MACANLALAY, RALPH ELVIN
BSN 4F-D
ASSESSMENT
SUBJECTIVE DATA:
“Nakahiga lang ako at
nagpapatulong nalang
sakanya para umupo at
humiga, kakatapos lang kasi
nila ilagay itong isang tubo”
as verbalized by the patient,
referring to the nephrostomy
tube
OBJECTIVE DATA:
>Slowed Movement
>Difficulty lying down and
siting up without assistance
>Nephrostomy tube on
patient’s Right Side attached
to urine bag with
sanguineous output
>Discomfort with movement
>Edema +1 on feet
DIAGNOSIS GOALS & OBJECTIES
Impaired Physical STO:
Mobility related to 1. The client will be able to
recent surgical evaluate level of pain &
intervention as discomfort verbally
evidenced by 2. The client uses safety
discomfort with measures to minimize
movement potential for injury
3. The client shows
willingness to
participate in the
treatment regimen
LTO:
1. The client displays an
increase in independent
physical mobility
2. The client is free of
complications from
immobility and displays
intact skin, absence of
thrombophlebitis and
edema on lower
extremities
INTERVENTIONS
Dx:
1. Check for functioning
level of mobility &
ability to perform ADLs
2. Assess the type of
assistance the client
requires
Tx:
1. Provide safe environment
and place important items
nearby
2. Perform limited ROM
exercises to client’s level
of comfort
3. Perform regular log-
rolling and skin care
measures
4. Administer pain
medications as needed
Edx:
1. Explain progressive
activity to client
2. Instruct caregiver on fall
prevention strategies and
importance of log rolling
3. Encourage to verbalize
feelings and concerns
RATIONALE EVALUATION
Dx: STO:
1. Guides the best form of management Goal Met
and act as a baseline to ensure treatment After 20 minutes of effective
regimen is within client’s level of nursing intervention, the
comfort & safety client has expressed level of
2. Allows the nurse to consider what the pain comfort, and
client will need and plan throughout the willingness to participate in
treatment regimen treatment regimen
Tx:
1. Minimize the risk of injury while still LTO:
allowing the client to take independent Goal Partially met
action After 8 hours of effective
2. Promotes circulation maintain muscle nursing intervention, the
flexibility throughout the treatment client has not shown
regimen complications from
3. Minimize risk of developing skin immobility but still requires
breakdown related to lack of mobility assistance mobilizing
4. Allow the client to exercise, sleep well,
and promote recovery in comfort
Edx:
1. Providing small attainable goals
increases client’s self-esteem and
confidence to reduce frustration
throughout the treatment regimen
2. Allow caregiver & S/o to participate in
treatment regimen
3. Allows the nurse to adjust the treatment
regimen and accommodates the client’s
needs and concerns
 MACANLALAY, RALPH ELVIN
BSN 4F-D
ASSESSMENT
OBJECTIVE DATA:
>Compromised host defense
related to Ovarian Cancer
and Chemotherapy
>Recent surgical intervention
>Chronic Condition; CKD
S/T Obstructive Nephropathy
DIAGNOSIS GOALS & OBJECTIES INTERVENTIONS RATIONALE EVALUATION
Risk for Infection STO: Dx: Dx: STO:
related to compromised 1. The client and s/o 1. Assess for presence of host 1. Allows prompt treatment and Goal Met
host defense and recent will display & specific factors that affect management for potential and/or existing After 30 minutes of effective
surgical intervention verbalize immunity such as risks for infection nursing intervention, the
understanding on medications, lifestyle, 2. Early detection of infection and prompt client verbalized
infection control treatments and modality, treatment reduces further complications understanding on infection
2. Early recognition of and exposure throughout the treatment regimen control and early signs and
infection (or signs 2. Observe for changes in skin Tx: symptoms of infection
and symptoms for color, integrity, mental 1. Hand hygiene and protective measures
prompt referral and status, secretions, and odor such as gloves to reduce direct patient LTO:
treatment) Tx: contact reduces risk for infection Goal met
LTO: 1. Practice proper hand 2. A clean and well-ventilated area reduces After 8 hours of effective
1. The client will hygiene and protective presence of variables that may be causes nursing intervention, the
remain free of measures when giving of infection patient has not shown any
infection (and treatment to client 3. As per physician order; for patients who signs and symptoms of
corresponding signs 2. Provide clean and well- are immune-compromised are to be infection.
& symptoms) ventilated environment to isolated from external sources of
2. Any signs & client infection for their own protection (this
symptoms of 3. Provide and enforce includes other patients and people)
infection will be isolation or reverse isolation Edx:
managed and treated measures as ordered by 1. Hand hygiene and protective measures
accordingly physician such as gloves to reduce direct patient
Edx: contact reduces risk for infection
1. Emphasize the importance 2. Allows client and s/o to participate in
of hand hygiene and treatment regimen and informs them on
infection control to S/O and subjective signs and symptoms that may
caregiver be missed by physician or nurse.
2. Educate on early signs and
symptoms of infection for
prompt assessment and
management
MACANLALAY, RALPH ELVIN
BSN 4F-D
Indication /
Drug Name Mechanism of Action Adverse Effects Nursing Responsibilities
Contraindication
Generic Name: Binds to opioid receptors and Indication: CNS: Dizziness, headache, somnolence, Dx:
Tramadol inhibits reuptake of Moderate to Moderately vertigo, seizures, anxiety, asthenia, CNS 1. Assess level of pain prior to preparation and
norepinephrine and serotonin Severe Chronic pain Stimulation, confusion, coordination administration
Drug Class: disturbance, euphoria, malaise, nervousness, 2. Monitor CV and Respiratory status, Bowel and
Analgesic Contraindication: Sleep disorder, paresthesia, tremor, agitation, Bladder functions, Other V/S and level of Pain
>hypersensitivity apathy 3. Monitor accordingly for risk of seizures
Controlled Substance >severe hepatic and/or renal CV: vasodilation, HTN, peripheral edema 4. Check for drug dependence regularly
Schedule: impairments EENT: visual disturbance, nasophryngitis, Tx:
IV > GI Obstruction pharyngitis, rhinitis, sinusitis 1. Don’t stop abruptly; withdrawal symptoms may occur
>Severe respiratory GI: constipation, nausea, vomiting, abdominal 2. Re-assess level of Pain after administration
Dosage: depression pain, anorexia, diarrhea, dry mouth, dyspepsia, 3. Give drug before onset of intense pain
50mg PRN for flatulence
Breakthrough Pain q12 GU: menopausal symptoms, proteinuria, Edx:
urinary frequency, urine retention, pelvic pain, 1. Caution patient on drug dependence
Route: UTI 2. Advise patient and caregiver on early pain
IV Metabolic: Weight Loss management
M/S: hypertonia, arthralgia, neck pain, myalgia 3. Counsel patient on drug interval and overdose
Respiratory: bronchitis, respiratory depression 4. Advise patient on hepatic, and renal effects on
Skin: diaphoresis, pruritus, rush dependence of drug.
MACANLALAY, RALPH ELVIN
BSN 4F-D
Indication /
Drug Name Mechanism of Action Adverse Effects Nursing Responsibilities
Contraindication

