MEDICAL COLLEGES OF NORTHERN PHILIPPINES

ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN

S.Y. 2020 - 2021
COLLEGE OF NURSING

A Case Study Presented to Ms. Gina Manongas, RN,

MSN in Partial Fulfillment of the requirement for the
Degree Bachelor of Science in Nursing

UTERINE PROLAPSE

BY:

Gerald Batugal
Ericah Bayani
Angela Lacambra
Crisel Reyes
Jesus Christian Taguibao
Sartre Genesis Ubiña
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

TABLE OF CONTENTS

INTRODUCTION
Clinical Abstract
Risk Factors
Signs and Symptoms
Medical Management
Surgical Management
Nursing Management

CASE SCENARIO

NURSING CARE PLAN

PATHOPHYSIOLOGY

DRUG STUDY
Cefazolin
Famotidine
Tramadol
Folic Acid
Ferrous Sulfate
Vitamin B Complex
Ascorbic Acid
Celecoxib
Mefenamic Acid

DISCHARGE CARE PLAN

 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

INTRODUCTION

Uterine prolapse is a condition where the internal supports of the uterus become weak over
time, and with multiple vaginal deliveries during childbirth, the muscles and ligaments around
your uterus can weaken. When this support structure starts to fail, uterus can sag out of
position. The uterus is one of the organs that makes up part of reproductive system. Also called
the womb, the uterus is located in your pelvis and is roughly shaped like a pear. During
pregnancy, the uterus holds the developing baby. It actually stretches through the pregnancy to
fit the baby and then shrinks back down in size after delivery.

Prolapses can vary depending on how weak the supports of the uterus have gotten. In an
incomplete prolapse, the uterus may have slipped enough to be partway in the vagina (birth
canal). This creates a lump or bulge. In a more severe case, the uterus can slip far enough that
it is felt outside of the vagina. This is called a complete prolapse.

Uterine prolapse is most likely to happen in women who: have had one or more vaginal
deliveries, are post-menopausal, have family members who have had prolapse.
Menopause occurs when your ovaries stop producing the hormones that regulate your monthly
menstrual cycle (period). When you haven’t had a period for 12 straight months, you are
considered menopausal. One of the hormones that stops during menopause is estrogen. This
particular hormone helps keep your pelvic muscles strong. Without it, you are at a higher risk of
developing a prolapse.

Uterine prolapse is a fairly common condition. Your risk of developing the condition increases
with age. You are also at a higher risk of uterine prolapses if you have had multiple vaginal
deliveries during childbirth throughout your life. Your uterus is held in place within the pelvis by
a group of muscles and ligaments. You may hear this called the pelvic floor muscles. When
these structures weaken, they become unable to hold the uterus in position, and it begins to
sag. Several factors can contribute to the weakening of the pelvic muscles, including: Loss of
muscle tone as the result of aging, Injury during childbirth, especially if you have had many
babies or large babies (more than 9 pounds), Obesity, Chronic coughing or straining, chronic
constipation.

Mild case of uterine prolapse, may not have any obvious symptoms. However, as the uterus
slips further out of position, it can place pressure on other pelvic organs—such as the bladder
or bowel—and cause symptoms like:A feeling of heaviness or pressure in the pelvis, Pain in the
pelvis, abdomen or lower back, Pain during sex (intercourse), Uterine tissue that falls through
the opening of the vagina, Frequent bladder infections, Unusual or excessive discharge from the
vagina, Constipation, Urination problems, including involuntary loss of urine (incontinence), the
need to urinate frequently (urinary frequency) or the sudden urge to urinate (urinary
urgency).Symptoms can get worse when you stand or walk for long periods of time. In these
positions, gravity places extra pressure on the pelvic muscles.

The healthcare provider will perform a pelvic examination to determine if the uterus has
lowered from its normal position. During a pelvic exam, the healthcare provider inserts a
speculum (an instrument that lets the provider see inside the vagina) and examines the vagina
and uterus. Your provider will feel for any bulges caused by the uterus dropping down into the
vaginal canal.

