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CEPHALIC PRETERM LIVEBIRTH BY PRIMARY LSTCS SECONDARY TO HELLP SYNDROME

PREECLAMPSIA WITH SEVERE FEATURES

December 14, 2018

Submitted by:

Hiramis, Jhonna Faith

Coniendo, Asterlyn
Lim, Alvan
Batobalonos, Catherine
Salise, Mary Symphony
Vasquez, Krizzandra
Regidor, Iris Dimple
Khryzzia Mae Diacoma
Flores, Jose Marie
Vendiola, Khoreine Leigh

Submitted to Ms. Ivy Villaceran R.N, M.A.N

 INTRODUCTION

HELLP Syndrome (Hemolysis, Elevated Liver enzyme, and Low Platelet count). Hemolysis: this is the
breakdown of red blood cells. These cells carry oxygen from the lungs to the body. Elevated Liver
enzyme: when levels are high, it could mean there’s a problem with the liver. Low Platelet count: platelet
helps the blood clot. HELLP Syndrome causes problems with the blood, liver, and blood pressure.
HELLP Syndrome and Preeclampsia. Preeclampsia is when a pregnant woman has high blood pressure
and damage to other organs such as liver and kidneys. It is usually starts after 20 weeks of pregnancy.
General signs of preeclampsia include rapid weight gain; swelling of arms/face, headache; vision
changes( blurred vision, seeing double, seeing spots), dizziness/faintness/ringing in
ears/confusion;seizures and abdominal pain, decreased production of urine; nausea, vomiting, blood in
vomit or urine. Preeclampsia can progress to HELLP Syndrome. HELLP Syndrome can cause major
complications these include seizures, stroke, liver rupture and placental abruption (separation of the
placental from the wall of the uterus before the baby is born) and can cause bleeding, affect the baby’s
growth, and lead to premature birth or stillbirth. HELLP Syndrome occurs in approximately 2 - 6 percent
of all pregnancies. In comparison, preeclampsia occurs in 5 – 7 percent of pregnancies. Superimposed
HELLP Syndrome develops in 4-12 percent of women with preeclampsia or eclampsia. The risk factors
for HELLP syndrome differ from those associated with preeclampsia. The syndrome generally presents in
the third trimester of pregnancy, although it occurs at least than 27 weeks of gestation in an estimated
11% of patients. The syndrome presents antepartum in 69% of patients and postpartum in 31% od
patients. With postpartum presentation the onset is typically within the first 48 hours after delivery;
however, signs and symptoms may not become apparent until as long as seven days after delivery.

Complications associated with HELLP syndrome include:

 liver rupture.
 kidney failure.
 acute respiratory failure.
 fluid in the lungs (pulmonary edema)
 excessive bleeding during delivery.
 placental abruption, which occurs when the placenta detaches from the uterus before the baby is born.
 stroke.
 death.
 Comparison of Risk Factors for HELLP Syndrome and Preeclampsia

HELLP SYNDROME PREECLAMPSIA

Multiparous Nulliparous

Maternal age greater than 25 years Maternal age less than 20 years or greater than 45
years
White race Family history of preeclampsia

History of poor pregnancy outcome Minimal prenatal care

Diabetes Mellitus

Chronic hypertension

Multiple gestation
General Information

Patient’s Profile

Name: Patient E.A.

Age: 25

Sex: Female

Civil Status: Single

Case No.: 2016204917

Address: Maribago, Lapu-Lapu City

Nationality: Filipino

Religion: Roman Catholic

Date and Time of Admission: 11-27-18 at

Ward & Bed No. :LRD07-D

Medical Diagnosis: G1 P1 delivered cephalic preterm livebirth by primary LSTCS secondary to HELLP
Syndrome preeclampsia with severe features

Chief Complaint: Nape pain

DEVELOPMENTAL TASK : (According to Erik Erikson)

Intimacy vs Isolation
(18-40 years old)

