CASE STUDY

I. Demographic Profile
Pseudonym: Patient G13
Age: 39 City/Province: Nasugbu, Batangas
Sex: Female Highest Educational Attainment:
Date of Birth: October 7, 1980 Elementary Graduate
Place of Birth: Hamilo Religion: Roman Catholic
Nationality: Filipino Occupation: N/A

II. History of Present Illness

Chief Complaint: Labor Pain
Date of Admission: October 26, 2019
Admitting Diagnosis: G13P13 (13-1-0-12)
Final Diagnosis: Premature Labor and Birth

III. Obstetrical History

LMP: March 15, 2019 (Estimated)
EDD: December 22, 2019
IV. Family History

V. Social History
Affiliations only include religious church visits and occasional visits to the RHU.
VI. Physical Assessment Findings
A physical examination reveals the following:
 CNS: Conscious during assessment.
 Pulse: 68 bpm
 Blood pressure: lying, right arm 110/80
 Temp: 36.1°C
 Ambulatory during assessment

VII. Laboratory and Diagnostic Findings

Parameter Result Unit Ref. Range
WBC Count 11.50 4.00-12.00
RBC Count 4.23 10^12/L 3.50-5.00
Hematocrit L 0.330 L/L 0.359-0.445
Hemoglobin L 10.6 g/dL 13.2-15.3
Segmenters H 83.0% 50.0-70.0
Lymphocytes L 13.0% 20.0-40.0
Monocytes 3.0% 3.0-12.0
Eosinophils 1.0% 0.5-5.0
Basophils 0.0% 0.0-0.1
Stab
MCV L 78.0 fL 80.0-100.0
MCH L 25.1 pg 27.0-34.0
MCHC 322 g/L 320-360
RDW-CV 15.0% 11.0-16.0
RDW-SD 43.3 35.0-56.0
Platelet Count 185 150-450

VIII. Review of Anatomy and Physiology

The female reproductive system functions to produce gametes and reproductive hormones,

just like the male reproductive system; however, it also has the additional task of supporting

the developing fetus and delivering it to the outside world. Unlike its male counterpart, the

female reproductive system is located primarily inside the pelvic cavity

The external female reproductive structures are referred to collectively as the vulva. The mons

pubis is a pad of fat that is located at the anterior, over the pubic bone. After puberty, it

becomes covered in pubic hair. The labia majora (labia = “lips”; majora = “larger”) are folds of
hair-covered skin that begin just posterior to the mons pubis. The thinner and more

pigmented labia minora (labia = “lips”; minora = “smaller”) extend medial to the labia majora.

The labia minora serve to protect the female urethra and the entrance to the female

reproductive tract.

The superior, anterior portions of the labia minora come together to encircle the clitoris (or

glans clitoris), an organ that originates from the same cells as the glans penis and has abundant

nerves that make it important in sexual sensation and orgasm. The hymen is a thin membrane

that sometimes partially covers the entrance to the vagina. An intact hymen cannot be used as

an indication of “virginity”; even at birth, this is only a partial membrane, as menstrual fluid and

other secretions must be able to exit the body, regardless of penile–vaginal intercourse. The

vaginal opening is located between the opening of the urethra and the anus. It is flanked by

outlets to the Bartholin’s glands (or greater vestibular glands).

The vagina is a muscular canal (approximately 10 cm long) that serves as the entrance to the

reproductive tract. It also serves as the exit from the uterus during menses and childbirth.

The ovaries are the female gonads. Paired ovals, they are each about 2 to 3 cm in length, about

the size of an almond. The ovaries are located within the pelvic cavity, and are supported by the

mesovarium, an extension of the peritoneum that connects the ovaries to the broad ligament.

Extending from the mesovarium itself is the suspensory ligament that contains the ovarian

blood and lymph vessels. Finally, the ovary itself is attached to the uterus via the ovarian

ligament.

IX. Pathophysiology
Preterm Labor and Birth
X. Drug Analysis
BRAND GENERAL MECHANISM OF SPECIFIC SIDE EFFECTS/ADVERSE REACTIONS NURSING RESPONSIBILITIES
NAME DOSAGE ACTION INDICATION

