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INTRODUCTION Condyloma acuminata refer to all epidermal manifestation attributed to
epidermotropic vulvar papilloma virus. Condyloma acuminata are also referred to as venereal warts, genital warts and papilloma acuminatum. Approximately 90% of the cases of condyloma acuminata are related to HPV 6 and 11. These 2 types are benign and/or the least likely to have neoplastic potential. Certain types such as HPV 33, 35, 39, 40, 43, 45, 51-56, 58, have moderate potential for neoplastic conversion, and some have high potential for dysplasia such as HPV type 16 and 18. Condyloma acuminata is a sexually transmitted disease. It is manifested by the presence of warts in the vulvar, genital, and anal area. If left untreated in pregnant women, it could cause complication to the baby because the warts could be propagated to the airway passages of the child. Even if the disease is treated initially, it has a high chance of recurrence. In the hospitals we were affiliated, condyloma acuminata cases are very limited. In the first week of our exposure in Jose B Lingad Memorial Regional Hospital (JBLMRH), we were given a chance to handle a case of condyloma acuminata. We chose the disease for our study for several reasons. First, cases of this kind of venereal disease are very rare. Although we had encountered other types of sexually transmitted disease such as syphilis and gonorrhea in our previous exposure, we never encountered such derange this kind of manifestations. Second, because of the limited cases, we do not have much knowledge about the disease, and the curiosity that we had motivated us to conduct a case study regarding the ailment. Lastly, we chose condyloma acuminata because of the increasing number of cases of sexually transmitted diseases. In the United States of America, annual cases of condyloma acuminata is 1%. Prevalence had reported to exceed 50%. Health experts estimate there are more cases of genital HPV infection than any other STI in the United States. According to the American Social Health Association, approximately 5.5 million new cases of sexually transmitted HPV infections are reported every year. At least 20 million people in this country are already infected.
In this study, we are to deal with the pathophysiology of condyloma acuminata, the interpretation of abnormal results based on the diagnostic and laboratory procedures done to the patient. We will also deal with the appropriate interventions, nursing diagnosis for clients with the said disease condition, the suggested medical and surgical management including the diet, exercise, and medication we are to administer when caring for the patient. This case study warrants to widen our knowledge of the occurrence of the specific disease. It will also assist us in developing our clinical and academic competence by giving us a new array of knowledge about nursing interventions, and responsibilities appropriate for clients having, not only condyloma acuminata, but other STD’s as well. The study will also enable us to enhance our resourcefulness as nurses, and our critical thinking considering the limited client information that are available and presented. It will also help us develop our leadership skills and the flexibility that we have if we are presented with different unexpected situations by widening our knowledge and developing our nursing judgment. Most importantly, this study will enable us to show and evaluate the effectiveness and productiveness that we have as student nurses in applying preventive, curative, and rehabilitative measures for the patient with this disease.
NURSING ASSESSMENT 1. Personal Data a. Demographic Data Ms JS is a 29 year old female Filipino patient. She was born on December 28, 1976 in their home at Paligui Apalit, Pampanga. Her parents are Mr. Leonardo Santos and Mrs. Melisa Santos. She is the 5th child in the family of 12 children. Years back, she was living together with Mr. Alfred Ocampo. They were able to raise a family of 6 children even though they are unmarried. Their eldest child is 12 years old and youngest are the twins wherein one of the twins died on the date of July 18, 2006. Due to an undelivered baby boy in transverse lie (one of the twins) she was brought/ rushed to Jose B Lingad Memorial Regional Hospital (JBLMRH) on the same date (July 18, 2006) with a hospital number of 149044.. b. Socio-economic and cultural factors A year ago, Ms JS is employed in a school canteen earning about P120 per day. Her partner is a jeepney driver and is earning P300/day. In one month, they earn estimately P12, 600. Their monthly earnings is not being consumed only for food and daily needs. A portion of the income is meant for their monthly bills (electricity and water) and a portion for other necessities such as replacement for damage parts of their jeepney and mostly payment for their rented apartment in Apalit Pampanga. When it comes to dietary habits, the patient is fond of eating salty foods. They occasionally eat meat and preserved foods, in most cases of family financial crisis they simply eat rice with soysouce and salt. She is also fond of drinking coffee at least 3 cups per day and is able to consume the required 8-10 glasses of water/day.She also smokes at least1pack a day. Ms JS also believe in some superstitions and sayings, she does not take a bath or shower during her menstrual period believing that doing so could lead to insanity. After performing sexual intercourse, she does not take
She also experience premenstrual dysmenorrhea and has heavy menstrual flow on the fist 2 days of onset. When she was still living together with partner. She has TPAL record of 6. She gave birth to her first baby at the age of 17. The first twin pregnancy is the fifth pregnancy. She started to engaged in sexual activity at the age of 16 y/o. Alfred Ocampo. Environmental factors The patient was raised in Paligui Apalit. Two of which are twin pregnancies. All the births she had was performed at home by a “hilot”. 1. c. Unfortunately. Upon living together with Mr.Maternal-obstetric record Ms JS has an obstetric record of gravida 7. Form then on. b. The said place nearly situated beside a creek (“sapa”). the second baby did not survive and was diagnosed to be an intrauterine fetal death (IUFD). Pampanga. she had regular menstrual period every month and each period and lasted for 5-7 days. Antepartal/ Prenatal preparation . She was unable to deliver the second of the twins due to a transverse lie. a. partum 6. they decided to live together not bounded by marriage/matrimony. 6. both of the babies died due to premature delivery. They were born via vaginal birth but survived only for a short period of time. 0. they rented an apartment in the same area in Apalit. Pampanga.a bath either because of her misconception that it could result to what is known as “pasma” and lastly. Her latest twin pregnancy was in full term. Her children were born via NSD except for the latest twin pregnancy. From then on. Ms JS does not take oral contraceptives. 2. neither her partner practice the use of condoms. they perform sexual intercourse twice weekly. she believe in “hilot”. Maternal-Child Health History She had her menarche at the age of 12 years old and lasted for a week. One of the twins was delivered at home with the midwife’s assistance.
restricting normal bowel movement. Straining to defecate or constipation is also experienced by Ms JS on the third month. On the second trimester of her pregnancy. She accepted and followed the said advice and constipation was gradually relieved. She also experience early fatigability and headache which is a result of hindered maternal blood flow caused by the fetal growth and development. c. .Significant Trimester changes (1st to 3rd trimester) On the first trimester of the latest pregnancy (twin pregnancy). especially at the second trimester. Third trimester pregnancy discomforts the patient experienced shortness of breath and manage it by rest and proper ventilation. She was advised to drink an ample amount of liquid (8-10 glasses of water) and high fiber food such as papaya in order to relieve the discomfort. She received 3 doses tetanus toxoid vaccine in the barangay health center. She also felt/experienced early fatigability and manage it through rest. There were circumstances. She neither did nor performed any home remedy/management in order to relive the discomfort. She is knowledgeable that nausea and vomiting is a natural discomfort of pregnancy.The patient had her monthly check-up for the latest twin pregnancy in a barangay health center with the attending registered midwife. This was a result of the compression of the large intestine. wherein she was unable to completely comply with her prenatal monthly check-ups. experienced episodes of nausea and vomiting. she had complained of frequent episodes of backache which was caused by the weight of the developing babies. These second trimester discomforts were managed by the patient through bed rest.
& HPN Leonardo Santos Melisa Lopez HPN Lolita Santos Vilma Santos HPN Tony Santos (+) TB.premature Judith Santos (09-04-05) Baby Boy Santos Baby Boy Santos (07-18-06) Deceased . Family Health Illness History Lolo Santos Died of natural cause Lola Santos Binangungot Lolo Lopez Asthma. Smoker Lola Lopez Stroke. paralysis. UTI Alfred Ocampo Daisy Santos (08-29-93) Mark Santos (05-14-95) Rodel Santos (10-24-99) Ronald Santos (08-12-00) Joshua Santos Jaira Santos (12-30-04) Deceased. Smoker Bernadette Yang Luisa Santos Bernardo Santos Leonardo Santos (+) DM Aileen Santos Maricel Santos Eunice Santos Michael Santos Janet Santos HPN.3. condyloma acumintata.
History of Present Illness During the nurse patient interaction. She also mentioned experiencing pain in the urinary meatus during urination but she was unaware of having genital warts until she was brought to JBLMRH.4. History of Past Illness Ms JS is unknowledgeable of the vaccination that she had during her childhood.0oC Skin (+) pallor (-) rashes (-) cyanosis (-) jaundice Head (EENT) anicteric sclera palpebral conjunctiva pale . the patient stated that she had relationship problem with her partner. She had a history of urinary tract infection at the year 2004 and was prescribed to take antibiotics (ofloxacin).36. Aside from the major illnesses she experienced.180/100 mmhg PR-92bpm RR-24bpm Temperature. and fever. The patient also self medicate upon experiencing simple health discomforts like such and never seek medical attention. This is the reason of their separation. 5. She acquired german measles at the age of 14. 6. Physical Examination (IPPA-Cephalocaudal Approach) Physical assessment done by the doctor Vital signs BP. she usually have cough and colds. She accuses her partner of infidelity months before they separated. She had a history of having chicken pox at the age of 8. and there was even one circumstance of having her problem caught/seen with another woman. This is a significant information because her disease condyloma acuminata is caused by the Human Papilloma Virus which is a sexually transmitted disease.
(-) lumps or masses .(-) tenderness .4 oC Medium brown in color with poor skin turgor (+) pallor (+) dryness (-) edema • HEAD .(-) pain when palpated .lymphnodes Chest Lungs Cardio Breast Abdomen Rectum Genitals - lymphadenopathies symmetrical chest expansion (-) retractions slow breath sounds (-) murmur (+) engorgement NABS Soft non-tender (-) hemorrhoids Cervix open and fully Physical Assessment done by the student nurse (07-21-06) • SKIN - Temperature 36.skull symmetrical in shape .
rib cage moves symmetrically with respiration . BP= 120/80 mmHg Peripheral pulses (radial and brachial) easily palpated • - - .(-) retractions (-) adventitious breath sounds upon auscultation (-) colds • CARDIAC PR= 73 beats/ min.relaxed breathing.Chest .With adequate responses to normal sounds .(-) discharge MOUTH AND THROAT Teeth.(-) external lesions • NOSE AND SINUSES .Presence of dry wax buildup .Regular breathing with mouth closed .equal expansion noted .not inflamed (-) dysphagia NECK nontender lymph nodes Can turn the head from side to side without difficulty (-) stiffness (-) pain (-)lumps RESPIRATORY RR= 23 breaths/ minute .Can breath using both nostrils .with dental caries on almost all teeth .with plaque deposition Oral mucosa dry and yellowish in color Tonsils.• EYES - Eyelids are equal in movement Anicteric sclera Palpebral conjunctiva pink in color (+) PERRLA (-) external lesion Able to move up and down and right to left • EARS .(-) pain upon palpation of sinuses .
no bowel movement occurs .- (-) chest pain (-) murmur • GATROINTESTINAL .(-) urinary retention .(+) pruritus • • - GENITALS (+) warts (looks like a cauliflower) spread around the vulvar area Reddish or almost dark in color (+) foul odor (+) lochia serosa MUSCULOSKELETAL (-) pain (-) cramps Slow in movement • NEUROLOGIC Alert. mood appropriate to situation Responds to verbal command Speaks clearly HEMATOLOGIC Hgt and Hct low (hgt= 77.33) With lochia serosa ENDOCRINE (-) history of diabetes (-) thyroid problem (-) excessive sweating and thirst PSYCHIATRIC (-) history of psychiatric disorder . hct=0.(-) dysuria .(-) diarrhea .(-) food intolerance URINARY urinates 2x during the shift .
