1

CHAPTER I

GENERAL OBJECTIVE

To enhance knowledge, skills, and attitude in providing quality health care; management

of the client with Pelvic Organ Prolapse (POP); and utilizing the nursing process.

SPECIFIC OBJECTIVES

After 8 hours of exposure in the Gyne Ward we the nursing students able to:

1.Assess the client health situation.

2.Identify health needs and problems of the client.

3.Identify the different medications used by the client, for its actions, side effects, and apply

the 12 R’s in administering the drugs.

4.Recall the book-based pathophysiology of Pelvic Organ Prolapse and relate to the client

present health status.

5.Develop a Nursing Care Plan (NCP) appropriate to the client health problems.

6.Formulate a nursing diagnosis based on the identified client health needs and problem.

7.Provide quality nursing care that would help the client.

8.Evaluate the nursing interventions rendered to the client and properly document the

important data pertaining to the client.

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Introduction

Pelvic organ prolapse (POP) represents a significant health as well as economic problem

worldwide and may have a deleterious impact on a woman’s quality of life; however, it rarely

has significant morbidity or mortality .

Pelvic organ prolapse among women, which is manifested by protrusion of the vagina or

uterus out of the introitus, is caused by damage of the muscles, fascias, and ligaments that

stabilize organs located in the pelvis. Current understanding of this disorder is based on the

assumption that support to the pelvic organs (urethra, bladder, uterus, and rectum) is provided

directly by the vagina and indirectly by the structures involved in vaginal support. Therefore, it is

generally accepted that any damage to components involved in the support mechanism can result

in loss of vaginal stability and prolapse of the pelvic organs. The unique structure of the pelvic

floor could be considered in terms of the complex interaction between the vagina and its

supportive ligaments and fascias that are designed to withstand the downward descent of the

pelvic organs in response to an increase in abdominal pressure (Rechberger, 2010).

Modern health care systems are becoming gradually more community focused, with the

emphasis being on prevention rather than cure. While there are well established models in other

fields of medicine, the attempts at prevention of pelvic floor dysfunction remain in the very early

stages. The demand for conservative management increases in an ageing population, especially

with women giving birth in older age. The rapid adoption of minimally invasive techniques

(laparoscopic and robotic surgery) and the development of synthetic and biological grafts have

dramatically transformed pelvic organ prolapse surgery. We shall briefly discuss the evidence

regarding prevention measures, and conservative and surgical management options for pelvic

organ prolapse.
 3

We did this case study for us to have a deeper understanding of Pelvic Organ Prolapse,

thus to give us an idea of how we could give proper nursing care for our client’s condition.

CLIENT’S DATA

NAME: Mrs. A

ADDRESS: Cabanatuan City

DATE OF BIRTH: December 1951

AGE: 67 years old

GENDER: Female

CIVIL STATUS: Widowed

NATIONALITY: Filipino

RELIGION: Roman Catholic

EDUCATIONAL ATTAINMENT: HS Graduate

OCCUPATION: None

DATE OF ADMISSION: April 8, 2019

TIME OF ADMISSION: 12:13pm

ATTENDING PHYSICIAN: Dr. Strange

PRE-OP DIAGNOSIS: G8P8(8008) Pelvic Organ Prolapse Stage IV menopause 22yrs

s/p Appendectomy 1980

 4

Family History

As stated by the client, there is no known history of any diseases on her both parents but

her grandmother also diagnosed of having POP.

Past History of Illness

According to the client she had undergone appendectomy on 1980.

History of Past Illness

As stated by Mrs. A, she has her last menstruation 22years ago at the age of 45. She has a

total of 8 children who were all delivered as normal spontaneous delivery done at home. She

started to notice something different in her genital area but did not experience or complain any

pain. She has no check-up since then.

Until she decided to consult at Dr. PJGMRMC on March 7, 2019 when she felt that the

protrusion on her perineal area was getting worse. She was admitted and some diagnostic

procedures were done. After she was CP cleared she was advised to wait for the schedule of

operation and was ordered to go home on March 13, 2019. There was no prescribed home

medications but given some instructions on how she would take care of the protrusion. She was

advised to restrict or avoidding strenuous activities like lifting heavy objects because this may

worsen her condition.

