Professional Documents
Culture Documents
College of Nursing
Zamboanga City
Instructions:
Answer the provided questions comprehensively following the subsequent format.:
A. Use the Times New Roman Font Style with 12-point font size, 1.5 spacing, 8.5 x 13 paper size
B. Utilize at least three (3) or more references
C. References should be at least from the year 2015 onwards
D. Refer to the rubrics for alternative learning system for the rating system of your output
Ms F ,a 35 year old woman in her first pregnancy was admitted in Labor Room. On examination, she was
tachycardiac and had postural hypotension and ketonuria. Ms F was admitted and treated with intravenous
fluids of normal saline / PNSS 1L to run at 30gttds/minute and metoclopramide(Plasil), 10 mg IV every 8
hours . A viable intrauterine pregnancy was confirmed on ultrasound scan; she improved on the above therapy
and was discharged 2 days later.
In the subsequent 2 weeks, she had three further admissions with hyperemesis gravidarum (HG). On the third
occasion, she was severely dehydrated, had lost 7 kg in weight and was ketotic. She was admitted, rehydrated
and given regular cyclizine, 50 mg intravenously three times daily. Over the following week, she improved and
was sent home with oral antiemetic of metoclopramide 50mg as need for nausea and vomiting. folic acid (5 mg)
and thiamine hydrochloride (25 mg three times daily).
Vital Signs:
1) Blood pressure (BP) : 90/60 mmhg
2) Heart rate (HR) : 102 bpm
3) Respiratory rate (RR) : 22 b/min
4) Temperature : 36.7 0 C
5) Height : 158 cm (5’4)
6) Weight : 82.7 kg (starting weight)
History:
a.) Hyperemesis gravidarum during an earlier pregnancy
b.) Being overweight
c.) Being a first-time mother
Laboratory results:
Examinations Patient’s Result Normal Value Indication
Blood Exam
RBC 4.4 x 1,000,000/mm3 4.2-5.4 x 1,000,000/mm3 Normal
Hemoglobin 12.0 g/dL 12.0-15.5 g/dL Normal
WBC 6.2 x 1000/mm3 5.7-13.6 x 1000/mm3 Normal
Platelets 250 x 10^9/L 150 -400 x 10^9/L Normal
Urinalysis
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Appearance hazy Clear-very slight cloudy Abnormal
Color Dark yellow Pale light yellow – Yellow Abnormal
pH 5.0 4.5-8 Normal
Protein 4+ Negative Abnormal
Sp. Gravity 1.025 1.010-1.030 Normal
Glucose Negative Negative Normal
Casts None 0-5 Normal
WBC 1–2 <=2-5 Normal
RBC 0–1 <=2 Normal
Fecalysis
Color Dark brown Shades of Brown Normal
Consistency Soft formed Soft-firm Normal
Occult blood negative Negative Normal
Ova parasites None seen None Normal
Based on the Physical exam and history, the patient is diagnosed with Hyperemesis Gravidarum
Your Tasks:
1. Determine the need for the required laboratory and diagnostic examinations
Give the indications for the abnormal result/values
2. Illustrate the organ involved and label accordingly.
3. Discuss the normal function of the organ involved.
4. Explain the pathophysiology based on the patient’s diagnosis.
5. Explain the pathophysiology based on the diagnosis.
A. Create the pathologic pathway of the pathogenesis (the development of the disease and the chain
of events leading to the illness) contributing to the patient’s illness condition.
Indications for Abnormal Results or Values
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that a patient is dehydrated.
Reference:
Larsson A, Palm M, Hansson L-O, et al. Reference values for clinical chemistry tests during normal pregnancy.
Br J Obstet Gynaecol 2008;115:874. Lockitch G. Handbook of Diagnostic Biochemistry and Hematology in
Normal Pregnancy. Boca Raton, FL: CRC Press, 1993.