During this period, the major conflict centers on forming intimate, loving relationships with other people.
In this stage, we begin to share ourselves more intmately with others. We explore relationships leading
toward longer-term commitments with someone other than a family member. Success leads to strong
relationships, whilefailure results in loneliness and isolation. Adults who struggle with this stage
experience poor romantic relationships. They might never share deep intimacy with their partners or
might even struggle to develop anyrelationships at all. This can be particularly difficult as these
individuals watch friends and acquiantances fall in love, get married, and start families. Those who
struggle to form intimacy with others are often left feeling lonely and isolated. Some individuals may feel
particularly lonely if they struggle to form close frienships with others. Avoiding intimacy, fearing
commitment and relationsip can lead to isolation, loneliness and sometimes depression. Success in this
stage will lead to the virtue of love. Patient E.A. is a 25 years old, a housewife living with her partner, the
father of her baby they have been in a relationship for 12 years. Patient E.A’s pregnacy wasn’t planned
since both of them were not yet ready because her partner is the one who’s earning money for their daily
needs. They only support each other financially, emotionally and spiritually.
Gordon’s Functional Health Pattern:

Gordon’s Functional Health Before Hospitalization During Hospitalization

Pattern

1. Health Perception &
Maintenance
2. Nutrition & Metabolism
“ para nako healthy ko kay Pt. viewed being healthy is not only
mokaon kog mga utanon eating vegetables and fruits, and
ug prutas, nya kung naa realizes to seek help to healthcare
koy pamation sa akong providers
lawas ako rang paminawn
nya mawala raman sad” as
verbalized by the pt.
Pt. usually eats her meals 3x a day Pt. followed physician’s ordered fo
w/ snacks in between, likes to eat her intake
fruits & vegetables, and drinks at
least 8 cups of water a day, had no
allergies with food

3. Elimination Pt. voids at least 3x a day, Pt. has not been able to defecate,
regular urine color is light and
yellow , no burning urinates frequently
sensation felt during
urination, usually moves
her bowels every early
morning, and with brown
formed stools

4. Activity & Rest
5. Cognition & Perception
Patient ambulates w/in the house,
does household chores, and does
simple exercises
Pt. is a passive and easy
going person
Frequently talking with her partner
and taking a nap
Pt. became much
emotional and had frequent

6. Sleep & Rest
7. Sexuality & Reproduction
8. Self Perception & Self
Concept
9. Roles & Relationship
10. Stress Tolerance &
Coping
11. Values & Belief
Pt. sleep 8 hours at night, goes to
sleep early and does’nt use any
medication to sleep
Pt. menarche at age 13, had
sex at age 17, and had
sexual activity twice a
week
Pt. managed self by
practicing a healthy
lifestyle, was concerned to
her body image, was quite
anxious with the gained
weight
Pt. and her partner are
supporting each other
financially, emotionally,
spiritually, a bit scared of
being a mother
Pt. copes by eating her
favorite snack and copes
by opening up to her
partner
Pt. is a Roman Catholic
and isn’t that religious
mood swings
Pt. sleeps or takes naps and resting
periods as frequently as possible
Patient has not had sex with her
partner since 6th month of
pregnancy, and focusing to her
recovery
Although weak, still manages to be
calm and relaxed, hopeful and
positive, major concern is her
recovery
Pt. and her partner supports each
other financially, emotionally,
spiritually,and learning the role of a
mother and excited to see her baby
Takes naps and rests when
tired, verbalizes desire to
recover
Prays for her baby’s health and
condition
Physical Examination:

General Survey Observation

Received patient lying on the bed, awake ,
conscious and coherent, with uncombed hair. T- 36.7
Speech is adequate and converses are well oriented. P- 87 bpm
Pt. is responsive to questions both verbally and R- 19 cpm
physically, with the following vital signs: BP- 130/80 mmHg

Skin, Hair, Nails Fair skin, warm to touch. Hyperthropic scar

approximately 4.5 inches long secondary to
cesarean section noted on the lower abdomen.
Stretch marks noted, white in color and
approximately 3 to 4 inches long noted upon
inspection of the lower abdomen with black hair
uncombed but tied . Nails are trimmed.

Head, Neck & Cervical Lymph Nodes Head is hard and smooth , face is symmetric, no
abnormal movement noted, no swelling in the neck
area,centeredhead position, no enlargement nor
tenderness of lymph nodes.

Eye & Ear Eyes appeared swollen can move and follow w/o
corrective lenses
Ears are equal in size, no necessary discharge.

