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University of Cordillera

Governor Pack Road, Baguio City, Philippines 2600


S.Y. 2019-2020
2 Year / 2nd Semester
nd

A. What is the case problem of the patient? Prepare the pathophysiology of the case of the
patient using the available information from the video case.

- The case problem of the patient is uterine rupture with postpartum hemorrhage which is a
complication after 9hrs of induction of labor without augmentation. Patient appears vitally
stable with no vaginal or cervical tears. After 13 hours of delivery, an ultrasound was made
and result presented a hematoma in vesicouterine pouch following symptoms of abdomen
distention, tenderness, guarding and vital signs stable after 24 hours of delivery. Thus
exploratory laparotomy is done. Rarely uterine rupture may occur with patient being vitally
stable.

PATHOPHYSIOLOGY:
B. What is the history and chief complain presented in the video? What are the signs and
symptoms that the patient presented in the video? Prepare your 13 areas of assessment using
the available data from the video case. In cases where there are no data provided under a
specific area if assessment, then there is no need to include the mental status assessment in
your 13 areas of assessment report.

- A 35 years old patient who has previous four pregnancies with a history of one abortion and
two preterm births. She’s overdue by 7 days and was induced during labor. 12 hours after
delivery, patient presented symptoms of abdominal pain. She’s showing signs of a rapid heart
rate of 100bpm and low blood pressure of 112/70. Patient’s experiencing abdomen distention
and tenderness which persisted for 24 hours. Guarding was also observed to the patient.

13 AREAS OF ASSESSMENT

1) Sensory Status - The patient skin has receptors for pain and pressure. Such as pain and
tenderness in her abdomen. The pressure from her abdomen that is presented by her
guarding behavior.

2) Motor Status - The patient had just undergone a vaginal delivery so her range of motion
is altered. She needs assistance when performing vigorous activities of daily living. There
is presence of discomfort during range of motion exercises as manifested by symptoms of
abdomen al distention, pain and tenderness in the abdomen.

3) Circulatory Status - The blood pressure of the patient is 112/70 which is below normal
the average baseline of 120/80mmHg.

4) Sleep, Rest and Comfort Status – The patient’s status of sleep, rest and comfort is altered
with the presented symptoms of pain and abdominal distention which persisted 24 hours
after the delivery.

5) Reproductive Status - Some of her Reproductive organ is altered especially the external
area due to episiotomy but it is considered normal due to the process of delivery. Physical
assessment after the delivery shows that uterus is well contracted but symptoms of
abdominal distention and tenderness was observed which persisted for 24 hours. Pelvic
examination reveals that cervix is 2cm dilated and contour of the uterus maintained with
no mass felt in B/L broad ligament. An ultrasound was done 13 hours after delivery and
results showed hematoma on vesicouterine pouch.
C. What were the diagnostic procedures done on the patient to determine the real cause of the
patient’s health problems?

Diagnostic Procedures Performed Description and Purpose or Indication


1. UTZ of Abdomen
An ultrasound scan is a test that uses high-
frequency sound waves to make pictures of the
internal organs. It creates a sound that travels
through the soft tissue and fluid, but it bounces
back or echoes, off denser surfaces. It is usually 2
and18 megahertz and used for diagnostic
procedure. Ultrasound may be an effective
screening method for lower uterine gastrointestinal
bleeding.

Source:
https://www.healthline.com/health/ultrasound
2. Laparotomy
A laparotomy is a surgical incision into the
abdominal cavity. A laparotomy is performed to
examine the abdominal organs and
aid diagnosis of any problems. Exploratory
laparotomy is used to visualize and examine the
structures inside of the abdominal cavity. This
method of diagnostic tool allows physicians to
examine the abdominal organs. The procedure
may be recommended for a patient who has
abdominal pain of unknown origin or who has
sustained an injury to the abdomen.

Source: https://www.surgeryencyclopedia.com/La-
Pa/Laparotomy-Exploratory.html#ixzz6LH6ngz00
3. CBC
A complete blood count (CBC) is a blood test used
to evaluate your overall health and detect a wide
range of disorders, including anemia, infection and
leukemia. A CBC may be ordered when a person
has any number of signs and symptoms that may
be related to disorders that affect blood cells.
When an individual has an infection,
inflammation, bruising, or bleeding, a doctor may
order a CBC to help diagnose the cause and/or
determine its severity.