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A. outputt Template
(3) Complications of
Hyperemesis
Gravidarum; A Disease
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of Both Mother and
Fetus, Review Article,
2018, Abanoub Gabra,
Chief Resident,
Obstetrics and
Gynecology, Assuit
University, Egypt
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IV set Intravenous purpose For intravenous medication and fluid
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3. Nursing Care Plan
PLANNING
NURSIN
ASSESSMENT OBJECTIVE OF IMPLEMENTATION EVALUATION
G INTERVENTION RATIONALE
CARE
DIAGNO
SIS
Imbalanced Short term goals: Independent The patient reported
Subjective Cues: Nutrition: less than The patient will report decreased severity of
Determine the cause of Assessing the patient The patient had been
client stated that "These body requirements decreased severity or nausea and vomiting with the causes of diagnosed with hyperemesis nausea and
days, I throw up at any
related to nausea elimination of nausea. nausea will guide the gravidarum. demonstrated behaviors
random moments, and I don't
have an appetite to eat and vomiting choice of interventions and lifestyle, such as
because of this." secondary to Long term goals: to be used. Treatment sticking to healthy fiber
Hyperemesis The patient will demonstrate may not be needed if diet to regain and
gravidarum as behaviors and lifestyle the stimulus is maintain appropriate
Objective Cues: evidenced by loss changes to regain and weight during
eliminated.
had postural hypotension
7kg in 2 subsequent maintain appropriate weight pregnancy.
tachycardiac
ketonuria/ketotic
weeks. during her pregnancy. Determine lifestyle factors Socioeconomic The patient is 35 years old
three further admissions with that may affect weight. resources, amount of with viable intrauterine
hyperemesis gravidarum money available for pregnancy. Initially, she’s
had lost 7kg purchasing food, the 87kg at 5’4 ft height with 33
severely dehydrated proximity of grocery BMI classified as obese.
store, and available After 2 weeks diagnosed
storage space for food with HG, she had lost 7kg in
are all factors that may just 2 weeks.
impact food choices
and intake.
Encourage a rest period of 1 Helps reduce fatigue The patient had rest before
hour before and after meals. during mealtime and and after meals in small
Provide frequent small provides an frequent feedings to avoid
feedings opportunity heavy vomiting.
to increase total caloric
intake
Weigh, as indicated Useful in determining 2/20 – 80kg
caloric needs, setting 2/27-80.3kg
weight goals, and
evaluating the
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adequacy of nutritional
plan.
Collaborative
Consult dietitian or feeding and caloric Consulted dietitian for
nutritional support team to requirements are based modification of patient’s
provide easily digested, on the individual diet.
nutritionally balanced meals. situation and specific
needs to provide
maximal nutrients with
minimal client effort
and energy
expenditure.
Establish an ongoing method To assist in Established an ongoing
of evaluating intake determining both method of evaluating food
amount of food taken intake.
and what food groups
are consumed or left
uneaten, to identify
nutritional deficits
References:
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2018). Nursing diagnosis manual: Planning, individualizing, and documenting client care. Philadelphia, PA: F.A. Davis.
In Herdman, T. H., In Kamitsuru, S., & North American Nursing Diagnosis Association,. (2018). NANDA International, Inc. nursing diagnoses: Definitions & classification 2018-2020.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span. Philadelphia: F.A. Davis Co.
4. Drug study
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GENERIC NAME: Metoclopramide MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE REACTION NURSING RESPONSIBILITY
Blocks dopamine/serotonin receptors in chemoreceptor trigger
zone of the CNS. Enhances acetylcholine response in upper Side effects: Baseline Assessment:
GI tract, causing increased motility and accelerated gastric drowsiness Antiemetic: Assess for dehydration
emptying without stimulating gastric, biliary, or pancreatic restlessness (poor skin turgor, dry mucous
secretions; increases lower esophageal sphincter fatigue membranes, longitudinal furrows
tone. Therapeutic Effect: Accelerates intestinal transit, lethargy in tongue).
promotes gastric emptying. Relieves nausea, vomiting. dizziness Assess for nausea, vomiting,
anxiety abdominal distention, bowel
BRAND NAME: Plasil INDICATION: headache sounds
insomnia Intervention/Evaluation
Oral Monitor for anxiety, restlessness,
symptomatic treatment of diabetic gastroparesis altered menstruation
extrapyramidal symptoms (EPS)
gastroesophageal reflux constipation
during IV administration.
IV/IM rash
Monitor daily pattern of bowel
DRUG symptomatic treatment of diabetic gastroparesis dry mouth
activity, stool consistency.
placement of enteral feeding tubes galactorrhea
Assess skin for rash.
prevent nausea gynecomastia
Evaluate for therapeutic response
stimulate gastric emptying and intestinal transit barium
when delayed emptying interferes with the radiological Adverse Reaction: from gastroparesis (nausea,
examination of the stomach and/or small intestine. vomiting, bloating).
extrapyramidal reactions
To facilitate small bowel intubation in adults and Monitor renal function, B/P, heart
akathisia rate.
children. neuroleptic malignant syndrome Patient/Family Teaching
fever Avoid tasks that require alertness,
unstable Blood pressure motor skills until response to drug
muscular rigidity is established.