Her attending physician called and stated that she needs to be admitted on April 8, 2019

as she was scheduled to have her surgery on April 10, 2019 at 4pm.
 5

Admitting History

On April 8, 2019 as per advised by her doctor, she was admitted at Gyne Ward and has

been given medications prior to operation scheduled on April 10.

Physical Assessment

The table below shows the physical assessment of the client from head to toe.

Body Parts Normal findings Actual findings Result

Skull Generally round within the The client’s skull is Normal

prominence in the frontal or generally round and no

occipital area tenderness noted upon

No tenderness noted upon palpation.

palpation

Scalp Can be moist or oily The client’s scalp is moist Normal

and no scars noted.

No scars noted

Free from lice, nits and The client’s scalp is free

from lice, nits and
dandruff
dandruff.
No tenderness nor masses on
The client’s scalp has no
palpation
tenderness or masses.

Hair Can be black or brown The client’s hair is black Normal

Eventually distributed, covers and evenly distributed and

covers the whole scalp.
 6

the whole scalp

Face Symmetrical The client’s face is Normal

No involuntary muscle symmetrical and there is

no involuntary muscle
movement
movement.

Eyes Pupils equal, round and The client’s pupils are Normal

reactive to light and equal, round and reactive

accommodation to light and

accommodation.

Ears The ear lobes are bean shaped, The client’s ear lobes are Normal

parallel and symmetrical bean shaped, parallel and

symmetrical.
No discharges or lesions noted

There is no discharges and

no lesions upon inspection

of the client’s ear

Nose and No nasal flaring There is no nasal flaring. Normal

Paranasal Both nares are patent The client’s both nares are
sinuses
No tenderness noted on patent

palpation There is no tenderness

noted upon palpation of

the client’s nose.

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Mouth The lips are normally Lips are pale in color Abnormal

symmetrical, pink, smooth,

and moist. There should be no

growths, lumps, or

discoloration of the tissue.

Teeth should be white with

shiny enamel and smooth

surfaces and edges.

Gums should be symmetrical,

moist and pinkish.

A healthy dorsal tongue is

symmetrical, pink, moist,

slightly rough from the

papillae, possibly with a thin,

whitish coating.

Neck Neck is straight The client’s neck is Normal

straight.
No visible mass or lumps

There is no mass, lumps or

No jugular venous distention
jugular venous distention

upon assessing clients

neck
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Chest Normal breath sounds The client’s respiration is Normal

20 cycles per minute.

-vesicular sounds

-bronchial sounds

-bronchovesicular sounds

Normal respiration

-adult: 12-20

Thorax Symmetrical chest expansion There is symmetrical chest Normal

expansion

Abdomen No lesion The client’s abdomen has

no lesions, no tenderness
No tenderness
and no muscle guarding.
No muscle guarding

Extremities Both extremities are equal in The client’s both Normal

size extremities are in equal

size.
No involuntary movement

There is no involuntary
No edema
movement nor edema

Skin Smooth, no blemishes Smooth, no blemishes Normal

Brownish in color

Wrinkled due to age

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Genital Area External Genitalia- labia, Protruded part of the Abnormal

clitoris, urethral orifice & uterus

introitus – all nornal

Inspection of Cervix and

Vagina- 0 bulging with

straining, normal vaginal

mucosa, cervix pink

0 discharge.
 10

Chapter II
CASE DISCUSSION AND PRESENTATION

DEFINITION

Pelvic organ prolapse is the descent of one or more aspects of the vagina and uterus: the

anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina

(vaginal vault or cuff scar after hysterectomy). This allows nearby organs to herniate into the

vaginal space, which is commonly referred to as cystocele, rectocele, or enterocele. Mild descent

of the pelvic organs is common and should not be considered pathologic. Pelvic organ prolapse

only should be considered a problem if it is causing prolapse symptoms (ie, pressure with or

without a bulge) or sexual dysfunction or if it is disrupting normal lower urinary tract or bowel

function. Pelvic organ prolapse can be defined using patient-reported symptoms or physical

examination findings (ie, vaginal bulge protruding to or beyond the hymen). Most women feel

symptoms of POP when the leading edge reaches 0.5 cm distal to the hymenal ring (Lazarou,

2019).