(Unknown) 500mg/caps Cefalexin, a 1st Skin and skin Significant: Hypersensitivity (rash, urticaria, angioedema, Inform patient to take the drug with food.
ule generation oral structure erythema multiforme, Stevens-Johnson syndrome, toxic Inform patient to take the drug for the full duration
cephalosporin, binds infections epidermal necrolysis), diarrhoea, pseudomembranous colitis, in the prescription.
to 1 or more of the positive Coombs’ test, seizures (in patient with renal Inform patient of importance in completing drug
penicillin-binding impairment), acute intravascular haemolysis, elevated INR. prescription.
proteins (PBPs) Blood and lymphatic system disorders: Eosinophilia, Provide safety and comfort measures for the
which in turn blocks neutropenia, thrombocytopenia, haemolytic anaemia. patient.
the final Gastrointestinal disorders: Dyspepsia, abdominal pain, gastritis, Discourage intake of alcohol during drug
transpeptidation step nausea, vomiting. treatment.
of peptidoglycan General disorders and administration site conditions: Fatigue,
synthesis in bacterial fever.
cell wall, thus Hepatobiliary disorders: Rarely, transient hepatitis, cholestatic
inhibiting its jaundice.
biosynthesis and Investigations: Slightly elevated AST and ALT.
arresting cell wall Musculoskeletal and connective tissue disorders: Arthralgia,
assembly resulting to arthritis.
bacterial lysis. Nervous system disorders: Headache, dizziness.
Psychiatric disorders: Agitation, confusion, hallucinations,
nervousness, hyperactivity.
Renal and urinary disorders: Interstitial nephritis (reversible).
Reproductive system and breast disorders: Genital and anal
pruritus, vaginitis, genital moniliasis and candidiasis, vaginal
discharge.

GENERIC SPECIFIC GENERAL CONTRA- DRUG INTERACTIONS

NAME DOSAGE INDICATION INDICATIONS
Cephalexin 500mg/caps Respiratory tract Hypersensitivity Renal excretion may be inhibited by probenecid resulting to
ule infections, Otitis to increased plasma concentration of cefalexin. May increase
media, Skin and skin cephalosporins. plasma concentration of metformin. Increased risk of
structure infections, Acute porphyria. nephrotoxicity with amphotericin, loop diuretics,
Bone infections, aminoglycoside, capreomycin or vancomycin. May increase risk
Genitourinary of hypokalaemia with gentamicin (in patient taking cytotoxic
infections. drugs for leukaemia). May decrease efficacy of oestrogen-
containing oral contraceptives.

BRAND GENERAL MECHANISM OF SPECIFIC INDICATION SIDE EFFECTS/ADVERSE REACTIONS NURSING RESPONSIBILITIES
 NAME DOSAGE ACTION

Methergine PO 0.2mg Methergine Following delivery of placenta, The most common adverse reaction Inform patient that it can cause hypertension, cramps,
tablet (methylergonovine for routine management of is hypertension associated in several cases nausea, vomiting, and dyspnea.
maleate) acts uterine atony, hemorrhage and with seizure and/or headache. Hypotension has
subinvolution of the uterus also been reported. Abdominal pain (caused by Monitor BP, heart rate, and uterine response.
directly on
uterine contractions), nausea and vomiting have Monitor uterine bleeding and notify physician of any
the smooth
occurred occasionally. Rarely observed reactions changes.
muscle of have included: acute myocardial infarction,
the uterus and transient chest pains, vasoconstriction,
increases the tone, vasospasm, coronary arterial
rate, and amplitude spasm, bradycardia, tachycardia, dyspnea, hemat
of rhythmic uria, thrombophlebitis, water intoxication,
contractions. Thus, hallucinations, leg cramps,
it induces a rapid dizziness, tinnitus, nasal congestion, diarrhea,
and sustained diaphoresis, palpitation, rash, and foul
titanic uterotonic taste.Ventricular fibrillation,ventricular
tachycardia, angina pectoris, atrioventricular blo
effect which
ck.
shortens the third
stage of labor and
reduces blood loss.
GENERIC SPECIFIC GENERAL CONTRA-INDICATIONS DRUG INTERACTIONS
NAME DOSAGE INDICATION
Methylergo PO 0.2mg Following delivery of Conditions: Beta-blockers
novine tablet placenta, for routine Blockage or narrowing of mitral Caution should be exercised when Methergine is
management of heart valve, high blood pressure, a used concurrently with beta-blockers.
uterine heart attack, coronary artery Concomitant administration with beta-blockers
atony, hemorrhage an disease, a stroke, blockage of the may enhance the vasoconstrictive action of ergot
d subinvolution of arteries called arteriosclerosis, alkaloids.
the uterus. For serious numbness or prickling or
control of uterine tingling of fingers and toes, liver Anesthetics
hemorrhage in problems, kidney disease with Anesthetics like halothan and methoxyfluran
the second stage of reduction in kidney function, may reduce the oxytocic potency of Methergine.
labor following seizures, pregnancy, Increased
delivery of Cardiovascular Event Risk, Sepsis
the anterior shoulder. Glyceryltrinitrate And Other Antianginal
Drugs
Allergies:
Methylergonovine maleate produces
Ergot Alkaloids, Amine Ergot vasoconstriction and can be expected to reduce
Alkaloid, Hydrogenated Ergot the effect of glyceryl trinitrate and other
Alkaloid, Semi-Synthetic Ergot antianginal drugs.
Alkaloid, Dopamine Receptor
Agonist