There are surgical and non-surgical options for treating uterine prolapse. Your healthcare
provider will pick your treatment path based on the severity of your prolapse, your general
health, age and whether or not you want children in the future. Treatment is generally effective
for most women. Treatment options can include; Non-surgical options: Exercise, Special
exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. This may be the
only treatment needed in mild cases of uterine prolapse, vaginal peccary: A pessary is a rubber
or plastic doughnut-shaped device that fits around or under the lower part of the uterus
(cervix).
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

This device helps prop up the uterus and hold it in place. Surgical options; Hysterectomy and
prolapse repair: Uterine prolapse may be treated by removing the uterus in a surgical procedure
called a hysterectomy. This may be done through a cut (incision) made in the vagina (vaginal
hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major
surgery, and removing the uterus means pregnancy is no longer possible, Prolapse repair
without hysterectomy: This procedure involves putting the uterus back into its normal position.
Uterine suspension may be done by reattaching the pelvic ligaments to the lower part of the
uterus to hold it in place. The surgery can be done through the vagina or through the abdomen
depending on the technique that is used.

Most of the time, treatment for a uterine prolapse is effective. However, sometimes a prolapse
can come back. This is more common if you have a very severe prolapse, are obese or a
younger woman (under age 60).In most cases, the outlook for uterine prolapse is very good.
There are typically very positive results from treatment for the condition and lifestyle changes
(maintaining a good weight and exercising) can help prevent a prolapse from happening again.

For the Nursing Management it includes encouraging the patient to maintaining a healthy body
weight, exercising regularly. In addition, do Kegel exercises to strengthen your pelvic floor
muscles. Remember, check with your healthcare provider before starting any new exercise
program, eating a healthy diet. Talk to your healthcare provider or a nutritionist (a special type
of healthcare provider who helps you form a meal plan) about the best diet for you. Stop
smoking. This reduces the risk of developing a chronic cough, which can put extra strain on the
pelvic muscles. Using proper lifting techniques.
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

CASE SCENARIO
A 33-year old woman, G4P3(3003) at 35 weeks 4 days of pregnancy presented to the labor
room with pain in abdomen for two days and something coming out of the vagina for one
month. There was a history of difficulty in passing urine and stool for one month. All her
previous deliveries were vaginal and in short intervals. There was no history of uterine prolapse
in her previous pregnancies. She also had undergone right ovarian cystectomy one year back.
Upon assessment her blood pressure reveals 120/80 mmHg, pulse rate of 90 beats per minute
and respiratory rate is 30 cycles per minute. She's afebrile. Initial Hemoglobin of 90 mg/dL,
Hematocrit 0.262, Red Blood Cell 3.94.

On abdominal examination, the uterus was found to be 34-36 weeks of size with mild
contraction. The fetus was in the longitudinal lie with cephalic presentation and fetal heart
sound was audible. On pelvic examination, stage 3 uterine prolapse with edematous cervix and
parous size os was found. Pelvic organ prolapse quantification (POPQ) was done and it revealed
point C as the leading edge with other measurements being Aa-2, Ap-2, Ba-2, C+3, D-1. gh 6,
pb 2, tvl 6. The reposition of the prolapsed uterus was tried but could not be achieved.

Ultrasound examination revealed a single live fetus with gestational age corresponding to 34
weeks and placenta lying in the anterior and upper segment of the uterus. A homogenous mass
of size 13 cm x 10 cm was seen arising from the posterior part of the cervix lying below the
fetal head. Cesarean section was planned to deliver the fetus as the patient was progressing
into obstructed labor. The anesthesiologist used general anesthesia. Plain LRs 1L x 8 hours was
hooked to the patient. Preoperatively blood was cross-matched anticipating massive postpartum
hemorrhage.