Generic Name: Potentiates effects of GABA, Indication: CNS: insomnia, irritability, dizziness, Dx:
Alprazolam and depress CNS Anxiety headache, anxiety, confusion, drowsiness, 1. Monitor for respiratory depression or sedation
light-headedness, sedation, somnolence, 2. Monitor renal/hepatic function regularly
Drug Class: Contraindication: difficulty speaking, impaired coordination, 3. Check for uses of other CNS and CV/CP Depressants
Anxiolytic >Hypersensitivity memory impairment, fatigue, depression, 4. Give smallest effective dose if possible
>Hepatic and Renal ataxia, paresthesia, dyskinesia, agitation, mania 5. Check for signs of drug dependence
Controlled Substance disorders CV: palpitations, chest pain, hypotension Tx:
Schedule: >History of substance abuse EENT: blurred vision, allergic rhinitis, nasal 1. Don’t stop abruptly; withdrawal symptoms may occur
IV >Elderly patients congestion 2. Be alert for panic disorders and depressive symptoms
GI: diarrhea, dry mouth, constipation, nausea, 3. Do not crush extended-release tablets
Dosage: vomiting, dyspepsia, abdominal pain 4. Place patient on Fall-precaution and safety throughout
250mcg PRN for GU: dysmenorrhea, sexual dysfunction, drug effectiveness
Insomnia premenstrual syndrome, difficulty urination
Metabolic: Changes in Weight Edx:
Route: M/S: Arthralgia, myalgia, arm/leg/back pain, 1. Caution patient on drug dependence
Oral Tablet muscle rigidity, cramps, muscle twitching 2. Advise patient and caregiver on proper relaxation
Respi: URI, dyspnea, hyperventilation techniques for early sleeplessness and anxiety
Skin: pruritus, increased sweating, dermatitis management
3. Counsel patient on drug interval and overdose
4. Advise patient on hepatic and renal effects on
dependence of drug.
5. Advise patient and caregiver on fall precautions
5. Tell patient to swallow extended release tablets whole
MACANLALAY, RALPH ELVIN
BSN 4F-D
Indication /
Drug Name Mechanism of Action Adverse Effects Nursing Responsibilities
Contraindication
Generic Name: Inhibits cell-wall synthesis Indication: CNS: altered mental status, anxiety, asthenia, Dx:
Ertapenem through penicillin-binding Post-surgical infection dizziness, fatigue, fever, headches, insomnia 1. Monitor renal, hepatic, and hematopoietic function in
proteins CV: Chest pain, edema, HTN, hypotension, prolonged therapy
Drug Class: Contraindication: phlebitis, swelling, tachycardia, 2. Watch out for anaphylactic reactions
Antibiotic >hypersensitivity thrombophlebitis 3. Check for diarrhea during therapy and notify to r/o
>severe hepatic and/or renal EENT: pharyngitis CDAD
Dosage: impairments GI: diarrhea, abdominal pain, acid reflux Tx:
500mg q24 > CNS Disorders regurgitation, constipation, dyspepsia, nausea, 1. Obtain specimen for C&S testing prior to therapy
>Elderly patients oral candidiasis, vomiting 2. Check for hypersensitivity prior to drug
Route: >May causes CDAD GU: renal dysfunction, vaginitis administration
IV Hematologic: leukopenia, neutropenia, 3. Infuse over 30 minutes
thrombocytopenia, anemia, coagulation 4. Do not mix with dextrose and other IV Drugs
abnormalities, eosinophilia, thrombocytosis
Hepatic: jaundice Edx:
Metabolic: hyperkalemia, hypokalemia, 1. Advise patient and caregiver to report all adverse