The patient’s intake of medications such as antibiotics (Cefuroxime) also precipitated to reduce levels of hemoglobin. Results 77g/L Normal Values Female: 115-155 g/L Analysis and Interpretation The hemoglobin content of the blood of the patient is below the normal range. Diagnostic and Laboratory Procedures Hematologic Examinations. Another reason of the deviation from the normal values is the post partum condition of patient.test/procedures done to patients to determine the ranges/count of blood components. there was a higher/increase demand of nutrients because of the growing baby in her womb. and therapy response. 2006 Indication/Purpose Used to determine Hgb content of blood. >evaluates blood loss. anemia. Hemoglobin is the iron containing and the oxygen carrying pigment/CO2 carrying pigment of the blood/RBC formed in the bone marrow. This is indicative of anemia which is a result of the patient’s blood loss during the surgical procedure she underwent (CSIII & BTL).7. the maternal absorption of Fe was compromised by fetal development causing inadequacy resulting to anemia. Due to the inadequate intake of nutrients including Fe. Diagnostic Procedure Hemoglobin Count Date Ordered July 18. . During her latest/last pregnancy. erythropoietin activity/ability.
anemia.23/23% Normal Values Female: (48%) Analysis and Interpretation . Results 0. inadequate Fe intake medications specifically antibiotics 0. food replacement therapy. and fluid balance. and screens RBC status. It measure the concentration of RBC within the blood volume and is expressed in percentage. Decrease Fe absorption related to increase demands secondary to pregnancy (altered maternal absorption) 3.38 (38%) to 0.0[NV: 5-10 x 10 3/L]) .Diagnostic Procedure Hematocrit Count Date Ordered July 18. 2. 2006 Indication/Purpose Hematocrit count evaluates blood loss.48 hemoglobin count. the patients significant increase in WBC levels (findings of WBC: 23. The decrease in hematocrit is also caused by the same factors namely: 1. blood loss related to intra-operative period.Blood hematocrit content is directly proportional to the hemoglobin count is directly related of the increase in the hematocrit counts. 4. The decrease in the patients 5.
syphilis. STD’s such as gonorrhea. These reflect the integrity of the client’s immune system. . The increase in neutrophil count is Used to evaluate/detect the 0.45-0. Diagnostic Procedure WBC count Date Ordered July 18. Diagnostic Procedure Neutrophil Count Date Ordered July 18.65 Analysis and Interpretation The increase in the neutrophil count is caused by the inflammatory response of the body of the patient due to infection.White Blood Cell with differential count Indication This evaluates the number of conditions and differentiation causes of alterations in the total WBC count including inflammation. > also caused by the inflammation reaction of the patient’s body as a cardinal sign of infection.00x103/L Normal Values 5-10. It is also caused by the presence of syphilis (HPV) as manifested by genital warts (condyloma acuminata) > also. 2006 Indication/Purpose This is used to determine/detect the presence of infection or inflammation and to monitor the patient’s response to antibiotic/anti-microbial therapy. 2006 Indication/Purpose Results Normal Values 0.000/cumm Analysis and Interpretation The increased in the patient’s WBC count (leukocytosis) is caused by an skin integrity as evidenced by lower abdominal midline incision (Due to CS & BTL procedure) and excision sites in the vaginal area. The differential white cell count identifies the 5 specific types of WBC present in blood. infection. and other inflammatory condition. Results 23.87 presence of bacterial infection. neutrophil count is directly proportional/related to the WBC count. and tissue necrosis.
tissue trauma as evidenced by surgical incision and excision site 2. poor response of the patient’s body to anti-microbial/ antibiotic therapy (cefuroxime). 2006 This test was indicated for the patient in order to determine if the patient. altered maternal nutrient absorption secondary to recent pregnancy/ postpartal status. of Measures the number thrombocytes per cubic milliliter in order to determine if the patient have abnormal blood clotting capabilities and to obtain data if patient is at risk for bleeding tendencies specially in her post operative condition/state. provides a gross Diagnostic Procedure Platelet Count July 18. 2006 July 23. Lymphocytes count is an indicator of immune function. 0. Diagnostic Procedure Venereal Disease Research Laboratory (VDRL) Date Ordered Date Results In July 21.also caused by the following factors: 1.20-0.13 0. inadequate intake ofInterpretation Analysis and foods rich in vitamins minerals. Lymphocyte July 18. aside from the HPV infection. 2006 A test used to determine lymphocyte count. Non reactive Non reactive/ negative > Normal Indication/Purpose Results Normal Values Analysis and Interpretation 359 x 109 /L 150-400x109 /L Results Normal Values 2. This is obtained by venous blood sample. has syphilis. & calories > Normal . with blood as a specimen. 2006 Date Ordered measures of nutritional Indication/Purpose status.35 The patients decrease in lymphocyte count is indicative of/caused by immunodeficiency secondary to inadequate nutrition caused by the following factors: 1.
Tourniquet the distal site.Nursing Responsibilities: Pre-Procedure: Explain the procedure to the client.Apply firm gentle pressure on the extraction site to avoid bleeding/hematoma. During: Post: . Gently extract/collect blood specimen using a collecting media (syringe). Place the patient in a comfortable position. Properly clean the skin of the selected puncture site with alcohol. Remove the tourniquet before withdrawing the needle. .
regent strip are various methods used Results Normal Values Analysis and Interpretation The patient’s urinalysis indicated both normal and abnormal results in different aspects. It is economical and results are obtained immediately.002. sugar: > The patient has positive sugar in the urine because Color: yellow Color: clear to Sugar: positive slightly hazy.is one of the oldest and most common laboratory test. (_booktitle _) > The client’s intake of multivitamins also may produce a false positive because of the ascorbic acid content of the multivitamins. The following are the abnormal results in the Transparency: clear examination. Visual examination.5-8 lactation may occur a false positive due to the lactose or Specific: 1. The procedure is non-invasive with urine as specimen.Urinalysis . could be present in post partal women and in Analysis WBC-none-4 Epithelial cell: none RBC: none Epithelial cell: 1. (-) albumin trace significance.035 . The patient had normal values in the following: (1) color of urine.020 Protein: (-) testing. (2) urine pH. yellow to deep amber may manifest symptoms in clear Sugar: negative results.galactose. On the other hand. As a supporting detail. & (3) specific gravity. researcher show a temporary glycosuria that appears to be no clinical intrapartal women. Urine pH: 4. and refractometry trace 01-21-06 in performing complete urinalysis. considerable deviation were evident in the urinalysis urine test together with their analysis: 1. Protein: ++ Transparency: Urine pH: 6 (+) albumin Analysis WBC-1-2 none RBC: over 10 amber yellow. microscopic Specific: 1. Diagnostic Procedure Urinalysis Date Ordered 01-08-06 Indication/Purpose Urinalysis screens for abnormalities with the urinary system as well as systemic problems that the urine.
RBC: Urine Hemoglobin > The presence of urine hemoglobin in the patient is caused by the urinary tracts ulceration particularly in the urinary meatus which were caused by genital warts.0 [5-10x109/L 2. Color: Appearance: Albumin: Reaction: transparency/ appearance > The turbid/slightly turbid appearance is caused by the disease condition of the patient which lead to vaginal contamination.2. Trauma 3. Acute infection (blood result of 23. Urine Albumin (Albuminuria) > The presence of urine albumin (albuminuria) in the patient’s urine is caused by several factors. Vaginal contamination is a common cause of turbid or cloudiness. Mixture of pus and urine Hgb/RBC due to vaginal infection/UTI brought about by the genital warts . Dehydration 5. Hypertension (180/100 mmHg) 4. 3. 1. 4. Enumerated below are the factors contributing to patient’s albuminuria.
Aside from the initial diagnostic tests that were performed to the patient. explain procedure. 2. Aspirate urine from the catheter itself using a sterile syringe slanting the needle towards the drainage tubing. follow-up blood examinations and urinalysis were ordered by the patient’s attending physicians in the date of July 19. The patient also refused to undergo HBs Ag reaction test screening and Chest Xray and also signed the HAMA form for her refusal. . the patient did not comply with the follow-up laboratory and diagnostic procedures and was made to sign a Home Against Medical Advise (HAMA) on the same date. Immediately send the specimen collected to the laboratory.Nursing Responsibilities Mode of collection used in the patient: collection from an indwelling catheter Before 1. if sedated. But due to the patient’s lack of financial capabilities and deficient knowledge about their importance. explain the procedure to the significant others. 4. Drain the urine standing inside the collection bag because long standing will undergo chemical changes thus interfering with results. Place specimen in a sterile urine collection cup. 2. During 1. Avoid exposing the urine to air and avoid making the urine stand for a long period of time in the cup. 3. 2. 2006. After 1. Follow-up the results of urinalysis. If client is conscious and coherent. Document findings/place lab results in the patient’s chart properly.
2006 An ECG procedure was ordered to be performed to the patient because of the episode of hypertension and chest pains she it was indicated to evaluate the effectiveness of the medication given to manage the above mentioned discomforts. >Normal QRS.12-Lead Electrocardiogram Diagnostic Procedure 12-Lead Electrocardiogram . or if she have a cardiac pacemaker. belt. PR. QT. coins. 2006 (Refused and Signed HAMA) >July 21. height.July 19. Place all valuables within clients supervision or in care of SO. >Normal QRS. and ask client if she did not undergo heap replacement (other metallic implants. Aside from this 100 bpm >Normal Date Ordered Indication/Purpose Results Normal Values Analysis and Interpretation . Lastly. for it may hinder the electrical flow of ECG. Nursing Responsibilities: Pre-procedure: Record client age. cellphones. QT. it was indicated to determine the underlying factor causing chest pains and hypertension results. and if she take cardiac medication. PR. metal dentures. weight. > Cardiac Rate >Cardiac Rate 60100 experience. Instruct patient to remove all metal materials/ other conductors such as jewelries.
. Remove tapes or conductive gels use on the client skin. Place ECG strips to the patients chart properly and label accordingly. Refrain form talking to the patient. Post: Disconnect the equipment. Proper attach the electrical nodes/ electrodes in the patients skin Connect the electrodes properly to the ECG machine. During: Monitor and ensure proper attachments of electrodes to the patient skin.- Explain the test that it helps to evaluate the Heart Status by recording its electrical activity.