Source: https://www.mayoclinic.org/tests-
procedures/complete-blood-count/about/pac-
20384919
D. What are the Drugs prescribed to the patient to address the patient’s health problem? Prepare your Drug Study following the
prescribed format of CON.

DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING


CONTRAINDICATION RESPONSIBILITIES

GENERIC: INDICATIONs: CNS: BEFORE:


Cefuroxime 
Interferes with bacterial cell- Surgical prophylaxis for  Headache Dx:
BRAND: wall synthesis and division 
gastrointestinal, gynecological Hyperactivity a. Check physician’s
Ceftin by binding cell wall, causing surgery (including caesarean  Hypertonia order.
cell to die. Active against section) and orthopedic b. Assess for history of
 Seizures seizure disorders.
CLASS: gram-negative and gram- operations.
c. Check for allergies.
Second positive bacteria, with
 Severe infections EENT: d. Assess baseline mental
generation expanded activity against  Complicated urinary tract  Hearing loss status.
cephalosporin gram-negative bacteria. infections, including e. Observe the 10 Rights
 Oral candiasis
Exhibits minimal pyelonephritis. before administering
CV:
THERAPEUTIC immunosuppressant activity. medication.
 Intra-abdominal infections.  Edema
Anti-infective Cefuroxime is used to treat a Soft-tissue infections: GI: Tx:
wide variety of bacterial cellulitis, erysipelas and  Abdominal cramps a. Perform a thorough
PHARMACOLOGIC: infections. This medication is wound infections.  Diarrhea physical assessment to
B-lactam Antibiotic known as a cephalosporin  Community acquired
antibiotic. It works by  Elevated liver enzymes establish baseline data
pneumonia and acute  Hepatic failure before drug therapy
DOSAGE: stopping the growth of exacerbations of chronic
750 mg or 1.5 g bacteria.  Hepatomegaly begins, to determine
bronchitis. the effectiveness of
 Nausea
 Surgical prophylaxis for therapy, and to
 Pseudomembranous colitis
cardiovascular and evaluate for the
 Vomiting
oesophageal operations.
GU: occurrence of any
 Elevated BUN level adverse effects
CONTRAINDICATION:  Nephrotoxicity associated with drug
 Patients with known  Renal failure therapy.
hypersensitivity to  Vaginal candidiasis b. Restrict amount of
cephalosporin antibiotics. DERM: drug available to
SOURCE:  History of severe  Ecchymosis patient.
Nurses Drug Handbook hypersensitivity (e.g. c. Build a rapport.
 Erythema
https://www.webmd.com/dru anaphylactic reaction) to any  Erythema multiforme
gs/2/drug-3779- other type of beta-lactam EDx:
 Pruritus
8011/cefuroxime-axetil- antibacterial agent a. Instruct patient that
 Rash
oral/cefuroxime-oral/details (penicillins, monobactams drowsiness or
 Stevens-Johnson syndrome dizziness may occur.
and carbapenems).
b. Educate client on drug
therapy to promote
DRUG TO DRUG compliance.
INTERACTION:
 Furosemide DURING:
The interaction is more likely Dx:
to occur when the a. Monitor mood
cephalosporin is given at high changes.
b. Monitor for adverse
dosages by injection into the
effects (e.g. sedation,
vein or when it is given to the dizziness, respiratory
elderly or individuals with dysfunctions, GU
pre-existing kidney function problems, etc).
impairment. c. Check for drug or
herbal interactions
Tx:
DRUG TO FOOD a. Inspect injection sites
INTERACTION: frequently for signs of
 Grape Juice infection.
you should avoid eating b. Administer medication
with the right drug,
grapefruit and drinking
right dosage at the
grapefruit juice while taking right time.
cefuroxime. c. Introduce name and
Grapefruit juice slows down build a good rapport to
how quickly the body is able the patient.
to break down cefuroxime,
which could cause levels in Edx:
the blood to rise dangerously a. Instruct pt. SO to
high. report nausea,
drowsiness, dizziness,
or persistent headache
to physician.
b. Inform of drugs and
herbs that can interact
c. Instruct patient to
verbalize feelings and
concerns.