Thorax & Lungs Thorax and lungs are symmetrical, does not have
any difficulty in breathing.

Cardiovascular Heart sound is normal without murmurs

 Breast Both breasts are firm to touch, nipples and areolas
are dark and enlarged, no discharge

Abdomen Abdomen is globular upon inspection. Skin

integrity in the abdomen is intact with hyperthropic
scar approximately 4.5 inches long secondary to
cesarean section noted on the lower abdomen.
Stretch marks noted, white in color and
approximately 3 to 4 inches long noted upon
inspection of the lower abdomen. With abdominal
binder

Bdominal Genitourinary Reproductive Pt. is with FBC attached to urobag . No unusual

discharges
Musculoskeletal No fractured bones or history of it,patient can
properly move

Neurologic No problems detected during the screening. Is able

to read and write and determine objects
Diagnostic and Laboratory Results:

HEMATOLOGY SECTION

Test Date & Time Normal Patient’s Interpretation

Values result
CBC 11/28/18 @ 10:02
PM
WBC Count 4.4-11.0 22.24 H Indicates
bacterial/viral
infections,
inflammtatory
conditions,
polycythemia
vera, acute/chronic
lymphotic
leukemia,
acute/chronic
myelogenous
leukemia
RBC Count 4.5-5.1 4.00 L Indicates anemia,
acute or chronic
bleeding, RBC
destruction,
nutritional
deficency (iron,
vitamin b12 or
folate deficiency),
bone marrow
disorders or
damage, chronic
inflammatory
 disease, kidney
failure
Hemoglobin 123-153 115.00 L It indicates anemia

Hematocrit 35.9-44.6 Low hematocrit is

32.300 L anemia
MCV 80-96 82.40

MCHC 27.5-33.2 28.80

Ma+ 33.4-35.5 34.20

RDW-CV 11.50-14.50 13.50

Platelet Count 150-450 103.00 L Low platelet count
or termed
thrombocytopenia
(insufficient
platelets in the
blood, body can’t
form clots)
Differential Count Indicates an acute
infection,
55-65 78.90 %H especially a
Neutrophils bacterial infection.

Lymphocytes 25-35 14.30 %L Indicates infection

Monocytes 3-11 6.40 %

Eosinophils 2-4 0.20 %

Basophils 0-1 0.20 %

 Test Date & Time Normal Interpretation
Values Patient’s
result
Test Date & Time Normal Values Patient’s Interpretation
result
Creatinine 11/28/18 @ 10:02 PM 0.66-1.09 L 0.55 Indicates that
mg/dl muscles are less
strong or are
deteriorating

SRGPT/ALT 0-34 25.78

U/L

LDH 0-247.00 H Tissues are

291.69 damaged by injury
U/L or disease.
Conditions that can
cause increased
LDH in the blood
examples: liver
disease, anemia,
muscle trauma
Sodium 135.00-145.00 L 132.90 Hyponatremia
mmol/L abnormal amount of
sodium in the blood
Potassium 3.50-5.50 4.12
mmol/L

Chloride 98.00-108.00 103.40

mmol/L
Ionized Calcium 1.10-1.40 L 1.02 Indicates
mmol/L hypoparathyroidism,
inherited resistance
to parathyroid
hormone a
malabsorption of
calcium. A vitamin
D deficiency
 CHEMISTRY SECTION

URINALYSIS

Test Date & Time Normal Values Patient’s result

Color 11/28/18 @ 10:30 PM Straw
Transparency Yellow (light/pale to Slightly cloud
dark/deep amber)
Specific gravity Clear or cloudy 1.005
PH 4.5-8 6.5
Glucose 1.005-1.025 Negative
Protein <150 mg/d Negative
RBC <2 /hpf 5-10/hpf
WBC <2-5/ hpf 0-1 hpf/
Cast 0-5 hyaline casts
Crystals Occasionally Negative
Miscellaneous Structures
Squamous E. Cells None Rare/hpf
Bacteria None Rare/hpf
Mucus Threads None Rare/hpf
 ANATOMY AND PATOPHYSIOLOGY

