Mindanao State University

College of Health Sciences

Marawi City

Name of Students: __Ardiente, Ampuan, Bacarat, Mustapha__

Area of Assignment: ___OB ward___

PATIENT’S PROFILE

Name: ______________Susan Brown_______________ Address: __________________Los Angeles, California_______________ Age: _28 years old_

Sex: _Female_ Religion: __Roman Catholic___ Civil Status: ____Married____ Occupation: ______________Housewife_______________

NURSING ASSESSMENT I

HEALTH HABITS

Frequency Amount Period/Duration

1. Tobacco X X X
2. Alcohol _ X__ X X
3. OTC-drugs/ __ X______ X X
non-prescription drugs Paracetamol__ 1-tab x 65 mg when having mild fever, when relieved

A. CHIEF COMPLAINTS:

“Ah! It feels like I’m peeing” - as verbalized by the patient with evidence of post-partum bleeding/ hemorrhage.

B. HISTORY OF PRESENT ILLNESS (HPI) {onset, character, intensity, duration, aggravation, and alleviation, associated symptoms, previous treatment and results, social and
vocational responsibilities, affected diagnoses}.

Patient is a 28-year-old female from Los Angeles, California, no onset of pain associated after precipitous vaginal delivery, still admitted and bed rest post-delivery;
had post-partum hemorrhage, leftover particles of the placenta, and in need of emergency care.
C. HISTORY OF PAST ILLNESS (previous hospitalization, injuries, procedures, infectious disease, immunization/health maintenance, major illnesses, allergies, medications, habits,
birth and developmental history, nutrition- for pedia).

Patient was previously hospitalized at Santa Maria Medical Center upon labor of her 1st pregnancy. No history of accidents, injuries, and infectious diseases. Patient is
rubella immune, GBS negative, and has complete immunization. Patient maintain taking up calcium carbonate during pregnancy. Patient has no major illness no allergies.

FAMILY HISTORY WITH GENOGRAM

Acquired Diseases: Heredo- familial Diseases:

Hypercholesterolemia ___X___ Diabetes ___X___
Kidney Disease ___X___ Heart Diseases ___X___
Tuberculosis ___X___ Hypertension ___X___
Alcoholism ___X___ Cancer ___X___
Drug Addiction ___X___ Asthma ___X___
Hepatitis A ___X___ Epilepsy ___X___
B ___X___ Mental Illness ___X___
C ___X___ Rheuma/Arthritis ___X___
Others (pls. specify) ___X___ Others (pls. specify) ___X___

D. PATIENT’S PERCEPTION OF:

1. Present Illness

“Am I going to be okay?” – as verbalized by the patient with grimacing and concerned face.

2. Hospital Environment

“The room is great and the environment is clean” – as verbalized by the patient.

