Tomas Claudio Colleges

Morong, Rizal
College of Nursing
Second Semester, S.Y. 2023-2024

Intrauterine Fetal
Demise
RIZAL PROVINCIAL HOSPITAL, MORONG

Dr. LILIBETH B. NADAL, RN, MAN

Clinical Instructor

Leader: San Juan, Karl Den L.

Members: Alba, Alyssa Louise R.
Apaya, Rona Lee DS.
Ataylar, Clarisse Jewel L.
Badili, Lourdeza C.
Cardenas, Maureen R.
Corpuz, JC M.
Leñida, Joanna R.
Maniaul, Kent Jerimhe D.
Pujalte, Kynn Rose R.
Zenarosa, Jade Nicole T.
1 Introduction

Intrauterine Fetal Demise/Death

The occurrence of Intrauterine Fetal Demise (IUFD) presents a

heartbreaking challenge and devastating experience that affects families around

the world. Imagine the hope that is filled with joy and dreams of having a

newborn only to be confronted with the overwhelming grief over a child’s lifeless

form. This case study holds significant importance as it provides insight into the

emotional, psychological and physical difficulties encountered by the parents and

to study the maternal and fetal factors associated with Intrauterine Fetal Demise.

In 2020, The Philippine Statistics Authority (PSA) reported that there were

approximately 1.01% of women in the Philippines suffered from Intrauterine Fetal

Demise (IUFD), also known as stillbirths. This alarming statistic translates to

11,700 reported cases of IUFD, with an estimated 1,148,000 live births in the

same year. It is concerning to note that the stillbirth rate in the Philippines is

significantly higher than the global average. According to The Philippine Statistics

Authority, the risk factors associated with Intrauterine Fetal Demise include

maternal age, placental abnormalities, fetal factors (congenital anomalies,

intrauterine growth restriction, and multiple gestations), maternal lifestyle factors

(smoking, obesity, alcohol consumption, illicit drug use), and certain medical

conditions such as hypertensive disorders of pregnancy, diabetes mellitus,

chronic kidney disease, thrombophilic disorders and autoimmune disorders and

socioeconomic factors.
 Numerous studies have consistently examined the clinical characteristics

of women with Intrauterine Fetal Demise. The most common clinical

manifestations reported were decreased or absent fetal movement followed by

vaginal bleeding and abdominal pain. Other less common manifestations

included uterine tenderness, maternal fever, and uterine contractions. The

management of IUFD typically involves a multidisciplinary approach.

Confirmation of fetal demise is usually done through ultrasound examination,

followed by the induction of labor to expel the fetus and placenta (Patel et al.,

2020). Supportive care, including pain management and emotional support, is

crucial for women experiencing this traumatic event. Additionally, investigations

into the underlying cause of IUFD, such as placental abnormalities or maternal

conditions, are often recommended to guide future pregnancy planning and

management (Jones et al., 2017).

1.2 Demographic Profile

Name: Toquero, Joymhie M.

Age: 35 years old

Gender: Female

Civil Status: Single

Nationality: Filipino
Address: Manila East Road, Plaza Aldea, Tanay, Rizal

Birthday: March 25, 1989

Birthplace: Novaliches

Occupation: Saleslady, caretaker

Religion: Roman Catholic

Educational Attainment: Highschool Graduate

Income: Dependent

Housing: Rent

Family structure: Separated, Extended Family

Household size: 5 Children/3 Adults and 1 Child Girl,7yrs old

1.3 Medical Profile

Date of admission: March 22, 2024

Chief complaint: Intrauterine Fetal demise 2 High Blood

pressure

Admitting diagnosis: G3’P1 (1’0’1’1) IUFD 23-24 weeks age of

gestation cephalic in presentation

Final diagnosis:

Operation performed:
Name of attending physician: Maricar B. Raines M.D

Arrived: G3,P1 (1011) PU23

Vital sign: Blood pressure: 160/90

Pulse rate: 125

Respiratory rate: 20

O2 Sat: 98%

Height: 149cm

Weight: 65.5 kg

BMI: 29.5 (Overweight)

2 Objectives
General objectives

The presenters and the audience will improve their understanding of

intrauterine fetal demise at the end of the case presentation. and gain knowledge and

enhance skills in handling a mother with Intrauterine fetal demise.

Students centered objectives:

 To obtain necessary information regarding the patient and her condition.

 To improve effective communication skills to the patient and during care

presentation

 Describe management approaches of patient diagnosis of Intrauterine fetal

demise.
  Develop a warm environment between the students and the patient towards

improvement of health -strengthen cooperation and unity among member of the

group by performing right and proper nursing care and responsibilities.