Placenta: the placenta is an organ in the uterus that is formed and grows with the baby during pregnancy.
It is connected to the baby by the umbilical cord, thorough which important nutrients, blood and oxygen
are delivered. In the context of maternal and birth injuries, medical providers must be prepared to deal
with chorioamnionitis (infection), placentaprevia, placental abruption , and uteroplacental insufficiency.
Umbilical cord: the umbilical cord is a tube that connects the baby to the placenta. It provides nutrients,
blood and oxygen to the baby, and removes waste products and carbon dioxide. Medical providers must
be careful to diagnose whether the umbilical cord is wrapped around the baby’s neck during labor (called
a nuchal cord), or whether umbilical cord prolapse is limiting oxygen to the baby.
Fetus: technically, a fetus is the term used to describe a baby inside the womb from the ninth week to the
38th week (or delivery, whichever is earlier). A fetus is considered full-term at 37 weeks—before
that, prematurity can be a problem.

Uterus: the uterus is also known as the womb. It is where the fetus grows and develops. It is connected
to the fallopian tubes, which deliver a woman’s eggs. It is also connected to the cervix.
Amniotic sac: soon after conception, an amniotic sac (“bag of waters”) is created within the uterus. It
encloses the baby and is filled with amniotic fluid, which cushions the baby and regulates its
temperature. The sac will rupture on its own or through a doctor’s intervention as a precursor to
delivery. Doctors can remove a sample of amniotic fluid (called amniocentesis) to test for genetic
abnormalities, such as spina bifida and cystic fibrosis.
Cervix: the cervix is the lower portion of the uterus (it is Latin for “neck of the womb”). It leads up to
the opening of the vagina. During labor the cervix changes and becomes effaced, meaning that it spreads
and thins out in preparation for delivery.
PATHOPHYSIOLOGY

HELLP is a variant of preeclampsia. In preeclampsia, defective placental vascular remodeling during

weeks 16-22 of pregnancy with the second wave of trophoblastic invasion into the decidua results in
inadequate placental perfusion. The hypoxic placenta then releases various placental factors such as
soluble vascular endothelial growth factor receptor-1 (sVEGFR-1), which then binds vascular endothelial
growth factor (VEGF) and placental growth factor (PGF), causing endothelial cell and placental
dysfunction by preventing them from binding endothelial cell receptors. The result is hypertension,
proteinuria, and increased platelet activation and aggregation.

Furthermore, activation of the coagulation cascade causes consumption of platelets due to adhesion onto a
damaged and activated endothelium, in addition to microangiopathic hemolysis caused by shearing of
erythrocytes as they traverse through capillaries laden with platelet-fibrin deposits. Multiorgan
microvascular injury and hepatic necrosis causing liver dysfunction contribute to the development of
HELLP.

A study by Weiner et al reported that although severe preeclampsia and HELLP syndrome have similar
placental histopathologic findings, HELLP syndrome was associated with higher rates of placental
maternal vascular supply lesions and small-for-gestational-age.

Another hypothesis proposes acute maternal immune rejection due to immunocompetent maternal cells
coming into contact with a genetically distinct fetus, altering the maternal-fetal immune balance and
causing endothelial dysfunction, platelet activation and aggregation, and arterial hypertension.

Other theories include inborn errors of fatty acid oxidative metabolism secondary to long- and medium-
chain fatty acid mutations, which cause liver damage secondary to insufficient mitochondrial oxidation of
fatty acids required for ketogenesis.

Yet another theory suggests a placental-instigated acute inflammatory condition targeting the liver.

In addition, dysfunction in the complement system via excessive activation or defective regulation for a
given amount of endothelial injury has been proposed to cause damage to hepatic vessels in HELLP.