AFTER:
Dx:
a. Assess
knowledge/teach
patient appropriate use
,interventions to
reduce side effects,
and adverse symptoms
to report.
b. Monitor for
effectiveness as
exhibited by a
decrease in symptoms
c. Monitor for side
effects.

Tx:
a. Provide safety
measures (e.g.
adequate lighting,
raised side rails, etc.)
to prevent injuries.
b. Provide comfort
measures (e.g. voiding
before dosing, etc.) to
help patient tolerate
drug effects.
c. Introduce name and
build a good rapport to
the patient.
Edx:
a. Monitor patient
compliance to drug
therapy.
b. Monitor patient for 2-
4 weeks to ascertain
onset of full
therapeutic effect.
c. Advise pt. to avoid
alcohol intake.
d. Instruct patient to
verbalize feelings and
concerns.
DRUG NAME MECHANISM OF INDICATION / ADVERSE EFFECT NURSING
ACTION CONTRAINDICATION RESPONSIBILITIES

GENERIC: Interferes with bacterial INDICATIONS: CNS: headache, lethargy, BEFORE:


Cefoxitin cell-wall synthesis and Respiratory tract infections, paresthesia, syncope,seizures Dx:
division by binding to cell skin infections, bone and joint a. Assess history that
is contraindicated
BRAND: wall, causing cell to die. infections, urinary tract CV: hypotension, palpitations,
to the drug.
Mefoxitin Active against gram- infections, gynecologic chest pain, vasodilation, b. Check the doctor’s
negative and grampositive infections, septicemia. thrombophlebitis order.
CLASS: bacteria, with expanded c. Identify the name
Second activity against gram- CONTRAINDICATIONS: EENT: hearing loss of the patient for
generation cephalosporin negative bacteria. Exhibits Hypersensitivity to GI: nausea, vomiting, diarrhea, the drug
minimal cephalosporins or penicillins. abdominal cramps, oral administration.
d. Observe the 10
THERAPEUTIC: immunosuppressant candidiasis,
Rights before
Anti-infective activity. DRUG TO DRUG pseudomembranous colitis administering
INTERACTIONS: medication.
PHARMACOLOGIC: Aminoglycosides, loop GU: vaginal candidiasis, e. Check for
B-lactam Antibiotic SOURCE: diuretics: increased risk of nephrotoxicity allergies.
Schull, P. (Seventh Edition. nephrotoxicity Probenecid: Hematologic: lymphocytosis, Tx:
DOSAGE: (2013). Mc-Graw-Hill decreased excretion and eosinophilia, bleeding a. Perform a
thorough physical
1 g, 2 g nurses drug handbook. increased blood level of tendency, hemolytic anemia,
assessment to
cefoxitin. hypoprothrombinemia, establish baseline
neutropenia, data before drug
DRUG TO DIAGNOSTIC thrombocytopenia, therapy begins, to
TEST: agranulocytosis, bone marrow determine the
Alanine aminotransferase, depression effectiveness of
therapy, and to
alkaline phosphatase, evaluate for the
aspartate aminotransferase, Hepatic: hepatic failure, occurrence of any
bilirubin, blood urea nitrogen, hepatomegaly adverse effects
associated with
creatinine, eosinophils,
drug therapy.
gamma-glutamyltransferase, Musculoskeletal: arthralgia b. Assist client to
and lactate dehydrogenase: position of
increased levels Coombs’ test, Respiratory: dyspnea Skin: comfort.
urinary 17-ketosteroids, urticaria, maculopapular or c. Periodically assess
nonenzyme-based urine erythematous rash dose.
glucose tests (such as d. Introduce name
and build a good
Clinitest): false-positive Other: chills, fever,
rapport to the
results Hemoglobin, platelets, superinfection, pain at I.M. patient.
white blood cells: decreased site, anaphylaxis, serum Edx:
values. sickness a. Educate the client
on the adverse
effect of the drug.
b. Educate the client
on drug therapy to
promote
compliance.
c. Ensure the patient
takes the
medication as
prescribed.
d. Educate the client
on the purpose of
the medication.

DURING:
Dx:
a. Obtain vital signs.
b. Assess for nausea
and vomiting,
thirst, and severe
constipation.
c. Check if it is the
right medication.
Tx:
a. Assist client on
bathroom
privileges.
b. Assist client in
taking the
medication.
Edx:
a. Advice the client
to take the
medication after
meals.
b. Encourage the
client to verbalize
feelings and
concerns.
c. Instruct client the
drug is taken
through the mouth.
d. Educate regarding
the purpose or use
of the medication.