 Obtain baseline data of signs and symptoms of a patient with intrauterine fetal

demise.

Client centered objectives:

 Express awareness on the needs and condition of her status

 Identify the importance treatments done to the patient

 Modify the need for a healthy lifestyle to improve condition

 Develop the family support system and distinguish their perspective roles in

improving her health status

 Practice managing and self care

3 Past and Present Medical History

3.1 Past History

During interview, the patient reported that she has a total of 3 pregnancies

in which the first pregnancy resulted in abortion when the fetus is 3 months of

age in gestation. She underwent a dilatation and curettage at Padilla Antipolo

Annex. In her second pregnancy, a caesarean section was performed as the

patient had sever preeclampsia that is also performed in Antipolo Annex. Ever
since the age of 6, the patient had recurring Urinary Tract Infection and Asthma

episodes.

The medication involves a maintenance for asthma which is Seretide

inhaler. Pecof syrup is also used to manage her asthma. The patient use

Losartan as a maintenance drug for hypertension. During her preeclampsia in the

second pregnancy, she had magnesium sulfate 10mg. She also drinks

Paracetamol (Biogesic) is the go-to medication for headaches. She also noted

that she immediately takes paracetamol whenever she felt a headache.

In the year 2023, she took a course of contraceptive pill. The patients diet

includes rice and instant noodles. Eating 1-2 cups of rice every meal and having

4-5 meals per day.

There is a history of vaginal spotting during her first pregnancy. The

patient has little to no exercise prior to the pregnancy.

Patient noted no allergies

3.2 Present history

Upon interview, the patient has no check-ups for pre-natal, no

vaccinations, no ultrasound prior to admission. The patient also has community

acquired pneumonia. Last reported menstrual period was the last week of

September 2023.
 Tuesday, March 19, 2024, the mother check-up in health center.

Thursday, March 21, 2024, night time, she felt pain in the pelvic region after

commute. Friday, March 22, 2024 performed a pelvic ultrasound resulting to a

diagnosis of Intrauterine Fetal Demise and the fetus already passed meconium in

the uterus. The patient stated that she had a second opinion but later confirming

that the physician’s diagnosis was consistent with the second opinion. That same

day, the patient was admitted into the hospital and performed a pelvic ultrasound

and a chest x-ray. The laboratory results to a probable mild cardiomegaly and a

lower lobe pneumonia.

4 THEORETICAL FRAMEWORKS

5 GORDON’S ASSESSMENT

FUNCTIONAL HEALTH QUESTIONS PATIENT’S RESPONSE

PATTERNS
Heath perception/ • Tanda nyo pa po ba -LMP (Sa pagkakatanda
Health management huling menstruation nyo? ko, September 27”)
O kailangan huling dalaw - Antibiotics, Cefuroxine,
nyo? salbutamol, Losartan
• May mga iniinom po ba
kayong gamot bata
mabuntis?
Nutritional-Metabolic Assess for patient’s skin, -No underlying findings
teeth, nails and hair
Elimination May napapansin po ba -Normal discharge
kayong kakaiba sa - Constipated
discharge nyo? -Normal urine output
• Kapag umiihi po ba
kayo o dumudumi, may
nararandaman po ba
kayong pananakit?
Activity- Exercise • May work po ba kayo? -Nature of work
Ano pong trabaho nyo “nag aalaga ako ng tita
bago kayo mabuntis? kong may dementia,
• May active lifestyle p naging sales lady)
ova kayo? Nag -“ Pag lilinis nalang sa
 zuzumba? Nag bahay yung nagiging
eexercise? exercise ko”
• Mabilis po ba kayo - Dyspnea even without
hingalin? workloads

