normal
Neutrophils 0.5 0.50-0.70 Normal
Lymphocytes 0.32 0.22-0.40 Normal
Monocytes 0.08 0.02-0.08 Normal
Eosinophils 0.08 0.01-0.04 Increased
Basophils 0.01 0.00-0.01 Normal
Platelet Count 310g/L 150-400 Normal
CBC (Complete Blood Count)
A complete blood count is a screening test known to be one of the most frequently
ordered laboratory procedures. It identifies the total number of blood cells (WBC, RBC, and
platelets) as well as the Hgb, Hct (percentage of blood consisting of RBCs) and RBC indices.
The CBC may reveal considerable data about the patient including diagnosis, prognosis,
treatment response and recovery.
Purpose: It is a hospital routine to evaluate the reaction of the body during infection and
to determine other existing disease such as anemia. This is taken for CP clearance inclusion.
 Procedure:
1. Perform a venipuncture and collect a blood sample in a 7 ml lavender top-tube.
2. Fill the collection tube completely and invert it gently several times to adequately mix the
sample with the anti-coagulant.
a. Hemoglobin
Hemoglobin is the main component of RBC. It contains iron and makes up 95%
of the cell mass. It delivers oxygen to body tissues through circulation and returns carbon dioxide
from tissues to lungs.
Indication: This is to screen the disease associated with anemia
b. Hematocrit
Hematocrit is a measure of the packed cell volume of red cells, expressed as a
percentage of the total blood volume. It indicates relative proportions of plasma and RBCs
(volume of RBCs per liter whole blood).
Indication: The test is done to determine the space occupied by packed red blood cells.
The results are expressed as the percentage of red cells in a volume of whole blood.
c. RBC (Red Blood Cell)
RBC count is a count of the erythrocytes in a specimen of whole blood.
Erythrocyte is the major cellular element of the circulating blood. It is a reddish biconcave disk
that contains hemoglobin confined within a lipoid membrane. Its principal function is to carry
hemoglobin to provide oxygen to tissues.
Indication: This test determines the total number of RBC found in a cubic millimeter of
blood. It is an important measurement in the determination of anemia.
d. MCV (Mean Corpuscular Volume)
This is an evaluation of the average volume of each red blood cell, derived from
the ratio of the volume of packed red blood cells (the hematocrit) to the total number of red
blood cells. It also indicates size of RBCs.
Indication: To determine the ratio of the volume of packed cells to the red cell count.
e. MCH (Mean Corpuscular Hemoglobin)
This is an estimate of the amount of hemoglobin in an average erythrocyte,
derived from the ratio between the amount of hemoglobin and the number of erythrocytes
present. It is related to MCV, because weight of a red blood cell increases when the amount of
hemoglobin increases and therefore its size increases.
Indication: To determine the weight of hemoglobin in an average red cell.
f. MCHC (Mean Corpuscular Hemoglobin Concentration)
This is an estimation of the concentration of hemoglobin in grams per 100mL of
packed RBC, derived from the ratio of the hemoglobin to the hematocrit. This is an average
concentration of hemoglobin in RBCs.
Indication: It measures the portion of hemoglobin in an average cell.
g. WBC
This is one of the formed elements of the circulating blood system. WBC count is
a test that counts the total number of WBCs in 1 cubic millimeter of peripheral venous blood.
WBCs are needed to depend against invading organisms through phagocytosis and produce or
transport and distribute antibodies to help maintain immunity.
Indication: WBC count serves as a useful guide to the severity of the disease process.
This is also done to determine the ability of the WBC to phagocytosis and destroy bacteria.
h. Neutrophils
Neutrophils are the circulating white blood cells. They are the first one to launch
at the site of the injured tissue. They are also essential for phagocytosis and proteolysis by which
bacteria, cell debris, and solid particles are removed and destroyed. It is essential in preventing or
limiting bacterial infection via phagocytosis. The protective function of neutrophils includes
phagocytosis, where foreign particles were degraded, pyrogen are released, causes fever by
acting on the hypothalamus to set the body’s thermostat at the higher level.
Indication: This test determines the presence of infection, inflammation, and stress.
bacterial infectious process. They are the first line defense of the body during infection.
i. Lymphocytes
These are small agranulocytic leukocytes originating from fetal stem cells and
developing in the bone marrow. Lymphocytes normally comprise 25% of the total WBC count
but increase in number in response to infection. It is the integral component of immune system
and helps in the antibody reactions. These cells are the source of serum immunoglobulins and of
cellular immune response and play an important role in immunologic reactions.
Indication: This is to determine if there is bacterial infection.
 j. Platelet
It is the total number of platelets in circulation. Platelet is the smallest of the cells
in the blood. These are disk-shaped and contain no hemoglobin. They are essential for the
coagulation of blood.
Indication: This test measures the total number of platelets in circulation.
Nursing Responsibilities
1. Make a laboratory request and forward it to the laboratory to inform the medical
technologist.
2. Inform the patient about the type of procedure, and its purpose, to gain his cooperation
and also to increase his awareness regarding the procedures that will be done to him.
3. Follow-up result, attach to the chart of the patient and refer it to the physician to
inform the abnormality of the found value.