E. SUMMARY OF INTERACTION

The 28-year old female patient, gravida 2 para 2, with no history of risks for health problems or concerns had a post-partum bleeding or hemorrhage. Patient is
conscious, responsive, and responds in assessment questions. Patient is looking tired and feels sore due to assumption of peeing but no pain from delivery.
 Physical Examination
Name: ________Susan Brown____________
Chief Complaint upon Initial Assessment: _____ Post-partum Bleeding/Hemorrhage_______
Chief Complaint upon Final Assessment: ____________Pain on the Vaginal Area__________
Initial Vital Signs: Temp: _98.8 F_ RR: _102 bpm_ PR: 102 bpm O2Sat: 98% BP: 116/72 mmHg
Initial Assessment
 Patient is received awake, conscious, coherent, oriented to time,
place and person.
 Patient look like her stated age, skin color matches her ethnicity,
posture is normal, no external abnormalities, and observes proper
GENERAL hygiene.
 Patient’s vital signs are as follows: temperature = 98.8 F, BP =
116/72 mmHg, respiratory rate = 18 cpm, pulse rate = 102 bpm,
O2Saturation = 98%
 HEAD: smooth skull contour; no nodules or masses noted. Hair is
well distributed and black in color. No head lice infestation and
dandruff seen. Face and features are symmetrical.
 EYES: sclera of both eyes is white. Pupils are equally round, reactive
to light and accommodation and pale conjunctiva.
HEENT  EARS: symmetrical ears and equal size with no presence of
cerumen/ear wax. No pain upon palpation and assessment
presence of swelling on both ear auricles, non tender.
 NOSE: nose is symmetrical in shape and same color with face; can
breathe with one nostril when one nostril is closed vice versa. No
presence of discharge, bumps, and tenderness. No pain noted and
non-tender sinuses.
 THROAT: No evidence of lesions and no swelling noted from tongue
and throat. Lips are symmetrical with no lesions noted.
Date: _June 3, 2021_
Height: ___5’10”
Weight: __173 lbs__
Pain Score: 2/10 (after) BMI: ____24.8_____
Final Assessment (Last Day)
 Patient is awake, alert, and oriented to date, time, place, person
and responds to stimuli.
 Speech is of appropriate age and flows easily while maintaining eye
contact, observed can smile and frown appropriately.
 Patient’s vital signs are as follows: temperature = 98 F, BP = 108/72
mmHg, respiratory rate = 22 cp, pulse rate = 102 bpm, O2Saturation
= 98%
 HEAD: smooth skull contour; no nodules or masses noted. Hair is
well distributed and black in color. No head lice infestation and
dandruff seen. Face and features are symmetrical.
 EYES: sclera of both eyes is white. Pupils are equally round, reactive
to light and accommodation and pale conjunctiva.
 EARS: symmetrical ears and equal size with no presence of
cerumen/ear wax. No pain upon palpation and assessment
presence of swelling on both ear auricles, non tender.
 NOSE: nose is symmetrical in shape and same color with face; can
breathe with one nostril when one nostril is closed vice versa. No
presence of discharge, bumps, and tenderness. No pain noted and
non-tender sinuses.
 THROAT: No evidence of lesions and no swelling noted from tongue
and throat. Lips are symmetrical with no lesions noted.
  Skin color is consistent with the genetic or ethnicity background.
 Lower and upper extremities are warm (normal body temperature)
 Poor skin turgor due to the presence of interstitial fluids on areas of
INTEGUMENTARY edema which are dry and shiny.
 Skin is pallor and pale nail beds observed.
 Hair is well distributed and black in color. No head lice infestation
and dandruff noted.
 Patient has a symmetrical chest wall shape and size.
RESPIRATORY  No barrel chest and use of accessory muscles, (scalene and
sternocleidomastoid) muscles while breathing.
 Patient had a presence of crackles upon auscultation.
 Normal values are obtained for pulse rate, rhythm of carotid
CARDIOVASCULAR arteries, and amplitude of 2+ upon palpitation.
 Peripheral pulses are equal in pulse rate and rhythm with no
bulging veins observed.
 Fundus is firm, midline, at the umbilicus.
 No vomiting or difficulty of swallowing observed.