Pfannenstiel abdominal incision was given and the uterine incision was put transversely
avoiding the fibroid in the incision line during surgery. A cervical fibroid of size 10 cm x 10 cm
partially covering the os was detected. A healthy child was delivered by vertex with a good
APGAR score. The intraoperative blood loss was average in amount and the team did not
encounter any complications during surgery. Postoperatively, the prolapsed vaginal mass was
successfully reposed and the rest of her hospital stay was uneventful. Patient given Cefazolin 1
gram after negative skin testing, Famotidine 20 milligram IV and Tramadol 50 milligram IV.
Patient was prescribed to take Hematinics (Folic Acid, Vitamin B12, and Ferrous Sulfate),
Ascorbic Acid OD (Once a Day), Celecoxib 500 milligram, Mefenamic Acid 500 milligram for
pain. The patient was discharged with advice for further monitoring and management of the
cervical fibroid and uterine prolapse in the postpartum period but she was lost to follow up.
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Acute Pain After 8 hours INDEPENDENT Goal Partially
“Masakit po related to of nursing Assessed patient’s To identify Met:
yung sugat surgical intervention, pain scale improvement or After 8 hours of
ko.” as incision as the patient’s any changes in nursing
verbalized by manifested pain will be patients pain intervention,
the patient by pain reduce. the patient’s
scale of 8 Monitored vital signs To determine pain reduced
Objective: over 10. every 2 hours any changes or with a pain
Weakness alteration in the scale of 5 out of
Pain Scale of 8 patient’s vital 10.
over 10 signs

Vital Signs: Placed patient in a For the patient’s

Temp: 36.8oc comfortable position comfort
PR: 90 bpm
RR: 20 cpm Provided a well For the patient’s
BP: 120/80 ventilated and restful comfort
mmHg environment

Encouraged adequate To prevent

rest periods fatigue that can
impair ability to
manage and
cope with pain

Taught patient To help the

relaxation technique patient alleviate
such as Deep the pain
Breathing Exercise

Offered diversional or To divert

distraction activities patients
such as books, attention from
television, or movies. pain

Encouraged To evaluate
verbalization of coping abilities
feelings about the and to identify
pain such as concern areas of
about tolerating pain. additional
concern

DEPENDENT
Administered To help reduce
prescribed analgesic patients pain
as ordered by the
Physician
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired Skin After 4 hours INDEPENDENT Goal Met:
“Masakit po Integrity of nursing Assessed vital To determine
yung sugat related to intervention, signs every 2 any changes or After 4 hours
ko.” as surgical the client will hours alteration in of nursing
verbalized by wound manifest the patient’s intervention,
the patient intact skin vital signs the client
integrity as manifested an
Objective: evidence by Done proper Aseptic intact skin
Weakness absence of aseptic wound Technique integrity as
Pain Scale of 8 inflammation, care using decreases the evidenced by
over 10 redness, appropriate chances of no presence of
purulent barrier dressings, transmitting or inflammation,
Vital Signs: discharges on wound coverings spreading redness or
Temp: 36.8oc skin or or skin protective pathogens to purulent
PR: 90 bpm operative site. agent as needed or between discharges
RR: 20 cpm patients noted on the
BP: 120/80 surgical site.
mmHg Keep the area To assist
clean and dry, body’s natural
and carefully process of
dress wounds repair and
protect the
wound

Given health Knowledge of

teaching on ways to reduce
proper wound or eliminate
care or dressing germs reduces
and importance the likelihood
of not touching of transmission
the wound

Encouraged Proper
intake of protein- nutrition place
rich and calorie- a part in
rich foods supporting the
immune
system’
responsiveness

DEPENDENT
Administered To help reduce
prescribed patients pain
medications as and assist in
ordered by the wound healing
physician
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATION

N
Subjective: Activity After 6 INDEPENDENT Goal Met:
“Masakit po intolerance hours of Assessed vital To determine any
yung sugat r/t lump in nursing signs every 2 changes or After 6 hours
ko.” as the vagina intervention, hours alteration in the of nursing
verbalized by patient’s vital intervention,
secondary the patient
the patient signs the patient
to 3rd will be able
was able to
Objective: degree to do
Established Motivation and do Activities
Weakness uterine Activities of of Daily Living
guidelines and cooperation are
Pain Scale of prolapsed. Daily Living alone and
goals of activity enhanced if the
8 over 10 alone and maintain
with the patient
maintain activity level
patient and/or participates in
Vital Signs: activity level within
SO. goal setting.
Temp: 36.8oc within capabilities.
PR: 90 bpm capabilities.
RR: 20 cpm Assisting the
BP: 120/80 Assisted with patient with
mmHg ADLs while ADLs allows
avoiding conservation of
patient energy.
dependency.
This helps the
patient to cope.
Encouraged Acknowledgment
verbalization of that living with
feelings activity
regarding intolerance is
limitations. both physically
and emotionally
difficult.