.Ensure patient is properly position in front of the x-ray board. are within configuration. existing pulmonary disease normal > Both lung fields > Normal Chest findings. Post: -Follow up CXR result. . . Nursing Responsibilities: Pre-procedure: . clear > Heart and great vessels are within normal configuration. > Other chest structure not remarkable.Diagnostic Procedure Chest X-ray Date Ordered > July 19. instruct patient to release his breath.If the image is taken. > Other chest structure not remarkable. During: . 2006 Indication/Purpose Results Normal Values Analysis and Interpretation The CXR was performed in > Both lung order for the physician to fields clear determine if the patient has > Heart and cardiac enlargement and to great vessels determine if she has or disorders. .Ask client to inhale/breath deeply and hold breath while she is instructed to release breath.Ask client to remove any radio opaque objects such as jewelries (necklace) in order to obtain a clear CXR result.Position the patient properly to the x-ray board.
ANATOMY AND PHYSIOLOGY .
the labia majora are two folds of adipose tissue covered by loose connective tissue and epithelium.The female reproductive organs consist of the ovaries. Clitoris. Labia Minora. which spreads out on both sides of the uterus and to which the ovaries and uterine tubes attach.the mons veneris is a pad of adipose tissue located over the symphysis pubis.located just lateral to the urinary meatus. Skene’s gland. curly hairs. The area is abundant with sebaceous glands. uterus. Labia Majora. It is covered by a triangle of coarse. The uterus and the vagina are at the midline.is the flattened. Female External Structure Mons Veneris. external genitalia. .is a small (approximately 1 to 2 cm) rounded organ of erectile tissue at the forward junction of the labia minora. vagina. between the urinary bladder and the rectum. the pubic bone joint. The internal reproductive organs are held in place with the pelvis by a group of ligaments. so localized sebaceous cyst may occur here. they are positioned lateral to the labia minora. Center of sexual arousal and orgasm in the female. The most conspicuous is the broad ligament. Other external organs: Vestibule. The internal reproductive organs of the female are located within the pelvis.just posterior to the mons veneris spreads two hairless folds of connective tissue. smooth surface inside the labia. uterine tubes (or fallopian tubes). with an ovary to each side of the uterus. serves as protection for the external genitalia and the distal urethra and vagina. The purpose of the mons veneris is to protect the junction of the pubic bone from trauma. and mammary glands.
They are grayish-white and appear pitted. and at maturity of the fetus. It is often torn during the time of first sexual intercourse. or the size and shape of almonds. the viscosity of its changes through out the menstrual cycle. Cervix. The function of the two ovaries (the female gonads) is to produce. the ovaries produce estrogen and progesterone and initiate and regulate menstrual cycles. furnish protection to a growing fetus. It is approximately the size of an olive.Bartholin’s gland. The canal normally contains mucus. Female Internal Structure Ovaries. Fallopian Tubes. linking the cavity of the uterus with the vagina.a neck like part.the uterus is a hollow. This is the structure that is sometimes cut (episiotomy) during childbirth to enlarge the vaginal opening. Hymen. mature and discharge ova (the egg cells). Their function is to convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum by sperm. The cervix is capable of wide dilatation during child birth. . The function of the uterus is to receive the ovum from the fallopian tube.located just lateral to the vaginal opening on both sides. muscular.is the ridge of tissue formed by the posterior joining of the two labia minora and the labia majora. The cervical canal passes through it.5 cm thick. Fourchette.the ovaries is approximately 4 cm long by 2 cm in diameter and approximately 1.the fallopian tubes arise from each upper corner of the uterine body and extend outward and backward until each opens at the distal end next to an ovary. posterior to the bladder and anterior to the rectum. especially the cervix uterine (neck of the uterus). expel it from the woman’s body. Secretions from both these glands help to lubricate the external genitalia during coitus.is a tough but elastic semicircle of tissue that covers the opening to the vagina in childhood. provide a place for implantation and nourishment during the fetal growth. secretions from both these glands help to lubricate the external genitalia during coitus. In the process. pear-shaped organ located in the lower pelvis. which projects into the vagina. Uterus.
The layer closest to the uterine wall. forming a seal to keep out ascending infections. or the basal layer. the endocervix becomes plugged with mucus. is also affected by hormones. The myometrium serves the important function of constricting the tubal junctions and preventing . is not much influenced by both estrogen and progesterone. as much as 700 ml of mucus per day is produced. The endometrium layer of the uterus is important in terms of menstrual function and childbearing. and an outer one of connective tissue (the perimetrium). and oblique directions. transverse. The endocervix. During pregnancy. only a few milliliters are produced. Because mucus alkaline. At the point in the menstrual cycle when estrogen productin is at its peack. The mucous membrane lining of the cervix is termed the endocervix. or muscle layer of the uterus. This network offers extreme strength to the organ. This is the layer that grows and becomes so thick and responsive each nth under the influence of estrogen and progesterone that it is capable of supporting a pregnancy. aiding in sperm survival. it helps to decrease the acidity of the upper vagina. the efficiency of this lubrication increases or wanes depending on hormone stimulation. at the point that estrogen is very low. continuous with the endometrium. the fibers of which are arranged in longitudinal. The lower surface of the cervix and the lower third of the cervical canal are lined not with mucous membrane but with stratifies squamous epithelium similar to that lining the vagina. but changes are manifested in a more subtle way. The cells of the cervical lining secrete mucus to provide a lubricated surface so spermatozoa can readily pass through the cervix. this is the layer that is shed as the menstrual flow. The myometrium.Uterine and Cervical Coats. It is not a single structure but is rather formed by two layers of cells. If pregnancy does not occur.the uterine wall consists of three separate coats or layers of tissue: an inner one of mucous membrane (the endometrium). Locating the point at which this tissue changes from epithelium to mucous membrane is important when obtaining a Papanicolaou smear (a test for cervical cancer) because this tissue interfere is most often the origin of cervical cancer. is composed of three interwoven layers of smooth muscle. a middle one of muscle fibers (the myometrium).
The perimetrium. undergo cell division by mitosis. it expands to serve as the birth canal. It also holds the internal cervical os closed during pregnancy to prevent a preterm birth. Following this division. this interlacing network of fibers is able to constrict the blood vessels coursing through the layers. or daughter cell division. In the male. Division activity then appears so halt until at least puberty. A new individual formed from the union of an ovum and an X-carrying spermatozoon will be female (an XX chromosome pattern). arise from the myometrium. all the chromosomes are duplicated in each new cell just before cell division. equal pressure is exerted at all points throughout the cavity because of this unique arrangement of muscle fibers. Its function is to act as the organ of intercourse and to convey sperm to the cervix so sperm can meet with the ovum in the fallopian tube. In this type of division. an individual formed from the union of an ovum and a Y-carrying spermatozoon will be male (an XY chromosome pattern) . Cells in the body. After childbirth. When the uterus contractrs at the end of pregnancy to expel the fetus. thus limiting loss of blood in the woman. Oocytes divide in intrauterine life by mitotic division.regurgitation of menstrual blood into the tubes. occurs. giving every new cell the same number of chromosomes as the original parent cell. It extends from the cervix of the uterus to the external vulva. Wtioh childbirth. a spermatozoon has 22 autosomes and either X or a Y sex chromosome. when a second type of cell division. an ovum has 22 autosomes and an X sex chromosome. Vagina is a hollow musculmembranous canal located posterior to the bladder and anterior to the rectum. meiosis (cell reduction division). it occurs just before ovulation. such as skin cells. or outermost layer of the uterus. this reduction division occurs just before the spermatozoa mature. or benign uterine tumors. offers added strength and support to the structure. Myomas. In the female.
complications Precipitating factors: -smoking -diet -multiple sexual partners or partner with multiple sexual partners.pathophysiology . Incubation period (6-8 months) Latent Viral Phase Months to years WBC. -early age of Sexual Intercourse -previous/recurrent STD’s -intake of oral contraceptives Sexual contact with infected person Transfer of HPV Innoculation in the Stratified Squamous epithelium. PATHOPHYSIOLOGY Legend: Predisposing Factors: -immunosuppression -pregnancy -age 17-33 . (X) presence of discharge Production of viral DNA and capsids Infections of Host Cells Morphological Atypical Koilocytosis of Condyloma Acuminata VDRL examination / HPV exam . neutrophils. hyperthermi a.clinical manifestation .IV.
Oropharyn x Penile Cancer - in lesions Pubic Area .difficult vaginal delivers Larynx Rectum .spontaneous rupture of lesions after delivery Polyuria Anus/ Perineal Area Oral Cancer .easy bleeding Trache a Urethra / Bladder Purulent Discharge Cervix .Males: Pruritus in the: Abnorm al PAPsme ar Penis Females: pruritus in the Vulvar area Vulvar Cancer Anus/ Perineal Area Anal Cancer Uncommon Sites: Mucosal Lessions in the: -activation of numerous large cells.easy bleeding Extremiti es HPV-6 Cervical Cancer .
In Pregnant Women with Condyloma Acuminata Transfer of Human Papilloma Virus to the child via Birth canal. During Pregnancy Laryngeal Papillamotomasis Breathing Passage Obstruction Infant Death .
2006 D5LRS 1L x 3132 gtts/min b. etc. NGT feeding. July 18. It is also indicated because of its modest calorie content helpful decreasing/shortening (HPV) the patient has. July 18. 2006 c. which would be in the course of the viral disease Nursing Responsibilities Before . O2 Therapy.in the case of the > the clients extracellular fluid volume was restored Ringer Solution with 5 % dextrose is a hypertonic intravenous fluid solution because it is a combination of 2 solutions namely D5W and LR patient. Medical Management a. PATIENT AND HIS CARE 1. Nebulization. BT. Medical Management Treatment Date Ordered Date(s) Performed Date Changed/discontinue General Description Indication(s) or Purposes(s) Client’s response to the treatment Intravenous fluid: a. bleeding intraoperative during phase the and bleeding caused by retained dead baby boy and placenta in her uterus. The calorie content of D5LRS also assisted in deficit which was caused by gradually regaining the client’s energy.V. IVFs. 2006 - Lactated - . Discontinued July 23. TPN. D5LRS is indicated in as evidenced by normal skin turgor and normal vital order to replace ECF volume signs.
Assess for client’s level of dehydration. bleeding. Check patency of IV cath regularly 5. Instruct patient to apply warm compress to site to relieve discomfort . Properly check the regulation and level of the IVFs and document findings 2. Watch for bulging on IV site After 1. and V/S 2. Explain to client the importance and indication of the treatment 3. Secure the placement of the IV catheter by proper taping 5.1. Monitor intake and output 3. In insertion of intravenous catheter. maintain aseptic/sterile technique 4. Apply firm gentle pressure on the insertion site after removing the IV catheter 2. Regulate IVF as ordered by the physician During 1. Replace the IVF bottle if empty and change to the recently/latest prescribed IVF 4.