3. RADIOLOGY or X-ray
Date ordered: June 29, 2010

Requesting Physician: Dr. Rasos

Indication: Radiology is done to identify various abnormalities of the lungs and structures in the
chest and other parts of the body.

Examination desired: Chest

Radiology report: No definite active parenchymal infiltrates seen

Pulmonary vascularity in within the normal limits

Heart is not enlarged

Diaphragm is normal in position and contour

Both costophrenic sulci and visualized bones are intact

Impression: Normal Chest Findings

Nursing Responsibilities

1. Explain the procedures and its importance to the client to gain cooperation.
2. Instruct the client to take a deep breath, holding it and remaining motionless during the
 X-ray.

3. Inform to the client that the test will take only a few minutes and inform the client that it
is painless to allay anxiety.
4. Instruct the client to remove clothing and all jewelries or other metals that might obscure
the anatomic details on the X-ray film.
5. Refer radiology report to the physician, as result is available.

4. ELECTROCARDIOGRAPHY

An electrocardiography is a graphic representation of the electrical act, impulse formation

and conduction in the heart. The electrical act produces electrical current that can be applying
electrodes to the skin and amplifying them through an ECG apparatus to produce a graphic read-
out or display.

Date ordered: June 29, 2010

Requesting Physician: Dr. Rasos

Indication: This procedure was done to our patient for CP clearance prior to the schedules
operation

ECG report:

Measurements
- Durations
PR: 0.16 sec.
QRS:0.08 sec.
QTa:0.4 sec.
QTc:
- Rhythm (/) sinus
- Morphologies
P wave: upright
QRS: good R wave progression
ST segments: isoelectric
T wave: upright
 - Rates
Atrial: 25/min.
Ventricular: 25/min.
- Axis: NORMAL

Interpretation:

 Regular sinus rhythm

 Normal Axis

Nursing Responsibilities:

1. Inform and explain to the patient and significant other about the procedure, including
where it will take place and its expected duration to alleviate anxiety and to gain
cooperation of the patient.
2. Fill-up request properly and completely then forward it to the cardiology department to
notify the cardiologist.
3. Refer to the physician the ECG result once available and then attach it to the client’s
chart so that the physician will be able to determine the appropriate management to be
applied to the patient based on the result.
4. Report any abnormalities in the v/s and urine output to the physician to make an
immediate intervention to prevent complication.
DRUG STUDY
Date ordered: July 13, 2010

1. Generic name: Ampicillin/Sulbactam

Brand name: Unasyn

Classification: Anti-infective, aminopenicillins/beta lactamase inhibitors

Dosage, Frequency, Route: 75 mg IV every 8 hours ANST (-)

Mechanism of action: This drug binds to bacterial cell wall, resulting in cell death. The
addition of sulbactam increases resistance to beta-lactamases, enzymes produced
by bacteria that may inactivate ampicillin.
 Indication: This drug is indicated for patients after undergoing surgery to prevent
infection of skin and soft-tissue structures.