Knowledge
Taught the promotes
patient and/or awareness to
SO to prevent the
recognize signs complication of
of physical over overexertion.
activity or
overexertion.
Patient with
Instructed the limited activity
patient to tolerance need
refrain from to prioritize
performing important task
nonessential first.
activities or
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

PATHOPHYSIOLOGY

PREDISPOSING PRECIPITATING
FACTORS FACTORS

Pregnancy
Multiparous women
Hypoestrogenism
Low Hemoglobin Obesity
Low Hematocrit Chronic pulmonary
Low Red blood cell count disease
Post-menopausal Smoking
Constipation
Pelvic tumors
Sacral nerve disorder
Diabetic neuropathy

Increase in intra-
abdominal pressure

Stretching and tearing

of endopelvic fascia and
the levator
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

Decrease perineal
muscle tone stretching

Further sagging and

stretching of perineum

Vaginal and uterine

descent at or through
the introitus

Ulceration of the
Sensation of vaginal
protruding cervix or
fullness of pressure
vagina

Coital Vaginal
difficulty spotting

Displacement of
pelvic organs
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

Sacral back Lower

Displacement Rectal
pain with abdominal
of the bladder pressure
standing discomfort

Voiding
difficulties Defecatory
(incontinence, difficulties
frequency and (constipation,
retention) uncontrollable gas
and fecal
incontinence
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

DRUG STUDY
CEFAZOLIN
● The patient was on drug Cefazolin 1mg after negative skin testing to kill bacteria to
avoid infections.

CLASSIFICATION :
● Cephalosporin Antibiotics

ACTION :
● First-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic
instability

INDICATION:
● Preoperative prevention in contaminated surgery

SIDE EFFECTS:
● Seizure, nausea, vomiting, diarrhea, dyspepsia, abdominal cramps, anaphylaxis, drug
fever

NURSING RESPONSIBILITIES
● Obtain culture and sensitivity test before giving first dose.
● Expect to adjust dosage and dosing interval if creatinine clearance falls down below
55ml/minute.
● After reconstitution, inject drug IM without further dilution .This drug isn’t as painful as
other cephalosporins. Give injections deeply into large muscle, such as the gluteus
maximus or lateral aspect of the thigh.
● Instruct patient to report adverse reactions promptly.
● Tell patient to report discomfort at IV injection site.
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

FAMOTIDINE
● The patient was on drug famotidine 20 mg to relieve heartburn or indigestions.

CLASSIFICATION :
● H2 receptor antagonist

ACTION
● Competitively inhibits action of histamine on the H2 at receptor sites of parietal cells,
decreasing gastric acid sectretion.

INDICATION
● Short-term treatment for duodenal ulcer
● Short-term treatment for benign gastric ulcer
● Pathologichy persecretory conditions (such as Zollinger-Ellison syndrome)
● Hospitalized patients who can’t take oral drug or who have intractable ulcers or
hypersecretory conditions
● Gastro esophageal reflux disease(GERD)
● To prevent or treat heartburn

CONTRAINDICATIONS
● Contraindicated in patients hypertensive to drug.

SIDE EFFECTS
● CNS:headache, dizziness, fever, malaise, paresthesia, vertigo.
● CV: flushing, palpitations.
● EENT: orbital edema, tinnitus.
● G.I.: anorexia, constipation, diarrhea, dry mouth, taste perversion.
● Musculoskeletal: bone & muscle pain.
● Skin: acne, dry skin.
● Other: transient irritation at I.V.site

NURSING RESPONSIBILITIES
● Assess patient for abdominal pain. Look for blood in emesis, stool or gastric aspirate.
● Oral suspension must be re-constituted and shaken before use.
● Store reconstitute oral suspension below 86 F(30 C).Discard after 30 days.
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

TRAMADOL
● The patient was on tramadol 50 mg IV as a relief to pain since the patient had
undergone surgery.