ANATOMY AND PHYSIOLOGY

Pelvic Diaphragm

The levator ani and coccygeus muscles that are attached to the inner surface of the minor

pelvis form the muscular floor of the pelvis. With their corresponding muscles from the opposite

side, they form the pelvic diaphragm. The levator ani is composed of 2 major muscles from

medial to lateral: the pubococcygeus and iliococcygeus muscles.

The bulkier medial portion of the levator ani is the pubococcygeus muscle that arises

from the back of the body of the pubis and anterior portion of the arcus tendineus. The arcus

tendineus of the levator ani is a dense connective tissue structure that runs from the pubic ramus

to the ischial spine and courses along the surface of the obturator internus muscle. The muscle
 11

passes back almost horizontally to behind the rectum. The inner border forms the margin of the

levator (urogenital) hiatus, through which passes the urethra, vagina, and anorectum.

• Various muscle subdivisions have been assigned to the medial portions of the

pubococcygeus to reflect the attachments of the muscle to the urethra, vagina, anus, and rectum.

• These portions are referred to by some investigators as the pubourethralis, pubovaginalis,

puboanalis, and puborectalis—or collectively as the pubovisceralis, because of their association

and attachment to the midline viscera.

• The urethral portion forms part of the periurethral musculature, and the vaginal and

anorectal portions insert into the vaginal walls, perineal body, and external anal sphincter

muscle.

• The puborectalis portion passes behind the rectum and fuses with its counterpart from the

opposite side to form a sling behind the anorectum. Other more posterior parts of the

pubococcygeus attach to the coccyx.

Iliococcygeus muscle

The thin lateral part of the levator ani is the iliococcygeus muscle, which arises from the arcus

tendineus of the levator ani to the ischial spine. Posteriorly it attaches to the last 2 segments of

the coccyx.

Urogenital Diaphragm (Perineal Membrane)

Another musculofascial structure, the urogenital diaphragm, is present over the anterior

pelvic outlet below the pelvic diaphragm. However, there is controversy over whether this

structure contains a transverse sheet of muscle extending across the pubic arch (deep transverse

perinei muscle) sandwiched between superior and inferior fascia or 3 contiguous striated muscles
 12

(compressor urethrae, sphincter urethrae, and urethra-vaginalis) and an inferior fascial layer

called the perineal membrane (Herschorn, 2004).

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PATHOPHYSIOLOGY (Book-Based)
Predisposing factor: Precipitating factors:
 Sex:  Multiparous women
 Age  Hypoestrogenism
 Hyperglycemic
 Elderly
 post menopausal women

Increase intra abdominal pressure

Stretching and tearing of the endopelvic fascia

and the levator

Decreased perineal muscle tone stretching

Further sagging and stretching of perineum

Vaginal or uterine descent through the

introitus

Ulceration of the protruding

Sensation of vaginal fullness
cervix or vagina
or pressure

Vaginal dspotting
Displacement of Coital difficulty
pelvic organ

Sacralback pain Displacement of Rectal pressure

the bladder
Lower abdominal
discomfort
Voiding Defecatory
difficulties difficulties
(incontinence) (constipation)
 14

PATHOPHYSIOLOGY (Client-Based)

Predisposing factor: Precipitating factors:

 Sex: female  Multiparous women
 Age: 67 years old  Hypoestrogenism
 Elderly/ post menopausal  Hyperglycemic- FBS: 123.68
women mg/dl

Increase intra abdominal pressure

Stretching and tearing of the endopelvic fascia and the levator

Decreased perineal muscle tone stretching

Further sagging and stretching of perineum

Vaginal or uterine descent through the introitus

Sensation of vaginal fullness Ulceration of the protruding

or pressure cervix or vagina

Displacement of
pelvic organ

Sacralback pain
Lower abdominal Displacement of
discomfort the bladder

Voiding
difficulties
(incontinence)
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Clinical Manifestations