Reference: https://emedicine.medscape.com/article/1394126-overview#a4
 NURSING CARE PLAN 1

Nursing Diagnosis: Pain related to surgical incision secondary to cesarean section procedure

Defining Characteristics Scientific Basis Planning Nursing Evaluation

Interventions
and Rationale
SUBJECTIVE Complex SHORT TERM Independent: After nursing
“ Sakit akong tahi sa responses of tissue After 30 minutes- intervention, the goal has
akong samad ” as and nerve endings 1 hour of nursing >established been partially met,the
verbalized by the patient. due to trauma from intervention the rapport patient verbalized pain
surgery (incision) patient will be Rationale: to decreased from 8/10 to
and cause able to alleviate have a good 3/10 as evidenced by:
hypersensitivity to pain in the nurse-client
the central nervous abdominal site relationship less facial grimace, being
OBJECTIVE system that causes incision responsive ,frequent
 painscale of 8/10 unpleasant >assessed pain small talks with
 facial grimace physical and LONGTERM status significant others,
noted emotional improved comfortability,
 teary eyed reactions and After 2-3 hour of Rationale:
 guarding behavior responses nursing : to establish
 irritable interventions, the baseline data for
 pale palpebral patient will be comparison in
conjunctiva able to verbalize making
Source: medical decrease intensity evaluation and
 skin warm to
surgical 2004 of pain from to assess for
touch
edition 8/10-3/10 possible internal
 uncomfortable
bleeding
 pain upon
movements >instructed
 reluctant to patient to avoid
attempt strenous
movement activities
 limited range of
motion (ROM) Rationale:
 VS taken as Prevents undue
follows: strain on
operative site.
T- 36.7
>provided
P- 87 bpm comfort
R- 19 cpm measures
Rationale: This
BP- 130/80 mmHg is to let the
patient rest due
to invasive
procedure
performed from
delivery

>monitored vital
signs
Rationale: to
establish
baseline data

>encouraged to
rest

Rationale:
Prevents fatigue
and conserves
energy for
healing

>encouraged
diversional
activities by
talking with the
SO
Rationale:
relieves pain felt
by the patient

>encouraged use
of of relaxation
technique, deep
breathing
exercise
Rationale: for
pulmonary
ventilation,
especially when
exercising, and
to relieve stress
and promote
relaxation, to
promote
circulation,
prevent pressure
on the operative
site

>kept watched
for any
unsualities
Rationale: to
observe for any
changes

Collaborative:
>Administer
analgesics or
nonsteroidal anti-
inflammatory
drugs as
prescribed.

Rationale: To
relieve mild or
moderate pain.
 NCP 2

Nursing Diagnosis: Risk for infection related to inadequate primary defenses secondary to surgical
incision

Defining Scientific Basis Planning Nursing Evaluation

Characteristics Interventions and
Rationale
SUBJECTIVE Due to an elective SHORT TERM Independent: After nursing intervention,
-none cesarean section, After 30 minutes patient is expected to be
patient's skin and of nursing >inspect dressing free of infection, as
tissue were intervention, and perform evidenced by normal and
mechanically patient will be wound care stable vital signs and
OBJECTIVE interrupted. thus, able to understand Rationale: moist absence of purulent
 dry and intact the wound is at risk causative factors, drainage can be a drainage from wounds and
dressing of developing identify signs of source of incisions
infection infection and infection
 WBC is report them to
increased Source: health care >monitor
4.4-11.0, provider elevated
22.24 H Scribd temperature,
patient’s result redness,
 VS taken as LONGTERM swelling,
follows: increased pain or
After 1-2 hour of purulent drainage
T- 36.7 nursing at incisions
interventions, Rationale: these
P- 87 bpm patient will are signs of
R- 19 cpm partially achieve infection
wound healing,
BP- 130/80 mmHg and free from >encouraged use
infection of relaxation
technique, deep
breathing
exercise
Rationale: for
pulmonary
ventilation,
especially when
exercising, and
to relieve stress
and promote
relaxation, to
promote
circulation,
prevent pressure
on the operative
site

>kept watched
for any
unsualities
Rationale: to
observe for any
changes

Collaborative:
>Administer
antibiotics as
prescribed
Rationale:
Antibiotics have
bactericidal
effect that
combats
pathogens
 NCP 3