CLASSIFICATION
● Opioid analgesic

ACTION
● Binds to mu-opioid receptors and inhibits the re-uptake of epinephrine and serotonin

INDICATON
● Relief to moderate to moderately severe pain

CONTRAINDICATION
● Hypersensitivity to the drug
● Raised intracranial pressure
● Severe renal impairment

ADVERSE EFFECT
● Sweating, dizziness, nausea, dry mouth, fatigue, constipation

NURSING CONSIDERATIONS
● Determine patient’s past or present history of addiction to or dependents on opioids
● Instruct patients to increase fluid intake to prevent dry mouth and constipation
● For better analgesic effect, give drugs before onset of intense pain
● Reassess level of pain at least 30 minutes after administration
● Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations
decrease or rate is below 12 breaths per minute
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

FOLIC ACID (VITAMIN B9, PTEROYLGLUTAMIC ACID)

● The patient was on drug folic acid to supplement and improve iron status of the mother.

CLASSIFICATION :
● Vitamin B9

ACTION :
● Vitamin B complex essential for nucleo-protein synthesis and maintenance of normal
erythropoiesis. Acts against folic acid deficiency that impairs thymidylate synthesis and
results in production of defective DNA that leads to megaloblast formation and arrest of
bone marrow maturation.

INDICATION :
● Folate deficiency,macrocytic anemia, and megaloblastic anemias associated with mal-
absorption syndromes, alcoholism, primary liver disease, inadequate dietary intake,
pregnancy, infancy, and childhood.

CONTRAINDICATIONS :
● Folic acid alone for pernicious anemia or other vitamin B12 deficiency states:normocytic,
refractory, aplastic, or undiagnose anemia.

ADVERSE EFFECTS :
● Reportedly non toxic.Slight flushing and feeling of warmth following IV administration.

NURSING RESPONSIBILITIES :
Assessment & Drug Effects
● Obtain a careful history of dietary intake and drug and alcohol usage prior to start of
therapy. Drugs reported to cause folate deficiency include oral contraceptives, alcohol,
barbiturates, methotrexate, phenytoin, primidone,and trimethoprim. Folate deficiency
may also result from renal dialysis.
● Keep physician informed of patient's response to therapy.
● Monitor patients on phenytoin for sub therapeutic plasma levels.
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

FERROUS SULFATE
● The patient was on drug ferrous sulfate to prevent iron deficiency anemia since the
patient had lost amount of blood.

CLASSIFICATION :
● Enzymatic mineral and Iron preparation.

ACTION :
● Ferrous Sulfate is an essential component in the formation of hemoglobin, myoglobin
and enzymes. It is necessary for effective erythropoiesis and transport or utilization of
oxygen.

INDICATION
● The prevention or treatment of iron deficiency anemia due to inadequate diet,mal-
absorption pregnancy, and blood loss.

CONTRAINDICATIONS :
● Patients receiving repeated blood transfusions;anaemia not due to iron deficiency.

ADVERSE EFFECTS :
● Large doses may aggravate peptic ulcer,regional enteritis, and ulcerative colitis.
● Severe Iron Poisoning: Vomiting, severe abdominal pain, diarrhea, dehydration,
hyperventilation, pallor or cyanosis, cardiovascular collapse

NURSING RESPONSIBILITIES :
● Store all forms at room temperature.
● Give between meals with water but may give with meals if gastrointestinal discomfort
occurs.
● Transient staining of mucous membranes and teeth will occur with liquid iron
preparation. To avoid, place liquid on the back of the tongue with dropper or use straw.
● Avoid simultaneous administration of antacids or tetracycline.
● Do not crush sustained-release preparations.
● Eggs and milk inhibit absorption.
● Monitor serum iron, total iron- binding capacity, reticulocyte count, hemoglobin, and
ferritin.
● Monitor daily pattern of bowel activity and stool consistency.
● Assess for clinical improvement, record of relief of symptoms (fatigue,irritability, pallor,
paresthesia,and headache).
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ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

VITAMIN B COMPLEX

Vitamin B12
● The patient was on drug Vit.B12 required for proper RBC development and energy
production that helps store replenished nutrients.

