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Paracetamol
Paracetamol
CASE STUDY
ON
HEPATITIS B
SUBMITTED BY:
SUBMITTED TO:
(CLINICAL INSTRUCTOR)
I. PERSONAL DATA
NAME: Patient X
ADDRESS: San Vicente East, Urdaneta City, Pangasinan
AGE: 41
SEX: Female
BIRTHDATE: December 11, 1978
EDUCATIONAL ATTAINMENT: First Year High School
CIVIL STATUS: Married
CITIZENSHIP: Filipino
RELIGION: Roman Catholic
ADMITTING DIAGNOSIS: PUFT Cephalic in Labor G4P3 T/C Placenta Previa
PRINCIPAL DIAGNOSIS: G4P4 (4004) PU 40 weeks, delivered to a live baby
girl LTCS +BTL for Placenta Previa Totalis
Patient X was born to a G3P3 mother via NSD. She was full term and was
delivered at home by a trained hilot. There were no birth traumas or defects noted
during delivery. Cough and colds was her usual illness but not that often. Patient X
regularly visits RHU for consultation. According to her, she received vaccinations
during her childhood but she can’t recall those vaccines.
Patient X had no other medical illness, no allergies, no history of previous
surgeries or accidents.
IV. PHYSICAL HEALTH ASSESSMENT
A. GENERAL SURVEY
The patient is well groomed and oriented to time and place as evidence by the
client answering our question appropriately.
The patient has paleness of skin (pallor) while the skin is intact and there is no
presence of reddened areas in the body. The skin is dry.
B. VITAL SIGNS
There is no
presence of
clubbing of nails
to patients
having anemia
HEAD Head is normally Normal Normal
hard and smooth
without lesions
FACE The face is Normal Normal
symmetric and round
NECK Symmetrical Normal Normal because there
are no presence of
bulging masses
EYE Test for near Normal Patient may read
visual acuity- what the normal
20/20 eye could read
in a near
Eye Normal distance
movement-
able to follow Normal functions
the fingers of the ocular,
from side to trochlear and
side than top trigeminal
to bottom Normal nerves of the
body and six
Reactivity to muscles that
light-PERRLA controls the eye
movement
Normal
Normal
Decreased
oxygenation of
the tissue
MOUTH No repair or no Presence of a Due to improper
decayed areas chalky white hygiene to the teeth
Internal Nose-
dark pink,
moist and free
from exudates
CLIENTS Normally she should Normal Normal
POSITION be sitting and
breathing easily with
arms in the sides
LUNGS Chest Normal Normal
expansion-
symmetrical
with 5-10 cm
apart
A. HEMATOLOGY
November 9, 2019
RESULT NORMAL INTERPRETATION
Hgb 11.4 12-16 g/L due to bleeding
Hct 34.7 36-47 % due to bleeding
RBC 5.23 4.2-5.4 10^g/L Normal
PLT 320 150-450 10^g/L Normal
WBC 17.6 5.0-10.0 10^g/L due to infection
Neutrophils 12.7 2.00-7.50 10^g/L due to infection
Lymphocytes 3.5 1.00-4.00 10^g/L Normal
Monocytes 0 0.00-1.00 10^g/L Normal
Eisonophils 1.2 0.00-0.50 10^g/L due to infection
Basophils 0.2 0.00-0.20 10^g/L Normal
MCH 21.71 27-31 pg due to bleeding
B. SEROLOGY
HBsAg - Non Reactive
Blood Typing - B+
VI. BRIEF DESCRIPTION OF THE DISEASE:
PLACENTA PREVIA
Predisposing Factors:
1. Multiparity (80% of affected clients are multiparous)
2. Advanced maternal age (older than 35 years old in 33% cases)
3. Multiple gestations
4. Previous Cesarean birth
5. Uterine Incisions
6. Prior Placenta Previa (incidence is 12 times greater in women with previous
placenta previa)
Complications for the baby include:
Problems for the baby, secondary to acute blood loss
Intrauterine growth retardation due to poor placental perfusion
Increased incidence of congenital anomalies
Clinical Manifestations:
Painless vaginal bleeding > occurs after 20 weeks of gestation, bright red in
color associated with the stretching and thinning of the lower uterine segment
that occurs in third trimester.