BOOK BASED CLIENT-BASED

A feeling of pressure or fullness in the A feeling of discomfort and fullness

pelvic area
A backache low in the back
Painful intercourse
A feeling that something is falling out of the Protrusion of tiny part of the uterus
vagina
Urinary problems such as leaking of urine
or a chronic urge to urinate
Difficulty starting to urinate or a weak or Difficulty of urinating and unable to empty
spraying stream of urine. bladder well
Constipation
Spotting or bleeding from the vagina

Medical Management
Pre Op
 On March 7, 2019, the diagnostic exam was done:
 Cervico-vaginal Cytology Consultation Report
 On March 11, 2019, the diagnostic exam was done:
 Clinical Chemistry
 Urinalysis
 On March 12, 2019, the diagnostic exam was done:
 Blood Chemistry
 On April 8, 2019, the diagnostic exam was done:
 Hematology
 Urinalysis
 On April 9, 2019, the diagnostic exam was done:
 HBsag
 Serology
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 X-ray
 On April 8, 2019, the following treatment was given:
Medications;
 Cefoxitin 1g q6 IV
 Celecoxib 400 mg 1 tab OD
PRN for Pain P.O
 Ferrous Sulfate 1 tab OD P.O

IV Fluid: PLRS 1L x 12 hrs

Nursing Management
 Advised the client to avoid activities that put pressure on her pelvic muscles. This

includes heavy lifting and straining.

 Advised to do exercises to tighten and strengthen her pelvic muscles. These are called

Kegel exercises. To do them:

o Squeeze the same muscles you would use to stop your urine. Your belly and

thighs should not move.

o Hold the squeeze for 3 seconds, and then relax for 3 seconds.

o Start with 3 seconds. Then add 1 second each week until you are able to squeeze

for 10 seconds.

o Repeat the exercise 10 to 15 times for each session. Do three or more sessions

each day.

 To relieve pressure on your vagina, lie down and put a pillow under your knees. Or you

can lie on your side and bring your knees up to your chest.

 Provide emotional support to establish a trusting relationship and let the client voice out

her fears.
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Surgical Management – Pre-op Checklist

 Consent for operation confirmed
 Physical examination and history completed
 False teeth, and nail polished removed
 Jewelry and valuables removed
 Assisted in full sponge bath
 Hospital gown on
 Pre-operative vital signs taken:
BP: 120/80 RR: 20 PR:76 T: 36.9C
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CHAPTER 3
Laboratory Values and Interpretation
March 7, 2019
Cervico-vaginal Cytology Consultation Report
Specimen type: Conventional smear
Specimen adequacy: Satisfactory for evaluation
General Categorization: Negative for Intraepithelial lesion or malignancy
March 11, 2019
Clinical Chemistry
Normal Range Results Interpretation
Glucose 70-105 mg/dl 101.68 mg/dl Normal
BUN (Blood Urea 8-23 mg/dl 10.74 mg/dl Normal
Nitrogen)
Creatinine 0.7-1.4 mg/dl 0.8 mg/dl Normal

Clinical Chemistry
Normal Range Results Interpretation
SGOT (Serum 8-33 u/l 25.75 u/l Normal
Glutamic
Oxaloacetic
Transaminase)
SGPT (Serum 3-35 u/l 11.27 u/l Normal
Glutamic Pyruvic
Transaminase)
The clinical chemistry result shows that SGOT and SGPT are both normal.

Normal Range Results Interpretation

FBS (Fasting Blood 74-106 mg/dl 105. 56 mg/dl Normal
Sugar)
 19

Clinical Microscopy
Urinalysis
Physical Exam Normal Range Results Interpretation
Color Yellow Yellow Normal
Transparency Clear Slightly turbid Normal
Reaction 5.0-8.0 6.5 Normal
Specific Gravity 1.003-1.030 1.020 Normal
Chemical Exam
Sugar Negative Normal
Protein Negative Normal
Microscopic Exam
Pus cells 1-2 Normal
Red cells 0-2 Normal
Epithelial cells Few Normal
Bacteria Few Normal

March 12, 2019

Blood Chemistry
Normal Range Results Interpretation
Sodium 135-145 142.40 mmol/L Normal
Potassium 3.5-5.0 4.57 mmol/L Normal
Chloride 97-108 103.10 mmol/L Normal