CLASSIFICATION :
● Vitamins and minerals

ACTION :
● A co-enzyme that stimulate metabolic function and is needed for cell
replication,hematopoiesis, and nucleo-protein and myelin synthesis

INDICATION :
● Used for Vit B complex deficiencies;neuritis, polyneuritis, diabetic neuritis, neuralgia,
lumbalgia, sciatica, intercostal and trigeminal neuralgia, peripheral neuroparalysis,
arthralgia and myalgia.

CONTRAINDICATION:
● Hypersensitive to vitamin B12 or cobalt

ADVERSE EFFECTS :
● CV: Peripheral vascular thrombosis,heart failure.
● GI: Transient diarrhea.
● Respiratory: Pulmonary edema.
● Skin:itching, transitory exanthema, urticaria.
● Other: anaphylaxis, anaphylactoid reactions with parenteral administration, pain or
burning at injection site.

NURSING RESPONSIBILITIES :
● Determine reticulocyte count, Hct, Vit.B12, iron, folate levels before beginning therapy.
● Obtain a sensitivity test history before administration
● Avoid I.V. administration because faster systemic elimination will reduce effectiveness of
vitamin.
● Don’t give large doses routinely because drug is lost through excretion.
● Protect Vit.B 12 from light. Don’t refrigerate or freeze.
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

ASCORBIC ACID
● The patient was on drug ascorbic acid once a day to prevent or treat low levels of
vitamin C. It is good for the patient to gain more nutrients.

CLASSIFICATION :
● Vitamins

INDICATION :
● Prophylaxis and treatment of scurvy and as a dietary supplement.
● Increases protection mechanism of the immune system,thus supporting wound healing.
Necessary for wound healing and resistance to infection.

CONTRAINDICATIONS :
● Use of sodium ascorbate in patients on sodium restriction; use of calcium ascorbate in
patients receiving digitalis. Safety during pregnancy(category C) or lactation is not
established.

ADVERSE EFFECTS :
● GI: Nausea,vomiting,heartburn,diarrhea.
● Hematologic:Acute hemolytic anemia (patients with deficiency of G6PD); sickle cell
crisis.
● CNS:Headache (high doses).
● Urogenital:Urethritis, dysuria,crystalluria (high doses).
● Other:Mild soreness at injection site;dizziness and temporary faintness with rapid IV
administration

NURSING RESPONSIBILITIES

Assessment and drug effects

● Lab tests: Periodic Hct & Hgb, serum electrolytes.
● Monitor for S&S ofacute hemolytic anemia, sickle cell crisis.

Patient & Family Education

● Take large doses of vitamin C in divided amounts because the body uses only what is
needed at a particular time and excretes the rest in urine.
● Mega doses can interfere with absorption of vitamin B12

Note: Vitamin C increases the absorption of iron when taken at the same time as iron-rich
foods.
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

CELECOXIB
● The patient was was on drug celecoxib 500 mg to reduces inflammation and to ease
pain from the surgery.

CLASSIFICATION :
● Non steroidal cyclooxegenase-2 (COX- 2) inhibitor, anti inflammatory drug (NSAID)

ACTION:
● Exhibits anti- inflammatory, analgesic, and antipyretic action due to inhibition of the
enzyme COX-2

INDICATION :
● Adjunctive treatment of decrease the number of adenomatous colorectal polyps in
familial adenomatous polyposis

CONTRAINDICATIONS :
● Hypersensitivity to drug, sulfonamides, or other NSAIDs
● Severe hepatic impairment
● History of asthma or urticaria
● Advanced renal disease
● Late pregnancy
● Breastfeeding