DIGESTIVE  Pain on the vaginal area is persistent from moderate to severe.
 Vaginal bleeding, main concern or problem.
 Patient was inserted with catheter.
EXCRETORY  Voided 3 times a day with observed dark yellow urine.
 Patient is observed with symmetrical and equal muscle mass,
MUSCULOSKELETAL tone, and strength.
 Rate of muscle strength are 4 in all four extremities.
 Motor function is normal and hyperactive.
 No pain pitting of areas.
 Range of motion is normal; patient is mobile with no signs of loss
mobility in the joints.
 Patient is observed to have no deficit functions for sensory,
cerebellar, and cerebral neurologic examination.
NERVOUS  Functioning well of smell, taste, sight, touch, and hearing senses.
 Lower and upper extremities are warm (normal body temperature)
 Poor skin turgor due to the presence of interstitial fluids on areas of
edema which are dry and shiny.
 Skin is pallor and pale nail beds observed.
 Hair is well distributed and black in color. No head lice infestation
and dandruff noted.
 Patient has a symmetrical chest wall shape and size.
 No barrel chest and use of accessory muscles, (scalene and
sternocleidomastoid) muscles while breathing.
 Patient had a presence of crackles upon auscultation.
 Normal values are obtained for pulse rate, rhythm of carotid
arteries, and amplitude of 2+ upon palpitation.
 Peripheral pulses are equal in pulse rate and rhythm with no
bulging veins observed.
 Fundus is firm, midline, at the umbilicus.
 No vomiting or difficulty of swallowing observed.
 Pain is persistently felt but in moderation on the vaginal area.
 Vaginal bleeding is cared and relieved patient.
 Patient’s bowel routine is once or twice a day with observed stool
color of brown in moderate amount.
 Voids 4-5 times a day with a urine color of dark yellow observed.
 Patient is observed with symmetrical and equal muscle mass, tone
and strength.
 Same rate of muscle strength are 4 in all four extremities.
 Motor function is still normal and hyperactive.
 No pain pitting of areas observed.
 Range of motion is still normal; patient is mobile with no signs of
loss mobility in the joints.
 Patient is observed to have no deficit functions for sensory,
cerebellar, and cerebral neurologic examination.
 Functioning well of smell, taste, sight, touch, and hearing senses.
  Sensory sensation and cranial nerves are all normal; no
abnormalities or deviations was detected.
 Thyroid gland is normal; no presence of enlargement, nodules,
ENDOCRINE tenderness or gritty sensation.
 Breast is symmetry and hard; breastfeeding.
 Nipples and areola is symmetry; tenderness and discharges are
found.
REPRODUCTIVE  Pubic hair is thin and evenly distributed; no presence of parasites,
inflammation, swelling or lesions.
 Skin of vulva area is darker than the rest of the body.
 Labia is round and symmetry.
 Clitoris, urethral orifice, and vaginal orifice is in good condition;
with presence of drainage, swelling and discharges.
 Lymph nodes are normal; no tenderness, masses or nodules.
LYMPHATIC  Spleen produced tympany when percussion was done; wasn’t
palpable when palpated.
 Sensory sensation and cranial nerves are all normal; no
abnormalities or deviations was detected.
 Thyroid gland is normal; no presence of enlargement, nodules,
tenderness or gritty sensation.
 Breast is symmetry and hard; breastfeeding.
 Nipples and areola is symmetry; tenderness and discharges are
found.
 Pubic hair is thin and evenly distributed; no presence of parasites,
inflammation, swelling or lesions.
 Skin of vulva area is darker than the rest of the body.
 Labia is round and symmetry.
 Clitoris, urethral orifice, and vaginal orifice is in good condition;
with no presence of drainage, swelling and discharges observed.
 Lymph nodes are normal; no tenderness, masses or nodules.
 Spleen produced tympany when percussion was done; wasn’t
palpable when palpated.
 DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended dosage, Of
CLASSIFICATION frequency, route of Action Indication Contraindication Adverse Reaction Nursing Responsibilities
administration