The clinical chemistry result shows that sodium, potassium and chloride are in normal

range.
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April 8, 2019

Hematology
Complete Blood Count
Normal Range Results Interpretation
Hemoglobin 120-160.0 125.0 g/L Normal
Hematocrit 0.37-0.42 0.36 Low
RBC count 4.25-5.00 x10^12 iL 4.08 Low
MCV (Mean 76.0-96.0 88.7 Normal
Corpuscular
Volume)
MCHC (Mean 32.0-36.0 33 Normal
Corpuscular
Hemoglobin
Concentration)
MCH (Mean 27.0-32.0 34.5 Elevated
Corpuscular
Hemoglobin)
WBC Count 5.0-10x9/L 6.61 Normal
Differential Count
Neutrophils 0.55-0.65 0.58 Normal
Lymphocytes 0.20%-0.35% 0.33 Normal
Monocytes 0.04%-0.05% 0.07 Elevated
Eosinophils 0.02%-0.04% 0.02 Normal
Basophils 0.00-0.01 0.00 Normal
Platelet Count 150-350x109/L 250 Normal
A low RBC count indicates a decrease in oxygen-carrying cells in the blood. The causes
can be many, ranging from infections and deficiencies to malnutrition to malignancies,
including: Anemia.
Elevated MCH condition occurs when the blood cells are too big, which can be a result of
not having enough vitamin B12 or folic acid in the body.
Elevated levels of monocytes is a normal immune response to an event, such as infection,
injury, inflammation, some medications, and certain types of leukemia.
 21

Clinical Microscopy
Urinalysis
Physical Exam Normal Range Results Interpretation
Color Yellow Yellow Normal
Transparency Clear Slightly turbid Normal
Reaction 5.0-8.0 6.5 Normal
Specific Gravity 1.003-1.030 1.020 Normal
Chemical Exam
Sugar Negative Normal
Protein Negative Normal
Microscopic Exam
Pus cells 1-2 Normal
Epithelial cells Few Normal
Bacteria Few Normal

April 9, 2019
Serology
HBsAg Screening: Non-reactive
Method: Rapid, Immunochromatographic test

X-Ray Report
Findings
 Both lung fields are clear.
 Heart size is within the upper units of normal.
 Other chest structures are not remarkable.
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CHAPTER IV
NURSING CARE PLAN
ASSESSMENT DIANOSIS OUTCOME PLANNING INTERVENTION EVALUATION
IDENTIFICA
TION
SUBJECTIVE : Impaired The client will After 1 hour of Independent After 1 hour of nursing
“Nahihirapan Urinary be able to nursing  Determine client’s previous intervention the client
ako umihi” as Elimination demonstrate intervention the pattern of urinary elimination and was able to understand
verbalized by the behaviors/tech client will be able compare with current situation. her condition.
impaired related
client niques to to understand the
to protrusion of Note reports of dysuria.
prevent urinary Goal was met.
the part of the condition. Rationale: To have a baseline data.
infection
Objective: uterus as  Palpate bladder to assess if
Difficulty on evidenced by distended
urinating dysuria Rationale: To assess degree of
interference/disability
 Assist with developing toileting
routines as appropriate and
Observe for signs of infection-,
cloudy, foul odor, bloody urine
Rationale: To assist in
treating/prevent urinary alteration
 Encourage client to verbalize
fear/concerns
Rationale: Open expression allows
client to deal with feelings and begin
problem solving.
 Check frequently for bladder
distention and observe for
overflow and Emphasize
importance of keeping area clean
and dry
Rationale: To reduce risk of
infection
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ASSESSMENT DIANOSIS Outcome PLANNING INTERVENTION EVALUATION