hyperglycemia reactions
M/S: leg pain 2. Tell patient to alert for pain or discomfort on injection
Respiratory: cough, dyspnea, rales, site
respiratory distress, rhonchi 3. Tell patient to report diarrhea ASAP
Skin: erythema, extravasation, infusion site 4. Advise patient on hepatic, and renal effects on
pain, pruritus, rash dependence of drug.
MACANLALAY, RALPH ELVIN
BSN 4F-D
Indication /
Drug Name Mechanism of Action Adverse Effects Nursing Responsibilities
Contraindication
Generic Name: Inhibits cell wall synthesis, Indication: CV: phlebitis, thrombophlebitis Dx:
Cefuroxime promoting osmotic Perioperative Prophylaxis GI: pseudomembranous colitis, nausea, 1. Monitor for S/Sx of Superinfection, and diarrhea
instability, usually vomiting 2. Monitor for signs of bleeding
Drug Class: bactericidal Contraindication: Hematologic: hemolytic anemia, Tx:
Antibiotc >hypersensitivity thrombocytopenia, transient neutropenia, 1. May increase alkaline phosphatase, ALT, AST,
>severe hepatic and/or renal eosinophilia bilirubin, and LDH on lab results. Check accordingly
Dosage: impairments Skin: maculopapular and erythematous rashes, 2. Obtain specimen for C&S testing before giving first
500mg BID x 10 days > History of Colitis urticaria, pain, induration, sterile abscesses, dose
temperature elevation 3. Give tablets without regard for meals
Route: Other: anaphylaxis, hypersensitivity, serum 4. Don’t crush tablets
Oral sickness
Edx:
1. Instruct patient to notify prescriber about rash, loose
stool, diarrhea, or evidence of superinfection
MACANLALAY, RALPH ELVIN
BSN 4F-D
Indication /
Drug Name Mechanism of Action Adverse Effects Nursing Responsibilites
Contraindication
Generic Name: Inhibits proton pump activity Indication: CNS: asthenia, dizziness, headache Dx:
Omeprazole by binding to hydrogen- Dyspepsia and/or short term GI: abdominal pain, constipation, diarrhea, 1. Periodically assess for osteoporosis
potassium adenosine treatment of gastric ulcers flatulence, nausea, vomiting, acid regurgitation 2. Monitor for S/Sx of interstitial nephritis
Drug Class: triphosphates, located at M/S: back pain, weakness 3. Gastrin level rises on first 2 weeks of therapy
Anti-ulcer drug secretory surface of gastric Contraindication: Respiratory: Cough, URI Tx:
PPI parietal cell, to suppress >hypersensitivity Skin: Rash 1. d/c drug on onset of s/sx of cutaneous lupus
gastric acid secretion. >hypokalemia, respiratory erythematosus, or SLE development
Dosage: alkalosis, low sodium diet 2. Drug may increase bioavailability on repeated doses
40mg >Long term administration
Edx:
Route: 1. Instruct patient that drug has to be taken 30-60
IV minutes prior to meals
2. Caution on hazardous activities when dizziness occurs
3. Advise patients on how to recognize S/Sx of low
magnesium levels
Name: Macanlalay, Ralph Elvin R. Date: 9/5/2023
Group: BSN 4F-D Instructor: Sir Jake O. Balacwid
I. Title: Effects of Relaxation-Focused Nursing Program in Women with Ovarian Cancer: A Randomized
Controlled Trial
Authors: Buse Güler, Ph.D. , Samiye Mete, Ph.D.
Source: El Sevier; Science Direct; Pain Management Nursing Volume 24, Issue 4, Pages e35-e-45
DOI: https://doi.org/10.1016/j.pmn.2023.03.006
Year of Publication: 2023
II. Summary:

Ovarian cancer is the third most common cancer among women globally and is the second most common
gynecological cancer in Turkey. Women experience many psychological and physical symptoms during the ovarian
cancer diagnosis period. The effects of mass pressure and cancer on systems are the basis of physical symptoms.
Physical symptoms are pain, fatigue, dyspnea, nutritional disorders, and decreased immune response Surgical
treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and
changes in respiratory functions, and psychological problems, such as anxiety and stress, may develop.

This study aims to investigate the effects of the Relaxation-Focused Nursing Program on pain, anxiety, lung
volume, level of knowledge, and nursing care satisfaction in ovarian cancer surgery. A randomized controlled trial in
which participants were randomly assigned to either the experimental (preoperative relaxation exercises and
education; n = 24) or control (usual nursing care; n =22) groups. The intervention consisted of practicing four sessions
of relaxation exercises and education in the hospital for two days before surgery. Data were collected using the Trait
and State Anxiety Inventory, Surgical Information Form, and Perioperative Assessment Form. The results were
analyzed using the Friedman and Wilcoxon tests. The findings showed significant reductions in pain (p = .045) and
anxiety scores (p < .001). The level of knowledge means scores were higher in the experimental group, but there was
no significant difference between mean scores of spirometer volume and care satisfaction.

The program was more effective than usual nursing care in preoperative anxiety, pain, and level of knowledge.
Although there was no difference between the care satisfaction scores of the patients, the reasons for care satisfaction
were different in the program. Developing and implementing care that combines stress reduction interventions
and preoperative education can improve the preoperative outcomes of patients.

III. Nursing Implications:

A. To Nursing Practice

The program is easy to learn and implement, as it is a well-standardized program. The problem-focused part
of this program can be easily practiced by all nurses. However, deep relaxation, which makes up the emotion-
focused part, can be practiced by nurses whose departments have received special education. The relaxation
exercise in the program is time-consuming and requires additional specialized education. Nurses who spend the
most time with patients and regularly assess patient health should participate in certification courses on
nonpharmacological techniques for pain and anxiety management.

B. To Nursing Education

Although studies involving preoperative psychoeducational interventions in patients with ovarian cancer are
limited, psychological support is included as a part of multimodal interventions in preoperative rehabilitation
programs in patients with gynecological cancer. In studies conducted with patients with gynecological cancer, it
has been shown that psychoeducational interventions, such as symptom management, patient education,
emotional support, and providing social support, reduce the uncertainty and depressive symptoms of patients and
improve their mental perspectives

C. To Nursing Research
This program will help nurses evaluate patients holistically and enable them to determine their priorities.
Thus, it will facilitate the provision of patient-focused care. The program will be a guide in eliminating the
patients’ anxiety caused by the lack of knowledge and provide appropriate psychological support. This study
aimed to investigate the effects of RFNP when practiced in the preoperative period on pain, state anxiety, lung
volume, the level of knowledge, and nursing care satisfaction in women with ovarian cancer.

IV. Personal Insights

I personally found this study to be intriguing in the sense of non-pharmacologic interventions done in a diagnosis
which at first glance may need to prioritize pharmacologic intervention, but then again, this study has indeed
Name: Macanlalay, Ralph Elvin R. Date: 9/5/2023
Group: BSN 4F-D Instructor: Sir Jake O. Balacwid
emphasized further the need for psycho-emotional support towards the patient not just from close relatives and
significant others, but also from the health care team to treat non-physiological symptoms that stem from physiologic
problems.