AFTER:
Dx:
a. Instruct patient to
report reduced
urinary output,
persistent diarrhea,
bruising, and
bleeding.
b. Assess calcium
level of the patient.
c. Assess for any
adverse effects of
the drug.
d. Assess
knowledge/teach
patient appropriate
use and
interventions to
reduce side effects.
e. Monitor for
effectiveness as
exhibited by a
decrease in
symptoms.
f. Asses the response
of the client to the
medication.
Tx:
a. Provide safety
measures to the
client.
b. Assist client on
bathroom
privileges.
c. Monitor patient’s
compliance to
drug.
Edx:
a. Instruct client to
verbalize feelings
and concerns.
b. Instruct not to
exceed
recommended
dosage.
c. Advice client to
increase fluid
intake.
d. Advice to notify
prescriber of
therapeutic
response to drug
decreases.
e. Instruct patient to
report if adverse
effect of drug is
experience.
DRUG NAME MECHANISM OF INDICATION / ADVERSE EFFECT NURSING
ACTION CONTRAINDICATION RESPONSIBILITIES

GENERIC: Interferes with bacterial INDICATIONS: CNS: headache, lethargy, BEFORE:


Cefazolin cell-wall synthesis, causing Respiratory tract infections confusion, hemiparesis, Dx:
cell to rupture and die. caused by group A beta- paresthesia, syncope, seizures a. Assess history that
BRAND: is contraindicated
hemolytic streptococci,
CV: hypotension, palpitations, to the drug.
Kefzol and Ancef SOURCE: Klebsiella species, chest pain, vasodilation EENT: b. Assess vital signs.
CLASS: Schull, P. (Seventh Edition. Haemophilus influenzae, and hearing loss GI: nausea, c. Observe the 10
First (2013). Mc-Graw-Hill Staphylococcus aureus; skin vomiting, diarrhea, abdominal Rights before
generation cephalosporin nurses drug handbook. infections caused by S. aureus cramps, oral candidiasis, administering the
and beta-hemolytic pseudomembranous colitis medication.
THERAPEUTIC streptococci; biliary tract d. Assess if the NSS
GU: vaginal candidiasis, IV solution is clear
Anti-infective infections caused by
nephrotoxicity Hematologic: and container is
Escherichia coli, Klebsiella lymphocytosis, eosinophilia, not damaged.
PHARMACOLOGIC: species, Proteus mirabilis, and bleeding tendency, hemolytic e. Assess if the
B-lactam Antibiotic S. aureus; bone and joint anemia, hypoprothrombinemia, medication for IM
infections caused by S. neutropenia, is in correct
DOSAGE: aureus; genital infections thrombocytopenia, dosage.
Powder for caused by E. coli, Klebsiella agranulocytosis, bone marrow f. Check for
depression Hepatic: hepatic allergies.
injection: 500 mg, 1 g, 10 species, P. mirabilis, and
failure, hepatomegaly g. Assess the skin for
g, 20 g Premixed strains of enterococci; redness or swelling
containers: 500 mg/50 ml septicemia caused by E. coli, Musculoskeletal: arthralgia before
in dextrose 5% in water Klebsiella species, P. administration.
(D5W), 1 g/50 ml in mirabilis, S. aureus, and S. Respiratory: dyspnea h. Identify the correct
D5W pneumoniae; endocarditis patient.
caused by S. aureus or Skin: urticaria, maculopapular
or erythematous rash Tx:
betahemolytic streptococci a. Perform a
Adults: For mild infections, Other: chills, fever, thorough physical
250 to 500 mg q 8 hours I.V. superinfection, anaphylaxis, assessment to
or I.M. For moderate to serum sickness establish baseline
severe infections, 500 to data before
administering
1,000 mg I.V. or I.M. q 6 to 8
drug, to evaluate
hours. For life-threatening of any adverse
infections, 1,000 to 1,500 mg effects.
I.M. or I.V. q 6 hours, to a b. Introduce name
maximum dosage of 6 g/day. and build a good
Children: For mild to rapport to the
moderate infections, 25 to 50 patient.
c. Assist the client to
mg/kg/day I.V. or I.M. in
needs such as
divided doses t.i.d. or q.i.d. bathroom
For severe infections, 100 privileges.
mg/kg/day I.V. or I.M. in
divided doses t.i.d. or q.i.d. ➣ Edx:
Acute uncomplicated urinary a. Educate the patient
on the purpose of
tract infections (UTIs) caused
the IM and IV
by E. coli, Klebsiella species, medication.
P. mirabilis, and strains of b. Educate patient on
Enterococcus and the side effects of
Enterobacter species Adults: 1 the drug.