O2 therapy is indicated for our > After the increase in O2 administration (from nasal canula.Medical Management Treatment Date Ordered Date(s) Performed Date Changed/discontinue b. facial mask. The mode of delivery as increased mentioned above are also 4L/min used based on physician order. monitor V/S especially RR. 2. Nursing responsibility Before 1. Place O2 away from plugs and other materials that could initiate fire 4. administered to the patient was slow the compensation of the patient’s body which was a result of decrease hemoglobin and hematocrit count.Delivery of oxygen via . July 18. This is ordered respiratory depression caused by The amount of O2 from due to 2-3L/min the to of Liter’s per minute. Prepare all materials needed. O2 therapy is necessary gradually compensated and was able to restore its medium. patient due to her postoperative 3L/min to 4L/min) the patient’s respiratory system forms of O2 delivery because by the physician in units anesthesia. to the humidifier. General Description Indication(s) or Purposes(s) Client’s response to the treatment Oxygen Inhalation a. July 18. 2006 @: first. 2006 2 days. Check for patient respiratory status. Administer O2 as prescribed by the physician . of the temporary normal and optimal functioning. cannula. O2 tube and O2 tank 3. 4 L/min . the tubing/nose and the cannula 5. Connect tubings properly form the O2. 2-3 L/min second. c. Disccontinued after venture mask and other contion.
8. Avoid creating sparks/fire near O2 tank because O2 is flammable After 1. Place O2 tank away from materials that could initiate fire. Assess for improvement of respiratory status . Monitor/assess for signs of improve respiratory status 7. Monitor V/S especially RR 2. Monitor V/S especially RR 2. Monitor level of administration 4. Keep or maintain an ample amount of water in the humidifier to avoid drying of nasopharyngeal mucosa 6. Ensure that there are no kinks in the tubings 3.During 1. Monitor for sign of a need for more O2 5.
Double check blood product compatibility and cross matching 6.Medical Management Treatment Date Ordered Date(s) Performed Date Changed/discontinue - General Description Indication(s) or Purposes(s) Client’s response to the treatment Blood transfusion a. 2006. cross matching and serial #. One unit of PRBC DBB in the patient’s uterus in hematocrit by 3% and shock hemoglobin by 1 g/dL. Explain procedure to the client and its side effects 5. Discontinued July 22. a. July 18. Obtain baseline V/S data 4. 3. Prepare all materials needed .Pact Red Blood Cell Transfusion of blood - To replace the blood lost > Refused and signed a Home Against Medical units containing blood during surgery and the blood loss Advise (HAMA) form. 2006 c. Nursing Responsibilities Before 1. Secure consent for BT. 2006 (PRBC). > Absence RBC. Check for proper blood typing. or anemia and other complications. July 22. 2006 b. July 21. 2. contents should particularly caused by retained placenta and increase order to prevent hypovolemia.
7. Administer pre BT meds such as Diphenhydramine or Antamin if prescribed During 1. Monitor V/S frequently Q15 min/Q 30 min 2. Assess for effectivity of treatment/management . Administer blood product as prescribed (gtts/min) 4. If anaphylaxis reaction occurs such as hypernatremia. immediately terminate transfusion and notify physician After 1. Monitor V/S frequently 2. Watch out for anaphylaxis reaction 3.
of the caused by the indwelling foley catheter. July 18. and the other port is the site for the injection of sterile water in order to secure and to the avoid dislodging the catheter from urinary bladder. July 18. . 2006 b. Discontinued July 20. Postoperative > client was not resistant in the duration of the foley specimen/urine bag. avoiding infection. client catheter. 2006 c. of urine to the sites of genital warts excision in the vulvar and vaginal area and the area of urinary meatus. hence. our client because of the > the patient was able to adjust with mild discomfort following reasons: condition 1. 2006. requiring a flat on bed status > no output abnormalities such as hematuria were as ordered by the physician observed all throughout the duration of the indwelling on the dates of July 18 to July catheter. 19. 2006 General Description Indication(s) or Purposes(s) Client’s response to the treatment - Indwellling - - Foley > Catheter was always in place and connected to the foley catheter is an alternative way of allowing flow bladder It has urine from to a to the a long catheterization is indicated for urinary bladder. The first port is for the attachment of the urine tube and urine bag. To avoid contact avoided. hose/tubing with 2 ports. The spinal anesthesia used during the surgery (CS & BTL) caused suppression of normal bladder function resulting to urinary > possible infections that urine may cause were 2. 3.Medical Management Treatment Foley Catheterization Date Ordered Date(s) Performed Date Changed/discontinue a.
During 1. Wear sterile gloves before preparing the catheter. 3. Document all findings. 4. 3. Nursing Responsibilities Before 1.incontinence. *** if accidentally inserted in the vagina never reused the catheter. Inflate the balloon with 5 to 10 cc of sterile water or saline solution using a sterile syringe. 4. Apply lubricant such as KY jelly on your hand and lubricate the foley catheter. 2. 5. Gently pull back to seal the catheter. Secure/reinforce the tapes to avoid dislodging the catheter. 2. . Ask patient to breathe deeply and insert the well lubricated catheter into the meatal opening. Assess the presence of blood in the urine. Clean the labia and the meatal opening one side at a time using downward stroke. Place the client in a supine position with her knees flex and separated. When urine return (presence of backflows). 2. 3. 6. and then set aside on the sterile field. Check the catheter balloon for appropriate filling. insert another inch of the foley catheter. Monitor intake and output. Drain the urine bag as necessary or every shift. 5. Explain the procedure to the client and also explain the discomfort it may cause. 5. 4. After 1.
dry mouth. • Monitor patient for seizures. constipation. Risk is increased with higher doses and in patients taking antidepressants. Pharmacotherapy Name Generic Name: Tramadol Contraindications Contraindicated in: Centrally • Hypersensitivity acting • Cross-sensitivity analgesic with opioids may occur • Binds to mu. anxiety. and intensity bradycardia of pain before and 2-3 hr (peak) after administration. • Assess type. pruritus. centrally and acting norepinephri analgesics. urticaria >GI: Nausea. tachycardia. • May cause dizziness and drowsiness. may cause opioid withdrawal symptoms. Who have previously received opioids for more than 1 wk. • Overdose may cause respiratory depression and seizures. flatulence >Other: Potential for abuse. Who are physically dependent on opioid analgesic (may precipitate withdrawal) • Not recommended for use during pregnancy or Drug class Action Brand Name: Tramal Side effect >CNS: Sedation. analgesics.b. reuptake of sedative/hypnoti serotonin cs. • Assess blood pressure and anaphylactoid respiratory rate before and reactions. rash. ne in the opioid CNS. >Dermatologic: Sweating. dizziness/vertigo. confusion. Caution pt to avoid driving or other activites requiring alertness . May occur within recommended dose range. opioid analgesics. vomiting. • Assess bowel function routinely. pallor. • Tramadol is not recommended for pts. or psychotropic agents • Pts. headache. or other drugs that decrease the seizure threshold. Adverse reaction Nursing Responsibility Seizures. periodically during administration. >CV: Hypotension. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. dreaming. sweating.• Patients who are opoid acutely receptors intoxicated with • Inhibits alcohol. location.
vomiting. Persons with a negative history of penicillin sensitivity may still have an allergic response. Adverse reaction >GI: pseudomembra nous colitis. • (IV) Change site every 48-72 hr to prevent phlebitis. penicillins. pain. >Local: Pain. inflammation at IV site . diarrhea. causing cell death. at injection site. decreased platelets. cephalosporins or dizziness. Monitor site frequently for thrombophlebitis. • Caution pt to avoid concurrent use of alcohol or other CNS depressants with his medication. flatulence. • Before initiating therapy. renal lethargy. decreased Hct Nursing Responsibility • Assess patient for infection (vital signs. lactation. • Administer slowly for 3-5 min. swelling). redness. liver toxicity >GU: Nephrotoxicity >Hematologic: Bone marrow depression >Hypersensitivity : Ranging from rash to fever to anaphylaxis. abdominal pain. Use glucose enzymatic or hexokinase tests to determine blood glucose. and stool. paresthesias pregnancy >GI: Nausea. • Cefuroxime may also cause falsenegative blood glucose results with ferricyanide tests. • Advise patient to change positions slowly to minimize orthostatic hypotension. WBC) at beginning and during therapy. Contraindications Side effect Allergy to >CNS: Headache. serum sickness reaction >Hematologic: decreased WBC. Name Generic Name: Cefuroxime Brand Name: Zinacef Action Drug classes Antibiotic Cephalosporin (second generation) • Antimicrobi al drugs • Bind to bacterial cell wall membrane. urine. sputum. obtain a history to determine previous use of and reactions to penicillins or cephalosporins. failure. anorexia. phlebitis. appearance of wound.lactation.
pus or mucus. vomiting. vomiting.>Other: Superinfections . diarrhea) • Advise patients who are to be treated continually for longer than several days. to thrombosis. Adverse reaction Nursing Responsibility >Ophtalmological • Monitor for Gastrointestinal problem disturbances (nausea. diarrhea Prophylaxis during pregnancy and before delivery. Advise pt not to treat diarrhea without consulting health professional. vaginal itching or discharge. especially if stool contains blood. before commencing and at regular intervals during the course of treatment. an ophthalmological examination. eye-ground and visual fields. is advised. disulfiram-like reaction with alcohol • Advise pt to report signs of superinfection (furry overgrowth on the tongue. • Instruct pt to notify health care professional if fever and diarrhea develop. Tranexamic acid should be discontinued if changes in examination results are found. color vision. Name Action Generic Name: Hemostatics/ Tranexamic Acid Antihemophilia Brand Name: Hemostan Contraindications Side effect Patient predisposed >nausea. including visual acuity. . loose or foul-smelling stools) allergy.
headache. carefully monitor BP. * No rebound effect noted when Name Generic Name: Nifedipine Brand Name: Calcibloc Action Drug classes Calcium channelblocker Antianginal agent Antihypertensi Contraindications >Use cautiously to patients with heart failure or hypotension. asthenia. • Antacid and tetracyclines may impair absorption of Fe. Fergan Action > Iron Supplement *Provides elemental iron. diarrhea. fatigue. an essential > Use cautiously component in on long term basis. *Before increasing the dose. black stools. sleep disturbances. Adverse reaction Nursing Responsibility > angina. unless your doctor directs you otherwise. Do not lie down for 30 minutes after taking this medication. Side effect >GI: epigastric pain vomiting. Use extended release tablets cautiously in patients with GI Side effect >CNS: Dizziness. >Others: temporary teeth staining if in liquid form Adverse reaction Nursing Responsibility anorexia • Fe Preparation should be administered with food to reduce gastric irritation through absorption may be impaired. constipation. Contraindications >Contraindicated to patients receiving repeated blood transfusions. nervousness. • Advice pt to take this medication with a full glass (8 oz or 240 ml) of water. the formation of hemoglobin.Name Generic Name: Ferrous Sulfate Brand Name: Feosol. * Do not exceed a single dose of 30 mg. blurred vision . • Do not crush or chew this medication before swallowing. light-headedness. This timedrelease product must be swallowed whole. • This medication may cause mild nausea or unpleasant taste. Consult your doctor if any of these effects persist or become severe.