Identification
SUBJECTIVE : Risk for The client will After 2 hours of Independent After 2 hours of nursing
“May lumabas sa infection related identify nursing  Note risk factors for intervention the client
pwerta ko” as to protrusion of interventions to intervention the occurrence of infection and verbalized understanding
verbalized by the prevent/reduce risk client will observe for localized signs of of individual
the part of uterus
client of infection verbalize causative/risk factor.
infection.
understanding of Rationale: To assess
Objective: individual causative/contributing factors
Protrusion of the causative/risk  Stress proper handwashing
part of uterus factor. techniques by all caregivers
The client will between clients.
demonstrate After 3 hours of Rationale: A first line defense After 3 hours of nursing
techniques, lifestyle nursing against nosocomial intervention the client
changes to promote intervention the infections/cross-contamination able demonstrate
safe environment. techniques, lifestyle
client will be able  Provide regular perineal care.
to demonstrate changes to promote safe
Rationale: Reduce risk of
techniques, environment.
infection
lifestyle changes Dependent
to promote safe Goal was met.
 Administer/monitor
environment. medication regimen and
note’s client’s response
Rationale: To determine
effectiveness of therapy/presence
of side effects.
 Emphasize necessity of taking
antibiotics as directed
Rationale: premature
discontinuation of treatment
when clients begin to feel well
may result in return of infection.
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ASSESSMENT DIAGNOSIS OUTCOME PLANNING INTERVENTION RATIONALE EVALUATION

IDENTIFICATION

SUBJECTIVE: Anxiety related to Client will Long Term Goal: Asses client’s level Different levels of After 4 hours of
actual/perceived demonstrate of anxiety anxiety will affect nursing
“natatakot ako mag
threat to health as problem-solving the coping intervention the
paopera” as
evidenced by skills of relax and After series of mechanism of the client was relax and
verbalized by the
increased tension anxiety reduced as effective nursing client anxiety reduced as
client
evidenced by intervention the evidenced by
client’s anxiety will
(-) sweating (-) sweating
be eliminated To identify physical
(-) voice quivering Monitor vital signs responses (-) voice quivering
OBJECTIVE: associated with
Short term goal: both medical and
(+) Sweating
And verbalized emotional condition And verbalized
(+) Voice quivering hindi na ako hindi na ako
natatakot After 10-30 mins of natatakot
naintindihan ko na nursing Acknowledgement naintindihan ko na
kung ano ang intervention the of the client’s kung ano ang
gagawin sa akin sa client will be able to feelings validates gagawin sa akin sa
loob ng OR know some Acknowledge the feeling and loob ng OR
techniques on how awareness of communicates
to lessen the client’s anxiety acceptance of those
anxiety such deep feelings Goal was met
breathing exercise
and verbalization of
This may help the
-hindi na ako
client to relax
natatakot mag
paopera

Instruct to do deep
Helps the client to
breathing exercise
identify what is
reality based
Provide accurate
information about
To avoid a
situation
contagious effect/
 25

transmission of
anxiety. The health
Establish a
care provider can
therapeutic
transmit her own
relationship,
anxiety to the
conveying empathy
hypertensive
and unconditional
patient
positive reward
maintain a calm
manner while
interacting with
client An ongoing
relationship
establishes a basis
Establish a working for comfort in
relationship with communicating
the patient through anxious feelings
continuity of care
 26

CHAPTER V

DRUG STUDY

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE REACTIONS NURSING

ACTION RESPONSIBILITIES
Generic Name: Thought to inhibit  Acute pain  Contraindicated in CNS: dizziness, Before:
prostaglandin clients who insomnia
Celecoxib  Observe for the 12
synthesis, impending experienced asthma,
CV: hypertension rights before giving
cyclooxygenase-2, to urticaria, or allergic-
medication.
type reactions after GI: diarrhea, nausea,
produce anti-  Before starting
taking aspirin or other abdominal pain
inflammatory, therapy, rehydrate
NSAIDs and in those
analgesic, and Respiratory: dyspnea dehydrated the client.
who have
antipyretic effects. demonstrated Skin: rash
Classification: allergic-type reactions
to sulfonamides.
NSAIDs During:
 Drug can cause fluid
retention; monitor
client with
hypertension, edema,
Dosage: or heart failure.
 Drug may be
400mg itab hepatotoxic; watch
OD for signs and
symptoms of liver
PRN for Pain toxicity

After:
 Monitor client’s renal
function; renal
insufficiency is
 27

Route: possible in clients

with preexisting renal
PO
disease. Long term
administration may
cause renal papillary
necrosis and other
renal injury.
 28