BRAND GENERAL MECHANISM OF SPECIFIC SIDE EFFECTS/ADVERSE REACTIONS NURSING RESPONSIBILITIES

 NAME DOSAGE ACTION INDICATION

(Unknown) 500mg/caps Mefenamic acid  For relief of Upset stomach, nausea, heartburn, dizziness,  Discontinue drug promptly if diarrhea, dark
ule has analgesic, anti- drowsiness, diarrhea, and headache. stools, hematemesis, ecchymoses, epistaxis, or
mild to moderate pain
inflammatory, rash occur and do not use again. Contact
in patients ≥ 14 years  fainting, persistent/severe headache, hearing changes
and antipyretic properties. physician.
of age, when therapy
(e.g., ringing in the ears), fast/pounding heartbeat,  Notify physician if persistent GI discomfort,
will not exceed one
The mechanism of action of mental/mood changes, stomach pain, difficult/painful sore throat, fever, or malaise occur.
week (7 days).
mefenamic acid, like that of swallowing, vision changes, symptoms of heart  Do not drive or engage in potentially hazardous
other NSAIDs, is not failure (such as swelling ankles/feet, unusual tiredness, activities until response to drug is known. It may
completely understood but unusual/sudden weight gain). cause dizziness and drowsiness.
involves inhibition  Monitor blood glucose for loss of glycemic
of cyclooxygenase (COX-1  Hypersensitivity reactions on rare occasions. control if diabetic.
and COX-2).  Do not breast feed while taking this drug
without consulting physician
Mefenamic acid is a potent
inhibitor
of prostaglandin synthesis i
n vitro. Mefenamic acid
concentrations reached
during therapy have
produced in vivo effects.
Prostaglandins
sensitize afferent nerves
and potentiate the action of
bradykinin in inducing pain
in animal models.
Prostaglandins are
mediators of inflammation.
Because mefenamic acid is
an inhibitor of
prostaglandin synthesis, its
mode of action may be due
to a decrease of
prostaglandins in peripheral
tissues.
GENERIC SPECIFIC GENERAL INDICATION CONTRA- DRUG INTERACTIONS
NAME DOSAGE INDICATIONS
Mefenamic 500mg/caps For relief of mild Hypersensitivity to Some products that may interact with this drug
Acid ule the drug include: aliskiren, ACE inhibitors (such
to moderate pain in patients
as captopril, lisinopril), angiotensin II receptor blockers
≥ 14 years of age, when History of asthma, (such as valsartan, losartan), cidofovir, corticosteroids
therapy will not exceed one
urticaria (e.g., prednisone), fluconazole, ketorolac, lithium, metho
week (7 days).
trexate, "water pills" (diuretics such as furosemide).
 For treatment of
primary dysmenorrhea.
This medication may increase the risk of bleeding when
taken with other drugs that also may cause bleeding.
Examples include anti-platelet drugs such as clopidogrel,
"blood thinners" such as dabigatran/enoxaparin/warfarin,
among others.

Check all prescription and nonprescription medicine

labels carefully since many medications contain pain
relievers/fever reducers (aspirin, NSAIDs such
as celecoxib or ibuprofen). These drugs are similar
to mefenamic acid and may increase your risk of side
effects if taken together. However, if your doctor has
directed you to take low-dose aspirin to prevent heart
attack or stroke (usually at dosages of 81-325 milligrams
a day), you should continue taking the aspirin unless
your doctor instructs you otherwise.
XI. Nursing Care Plan
ASSESSMENT
Subjective Cues:
“Masakit po pag gumagalaw
po ako pero kinakaya naman”
as verbalized by the patient.
Objective Cues:
Facial grimace
Guarding
Pain scale of 7/10
DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Acute pain related to After 2 hours of nursing Assist patient into comfortable Promotes relaxation, reduces Goals Partially Met.
manipulation of interventions, the patient position. muscle tension and general fatigue.
injured tissues After the 2 hours of nursing
will have reported
evidenced by reports interventions, the patient has
reduced pain scale from
of pain verbalized pain reduction from
7/10 to 4/10. The patient Provide diversional activities Helps lessen concentration on pain pain scale of 7/10 to 5/10. The
will also have displayed appropriate for condition. experience and refocus attention. patient also displayed
relaxed facial expressions comfortable facial expressions
and body posture. and posture.
Provide medication prescribed Helps relieve severe physical and
by physician. emotional distress related to pain.
Promote periods of uninterrupted Sleep deprivation can increase
sleep. perception of pain and/or reduce
coping abilities.
XII. References
https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/who_risk
https://opentextbc.ca/anatomyandphysiology/chapter/27-2-anatomy-and-physiology-of-the-
female-reproductive-system/
https://www.mayoclinic.org/diseases-conditions/preterm-labor/symptoms-causes/syc-20376842
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/cephalexin/
https://www.rxlist.com/methergine-drug.htm#side_effects
https://www.nrsng.com/methylergonovine-methergine-nursing-pharmacology-considerations/
https://www.rxlist.com/mefenamic-acid-drug.htm#side_effects