dizziness. flushing. cough. > Patients who need blood transfusions should undergo Coomb’s test to avoid problems in cross matching. pruritus. Adverse reaction > angina >Musculoskeletal: arthralgia > Hematologic: Thrombocyto- Nursing Responsibility > Monitor blood pressure regularly and note for hypotension. Perform weekly weights and note any extremity swelling. women. decreasing contractility and oxygen demand. breastfeeding light headedness. Novomedopa. chills. urticaria >GI: Nausea. rash. fever. flatulence. Dopamet Action > AntiHypertensive *Thought to inhibit the central Contraindications Side effect >Use cautiously to >CNS:dizziness. or severity of angina. nifedipine is discontinued. Name Generic Name: Methyldopa Brand Name: Aldomet. palpitations. shortness of breath. diarrhea. * During initial therapy and when dosage is increased. constipation. * Advise patient to report any symptoms of any persistent headache. may experience an increase in frequency.ve *Thought to inhibit calcium ion influx across cardiac and smooth muscle cells. narrowing. can be taken without regard to meal. weakness >CV: bradycardia. muscle cramps. headache. However if to were stopped decreased dosage gradually. dermatitis. palpitations. lightheadedness. duration. * Food may decrease the rate but not the extent of absorption. hepatic injury >Other: Nasal congestion. nausea. or lack of response. * Keep log of BP reports. >CV: hypotension >Dermatologic: Flushing. . Also may dilate coronary arterioles and arteries. cramps.sedation. joint stiffness. weight gain.
sucking sugarless candies may help). trichom vomiting. constipation. antiprotozoaltrichomonacid Adverse reaction > Severe. and peripheral vasculature. bone marrow depression Name Generic Name: metronidazole Action Drug classes Antibiotic Antibacterial Amebicide Antiprotozoal *Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes. diarrhea (small. fatigue pregnan >GI: Unpleasant cy (do metallic taste. Brand Name: Flagyl. oniasis diarrhea. • Instruct the patient regarding the side effects: dry mouth with strange metallic taste (frequent mouth care. dry mouth >Respiratory: dyspnea >Skin: rashes. disulfiram-like interaction with alcohol. ndicated ataxia. for nausea. frequent meals may help). dizziness.vomitin g. >EENT: nasal congestion >GI:nausea. vertigo. causing cell death. orthostatic hypotension. dazole. vomiting. to peripheral metroni neuropathy. nausea. GI in first upset. • . pruritus Contraindications Side effect • Contrai >CNS: Headache. this is expected. thereby decreasing sympathetic outflow to the heart. with incoordination.vasomotor centers. cramps trimeste penia. Instruct the patient that urine may appear dark. nsitivity seizures. hyperse insomnia. not use anorexia. hemolytic anemia. kidneys. candidiasis (superinfection) • Nursing Responsibility Administer oral doses with food.
the histamine abdominal pain Drug class Action . lactatio n. Histamine 2 famotidine. • r). temperature. >GU: Dysuria. loss of libido or impotence (reversible).al. action of constipation. headache (adjust lights. incontinence. unusual bruising or bleeding. hepatic skin irritation disease. insomnia * >Dermatologic: Competitively Rash blocks the >GI: Diarrhea. sexual impotence Nursing Responsibility • Instruct patient regarding the side effect of the drug: constipation or diarrhea. fever. pregnancy. renal malaise. CNS burning. somnolence. (topical) candidia sis (monilia sis). and . lactation. Adverse reaction > increase in total bilirubin. Use darkening of the cautious urine ly with >Local: redness. blood dyscrasi as. amebicidal: biochemical mechanism of action is not known. noise levels). dizziness. diseases dryness. histamine at anorexia. • Instruct patient to report sore throat. severe Name Generic Name: famotidine Brand Name: Pepcid Contraindications Side effect Allergy to >CNS: Headache. (H2) antagonist failure.
• Use cautious ly with impaire d renal or hepatic Side effect >CNS: Headache. headache (adjust lights. granulocytopeni a. local burning or itching at IV site Adverse reaction >Hematologic: Leukopenia. Name Generic Name: Ranitidine Action Drug class headache. inhibits basal gastric acid Brand Name: Zantac Contraindications • Contrai ndicated with allergy to ranitidin e. loss of libido or impotence (reversible). dizziness. muscle or joint pain. noise levels). pancytopenia >CV: Tachycardia. inhibits basal gastric acid secretion and chemically induced gastric acid secretion. vertigo >Dermatologic: Rash. abdominal pain. .(H2) receptors of the parietal cells of the stomach. • Instruct patient regarding the side effect of the drug: constipation or diarrhea. somnolence. vomiting. bradycardia. >Local: Pain at IM site. Histamine 2 (H2) antagonist * Competitively blocks the action of histamine at the histamine (H2) receptors of the parietal cells of the stomach. PVCs (rapid IV administration) Nursing Responsibility • Administer oral drug with meals and at bedtime. muscle or joint pain. nausea. temperature. severe headache. alopecia >GI: Constipation. malaise. diarrhea. lactatio n. fever. insomnia. unusual bruising or bleeding. • Instruct patient to report sore throat. thrombocytope nia.
diaphoresis Adverse reaction >Hematologic: Decreased platelet adhesion. drowsiness >CV: edema. Name Generic Name: Paracetamol Antipyretic Analgesic (non-narcotic) *Antipyretic: Contraindications • Contraindic ated with allergy to acetaminop hen. doses of 5–8 g/day are ingested daily for several . hypertension. and report to physician if hyperthermia myocardial damage when does not subside. .vomitin g. Action Drug classes function . and antipyretic effect. pruritus. arrhythmias >GI:nausea. to produce antiinflammatory.sedation. headache. > Monitor for temperature regularly dyspnea. • Use Side effect >CNS: Headache >Hematologic: Anemia >Skin: rash Adverse reaction Nursing Responsibility >CV: Chest pain. purpura. Name Generic Name: Ketorolac Brand Name: Toradol Action analgesic/ antiinflammatory *Thought to inhibit prostaglandin synthesis. analgesic. flatulence Skin: rashes. Contraindications >Contraindicated as prophylactic analgesic before major surgery or intraoperatively when hemostasis is critical. Side effect >CNS:dizziness. constipation. palpitations. increased bleeding time Nursing Responsibility > Correct hypovolemia before giving ketorolac > NSAIDs may mask the signs and symptoms of infection because of their antipyretic and anti-inflammatory actions.secretion and chemically induced gastric acid secretion.
weeks or when doses of 4 g/day are ingested for 1 year >GI: Hepatic toxicity and failure. nausea. flatulence. hyperchloremia o o o o o Nursing Responsibility Instruct patient to take Mefenamic acid exactly as directed by the physician. Instruct patient to take Mefenamic acid with food or milk to lessen stomach upset. pregnancy. jaundice >GU: Acute kidney failure. dal antiinsomnia . to NSAIDs. inflamma o Have an ulcer tory or bleeding in dyspepsia. diarrhea. hormones o Have liver and that cause kidney inflammat disease. drugs the stomach. Instruct patient to avoid prolonged exposure in the sunlight because . which helps dissipate heat Analgesic: site and mechanism of action unclear cautiously with impaired hepatic function. chronic alcoholism. abdominal pain (NSAIDs) o Drink more o Mefenamic than 3 acid alcoholic works by beverages a reducing day. renal tubular necrosis Name Generic Name: Mefenamic Acid Brand Name: Ponstan SF Action Contraindications Side effect o Have an allergy > dizziness. lactation. Instruct patient to take each dose with one full glass of water. Instruct patient not to take Mefenamic acid for longer than 1 week with consultation.Brand Name: Biogesic reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating. o nonsteroi headache. Adverse reaction > upper respiratory tract infection.
like reactions. Provide diphenhydramine injection on standby in case extrapyramidal reactions occur (50 mg IM). akathisia. Monitor for extrapyramidal reactions. o Have fluid retention. Side effect Adverse reaction extrapyramid • CNS: al reactions. pheochrom ocytoma (may cause hypertensiv e crisis). mechanical obstruction or perforation. insomnia .ion and pain in the body. or pancreatic secretions Brand Name: Plasil Contraindications Contraindic ated with allergy to metoclopra mide. and consult physician if they occur. Restlessn parkinsonismess. anxiety Nursing Responsibility Monitor BP carefully during IV administration. o Have heart disease. Mefenamic acid increases the sensitivity of the skin to the sunlight. drowsine ss. arrange for alteration in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption. dystonia. o Have high blood pressure. Monitor diabetic patients. GI hemorrhage . myoclon us. Name Generic Name: Metoclopram ide Action Drug classes GI stimulant Antiemetic Dopaminergic blocking agent *Stimulates motility of upper GI tract without stimulating gastric. lassitude . Provide phentolamine on . biliary. fatigue. dizziness . o Have bleeding disorder.
patients diplopia. contraindic hypotension.epilepsy. Use cautiously with previously detected breast cancer (one third of such tumors are prolactin dependent). Brand Name: Contraindications Side effect > drowsiness. diarrhea standby in case of hypertensive crisis (most likely to occur with undiagnosed pheochromocytoma). lactation. circulatory collapse. Make sure urine output . administrati depressed on reflexes. Parenteral hypothermia. with heart diaphoresis block or myocardial damage Contraindic ated in patients Adverse reaction > Bradycardia. flaccid paralysis. Disappearance of knee-jerk and patellar reflexes is sign of impending magnesium toxicity. respiratory paralysis Nursing Responsibility Watch our for respirator depression and sign and symptoms of heart block Keep IV calcium gluconate available to reverse magnesium intoxication Check Magnesium level after repeated doses. Name Generic Name: Magnesium Sulfate Action Anticonvulsant • • CV: Transient hyperten sion GI: Nausea. ated in flushing. Monitor fluid intake and output.
with toxemia of pregnancy during 2 hours preceding delivery. for the patient because of the presence of peristalsis and General Description Indication(s) or Purposes(s) Client’s response &/ or reaction to the activity/ exercise . liquids. is 100 ml more in 4-hour period before each dose. c. 2006 diet the restriction of oral intake of foods. and digestive tract upset because of the patient’s proper 2006. This diet is appropriate compliance. also known the patient is on NPO The NPO status was tolerated by the patient and was as nothing by mouth diet status because of her compliant to the diet status prescribed/ordered by the preoperative condition (CSIII physician. There were no complication such as aspiration & BTL) on the date of July 18. or drugs. Diet Type of Diet Date ordered Date started Date change Nothing per orem (NPO) July 18.