Generic Name: Dosage: 10 units/ml in Oxytocin is a protein Oxytocin is indicated  Hypertensive to  Nausea  Monitor fluid
Oxytocin 1 ml ampule, vial or produced by the for inducing labor, drug when intake and
syringe in compatible pituitary gland if vaginal delivery is  Vomiting output ratio.
Brand Name: Pitocin controlling bleeding
IV solution. mammals including advised.  Severe allergic Antidiuretic
after childbirth, and
Classification: man. Oxytocin works reactions effect may lead
Route: Intravenous, by increasing the treatment of  Cephalopelvic to fluid
Uterotonic agent intramuscular incomplete or disproportion is
concentration of  Bleeding after overload,
inevitable abortion. present.
Frequency: Single dose calcium inside muscle child birth seizures, and
cells that control  When delivery coma from
contraction of the  Abnormal heart water
requires beats
uterus. conversion as in intoxication.
transverse lie.  High blood  Assess uterine
pressure contractions
and FHR.
 Rupture of the
uterus  Assess the
blood pressure,
pulse and
respiration.

 Administer by
IV infusion.
Drug isn’t
recommended
for IM use, but
10 units may be
given IM after
delivery of
 placenta to
control
postpartum
hemorrhage.

 Evaluate the
length and
duration of
contractions.

 Notify physician
of contractions
lasting over 1
min or absence
of contractions.

 Have 20%
MgSl4 solution
available to
relax the
myometrium.

 Teach to report
increased blood
loss, abdominal
cramps or
increased
temperature.
 NURSING ASSESSMENT II

Name Mrs. Susan Brown Age 28 years old____ Sex Female____

Inclusive Dates of Care May 31 – June 6 2021_ _

NORMAL PATTERN CLINICAL APPRAISAL

Day 1 Day 2 DAY 3 DAY 4

Patient stays in bed the whole time. Patient stays in bed and go to
1.ACTIVITIES- REST the CR when needed.
Sleeps to rest.
a. Activities
Rests by sleeping.
b. Rest Patient has 8 hours of sleep.
Patient has 8 hours of sleep.
c. Sleeping pattern

2.NUTRITIONAL- METABOLIC
Patient can eat mechanical diet. Patient can eat rice.
a. Typical intake (food, fluid)

b. Diet Had eaten mashed potato and fish Diet is tolerated as it is.
fillet only.
c. Diet restrictions Drinks 1000 mL of water a day.
Drinks 1500 mL of water a day.
d. Weight

e. Medications/supplement
food
3. ELIMINATION The patient is catheterized with a dark The patient voids once with dark
a. Urine (frequency, color, yellow urine. yellow urine.
transparency)

b. Bowel (frequency, color, The patient has not defecated since The patient has not defecated
consistency) admission. since admission.

4. EGO INTEGRITY

a. Perception of self

b. Coping Mechanism
c. Support System
The patient’s wife was there by
The patient’s wife was there by her side
her side all the time. Family
all the time. Family support.
support.

d. Mood/Affect
Satisfied.
5. NEURO-SENSORY
The patient is conscious but less The patient is responsive and
a. Mental state active.
responsive due to restlessness.
.
Patient is responsive to stimuli verbally
b. Condition of five senses: and physically.
(sight, hearing, smell, taste,

Touch)
6. OXYGENATION

a. Vital signs 98.8 F 95.8 F

Temperature 18 cpm 18 cpm

Respiratory rate 102 bpm 90 bpm

Heart rate 116/72 mmHg 95/70 mmHg

Blood pressure 98% 92%

b. Lung sounds

c. History of Respiratory

Problems

Patient reported her pain that feels like Patient reported her pain that Patient reported her pain that Patient reported her pain that
7. PAIN-COMFORT she's peeing, pain score ranging from 3 feels like she's peeing, pain score feels like she's peeing, pain feels like she's peeing, pain
a. Pain (location, onset, to 4 out of 10. At the uterus associated ranging from 4 to 5 out of 10. At score 7 out of 10. At the uterus score 2 out of 10. The fundus is
character, intensity, with boggy uterus. the uterus associated with no associated with no contractions firm and midline and the uterus
duration, contractions and second degree and bleeding due to placenta is back to its normal
associated symptoms, laceration refined with local and pieces left. contraction. The placenta pieces
aggravation) has an ice pack. have been removed out.
Comfort measures are;
hydrotherapy, deep breathing, and Comfort measures are; Comfort measures are; Comfort measures are;
b. Comfort visualization hydrotherapy, deep breathing, hydrotherapy, deep breathing, hydrotherapy, deep breathing,
measures/Alleviation can increase the production of and visualization can increase and visualization can increase and visualization can increase
endogenous endorphins that bind to the production of endogenous the production of endogenous the production of endogenous
receptors in the brain for pain relief. endorphins that bind to endorphins that bind to endorphins that bind to
c. Medications receptors in the brain for pain receptors in the brain for pain receptors in the brain for pain
Refused pain medication. relief. relief. relief.