Report involuntary eye, facial,
CLASSIFICATION: CONTRAINDICATION: limb movement
Pharmacotherapeutic: Dopamine, Serotonin Hypersensitivity to metoclopramide
Avoid alcohol
receptor antagonist Concurrent use of medication likely to produce
Clinical: GI agent, Antiemetic extrapyramidal reactions.
DOSAGE/FREQUENCY/ROUTE: GI damages
History of seizure disorder
Nausea/Vomiting pheochromocytoma
IV: ADULTS, ELDERLY, CHILDREN: 1–2 mg/
kg 30 min before chemotherapy; repeat
q2h for 2 doses, then q3h for 3 doses.
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GENERIC NAME: Cyclizine MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE REACTION NURSING RESPONSIBILITY
The vomiting centre possesses neurons which are rich in muscarinic
cholinergic and histamine containing synapses. These types of neurons Side effects: Baseline Assessment:
are especially involved in transmission from the vestibular apparatus to drowsiness If pt is having an reaction, obtain a
the vomiting centre. Motion sickness principally involves overstimulation blurred vision history of recently ingested foods,
of these pathways due to various sensory stimuli. Hence the action of dry mouth drugs, environmental exposure,
cyclizine which acts to block the histamine receptors in the vomiting headache emotional stress.
centre and thus reduce activity along these pathways. Furthermore, constipation Monitor B/P rate; depth, rhythm,
since cyclizine possesses anti-cholinergic properties as well, the type of respiration; quality, rate of
muscarinic receptors are similarly blocked. pulse.
Adverse Reaction: Intervention/Evaluation
extrapyramidal reactions Monitor B/P.
BRAND NAME: Cyclizine INDICATION: hemorrhage Monitor effect of sedation
liver problems Patient/Family Teaching
Oral anaphylaxis Tolerance to antihistaminic effect
symptomatic treatment of diabetic gastroparesis psychomotor impairment does not occur
gastroesophageal reflux Tolerance to sedation may occur
IV/IM Avoid task that requires alertness
DRUG ILLUSTRATION: symptomatic treatment of diabetic gastroparesis Dry mouth, drowsiness, dizziness
placement of enteral feeding tubes may be an expected response to
prevent nausea drug.
stimulate gastric emptying and intestinal transit barium when
Avoid alcohol
delayed emptying interferes with the radiological examination of
the stomach and/or small intestine.
To facilitate small bowel intubation in adults and children.
CLASSIFICATION: CONTRAINDICATION:
Pharmacotherapeutic: Piperazine- Hypersensitivity to cyclizine
derivative antihistamine, antimuscarinic Taking anti-depressants
agent Clinical: Antivertigo, Antiemetic Hypotension
Glaucoma
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DOSAGE/FREQUENCY/ROUTE: Prostatic hypertrophy
Urinary retention
Nausea and vomiting Hepatic disease
Adult: As hydrochloride: 50 mg up to epilepsy
tid, up to 200 mg/day. For prevention of
motion sickness, 1st dose should be given
30 min before travelling.
Child: 6-12 yr: As hydrochloride: 25 mg
up to tid. For prevention of motion
sickness, 1st dose should be given 30 min
before travelling.
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B. Rubric for ALS
4 3 2 1
Follows and
Follows Demonstrat
Exceeds Follows
CATEGORY some but es little
expectations instructi
not all comprehens
noted in ons
instructions ion
instructions
I. STUDY OF ILLNESS CONDITION (total score = 48 points)
1. Assessment
Differentiates between subjective and
objective cues
Analyzes laboratory examinations
2. Anatomy
Indicates and labels the affected organ
Cites reference/s & Paraphrases
3. Physiology
Discusses the normal functions of the
organ involved
Cites reference/s & Paraphrases
4. Pathophysiology
Explains the pathophysiology based on
the diagnosis
Develops the pathologic pathway of the
patient’s current illness
Cites reference/s & Paraphrases
5. Analysis
Correlates signs & symptoms to the
illness condition
Relates laboratory / diagnostic exams to
the illness condition
Indicates the normal values and
significance of the laboratory results
TOTAL
POINTS
46 – 48 = 1.0
44 – 45 = 1.25
42 – 43 = 1.5
39 – 41 = 1.75
37 – 38 = 2.0
34 – 36 = 2.25
32 – 33 = 2.5
30 – 31 = 2.75
29 = 3.0
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Approved:
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