. Nursing Responsibilities 1. It is also indicated for the patient in order to avoid aspiration or worse. 2. Constantly/repeatedly reinforce to the patient her NPO status. Observe for restoration of GI function such as passage of flatus and presence of bowel sounds then document findings. The patient is at risk for aspiration because of the absence of her gag and coughing reflex secondary to anesthesia induction.bowel movement. 6. Educate patient that she could wet her lips using wet cotton but avoid excessive amount. atelectasis. liquid/beverages. Explain the importance of NPO status and its relation to the patient’s current condition. 3. or even meds by mouth prior to surgery and after surgery as ordered. 4. 5. Enumerate to patient and SO the complications that may arise if NPO status is not followed strictly. Instruct patient to avoid eating/drinking any food.
Type of Diet Date ordered Date started Date change General Description Indication(s) or Purposes(s) Client’s response &/ or reaction to the activity/ exercise General Liquid diet July 19. gelatin. and pasta/noodles and her prescribed oral meds. potatoes. Assess for signs of restored GI function such as passage of flatus. and other Nursing Responsibilities 1. mash soft noodles/pasta. . juices. There were no untoward signs bowel movement/ peristalsis. noodles/pasta. of GI upset. and presence of bowel sounds. 200 the patient was placed able to tolerate soft foods and general liquids such as on general liquids to soft diet gelatin. She was wherein the client is allowed to eat/take liquids. 2. well-cooked foods. It is indicated after NPO in order to allow the patient’s digestive system to compensate for its function depression caused by the spinal anesthesia used during her surgery (CSIII & BTL). If positive. and other noncarbonated beverages because of the presence of and her oral meds as well. and passage of flatus and restoration of gag reflex. or soft foods such as gelatins. document findings and notify physician. Instruct her to eat only in ample/moderate amounts. 19. 2006 to soft diet - A diet - On the date of July The ordered diet was observed by the patient. Inform patient of her general liquid to soft diet status and evaluate the possible foods she could eat such as water.
Assess for signs of GI upset such as epigastric pain/abdominal pain. Assess for bowel movement by asking the client about the frequency of defecation. etc. 5. then document. 4.3. Reinforce patient to comply to her general liquid to soft diet status and educate her about the possible complications she might experience if she could be noncompliant. .
3. Regularly ask patient about frequency of bowel movement. Assess for GI upset symptoms. . functions are restored. and any type of food without restrictions. 5. consecutive/ regular passage of flatus. Nursing Responsibilities 1. and her GI function remain normal and digestive 20 bowel functions as stable all throughout. evidenced by normal BM (12movement/min). Document findings. 6. The diet was well tolerated restoration of all her normal by the patient. ordered normal when It is all digestive on a DAT status because of the proper/normal GI function. 2006 indicates Diet that as the - The patient is placed The patient was placed on DAT status upon restoring tolerated by its name patient could eat/take all oral meds. 4. Instruct patient to eat only as tolerated and gradually increase intake as preferred. 2. Instruct patient to report signs of GI discomforts. Inform patient she could eat/drink the food and beverages she desires.Type of Diet Date ordered Date started Date change General Description Indication(s) or Purposes(s) Client’s response &/ or reaction to the activity/ exercise Diet as Tolerated July 21. complete recovery of the patient’s gag reflexes.
2006 July 19. 2. 2006 July 18. Nursing Responsibilities 1. commonly This status. 3. Maintain airway. Place patient flat on bed. with ordered for the patient because of her post was no onset of spinal headache postoperatively due to those with spinal anesthesia because of spinal the surgical procedures CS & BTL patients. the patient is placed 180o avoid spinal headache. 2006 Activity/Exercise General Description Indication(s) or Purposes(s) Client’s response &/ or reaction to the activity/ exercise . breathing and circulation Raise side rails or place pillows or both sides of bed to avoid falls and injuries (maintain safety) Monitor patients V/S every 15 min until stable (related to post-op status) 4.c.A non ambulatory status . 180o on bed with no pillow to elevate the patient’s head 5. Assess for return of consciousness Assess for surgical site and incision dressings. operative status. Type of Exercise Date ordered Date started Date change Flat on Bed July 18.reinforce or change as necessary . She was induced proper compliance. This is also or bed with no pillows. and was placed on FOB status to indicated to avoid incision bleeding and other injuries.The FOB status is indicated for > The patient was compliant with the FOB status there commonly postoperative Most induced anesthesia. 6.
. post-op In complications specially preterm this status bleeding the or dehiscence and evisceration.7. 2006 July 20. 2006 July 19.Indicated for the patient due to > Patient complied with BCR status. 9. as status patients pregnancy disorder such to the patient in order to avoid placenta previa. uterine contractions. the patient could also assume a high fowlers position. also her post-op condition but with the > Absence display of dehiscence and evisceration op absence of the effect of spinal > Absence of spinal headache onset with anesthesia. Document significant findings and intervention performed Notify physician for significant deviations *** All nursing responsibilities and interventions enumerated are performed in relation to the post operative condition and post op exercise status of the patient Type of Exercise Date ordered Date started Date change General Description Indication(s) or Purposes(s) Client’s response &/ or reaction to the activity/ exercise Complete Bed Rest July 19. Instruct patient to maintain 180o position on bed until the doctors order change the status of exercise 8. 2006 - CBR for is a post non . patient could assume semifowlers position or elevate her head with the use of a pillow. If tolerated. This is also indicated > Absence of postoperative complications ambulatory ordered patients.
purulent exudates or bleeding Reinforce or change wound dressings as needed/necessary Record significant findings and intervention preformed Inform physician for abnormalities or S/Sx of infection or would dehiscence/evisceration Administer post-op meds as prescribed *** All nursing responsibilities and interventions enumerated are performed in relation to the post operative condition and post op exercise status of the patient Type of Exercise Date ordered Date started Date change General Description Indication(s) or Purposes(s) Client’s response &/ or reaction to the activity/ exercise Ambulate as tolerated July 20. 2. walking gradual 1 yard. assuring a semi-fowlers position. . increase then in > Manifested stable V/S > Absence of wound dehiscence and evisceration > Absence of post-op complications Until discharged the patient may be started system functions and consistent observed activity until normal ADL performance is restored. 6. 4.Nursing Responsibilities 1.Indicated for the patient because > Ambulatory status was tolerated well ambulate as tolerated by of the restoration of all the patients > The health teachings/education given to the client were form bedside exercises to stable vital signs. or high fowlers position as tolerated Instruct patient to comply with ambulatory status and explain the complications that could occur if CBR is not observed Check surgical site for signs of dehiscence or evisceration. 2006 - Full privileged to . Monitor V/S Instruct patient about the activities she could perform like elevation of head. 2006 July 20. 8. 3. 5. 7.
8. 3. 5. Monitor V/S Instruct patient about ambulate as tolerated status Instruct patient to avoid standing immediately.Nursing Responsibilities 1. 2. 4. 7. Instruct to first sit down at the edge of bed before standing up to avoid orthostatic hypotension Instruct patient to start ambulating by performing bedside exercises then increase gradually Monitor surgical incision site Verify physician about significant findings Administer medication as prescribed Record/document all findings and intervention performed *** All nursing responsibilities and interventions enumerated are performed in relation to the post operative condition and post op exercise status of the patient . 6.
2. with normal vital signs. moist mucous membrane. Assess for factor that could precipitate blood loss such as bleeding on incision site and excessive lochia 5.to decreased temperature and provide comfort .to evaluate degree of fluid deficit Expected Outcome After 40 of Nursing Intervention the patient has able to maintain fluid volume at a functional level as evidenced by increase in urine output. Note patients preferences regarding fluids and foods with high fluid content 6.Assessment Subjective Objective The patient may manifest: increased urine output. decreased hgb. Provide TSB if patient has fever . hct count. . increased PR and temperature Nursing Diagnosis Fluid Volume Deficit R/T excessive blood loss during surgical procedure as manifested by a decreased in hgb & hct count. Nursing Intervention 1. and good skin turgor. decreased BP. moist mucous membranes.to gain patients trust and establish good patientnurse relationship . altered serum sodium. Increased in PR and temp) -to assess what factor contributes to fluid volume deficit that may be given prompt intervention. and cause a decreased in intravascular or intracellular fluid thus fluid volume deficient occur. Scientific Explanation As a result of post operative procedure of a cesarean birth blood loss occur at approximately 600 to 800 ml of blood leading to changes in hgb and hct ct. dry skin and mucous membrane. decreased skin turgor. good skin turgor and normal hgb & hct count. stable vital signs.food rich with high fluid content replaces or contributes for the correction of fluid loss . Planning After 40 of Nursing Intervention the patient will be able to maintain fluid volume at a functional level as evidenced by individually active urinary output.to note for the alterations in V/S (decreased BP. Establish rapport Rationale . Note for the causative factors that contribute to fluid volume deficit 4. Monitor and record vital signs 3.
Provide oral care by moistening lips & skin care by encouraging daily bath 9.7. Administer antipyretic drugs if patient has fever as ordered .to prevent injury related to hypotension -replaces fluid losses . Provide safety measures and assist patient when moving especially if patient has decreased BP 11. Administer blood products as ordered 13.to reduce body temperature .to protect skin and monitor losses . Keep fluids within client’s reach and encourage increased fluid intake 8.replaces fluid loss and provides hydration . Administer IV fluid replacement as ordered 12.replaces blood loss . Change dressings frequently 10.to prevent injury from dryness .
33) counts After 2o of nursing intervention. hgb count (77). urine (1). hct(0. and will demonstrate behavioral changes to improve circulation. I E Assessed for physical manifestations of anemia Assessed for factors that could precipitate to anemia such as bleeding on Assessed diet/food preference Encouraged to increase intake of food rich in iron such as animal liver & Instructed to watch for sign of bleeding on incision site (soaked dressing) Instructed compliance to oral iron supplement intake administered due medication Patient verbalized understanding of condition and therapeutic regimen and incision site. unsoaked vagial/perineal pads with moderate amount of lochia serosa. maghilab ya ing tiyan ku dati. tatakut naku”. PR-83 bpm.as verbalized by the patient Received on bed on supine position conscious and coherent. green & leafy vegetables when in DAT status and increase in lochia demonstrated behavioral changes to improve circulation S - “Eku migalo masakit kasi. (-)Homan’s sign. hct (0. (-) breast engorgement. with initial vital signs taken as follows: BP.120/80 mmHg. pale buccal mucosa and conjunctiva. A P Altered Tissue Perfusion r/t decrease hgb(77). with intact and unsoaked incision dressing. (-)BM. ambulatory. RR-26 bpm.-36. the patient will verbalize understanding of the condition.33).4 oC.ACTUAL SOAPIE S O “Hindi ako nagpa-BT kase wala pang pera”. excessive lochia and diet. treatment/therapy regimen.as verbalized by the patient . Temp.