Refused pain medication. Medications taken are Pitocin. Medications taken are Pitocin,
ketorolac, and cytotec.
8. HYGIENE AND ACTIVITIES Good hygiene, takes a bath every day. Good hygiene, takes a bath every Good hygiene, takes a bath Good hygiene, takes a bath
OF DAILY LIVING day. every day. every day.

9. SEXUALITY
A 28 years old female patient happily A 28 years old female patient A 28 years old female patient A 28 years old female patient
a. female (menarche, married with only one child. happily married and gave birth happily married and giving birth happily married and gave birth
menstrual for 2nd number of children. to 4kg baby boy for 2nd number for 2nd number of children.
cycle, civil status, number of of children.
children, reproductive
status)

b. male (circumcision, civil

status, number of children)
 ANATOMY AND PHYSIOLOGY

Reproductive system

The female reproductive organs can be subdivided into the internal and external genitalia. The female’s internal reproductive organs are the vagina, uterus, fallopian tubes, cervix,
and ovary. The external components include the mons pubis, pudendal cleft, labia majora, labia minora, Bartholin’s glands, and clitoris.

Two main components of female reproductive system:

 The uterus that hosts the developing fetus, contains vaginal and uterine secretions, and moves through the anatomically male sperm to the fallopian tubes.
 The ovaries that contain and produce the anatomically female egg cells.
UTERUS

 The uterus, also called the womb, is an inverted, pear-shaped muscular organ situated between the bladder and the rectum of the female reproductive system.
 It is a muscular organ that both exponentially expands to accommodate a growing fetus and contracts in order to push a baby out during birth.


Three distinct layers of tissue comprise the uterus:

 Perimetrium: The outer layer of tissue made of epithelial cells

 Myometrium: The middle layer made of smooth muscle tissue
 Endometrium: The inner lining that builds up over the course of a month and is shed if pregnancy does not occur


It has four main sections:

 Fundus: The broad curved area at the top and widest portion of the organ that connects to the fallopian tubes
 Corpus: The main part of uterus that starts directly below the level of fallopian tubes and continues downward, becoming increasingly narrower
  Isthmus: The narrow lower portion of the uterus
 Cervix: The lowest two inches of the uterus. The cervix, which is tubular in form, opens into the vagina and dilates (widens) to allow

Functions:

 To receive the fertilized egg from the fallopian tube.

 It is where the implantation and nourishment of the fertilized ovum or developing fetus takes place.
 It holds and provide protection to help prevent physical damage to the fetus.
 By muscle contraction, it helps push the baby out during birth.


PLACENTA

 In pregnancy, the placenta binds the developing fetus to the wall of the uterus of the mother. It forms in the uterine wall and is attached by the umbilical cord to the fetus
within the uterine cavity. The placenta is made up of cells originating from the fetus, making it the first of the fetal organs to form.
 During pregnancy, the placenta serves as a life-support system. Oxygen, and nutrients are transferred across the placenta to the fetus. For elimination, waste products
from the fetus are transmitted back across the placenta.
 The placenta produces a variety of hormones, such as lactogen, estrogen, and progesterone that are required during pregnancy.
 To protect the baby from diseases, it holds the mother's blood distinct from the baby's blood.
 It passes antibodies at the end of the pregnancy to protect the baby after birth.
 After birth, the placenta is expelled from the body, usually about 5 to 30 minutes after the baby is born. This is called the third stage of labour.


UMBLICAL CORD

 The umbilical cord is formed by the fetal membranes (amnion and chorion) and provides a circulatory pathway connecting the embryo to the placenta's chorionic villi.
 It is a narrow tube-like structure that transport oxygen and important nutrients to the fetus from the placenta and to return waste products from the fetus to the placenta.
 Contains one vein (carrying blood from the placental villi to the fetus) and two arteries (carrying blood from the fetus back to the placental villi).
 After birth, doctor clamp and cut the cord. It dries and falls off on its own leaving baby's belly button.
 PATHOPHYSIOLOGY

At term, the uterus and placenta receive 500-800 mL of blood per minute through their low resistance network of vessels. This high flow predisposes a gravid uterus to significant
bleeding if not well physiologically or medically controlled. By the third trimester, maternal blood volume increases by 50%, which increases the body's tolerance of blood loss
during delivery.