c. Encourage to
g I.V. or I.M. q 12 hours ➣
verbalize feelings
Surgical prophylaxis Adults: and concerns.
1g I.V. or I.M. 30 to 60 d. Instruct the patient
minutes before surgery, then to have a meal
0.5 to 1 g I.V. or I.M. q 6 to 8 prior to giving the
hours for 24 hours. If surgery medication.
exceeds 2 hours, another 0.5-
DURING:
to 1-g dose I.M. or I.V. may
be given intraoperatively. ➣ Dx:
Pneumococcal pneumonia a. Watch for signs
and symptoms of
Adults: 500 mg I.M. or I.V.
superinfection and
infusion q 12 hours other serious
adverse reactions.
CONTRAINDICATIONS: b. Check if the
Hypersensitivity to materials are
cephalosporins or penicillins present before
inserting the IV
and injecting the
DRUG TO DRUG
IM medication.
INTERACTIONS: c. Check if it is the
Aminoglycosides, loop right medication.
diuretics: increased risk of d. Assess patient
nephrotoxicity closely during and
Anticoagulants: increased following infusion.
anticoagulant effect e. Observe
precautions.
Chloramphenicol:
Tx:
antagonistic effect a. Position the patient
Probenecid: decreased in a comfortable
excretion and increased blood position.
level of cefazolin b. Introduce name to
the patient and
DRUG TO DIAGNOSTIC build a good
rapport.
TEST: c. Calm the patient
Alanine aminotransferase, before injecting
alkaline phosphatase, the IV.
aspartate aminotransferase, d. Stay with the
bilirubin, blood urea nitrogen, client for at least a
creatinine, eosinophils, minute and
gamma-glutamyltransferase, observe her
lactate dehydrogenase: response to the
increased levels Coombs’ test, medication.
Edx:
urinary 17-ketosteroids,
a. Encourage the
nonenzyme-based urine client to verbalize
glucose tests (such as feelings and
Clinitest): false-positive concerns.
results Hemoglobin, platelets, b. Educate the patient
white blood cells: decreased on the adverse
values effect of the
medication.
c. Advice the client
DRUG TO BEHAVIORS: to report if adverse
Alcohol use: acute alcohol effect of the
intolerance (disulfiram-like medication is
reaction) if alcohol is experience.
consumed within 72 hours of AFTER:
drug administration Dx:
a. Assess the
injection site for
burning, swelling,
or stinging.
b. Monitor the
patient’s response
to the drug for at
least 30 minutes.
c. Assess client for
signs of
contraindication,
or adverse effect
of the drug.
d. Assess for drug
toxicity.
e. Assess the
response of the
client to the
medication.
f. Re-assess vital
signs.
Tx:
a. Provide safety
measures to the
client.
b. Assist the client to
needs.
c. Provide a clean
and comfortable
environment.
Edx:
a. Encourage to
verbalize feelings
and concerns.
b. Encourage to
report any signs of
adverse effect of
the medication, or
presence of
allergic reaction.
c. Instruct patient
to avoid
alcohol ingestion.
E. What necessary nursing interventions can be done on the patient if you are the nurses assigned? Prepare your Nursing Care Plan
following the prescribed format of CON. Prepare at least 2NCPS (1 Actual NCP and 1 Potential NCP).
ASSESSMENT EXPLANATION OBJECTIVES NURSING RATIONALE EVALUATION
OF THE INTERVENTION
PROBLEM S
Subjective: The patient was STO: Dx: STO:
experiencing pain in
“Sobrang sakit, the abdomen after 12 Within 30 minutes-1 - Assess pain - These data can be (Goal Met)
para bang may hrs of delivery. She hour of effective characteristics used to identify the Within 30 minutes-1
sumusuntok sa delivered vaginally nursing interventions, (quality, severity, extent of the pain as hour of effective
tiyan ko,” as and labor was the patient will report location, onset, well as serve as nursing interventions,
verbalized by the induced. Physical decrease of pain. duration, baseline information. the patient rated her
patient. examination was precipitating and
LTO: pain 4/10 on a pain
conducted and relieving factors).
Objective: scale of 0 to 10
shows tenderness Within 24-48 hours of - Assess signs and -Attention to without any signs of
- Guarding and abdomen effective nursing symptoms associated signs may guarding unless
behavior distention while interventions, the associated with pain help in evaluating the movement is