ADVERSE EFFECTS

● CNS : dizziness, drowsiness, headache, insomnia, fatigue

● CV: peripheral edema
● EENT: ophthalmic effects,tinnitus, pharyngitis, rhinitis, sinusitis
● GI: nausea, diarrhea,, constipation, abdominal pain, dyspepsia, flatulence, dry mouth,
GI bleeding
● GU: constipation, dry mouth, tongue atrophy
● Respiratory: URI symptoms, cough, epistaxis
● OTHER: Cancer in preclinical studies, back pain, fever

NURSING RESPONSIBILITIES :
● Before:
 Asses pt. history of allergic reaction to the drug
 Monitor CBC, electrolyte levels, creatinine clearance,and occult fecal blood test
and liver function test results every 6-12 months
● During :
 Instruct pt. to take drug with food or milk
 Teach pt. to avoid aspirin and other NSAIDs (such as Ibuprofen and Naproxen)
during therapy
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

MEFENAMIC ACID
● The patient was on drug mefenamic acid 500 mg to relieve pain.

CLASSIFICATION:
● Nonsteroidal anti-inflammatory drugs (NSAIDs)

ACTION:
● Aspirin-like drug that has analgesic,antipyretic, & anti-inflammatory activities

INDICATION:
● Relief of pain including muscular, rheumatic, traumatic, dental, post-op and postpartum
pain, headache,migraine, fever,dysmenorrhea

CONTRAINDICATIONS :
● Pregnancy & lactation, hypersensitivity, active ulceration or chronic inflammation of
either upper or lower GIT, blood disorders, poor platelet function,kidney or liver
impairment, children < 14 yrs

ADVERSE EFFECTS :
● PRECAUTION: If rash occurs, administration should be stopped, asthmatics, History of
liver and kidney disease
● ADVERSE REACTION
GI discomfort, diarrhea or constipation, gas pain, nausea,vomiting, drowsiness

NURSING RESPONSIBILITIES
● Assess pt.’s pain before therapy
● Monitor for possible drug induced adverse reactions
● Advice pt. not to take drug for more than 7days
● Advice pt. to report immediately persistence or failure to relieve pain
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
ALIMANNAO HILLS, PEÑABLANCA, CAGAYAN
S.Y. 2020 - 2021
COLLEGE OF NURSING

DISCHARGE CARE PLAN

MEDICINE:
 Medications that are prescribe should be taken religiously as per dosage and frequency
 The take home meds, as per indication is fully explained by the Nurse on Duty or Clerk
 Take medicine as directed

EXERCISE:
 Advise to resume exercise as per doctors advice:
 Encourage and demonstrate deep breathing exercises to promote expansion of the
lungs for proper delivery of oxygen to her system
 Advise to resume activities of daily living GRADUALLY
 Encourage the patient to do passive exercises until full ambulatory is recommended
 Do not strain and Avoid HEAVY LIFTING Ugh!
 Sit with your legs elevated
 Do some Kegel exercises

TREATMENT:
 Encourage patient to take her medicines religiously as prescribe by her doctor
 Instruct and demonstrate how to clean the surgical incision properly to prevent infection.
 Inform the patient about the purpose actions and side effects of the medication given to
her
 Inform the patient the correct dose of the med.
 Strictly follow the time in taking her medication
 Inform the patient to continue taking her medicines as prescribe by the doctor

HYGIENE:
 Instruct patient to continue prescribed medications
 Educate the patient to maintain proper grooming/hygiene like cleaning her ears, brushing
her teeth, trimming her nails, regular bathing and always do handwashing to prevent
infection.
 Instruct the patient also to do perennial care using warm water to prevent infection.

OUTPATIENT:
 Instruct the patient to return on the scheduled date for her follow-up, check-up at the OPD
sections. Inform the patient that it is important to return for check because the health care
provider will evaluate her condition.
 In case of Lost Follow-ups, instruct the patient to submit their name and address in a
health facility or RHU for endorsement
DIET:
 Advise the patient to eat healthy foods like vegetables fruits fish and whole grains products.
 Instruct the patient to increase fluid intake to prevent dehydration.
 Instruct patient to increase calorie intake for energy supplement.

SPIRITUAL:
 Encourage the patient to pray always and attend Sunday masses regularly as this will draw
a closer relationship to god.