Nursing Diagnosis: impaired parenting related to premature birth

Defining Characteristics Scientific Basis Planning Nursing Evaluation

Interventions and
Rationale
SUBJECTIVE Inability of the SHORT TERM Independent: After nursing intervention,
"nahadlok ko para sa primary caretaker After 30 minutes patient verbalized
akong baby kay kulang to create, maintain, of nursing >Established a acceptance of the
sa bulan nako pag anak" or regain an intervention, therapeutic situation, identify own
as verbalized by the environment that patient will be relationship, strenghts, and methods as
patient promotes the able to foster conveying evidenced by being
optimum growth acquisition of empathy and hopeful, determined and
and developmental positive parenting unconditional motivated
OBJECTIVE of the child skills, Explain positive regard.
 teary eyed individual Rationale: To be
 seen afraid Source: 13th differences in aware of her own
 weakness noted Edition, Nurse's child feelings and
 seen depressed Pocket Guide temperaments, anxiety or
 hopelessness and compare and uneasiness,
noted contrast with promote
 VS taken reality of parents' positivity
expectations.
>acknowledged
P- 110 bpm anxiety or fear.
LONGTERM Do not deny or
reassure client
After 1-2 hours of that everything
nursing will be alright.
interventions, Rationale:
patient verbalized Acknowledging
acceptance of the anxiety is the
situation, identify first step to solve
own strengths and it
methods and to be
able to apply >Provided
effective comfort
parenting measures such as
methods back rub, talking
and listening to
the patient
Rationale: for
the patient to feel
comfortable and
at ease

>Allowed the
behavior to
belong to the
client; do not
respond
personally.
Rationale: Must
be patient-
centered

>Emphasized
positive aspects
of the situation
Rationale:
maintaining a
hopeful attitude
toward the
patient
capabilities and
potential for
improving the
situation
DRUG STUDY

Name Classificatio Mechani Indication Contraindicati Adverse Nursing

of Drug n sm of on Reaction Responsibili
Action ties
Generic Therapeutic Inhibits Serious lower Contrindicated CV:phlebitis, Before:
Name: class: cell-wall respiratory tract in patients thrombopheb Monitor
Cefuroxi Antibiotics Synthesis infection,UTI, hypersensetive itis patient for
me promotin skin or skin to drug or GI:diarrhea, sighs &
Axetil Pharmacolo g structure othere pseudomem symptoms of
gic class: osmotic infections, Cephalhalaspo branous superinfectio
Second– instabilty septicemia,minin rins colitis, n & diarrhea
generation usually gitis & gonorrhea nausea,
Brand Cephalospor bacterici Use cautiously anorexia,
Name: ins dal Perioperative in patients Vomiting During:
Ceftin prophylaxis hypersensitive Hematologic Drug may
to penicillin : increase INR
Bacteria because of Hemolytics & risk of
Patients Exacerbations of possibility of anemia, bleeding.
Dose: chronic cross sensitive thrombocy
500mg bronchitis or w/ other beta- topenia, After:
(bid) x secondary lactan transient Monitor
7days bacterial antibiotics neutropenia, patient don’t
infection of acute eosinopilia confuse drug
bronchitis According to Skin: w/ other
the COC,oral Maculopapul cephalospori
Acute bacteria sephalos- ar & ns
maxillary porins a rent erythema that sound
sinusitis recommended tous rashes, alike.
to treat urticaria
Pharynaitics & goroccoccal pain,
tonsilitis Infections. induration,
sterie
Otitis media According to abscesses,
clinical temperature
Uncomplicated practice elevation,
skin & skin guidelines, tissue
structure cefotaxime or sloughing at
infection ceftriaxone I.M.
should be used injection site.
Uncomplicated to treat Other:
UTI childhood Anaphylaxis,
bacterial hypersensitiv
Uncomplicated meningitis & ity reactions,
gonorrhea preumococcal serum
& sickness.
Early Lyme meningococcal
disease its caused by
penicillin
Impetigo resistail trains
&
haemgohilus
influeenzaes
type B
meningitis

Use cautiously
in patients w/
history of
colitis & in
those w/ renal
insufficiency.