with intact and unsoaked incision dressing.160/90 mmHg. vegetables. . (-)BM. to regain energy increase in activity level and will verbalize understanding to maintain safety. bread. the patient was able to display of uterine contractions: preterm labor activity level and will verbalize understanding to maintain safety.O - Received on bed on supine position conscious and coherent. rice.4oC. Instructed patient to perform ADL as tolerated Instructed adherence to presented meds administered due meds After 2 hours of nursing intervention. (-)Homan’s sign. (-) breast engorgement. with initial vital signs taken as follows: BP. the patient will display increase in Monitored V/S Assessed for episodes of preterm uterine contraction Assessed for degree of discomfort that limits patient’s movements Assisted in performing ADL Instructed to increase food rich in calorie sch as fruits. hgb count (77). pale buccal mucosa and conjunctiva. etc. unsoaked vagial/perineal pads with moderate amount of lochia serosa. hct (0.-36. A P I E Impaired Physical Mobility r/t pain and discomfort secondary to episodes After 2 hours of nursing intervention.33). Temp. PR-90 bpm. ambulatory. RR-23 bpm. urine (1).
but the legend is at least as old as the 2nd century AD. The beginning of the story is certainly the verb caedo: the phrase a matre caesus ("cut out of his mother") was used in Roman times to describe the operation. Etymology There are several elements which contribute to a linguistic explanation of the word caesarean. The mother's view is similar but from a lower angle. is a form of childbirth in which a surgical incision is made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. since the form caesareus cannot be derived directly from caesus without some interference of Caesar. or c-section. • • • The term may be simply derived from the Latin verb caedere (supine stem caesum).2. The real etymology of the name Caesar (a much older family name) is completely unrelated. Surgical Management Caesarean section A caesarean section (cesarean section AE). This is the view that the father can expect of their newborn child. but a very early folk etymology invented the story of Julius Caesar's birth by section in order to suggest that his name is derived from this verb. The title of the Roman law must be influenced by this legend. "to cut. The caesarean is possibly named after Roman military and political leader Julius Caesar who allegedly was so delivered. There are several types of caesarean sections (CS): . Types A caesarean section in progress. The form of the modern English word caesarean may come either from the law or from the name Caesar. Historically. Thus the Roman law may be the origin of the term. It is usually performed when a vaginal delivery would lead to medical complications. but the modern German Kaiserschnitt (literally: "Emperor's section") obviously comes directly from the legend of Julius Caesar's birth. this is unlikely as his mother was alive after he reached adulthood (extremely implausible if such a procedure was performed with the technology of the day). Roman law prescribed that the procedure was to be performed at the end of a pregnancy on a dying woman in order to save the life of the baby." The term caesarean section then would be a tautology. This was called the lex caesarea. although it is increasingly common for otherwise normal births as well. Most likely the term is the product of a combination of these.
The classical caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it more prone to complications. The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair. A crash caesarean section or emergency caesarean section is a CS performed in an obstetrical emergency and is usually initiated within 30 minutes after making the decision. A caesarean hysterectomy consists of a caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus. Traditionally other forms of CS have been used, such as extraperitoneal CS or Porro CS. a repeat cesarean section is done when a patient had a previous section. Typically it is perfomed through the old scar.
In many hospitals, especially in the United States, United Kingdom, Australia and New Zealand the mother's partner is encouraged to attend the surgery to support the mother and share the experience. The anesthesiologist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.  Indications Obstetricians or other care providers recommend caesarean section when vaginal delivery might pose a risk to the mother or baby. Possible reasons for caesarean delivery include:
• • • • • • • • • • • • • •
prolonged labor or a failure to progress (dystocia) apparent fetal distress apparent maternal distress complications (pre-eclampsia, active herpes) catastrophes such as cord prolapse or uterine rupture multiple births (though this is controversial) abnormal presentation, (breech or transverse positions) failed induction of labour failed instrumental delivery (by forceps or ventouse) the baby is too large (macrosomia) placental problems (placenta praevia, placental abruption or placenta accreta) contracted pelvis previous caesarean section (though this is controversial – see discussion below) prior problems with the healing of the perineum (from previous childbirth or Crohn's Disease)
Note, however, that different providers may disagree about when a caesarean is required. For example, one obstetrician may feel that a woman is too small to deliver her baby, another might well disagree. Similarly, some care providers may be much quicker to cite "failure to progress" than others. Disagreements like this help to explain why caesarean rates for some physicians and hospitals are much higher than are those for others. The medico-legal restrictions on VBAC, vaginal birth after caesarean, have also increased the caesarean rate. For religious, personal or other reasons, a mother may refuse to undergo caesarean section. In the United Kingdom, the law states that a labouring woman has the absolute right to refuse any medical treatment including caesarean section "for any reason or none", even if that decision may cause her own death, or that of her baby. Other countries have different laws. As scheduled caesarean sections have become a rather safe operation, there has been a movement to perform caesarean delivery on maternal request (CDMR). There is also a consumer-driven movement to support VBAC as an alternative for repeat caesareans in the face of increased medico-legal restrictions on vaginal birth. Risks Statistics from the 1990s suggest that less than one woman in 2,500 who has a caesarean section will die, compared to a rate of one in 10,000 for a vaginal delivery.  However the mortality rate for both continues to drop steadily. The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth. However, it is not possible to directly compare the mortality rates of vaginal and caesarean deliveries as women having the surgery are often those who were at a higher risk anyway. Babies born by caesarean sometimes have some initial trouble breathing. In addition, because the baby may be drowsy from the pain medication administered to the mother, and because the mother's mobility is reduced, breastfeeding may be difficult. A caesarean section is a major operation, with all that it entails. Pain at the incision can be intense, and full recovery of mobility can take several weeks or more. A prior caesarean section increases the risk of uterine rupture during subsequent labour. If a CS is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anesthesia risk. Obstetrical hemorrhage may lead to anemia or to a clotting disorder. Anaesthesia The mother usually receives regional anaesthesia (spinal or epidural), allowing her to remain awake for the delivery and avoiding sedation of the infant.
In current practice, general anaesthesia for caesarean section is becoming less common as scientific research has now clearly established the benefits of regional anaesthesia for both the mother and baby. General anaesthesia tends to be reserved for high-risk cases or emergencies. The risks of general anaesthesia for mother and baby are still extremely small overall. Anaesthetic care is not limited to the operation itself. Anaesthetic teams in the United Kingdom and New Zealand are responsible for post-operative pain relief. There seems to be a link between the use of anaesthesia during labour and birth, as a form of pain relief for women planning a vaginal birth, and caesareans. Recent medical research concluded that epidural anaesthesia did not lead to labour failure leading to a caesarean, but medical practice is to use labour induction drugs after anaesthesia is applied to counteract the obvious sedative effect that causes labours to slow down or often stop. Vaginal births after caesarean Vaginal birth after caesarean (VBAC) is not uncommon today. The medical practice until the late 1970s was "once a caesarean, always a caesarean" but a consumer-driven movement supporting VBAC changed the medical practice. Rates of VBAC in the 80s and early 90s soared, but more recently the rates of VBAC have dramatically dropped due to medico-legal restrictions. In the past, caesarean sections used a vertical incision which cut the uterine muscle fibers. Modern caesareans typically involve a horizontal incision along the muscle fibers. The uterus then better maintains its integrity and can tolerate the strong contractions of future childbirth. Cosmetically the scar for modern caesareans is below the "bikini line." Obstetricians and other caregivers differ on the relative merits of vaginal and caesarean birth following a caesarean birth. Some still recommend a caesarean routinely, others do not; still others respect the wishes of the expectant mother. Twenty years of medical research on VBAC, support a woman's choice to have a vaginal birth after caesarean. Because the consequences of cesareans include a higher chance of re-hospitalization after birth, infertility, and uterine rupture in the next birth, preventing the first caesarean remains the priority. For women with one or more previous caesareans, as an alternative to major abdominal surgery, VBAC remains a safer option.
Tubal Sterilization Overview Tubal sterilization is surgery to block a woman’s fallopian tubes. Tubal sterilization is a permanent form of birth control. After this procedure, eggs cannot move from the ovary through the tubes (a woman has two fallopian tubes), and eventually to the uterus. Also,
More than 190 million couples worldwide use surgical sterilization as a safe and reliable method of permanent birth control. During the Procedure While you are under anesthesia. including work. minimally invasive female sterilization procedures. Prior to the 1960s. Half are performed right after a woman gives birth. about 700. The skin incision is then closed with a few stitches. The changing cultural climate in the 1960s resulted in safe. Most women return to normal activities. Using instruments that are inserted through the laparoscope.” More formally. Tubal ligation can also be performed immediately after childbirth through a small incision near the navel or during a Cesarean delivery. The rest are elective procedures performed as a one-day operation in an outpatient clinic. sealed shut with cautery. Eleven million US women aged 15-44 years rely on sterilization as a means of birth control to prevent pregnancy. Filshie clip) is the most popular method of female sterilization in nonpregnant women. female sterilization in the United States was generally performed only for medical problems or when a woman was considered “too old” to have children or at risk. A new device acts much like tubal sterilization by blocking the fallopian tubes.sperm cannot reach the egg in the fallopian tube after it is released by the ovary. Periumbilical minilaparotomy (Pomeroy. although you may be advised not to exercise for several days. one or two small incisions (cuts) are made in the abdomen (usually near the navel). the tubes (fallopian tubes) are coagulated (burned). Currently. and a device similar to a small telescope on a flexible tube (called a laparoscope) is inserted. Thus. Falope ring. if any. The Food and Drug Administration has approved a small metallic implant (called the Essure . You may resume sexual intercourse when you feel ready. pregnancy is prevented. it is known as bilateral tubal ligation (BTL).000 of these procedures are performed each year in the United States. in a few days. This procedure is also called tubal ligation or you are said to have your “tubes tied. Parkland) is the most common procedure right after childbirth. Currently. or a small clip is placed on the tube. You are usually feeling well enough to go home from the outpatient surgery center in a few hours. Your health care provider may prescribe pain medications to help you manage the pain. laparoscopy (bipolar laparoscopy.