Adequately contract and stop blood flow from open vessels.
Decreasing urinary output.
Diagnostic Evaluation:
TRANSVAGINAL ULTRASOUND
If a woman is bleeding she is usually placed in the labor and birth unit or for
cesarean birth because profound hemorrhage can occur during the examination.
This type of vaginal examination knows as the double –set up procedure.
ULTRASONOGRAPHIC SCAN
If ultrasonographic scanning reveals a normally implanted placenta, an
examination may be performed to rule out local causes of bleeding and a
coagulation profile is obtained to rule out other causes of bleeding management
of placenta previa depends of the gestational age and condition of the fetus and
the amount and cesarean birth.
FETOSCOPE
To monitor fetal heart rate and conditions.
Medical Management:
Maternal stabilization and fetal monitoring
Control of blood loss, blood replacement
Delivery of viable neonate
With fetus of less than 36 weeks gestation, careful observation to determine
safety of continuing pregnancy or need for preterm delivery
Hospitalization with complete bed rest until 36 weeks gestation with complete
placenta previa
Possible vaginal delivery with minimal bleeding or rapidly progressing labor
Nursing interventions:
1. In continuation of the pregnancy is deemed safe for the patient and fetus
administer magnesium sulfate as ordered for premature labor.
2. Obtain blood samples for complete blood count and blood type and cross
matching.
3. Institute complete bed rest
4. If the patient and placenta previa is experiencing active bleeding, continuously
monitor her blood pressure, pulse rate, respiration, central venous pressure,
intake and output, and amount of vaginal bleeding as well as the fetal heart rate
and rhythm.
5. Assist with application of intermittent or continuous electronic fetal monitoring
as indicated by maternal and fetal status.
6. Have oxygen readily available for use should fetal distress occur, as indicated by
bradycardia, tachycardia, late or available decelerations, pathologic sinusoidal
pattern, unstable baseline, or loss of variability.
7. If the patient is Rh-negative and not sensitized, administer Rh (D) immune
globulin (RhoGAM0 after every bleeding episode.
8. Administer prescribed IV fluids and blood products.
9. Provide information about labor progress and the condition of the fetus.
10. Prepare the patient and her family for a possible cesarian delivery and the
birth of a preterm neonate, and provide thorough instructions for postpartum
care.
11. If the fetus less than 36 weeks gestation expect to administer an initial
dose of betamethasone, explain that additional dosage may be given again in 24
hours and possibly for the next 2 weeks to help mature the neonate lungs.
12. Explain that the fetus survival depends on gestational age and amount of
maternal blood loss. Request consultation with a neonatologist or pediatrician to
discuss a treatment plan with the patient and her family.
13. Assure the patient that frequent monitoring and prompt management
greatly reduce the risk of neonatal death.
14. Encourage the patient and her family to verbalize their feelings helps them
to develop effective coping strategies, and refer them for counseling, if
necessary.
15. Anticipate the need for a referral for home care if the patient bleeding
ceases and she’s to return home in bed rest.
16. During the postpartum period, monitor the patient for signs and early and
late postpartum hemorrhage and shock.
17. Monitor VS for elevated temperature, pulse, and blood pressure, monitor
laboratory results for elevated WBC count, differential shift; check for uterine
tenderness and malodorous vaginal discharge to detect early signs of infection
resulting from exposure of placental tissue.
18. Provide or teach perineal hygiene to decrease the risk of ascending
infection.
19. Observe for abnormal fetal heart rate patterns such as loss of variability,
decelerations, tachycardia to identify fetal distress.
20. Position the patient in side lying position and wedge for support to
maximize placental perfusion.
21. Assess fetal movement to evaluate for possible fetal hypoxia.
22. Teach woman to monitor fetal movement to evaluate well-being.
23. Administer oxygen as ordered to increase oxygenation to mother and
fetus.