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATIO ADVERSE REACTIONS NURSING

ACTION NS RESPONSIBILITIES
Generic Name: Inhibits cell-wall  Perioperative  Use cautiously CNS: fever Before:
synthesis, promoting prophylaxis in patients
Cefoxitin CV: phlebitis,  Observe for the 12
osmotic instability; hypersensitive
thrombophlebitis rights before giving
usually bactericidal to penicillin
because of medication.
GI: diarrhea, nausea,
possibility of vomiting During:
cross-sensitivity
with other beta- GU: acute renal  IV: change sites
lactam failure every 48-72 hours to
Classification: antibiotics. prevent phlebitis.
Hematologic:
 Use cautiously  Monitor site
Antibiotic hemolytic anemia,
in clients with frequently for
anemia, thrombophlebitis
history of
thrombocytopenia, (pain, redness, and
colitis, renal
transient swelling)
neutropenia
Respiratory: dyspnea After:

Dosage: Skin: maculopapular  If large dosage is

and erythematous given, therapy is
1g prolonged or client is
rashes, urticarial,
q6 pain at high risk, monitor
patient for signs and
symptoms of
superinfection
 Instruct client to
Route: notify health care
IV professional if fever
and diarrhea
develop, especially if
stool contains blood,
pus, or mucus.
 29

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATIO ADVERSE REACTIONS NURSING

ACTION NS RESPONSIBILITIES
Generic Name: Iron is essential for  Iron deficiency  Clients receiving Hypotension Before:
hemoglobin, repeated blood
Ferrous Sulfate Nausea  Observe for the 12
myoglobin and transfusions;
Constipation rights before giving
enzymes, it is anemia not due
to iron medication.
transported to organs Dark stools
deficiency.
where it becomes
Diarrhea During:
part of iron stores
Epigastric pain  take on an empty
Classification: Skin staining stomach to increase
absorption/vitamin C
Iron-supplement helps with
absorption

After:
 May cause seizures,
hypotension,
Dosage: constipation,
epigastric pain,
1tab diarrhea, skin
OD staining, anaphylaxis
 assess nutritional
status, bowel
function
 monitor hemoglobin,
hematocrit, iron
levels
 may cause elevated
Route: liver enzymes
PO
 30

CHAPTER VI

Evaluation/ Findings

Through assessment and data gathering, certain problems were identified. Problems on Impaired Urinary

Elimination, Risk for Infection and Anxiety were observed. Information and health teachings were imparted

which led to increasing client's awareness and knowledge with regards to her condition. This study teaches us to

provide clients care with POP more efficiently and competently to achieve effective and quality nursing care.

Recommendation (METHODS)

The client must be able to recover health and prevent further complications as possible. This, in turn,

will consider having a healthier status – be it physically, emotionally, mentally, and spiritually. For the clientt,

recommendations would include but not limited to the following:

Medications

Advised client and relatives to continue the prescribed medications to ensure optimum recovery.

Exercise

Advised client and family to do passive to active ROM exercises to help the client return to

activities of daily living. Avoid all strenuous and stressful activities that could pressure to the affected

area.

Treatment

Treatment includes maintaining of proper hygiene and restricting activities to avoid further stress

to the situation.

Health Teaching

Instruct the clientt and family about the treatment plan including the need to take medications as

prescribed and check with the physician before taking any new medications. Client and family teaching

addresses proper care to the area and to watched and report signs and symptoms of infection. The client
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should also be able to verbalize feelings to her family to take emotional care and actions. She should

also be able to express any discomfort in order for the health care provider to carry out certain measures.

Client A should be able to establish direct open communication with her family and health care

practitioner to link care and needs.

OPD

Remind the client and her family about the follow-up visits and succeeding visits prescribed by

the health care provider.

Diet

UPON RECEIVING AT WARD before operation

 NPO

POSTOP

Instruct to have high protein and high fiber diets such as pineapple, mango, orange, green leafy

vegetables, lean meat, dairy products, and fish.

Spirituality

Interpreting and understanding the diversity of religious and spiritual needs of the client.