If pregnancy occurs after the procedure. discuss your options with your health care provider. Results Most women recover from the laparoscopic procedure with no problems. the more likely she will regret choosing this permanent form of birth control. This may be caused by an incomplete closure of the tubes. Risks As with any surgery. placement of the device does not require an incision or general anesthesia. This is a dangerous situation. Unlike other currently available tubal sterilization procedures for women. During the first 3 months after the Essure procedure. This procedure cannot be reversed. The younger the woman. you must use another form of birth control. Surgery itself may present problems with bleeding or infection. you must undergo a final x-ray procedure in which dye is placed in your uterus and an x-ray is taken to confirm that the device is in place. There are no tests required to confirm that you are now sterile (that is. you may have injury to other organs in your body. your health care provider inserts an obstructive device into each of the 2 fallopian tubes at the time of hysteroscopy. This is done with a special catheter that is inserted through the vagina into the uterus and then into the fallopian tube. you are at increased risk for an ectopic pregnancy in which the pregnancy develops in the fallopian tubes. there is always a risk when you are given general anesthesia. Because the procedure is performed by tiny instruments inserted into your abdomen. Alternatives If you feel you want a permanent solution to birth control. blocking the fallopian tube and preventing fertilization of the egg by the sperm. . unable to become pregnant) after a laparoscopic procedure. There is still a chance you may become pregnant after tubal sterilization. At the 3-month point. You may have a bad reaction to the medication used. During the Essure procedure. The device works by inducing scar tissue to form over the implant. Many younger women who choose this procedure regret their decisions later.System) that is placed into the fallopian tubes of women who wish to be permanently sterilized. About 1 in 200 women become pregnant who have their tubes tied.
and will want to talk with your spouse. Many couples. Surgical removal of genital warts by excision Surgery Overview Visible genital warts on the penis or vagina or around the anus are removed by cutting them off with a surgical knife (scalpel). Warts on the cervix may be removed by laser or loop electrosurgical excision (LEEP). Tubal ligation is not temporary. This is an important decision. Why It Is Done . You receive medication that numbs the area around the warts (local anesthetic). which may indicate an infection Avoid sexual intercourse until the treated area heals and soreness is gone (usually 1 to 3 weeks. weigh the benefits and risks of whether the woman would undergo tubal sterilization or the man a vasectomy. For men and women who have had genital warts removed. Stitches (sutures) usually close the incisions. Do not think of it as a procedure to be reversed. Scarring may occur. your plans for your future and family. What To Expect After Surgery Recovery time depends on the location and number of warts removed. • • • Most people will be able to return to normal activities within 1 to 3 days. in looking at their birth control options.Your doctor will discuss your current number of children. The procedure is usually done in a health professional's office or clinic. Healing takes 2 to 4 weeks. When reversal is attempted. especially when they are ready to stop having children. Women with certain medical conditions may not be suited for this procedure. the operation becomes major surgery and is only successful about 50-80% of the time (meaning the woman is able to become pregnant after reversal). depending on the size of the area treated). call your health professional for any of the following: • • • • Bleeding that lasts longer than 1 week A fever Severe pain Bad-smelling or yellowish discharge. Tubal sterilization is surgery.
Condoms may help reduce the risk of HPV infection. You may receive antibiotics at the time of the procedure to reduce the risk of infection. Vaginal bleeding caused by the retained products of conception was stopped Bilateral fallopian tubes were ligated Complications that could be brought about the retained products of conception such as hemorrhage. Infection. but it is not known how much protection they provide. CLIENTS RESPONSE TO TREATMENT CS & BTL The dead baby and the retained placenta were successfully evacuated via transumbilical/lower abdominal midline incisions.1. Warts come back in 19% to 29% of people. the client manifested fast recovery from the effects of the anesthesia Physical mobility was impaired due to the pain caused by the surgical incision . You may need medication for several days after the procedure. A person treated for genital warts may still be able to spread the infection.Surgery is used to removal warts that continually return. or worst shock were prevented Postoperatively. 2 Risks Risks of surgery are: • • • Bleeding. How Well It Works Surgery is effective in up to 72% of cases. Discuss this with your health professional. A single treatment may be all that is needed. What To Think About Treating genital warts does not cure a human papillomavirus (HPV) infection. Pain. The virus remains in the body in an inactive state after warts are removed. The benefits and effectiveness of each type of treatment need to be compared with the side effects and cost. It also may be used when warts are widespread.
Monitor IV infusion at least once every hour. 2. pain. 4. GENITAL WARTS EXCISION BIOPSY 1. More frequent checks may be necessary if medication is being infused. a. coolness or pallor at site of insertion.- Tissue perfusion was impaired as a result of blood loss of the retained dead baby boy and placenta and minimal blood loss during the surgical procedure Low count of hgb & hct were obtained form the blood sample postoperatively. and cold clammy peripheries. Presence of manifestations of anemia such as pale conjunctiva. Genital warts in the vulvar. Check drip chamber and time drops c. 3. Check for local or systemic manifestations that indicate and infection present at the site This necessitates removing IV and restarting at . Be sure that clamp is in the open position. Inspect site for swelling. which may indicate infiltration of IV. Check tubing for anything that might interfere with flow. Check physician’s order for IV solution b. pale buccal mucosa. Observe dressings for leakage of IV solution 2. vaginal and perianal area were removed via vaginal incision Absence of bleeding on the excision sites Absence of outward manifestations of would infections such as presence of purulent exudates and hyperthermia Therapeutic and palliative goals of excision biopsy were obtain PROCEDURES FOR MONITORING AN IV SITE AND INFUSION Nursing Actions 1. another site 3.
chest examination and the procedures for several reasons. The patient also had minimal to moderate production of lochia alba. tab 4 x a day (8am. DISCHARGE PLANNING 1.8pm) Mefenamic acid * There was a decrease in pain level on the incision site and excision site. urinalysis. The patient was incompliant to undergo the requested follow-up blood examinations. is on an ambulatory status. On the other hand. She is negative of signs of embolism. 2006. and regular bowel movement. There were no signs of would dehiscence and evisceration.2 pm. regular/normal urination and intake and output. cap OD (8am) Methyldopa 250 mg. * Decrease in the mild inflammation * Patient increased activity level as a result of decrease pain discomfort . the patient displayed good skin turgor. Because of these there were no basis for evaluation of the treatment regimens for the physician such as if the patient’s anemia and infection was treated. the patient is very compliant/adherent in taking all her prescribed medications and was placed on a “May Go Home” status by her attending physician on the date of July 23. she had stable and normal vital signs in the continuity of consecutive shifts. and 2. firm and globular uterus. No sign of dehydration were also evident. General Condition of Client upon Discharge Days prior to the patients discharge.8am. hyperthermia.2am) Cefuroxime 500 mg cap 2 x a day (8am.VIII. outward manifestation of infection such as purulent exudates. METHOD M E Mefenamic Acid 500 mg cap 3 x a day (8am-1pm-6pm) Ferrous Sulfate. Her breasts are engorged. and inflammation.
Advised patient to rest 4. 3. Advised patient to exercise 5. Advised patient to eat foods rich in vitamin C such as oranges or guavas. Do perineal wash using “tawas” O D - Advised patient to come for follow-up check-up on July 31.- Ferrous Sulfate * There was elimination of physical/outward manifestations of anemia such as pale conjuctiva and buccal mucosa * improve general well-being as a result of increased/improved RBC content in the blood which resulted to proper perfusion and gas exchange. - Methyldopa * Blood pressure was restored to normal range * Episodes of acute hypertension were managed - Cefuroxime * There were no outward manifestations of infections such as increase temperature and purulent discharges from incision and excision sites * The pain and mild redness on incision and excision sites subsided T H - Continue due meds 1. Advised patient to increase fluid intake 2. Maintain proper hygiene 6. 2006 (Monday) Diet as Tolerated .
we were able to establish strong factual relationship of the factors contributing to the disease. we were able to . Conclusion In our practice of nursing. Most importantly. critical thinking. Because of this. It also enabled us to be tactful in dealing with a patient with such disease because of the fact that they get easily offended and they will not present all the essential information that we need. numerous cases of STD’s are left untreated. with all the new knowledge we have acquired as we conducted and accomplished or case study about condyloma acuminata. Unlike in our previous case studies which dealt with pathological deranges wherein we have knowledge about. Accomplishing this case study really helped us enhance the resourcefulness. and/or unclean. and its effects on the laboratory and diagnostic procedures. the synthesis of the disease condition. On the other hand.IX. We learned how to be efficient and consistent in prioritizing nursing interventions through proper history taking and accurate physical assessment. not all of these diseases or cases are reported to health care provider because of the common misconception that they may be looked upon as immoral. condyloma acuminata. For this reason. there is already a poor prognosis of the ailment due to secondary complications that arise. We were also able to improve our skills in building links and relationship between cause and effect relationship between the information obtained in the physical assessment and the disease condition in a highbrow and intellectual manner. encouraged us to strive and exert extra effort in order for us to accomplish this case study. Conducting a case study about a sexually transmitted disease (condyloma acuminata) is a very challenging task for us as student nurses. and knowledge that we possess especially in cases where limited facts and information’s are available. We were able to develop and apply the principles of therapeutic communications during our nurse-patient interaction and history taking. and worst. we have been made aware that sexually transmitted diseases cases continue to increase. making it easier for us to extract/obtain information from the patient without causing negative feelings. It was our first time to deal with a sexually transmitted disorder.
“Prevention is better than cure”. and other medical-related professionals. All the nursing objective of this case study as enumerated in the introduction were met and attained X. the hands. consolidating the 3 H’s of nursing. we would improve not only our academic and clinical competency but also our values and attributes as well. A broad continuum of skills and knowledge is needed in order to be flexible. This could be developed by reading books and being assertive in learning new things. we should be concerned of the importance of preventive. we should show more importance in We should also be able to learn the art of promoting preventive measures because. and rehabilitative treatment approaches. Learning how to adjust in circumstances that are unexpected should be learned by every nursing student. As nurses. We should never take for granted even the simplest tasks that we are to perform when handling patients. the head. Recommendations We. Each clinical exposure and lecture that we have should be considered a new learning experience because through this. curative. and the heart. hence.ameliorate our nursing skills. The knowledge of a nurse should not only be limited to what is currently existing. efficient and effective in performing nursing interventions and health teachings nor only in patients with condyloma acuminate but also with patients having other ailments as well. as factually known by the many. If this art is developed by all nursing students. should be proficient in performing our tasks and responsibilities. . More importantly. as student nurses. there will be a remarkable change in the medical field service. nurses. but to what is important in the nursing practice. enabling us to be efficient and effective in performing and delivering nursing care and interventions appropriate for the client with condyloma acuminate and other related sexually transmitted disease.
4 oC * * 38.VII.3oC * * . CLIENT'S DAILY PROGRESS DAYS Nursing Problems 1 2 3 4 5 6 Vital Signs PR RR BP Temp Diagnostic & Laboratory Procedure CBC U/A HbSAg CXR ECG Platelet ct.4 oC * 36.0oC 36.0oC * * * * * * * * * * * * 36. Medical Management O2 Inhalation Folley Catheter D5LRS I&O CS BTL ADMISSION 7/18/2006 DAY 1 7/19/2006 DAY 2 7/20/2006 DAY 3 7/21/2006 DAY 4 7/22/2006 DISCHARGE 7/23/2006 92 bpm 24 bpm 180/100 mmHg 90 bpm 23 bpm 160/90 mmHg 85bpm 20 bpm 160/90 mmHg 73 bpm 23 bpm 84 bpm 22 bpm 120/80 mmHg 83 bpm 21 bpm 120/60 mmHg 36.5oC 120/80 mmHg 36.
BT-PRBC Excision biopsy Drugs MgSO4 Cefuroxime Metronidazole DAYS Drugs Ketorolac Famotidine Tranexamic Acid Tramadol Paracetamol Ranitidine Metochlopramide Nifedipine Mefenamic Acid FeSO4 Methyldopa Diet NPO Gen Liquid to Soft diet Soft diet DAT Activity/Exercise FOB CBR ambulatory * * * * * ADMISSION 7/18/2006 * * * * * * * * * * * DAY 1 7/19/2006 * * * DAY 2 7/20/2006 * DAY 3 7/21/2006 * DAY 4 7/22/2006 * DISCHARGE 7/23/2006 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * .
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