VII. ANATOMY AND PHYSIOLOGY
11-9-19 ADMISSION:
6:30 am
A 36 year old was admitted in the ER per
ADMISSION wheelchair with chief complaint of profuse
bleeding; vital signs were taken as follows T-
IVF 36.5, BP-130/90, RR-34, PR-75. She was
D5LR 1L, 500cc FD, seen and examined by OBGYNE doctor.
500cc x 8° FD Consent for admission was signed by her
PLRS 1L FD husband. D5LR 1L was inserted as venolycsis
TF-PNSS 1L KVO on her right arm and regulated 500 ml Fast
Drip remaining 500 ml run to 8° FHT and
LABORATORY: labor progress was moitored. Laboratories
Blood Typing were requested and done. Referred to other
HBsAg OBGYNE doctor.
CBC 10:30am
OBGYNE doctor made orders
MEDICATION: IVF to 500cc FD, PLRS 1L FD
Ketorolac 30mg IV q6 Anesthesiologist and pediatrician were notified
Nalbuphine 5mg IV q4 Abdominal perineal preparation were done
Ranitidine 50mg IV q8 VS taken and recorded as follows BP 120/90,
Cefazolin 1gm IV q6 RR 19 bpm, PR 85 cpm
Indwelling foley cathether was inserted
DIET: NPO aseptically
Pre-op orders by OBGYNE doctor were made
NURSING INTERVENTION: and carried out
VS q15x2°, then every Patient on NPO
hour thereafter Consent for “E” CS=BTL was secured
Intake and output q 1° Risk and complications were explained and
and record accepted by patient
Transferred to O.R
12:15pm
In from O.R per stretcher, VS of CR 105 cpm;
BP-120/70; O2 saturation 99%
S?P LTCS = BTL under sab
Still on NPO
Patient maintained flat on bed for 6 hours
with O2 inhalation at 2-3 lpm
Ongoing IVF were PNSS 1Lx FD on the left
arm, and PLR 1L = 10 IU oxytocin x 8°
Patient for CBC in AM
2:30 pm
In from stretcher, conscious, with same IVF
on.
With complaint of post-op pain rated as 8/10.
Necessary interventions were done.
Comfort measures were provided
Meds ordered were given
11-10-19 IV meds to consume
Patient complaint that she was not able to
IVF sleep well cause of her incision. Necessarty
PNSS 1L x KVO interventions were done.
TF-PNSS 1L x KVO Patient (-) flatus and BM (-), she was
LABORATORY: instructed to turn to sides, on general liquid
CBC except carbonated drinks
IFC was removed aseptically
New meds were ordered an carried out
MEDICATION: VS, intake and output were taken and
Ketorolac 30mg IV q6 recorded
Nalbuphine 5mg IV q4 Meds given as ordered
Ranitidine 50mg IV q8
Cefazolin 1gm IV q6 4:00 pm
Patient’s temperature was 38°C. She was
New orders: then referred to OBGYNE doctor with orders
Co-amoxiclav 625mg tab made and carried out. Necessary
q6 interventions were done. Temperature
Celecoxib 200mg BID decreased. From 38 to 37.2.
Paracetamol 1 amp 7:30pm
Patient for BT VS taken T-37.1, BP-130/90,
DIET: General Liquid except RR-20, PR-79
carbonated drinks 1 iu PRBC properly cross matched was hooked
and regulated on the left arm
NURSING INTERVENTION: VS was taken and recorded, and patient was
Provide comfort, and strictly monitored for adverse reaction of BT,
environment conducive IVF consumed and terminated aseptically as
for sleep and rest ordered
Tepid Sponge Bath After BT, patient keep rested but still being
Monitored patient for monitored for post BT reaction.
adverse reaction on
blood transfusion
DIET: DAT
NURSING INTERVENTION:
Provide comfort and
environment conducive
for sleep and rest.
Health teachings
DIET: DAT
NURSING INTERVENTION:
Health teachings
DIET: DAT
NURSING INTERVENTION:
Health teachings
DIET: DAT
NURSING INTERVENTION:
Health teachings