Following delivery of the fetus, the gravid uterus is able to contract down significantly given the reduction in volume. This allows the placenta to separate from the uterine
interface, exposing maternal blood vessels that interface with the placental surface. After separation and delivery of the placenta, the uterus initiates a process of contraction and
retraction, shortening its fiber and kinking the supplying blood vessels, like physiologic sutures or "living ligatures."
 MEDICAL MANAGEMENT

IDEAL ACTUAL

Preoperative Postoperative
• 18-gauge IV access, saline lock in Left hand.
• IV fluids. IVF administration is indicated for patients with precipitous vaginal delivery. • Pain Management. Patients undergone vaginal delivery needed to be monitored
accordingly for any signs of postpartum hemorrhage or to pain, as early as the
Drugs need to administer: anesthesia wear off.
1. Ranitidine 50 mg IV q 8 while on NPO
2. Metaclopomide 10 mg IV q 8 PRN x nausea/vomiting Drugs administered:
3. Transclami acid 500 mg slow IV q 8 x 3 doses, next dose 11 pm
4. Furosemide 20 mg IV q 8 x 3 doses with BP precaution 1. Ketorolac 30mg q 6 hrs, IVTT
5. Ketorolac 30 mg slow IV q 6 x 4 doses ANST (-) to start @ PACU, then shift to 2. 30 units Pitocin 500LR bolus
Fremadala + Dexketaprofen 75/80 mg tab (Skudexa) q 8 PD x 5 days 3. Cytotec 800mcg Rectal
6. Tramadol 50 mg q 8 x 3 doses with BP precaution then PRN x severe pain 4. 10L O2 rebreather mask
7. Cefuroxime 750 mg IV q 8 5. Oxytocin 10 U, IM

Postoperative

• IV fluids. IVF administration is indicated for patients with CS procedure.

• Pain Management. Patients undergone vaginal delivery needed to be monitored
accordingly for any signs of postpartum hemorrhage or to pain, as early as the
anesthesia wear off.
• Administer pain reliever when needed.

Drugs needed to be administered:

1. Oxytocin 10 to 40 U in 1L crystalloid IV or 10 U IM
2. Methylergonovine 0.2 mg IM q 2-4 hours
3. Tranexamic acid 10mg/kg
4. PDF2-alpha (hemabate) 0.25 mg IM q 15-20 minutes, 8 doses maximum
5. Ketorolac 30 mg slow IV q 6 x 4 doses ANST (-) to start @ PACU, then shift to
Fremadala +
6. Carbetocin 100 mcg IV over 1 minute
7. Topical therapy: 5,000 U thrombin in 5 ml saline; soak gauze and pack in uterus.
 NURSING MANAGEMENT