uterus remains patient will be able to such as BP, heart pain. initiated. Patient is
-Rigid abdomen be relieved from pain
retracted. Until pain rate, temperature, less serious and
- Facial grimace persisted for 24 and perform activities color and moisture conversant.
hours and was of daily living without of skin, restlessness,
- Pain rated 8/10 managed by discomfort. LTO:
and ability to focus.
on a pain scale of 0 antibiotics - Vital signs are
(Goal Met)
to 10. medication. usually affected when
Ultrasound reveals pain is present. Within 24-48 hours
- Assess vital signs.
hematoma of of effective nursing
Nursing Diagnosis: vesicouterine pouch interventions, the
which the - It helps determine patient is active,
Acute Lower accumulation of the effectiveness of shows no sign of
Abdominal Pain blood outside of pain control guarding and
related to rupture - Review patient’s
blood vessels due to measures. If the verbalized
of the uterus. medication records
rupture of the uterus. patient demands pain performing her
and flow sheet.
It happens as a result medications more activities of daily
of blood vessel frequently, a higher living needing any
damage, and blood dose may be needed. without assistance.
abnormal leakage Tx: Upon palpation of
into tissues. Blood the abdomen, shows
- Provide a quiet
that escapes from no sign of grimacing
environment and
within a blood vessel or pain.
comfort measures.
is very irritating to - Additional stressors
can intensify the
ASSESSMENT EXPLANATION OBJECTIVES NURSING RATIONALE EVALUATION
OF THE INTERVENTION
PROBLEM S
Objective: After STO: Dx: STO:
a hysterectomy, 
- febrile, infection can Within 30 minutes-1 - Assess for - To assess causative (Goal Met)
Temp=38.5 occur in the incision, hour of effective localized signs of and contributing Within 30 minutes-1
the vagina, and nursing interventions, infection in the factors of infection.
- swelling surgical hour of effective
bladder or inside the the patient will be able surgical site.
incision - To note presence of nursing interventions,
abdomen. Infection o to identify proper
- Assess surgical infection and wound the patient identify
- redness noted on ccurs in about 10% actions to prevent
incision. complications. proper actions to
the surgical wound of women who possible occurrence of prevent infection and
undergo infection and verbalize - Vital signs are verbalize
- wet surgical understanding of the essential as it is an
a hysterectomy even understanding of
dressing risk factors of important baseline as
after receiving individual causative
preventative infection. it provides
- weakness in - Assess vital signs. risk factors of
appearance antibiotics before the LTO: information of infection.
procedure. possible infection.
-patient appears A surgical site infect Within 24-48 hours of LTO:
irritable and ion (SSI) occurs whe effective nursing (Goal Met)
restless n pathogens multiply interventions, the
at the site of patient will achieve Within 24-48 hours
Nursing Diagnosis: - To gain trust and
a surgical incision, timely wound healing, of effective nursing
Risk of infection resulting in be afebrile, and cooperation. interventions, the
Tx:
related to an infection. identify interventions patient is able to
traumatized tissue to prevent or reduce - Establish rapport. achieve timely
Reference: infection. wound healing,
secondary to - For patient not to
- Assist patient on afebrile with a
hysterectomy. Tavella, J., Watson strain self.
comfortable temperature of 36.8
K., (2018). Hpw tp position. - To address the degree Celsius, and
tell if you have an
fever. identified
infection following - Perform tepid
surgery. Retrieved sponge bath. interventions to
on May 2, 2020 at prevent or reduce
- Maintain a sterile - Regular wound infection such as
https://www.healthli
technique when dressing promotes proper cleaning of
ne.com/health/signs-
changing the fast healing and wound asceptically.
of-infection-after-
wound. drying of wounds.
surgery

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