Some
cephalosporins
have been
associated w/
seizures in
patients w/
renal
imperment
when dosage
wasn’t
reduced.
Name Classificati Mechanis Indicatio Contraindication Adverse Reaction Nursing
of on m n Responsibili
Drug of Action ties
Generi Therapeutic Provides >Preventi  Primary  headache Before:
c Class: elemental on and hemochro  dizziness -Monitor VS
Name: Iron iron, an treatment matosis  seizures of patient
Ferrous supplement essential and  Hemolyti  syncope -Check lab
Fumara s compone treatment c anemias  hypotensio results
te nt in the of iron and other n -Assess if
Pharmacolo formatio deficienc anemias  tachycardia patient is
Trade gic Class: n of y anemia not due to allergic to
 nausea
Name: Hematinics hemoglo > Used as iron medication
 constipatio
Femiro bin a deficiency -Prepare
n
n suppleme medication
nt during  diarrhea ahead of
Patient regnancy  dark stools time and
’s  epigastric prepare right
Dose: pain amount and
350 mg  GI dosage and
(OD) bleeding verification
 taste of correct
disorder patient
 vomiting
During:
-Make sure
that patient
is aware of
what the
medicine is
for
-Make sure
that patient
is able to
take the
medicine at
the right
time

After:
-Ensure to
tell patient
that stool
 bowel may
be darker
than normal

Name of Classificat Mechanism Indication Contraindic Adverse Nursing

Drug ion Of ation Reaction Responsibilitie
Action s

Generic Therapeut A centrally- Immediate- Hypersensiti -dizziness - Collect

Name: ic Class: acting Release vity to - headache baseline data-
Tramadol analgesic analgesic (IR): tramadol. In - CNS assess pain
not related Management acute stimulation before
Trade Pharmaco chemically of moderate intoxication - ataxia administration
Name: logic to opiates. to with - sedation/ - Determine
Ultram Class:synt Precise moderately alcohol, somnolence the
hetic mechanism severe pain hypnotics, - vertigo location,time
Patient’s derivative is not in adults. centrally - itching/ of onset and
dose: 50mg known. Investigation acting pruritus quality of pain
Two al: Premature analgesics, - constipation - Assess pain
complement ejaculation, opiates, or - nausea for
ary restless legs psychotropi psychological
mechanisms syndrome. c drugs. Use factors that
may be in clients can lower pain
applicable. Extended- with past or threshold such
It may bind Release present as anxiety,
to mu- (ER): addiction or depression,
opioid Moderate to opiate fear and anger
receptors moderately dependence - Assess
and inhibit severe or in those hepatic and
re-uptake of chronic pain with a prior renal function
norepinephr in adults who history of - Dose
ine and require allergy to intervals
serotonin. around-the- codeine or should be
The clock pain opiates. Use prolonged
analgesic therapy for for obstetric with hepatic
effect is an extended preoperative and renal
only period of medication dysfunction
partially time. or for - Take vitals
antagonized postdelivery - Listen to the
by the analgesia in patient, be
antagonist nursing aware of their
naloxone. mothers. claims
Causes Use in
significantl children less
y less than 16
respiratory years of age,
depression as safety
than and efficacy
morphine. have not
In contrast been
to determined.
morphine,
tramadol
does not
cause
release of
histamine.
Produces
dependence
of the mu-
opioid type
(ie, like
codeine);
however,
there is
little
evidence of
abuse.
Tolerance
occurs but
is relatively
mild; the
withdrawal
syndrome is
not as
severe as
with other
opiates.
Name Classificat Mechani Indication Contraindication Adverse Reaction Nursing
of ion sm Responsib
Drug of ilities
Action
Generic Therapeut Tranexa Treatment  Hypersensi  CNS: Before:
Name: ic Class: mic acid of tivity Dizziness
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that procedure
degrades During:
fibrin
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n and patient is
other aware of
plasma what the
proteins medicine
includin is for
g the -Make
procoagu sure that
lant patient is
factors V able to
and VII. take the
medicine
at the right
time

Check th
patency of
the IV and
IV line.

After:

-Ensure to
tell patient
that stool
bowel
may be
darker
than
normal

Advice
patient to
take
medicatio
n exactly
as
prescribed

Instruct
patient to
report
severe
allergic
reactions.
HEALTH TEACHING PLAN

Objectives Content Methodology Instructional Evaluation

Resources
Discuss proper After surgery, you One on one Conversational Patient will be
care of surgical will need to take discussion able to carry out
insicion care of the incision proper care of
as it heals. Doing surgical incision
so may limit
scarring, may help
you avoid pain or
discomfort, and
may help lower the
risk of problems
like infection.
Your doctor used
either stitches,
staples, tissue glue,
or tape strips to
close the incision.
And you will need
to keep the area
clean, change the
dressing according
to your doctor's
instructions, and
watch for signs of
infection.
Discuss the The colostrums of One on one Visual aids Patient will be
importance of the mother discussion able to
exclusive provides passive enumerate the
breastfeeding immunity to the advantage of
baby exclusive
breastfeeding
The milk of the
mother is easily
digestible for the
baby compared to
bottle and does not
cause constipation
Discuss the This gives comfort One on one Demonstration Patient will be
different to the mother and discussion able to utilize all
positions of the baby and help the position in
breastfeeding the process of breastfeeding to
breastfeeding give comfort to
easier and more her and the baby
successful
 Types of
breastfeeding
position:
-Modified cradle
Position
-Football hold
-Cradle position
-Side lying
Discuss the Burping eliminates One on one Conversational Raise patient’s
importance of gas from the baby’s discussion awareness on the
burping stomach. If baby is significance of
not burped, they burning the baby
tend to vomit. every after
Burping should be breastfeeding
done every after
feeding
Discuss the Proper position in One on one Demonstration Patient will be
different burping the baby discussion able to utilize
positions of helps the burping proper position
burping process easier and in burping the
successful. baby for the
baby’s comfort
How to let the baby after
burp: breastfeeding.
-Sit upright and
hold your baby
against your chest.
Your baby’s chin
should rest on your
shoulder as you
support the baby
with one hand
- Hold your baby
sitting up, in your
lap or across your
knee
- Lay your baby on
your lap on his on
her belly.
Discuss proper Patient must One on one Conversational Patient will be
diet monitor her diet discussion able to gain more
and must pay calories on daily
attention to her diet basis for the
by consuming nourishment of
more calories about the baby
500 per day. A
well-balanced meal
a day plus a
healthful snack
 should cover it.
Discharge Plan

Incision Care Instructed the patient to:

-Shower as needed. Pat incision dry.
- Watch incision for signs and infection, like more
redness or drainage
- Hold a pillow against the incision when she
laughs or coughs and when she gets up from a lying
or sitting position
- Reminded the patient that the incision takes 6
weeks to heal

Activity Advised patient to:

-Get lots of rest. Take naps in the afternoon.
- Plan her activities so that she doesn’t have to go
up or down stairs more than needed.
- Don’t lift anything heavier that the baby until the
healthcare provider tells her it’s OK.
- Allow others to do things for her. Don’t hesitate
to ask for help.

- Don’t have sexual intercourse until after she had a

checkup with healthcare provider and have
decided on a birth control method.

-Allow others to do things for her. Don't hesitate to

ask for help.

Treatments -Advised the SO to notify the nurse or physician on

Observation of Signs and Symptoms
arrangements for follow-up check ups.
- Encouraged to seek regular consultations for
monitoring on health conditions.
- Instructed the patient to practice proper hygiene.
Instructed the patient to call the health care
provider right away if any of these are present:
-Fever of 100.4°F (38°C) or higher
- Redness, pain, or drainage at your incision site
- Bleeding that requires a new sanitary pad every
hour
- Severe pain in the abdomen
- Pain or urgency with urination
- No bowel movement within 1 week after the birth
of your baby
 - Swollen, red, painful area in the leg
- Appearance of rash or hives
- Sore, red, painful area on the breasts that may
come with flu-like symptoms
- Feelings of anxiety, panic, and/or depression

Diet -Encourage patient to eat fruits and vegetable on a

daily basis to maintain a healthy lifestyle.
- Encouraged patient to drink 2000 to 3000 ml of
fluid daily to facilitate defecation.
- Encouraged patient to breastfeeding infant and eat
an extra 500 calories daily.
Spirituality Advised patient to always have faith in God to
strengthen and deepen spiritual relationship with
the latter.
Medication -Instructed patient not to administer medications
that are not prescribed by the physician.
- Instructed to continue administering the
prescribed home medications at the right time,
dosage, and route as ordered.
- Encouraged to administer medications religiously.
Environment -Instructed patient to have her house cleaned at
least three times a week to eliminate dust and the
spread of airborne disease.
- Instructed patient to wash hands before
breastfeeding and to clean nipples an areola, as
well.