IDEAL ACTUAL

Preoperative Postoperative
Independent: Independent:
• Monitor V/S  Monitor V/S every 2hrs especially the ff:
• Teach DOB to avoid some complications in the operation - Blood pressure
- respiratory frequency
Dependent: - heart rate and rhythm
• Advise the patient to do fasting 24 hours before the operation (if advised by the - pain intensity e.g. verbal rating scale
doctor) - I/O
• Administer Medications  Continuously evaluated bleeding status
 Evaluated electronic fetal and maternal monitoring tracings
Collaborative:  Evaluated signs of shock-rapid pulse, pallor, cold and moist skin, decrease in
• Monitor Blood test results especially the Blood type for Blood transfusion if blood pressure
needed in the operation  Inserted Indwelling Foley Catheter
• Administer Skin test
 Evaluated decrease of urine output
• Hemoglobin saturation and oxygen administration
 Inserted intravenous catheter into a large vein for fluid replacement.
Postoperative  Administered O2 to patient
Independent:  Regulated IV
• Monitor the level of consciousness  Administered Medications
• Monitor V/S especially the ff:  Check every 15 mins to note if the fundus is normal
- Blood pressure
- respiratory frequency Dependent:
- heart rate and rhythm  Administer drugs efficiently
- pain intensity e.g. verbal rating scale
- I/O Collaborative:
- Bowel sounds  Monitor CBC every 24hrs
Note:
This must be taken every half hour for two hours and hourly
thereafter provided that the observations are stable or satisfactory.
• Bedside Care to promote comfort and hygiene
Encourage Breast feeding
• Reposition the patient to a more patent airway
• Debriefing of the mother to reduce incidence of depression & anxiety.
• Health teaching about proper nutrition of a lactating mother
• After recovery from anesthesia
- observations (respiratory rate, heart rate, blood pressure, pain and
sedation) should be continued every half hour for 2 hours, and hourly
thereafter provided that the observations are stable or satisfactory. If these
observations are not stable, more frequent observations and medical review
are recommended.
• Change dressing promptly to avoid any means of possible infection
• Remove FBC after 24hrs to promote ambulation and reduce probability of
infection
• Perineal Care BID for hygiene and avoid infection
• Encourage Breast feeding
• Bedside Care to promote comfort and hygiene
• Regulate IVF to prevent tachycardia

Dependent:
• intravenous infusions
• An ECG, nerve stimulator, thermometer and capnograph should be readily
available as well as facilities for resuscitation and emergencies
• Observe drug administration properly

Collaborative:
• Get CBC as ordered by the physician.
 SURGICAL MANAGEMENT

IDEAL ACTUAL

Procedure given: Procedure given:

2nd degree laceration repaired with local 2nd degree laceration repaired with local

Postoperative Postoperative
• Assess for: • V/S every 15 mins. Until stable then hourly
- Poor Nutritional Status • Flat on bed for 8 hrs
- Age • IVF: PLR 1000cc with 30 units of pitocin @ 30 gtts/min
- Altered General Health • IVFTIF: D5LR 1000cc with 20 units of oxytocin @ 30 gtts/min
- Fluid and Electrolyte Imbalance • CBC w/ Urinalysis
- Fear • inserted Foley catheter
- V/S
- Urinalysis Medications:
- CBC 1. Ketorolac 30mg q 6 hrs, IVTT
- Serum electrolytes and pH 2. 30 units Pitocin 500LR bolus
- Blood typing and cross-matching 3. Cytotec 800mcg Rectal
• Health teaching on how the procedure goes 4. 10L O2 rebreather mask
• Obtain informed consent 5. Oxytocin 10 U, IM
• DOB exercise
• O2 support @ 3LPM via NC
• IVF PLR 1000cc @ 30 gtts/min

Intraoperative
• FBC attached
• Support the patient while anesthesiologist do administration of the anesthetic
drugs.
• Skin preparation to avoid any possible infection

Postoperative
• O2 support @ 3LPM via NC after fully awake
• V/S every 15 mins. Until stable then hourly
• Flat on bed for 8 hrs
• IVF: PLR 1000cc with 30 units of oxytocin @ 30 gtts/min
Medications:
1. Oxytocin 10 to 40 U in 1L crystalloid IV or 10 U IM
2. Methylergonovine 0.2 mg IM q 2-4 hours
3. Tranexamic acid 10mg/kg
4. PDF2-alpha (hemabate) 0.25 mg IM q 15-20 minutes, 8 doses maximum
5. Ketorolac 30 mg slow IV q 6 x 4 doses ANST (-) to start @ PACU, then shift to
Fremadala +
6. Carbetocin 100 mcg IV over 1 minute
7. Topical therapy: 5,000 U thrombin in 5 ml saline; soak gauze and pack in uterus.
• CBC w/ Urinalysis