Desired effect: This drug was given to our client as prophylaxis against possible
infection.

Nursing responsibilities

1. Obtain a history before initiating therapy to determine previous use of and reactions
to penicillins or cephalosporins.
2. Administer skin testing to assess if patient is sensitive to penicillin.
3. Observe patient for signs and symptoms of anaphylaxis.
4. Administer drug slowly to prevent irritation.
7. Monitor for side effects like nausea and vomiting, bleeding or bleeding gums, blood in
the stool and urine.

8. Stop drug if allergic reaction occur and notify doctor on duty.

9. Advise to increase CHON and Vitamin C on diet.

10. Instruct client to clean wound aseptically to prevent infection.

2. Generic name: Diclofenac Sodium

Brand name: N/A

Classification: Nonsteroidal Anti-inflammatory

Dosage, route, frequency: 75 mg IV every 8 hours ANST (-)

Mechanism of action: May inhibit prostaglandin synthesis to produce anti-inflammatory

and analgesic effect.

Indication: This drug is used for a short-term management of pain.

Desired effects: This drug was given to the patient to relieve pain.
 Nursing Responsibilities

1. Assess the client’s history of allergy to the drug to avoid complications.

2. Encourage client to report severe pain for prompt intervention.
3. Administer the drug through the Y-tube in a free flow for at least 15 seconds
because this can be irritating.
4. Tell patient to avoid activities requiring alertness because this drug can cause
drowsiness.
5. Monitor for vital signs.
6. Monitor for signs and symptoms of bleeding like melena or hematemesis. GI
ulceration with perforation can occur anytime during treatment. This drug can
decrease platelet aggravation, thus, may prolong bleeding.
7. Instruct the patient not to crush, break, and chew enteric- coated tablets.

3. Generic name: Nubain

Brand name: Nalbuphine

Classification: Opiod analgesics

Dosage, route, frequency: 10mg IVP every 6 hours for 2 doses

Mechanism of action: This drug binds to opiate receptors in the CNS, which causes
alteration in the perception and response to painful stimuli. Thus, pain decreases.

Indication: This drug is used to treat moderate to severe pain.

Desired effect: This drug is given to our patient to relieve pain after operation.

Nursing responsibilities

1. Instruct watcher to assist patient during doing activities to prevent accidents.

2. Encourage patient to take adequate bed rest to decrease oxygen demand and BMR,
thereby conserving body energy.
3. Provide proper oral care to decrease the incidence of dry mouth.
4. Assess vital signs to prevent complications.
 5. Instruct patient on how and when to ask for pain medication to prevent drug
dependence and tolerance.
6. Caution patient to change positions slowly to minimize orthostatic hypotension.
7. Encourage patient to turn, cough and breathe deeply every 2 hours to prevent lung
collapse.

4. Generic name: Celecoxib

Brand name: N/A

Classification: Nonsteroidal Anti-inflammatory

Dosage, route, frequency: 400mg once a day

Mechanism of action: It inhibit prostaglandin synthesis, impending cyclooxygenase- 2 to

produce anti inflammatory and analgesic effect.

Indication: This drug is used for a short-term management of pain.

Desired effect: This drug was given to the patient to relieve pain.

Nursing responsibilities

1. Instruct watcher to assist patient during doing activities to prevent accidents.

2. Encourage patient to take adequate bed rest to decrease oxygen demand and BMR,
thereby conserving body energy.
3. Instruct the client to take the drug with food if stomach upset occurs.
4. Provide proper oral care to decrease the incidence of dry mouth.
5. Assess vital signs to prevent complications.
6. Instruct patient on how and when to ask for pain medication to prevent drug
dependence and tolerance.
7. Caution patient to change positions slowly to minimize orthostatic hypotension.
8. Encourage patient to turn, cough and breathe deeply every 2 hours to prevent lung
collapse.