Cognitive- Perceptual Assess for skin, check -Vision is not clear,

for skin infection or already have a
rashes prescription even before
Assess for sensory and pregnancy
cognitive patterns - No skin condition
• May mga pagbabago -Normal hearing
po ba sa balat nyo? May -Taste— Normal
mga rashes po ba or -Smell— Normal
mga hindi gumagaling na - Cognitive—- Accurate
sugat? - “sa pag dedesisyon,
• Before po tayo mag hipag ko pati katuwang
proceed sa assessment ko na din”
may babanggitin po
akong mga salita na
kailangan nyo tandaan at
itatanong ko po after ng
assessment (Airplane,
Pretzel, Pencil)
Start assessing the
patient for vision,
hearing, smell, taste &
pain)
• Sa pag dedesisyon,
may nakakatulong po ba
kayo?
•Sino po ang katuwang
nyo?
Sleep-Rest • Nakakakumpleto po ba -“Hindi, minsan lang din
kayo ng tulog? makatulog sa hapon”
• Nakakaidlip naman po
sa tanghali?
Self Perception/ Self Observe the patient’s -Patient has no sign of
concept attitude and way of uncomfortability
response in the interview
— Assure the
comfortability of the
patient
Role-Relationship • Ngayon po na nandito -“Papa ko nag tutustos”
kayo sa hospital, sino po -“Hirap pero kakayanin”
ang nag tutustos ng
gastusin at
 pangangailangan nyo?
• napupunan naman po
ba ang mga
pangangailangan sa
araw araw sa bahay?
Sexual Reproductive -“pang ilang pagbubuntis - pangatlong
nyo na po” pagbubuntis ko na to
- ilang taon na po yung - nalaglag yung pnaka
panganay nyo? Sa una kong pagbubuntis 3
pangalawa po and months. And pangalawa
pangatlo po ko naman ay na
preeclampsia ako kaya
pinaanak agad. Then ito
ngang pangatlo, nawala.
Coping/ Stress • pag handle po ng “ Pag lilinis ng bahay
Tolerance stress, ano po ang lang din ginagawa ko”
ginagawa nyo? “ Meron naman”
•May napag sasabihan “nanunuod ng k-drama”
po ba kayo ng
problema?
Value- Belief • may paniniwala po ba “Wala naman akong
kayo sa relihiyon nyo na iniinom”
inaapply nyo san naging
pag bubuntis nyo?
• May iiniinom po ba
kayong mga herbal
drinks na hindi
pinescribe ng doctor
nyo? O mga iniinom sa
bahay?

HEALTH PERCEPTION – HEALTH MANAGEMENT

 The patient had practice of self medication & no records of regular

prenatal checkups.

 Was able to recall her last menstrual period

NUTRIONAL/ METABOLIC PATTERN

 Patient had a multiple pregnancy discomfort & unhealthy food intake leads

to overweight even before the pregnancy

ELIMINATION

 Positive for Urinary tract infection before pregnancy

 Patient has history of constipation during all throughout the pregnancy

ACTIVITY/EXERCISE

 Patient’s nature of work has heavy workloads as a caretaker with

dementia

 No active lifestyle & only do household chores as her past time and

experiencing shortness of breath

SLEEP/ REST

 Trouble of having adequate sleep due to her nature of work

ROLE-RELATION PATTERN

 Financially dependent as of the moment

SEXUALITY – REPRODUCTIVE

 Patient verbalized the occurence from her 1st pregnancy up to recent

 missed miscarriage fr first pregnancy

 Preeclampsia second pregnancy

 confirmed Intrauterine fetal demise at 23-24 weeks (recent)

COPING/STRESS TOLERANCE

 Patient has a strong support emotional system and doing household

chores as one of her coping mechanism

VALUE/ BELIEF *

 No practices and belief applied on the pregnancy

INSIGHT——

POSSIBLE CAUSES OF IUFD BASE ON PHYSIOLOGICAL AND

PSYCHOLOGICAL ASSESSMENT

 Missed Miscarriage (first pregnancy)

 History of preeclampsia (2nd pregnancy)

 Recurrent Urinary Tract Infection (Since Elementary)

 Community Acquired Pneumonia

 Probable Mild Cardiomegaly

 Poor diet

GORDON’S PHYSIOLOGY AND PSYCHOLOGY ASSESSMENT

Functional Health Patterns

1.Health perception/ Health management

1.1 Last menstrual Period
State: September 27, 2023
1.2 Medical & Medication history during pregnancy
State: ____G1 +abortion,G2 Preeclampsia, G3 IUFD____
1.3 Do you have regular check up?
Prenatal: Yes ( ) No ()
2. NUTRITIONAL/ METABOLIC PATTERN
2.1 Pregnancy discomfort
(  ) Headache ( ) Heartburn ( ) Frequent
urination
( ) Nausea (  ) Asthma
(  ) Constipation ( ) Shortness of breath
(  ) Blurred vision ( ) Nausea
2.3 Assessment of metabolic
Weight during pregnancy: __65.5 kg
Food allergies: No (  ) Yes ( ) If yes, specify: ______
Skin allergies: No (  ) Yes ( ) If yes, specify: _______
Open/ unhealed wounds : No (  ) Yes ( ) If yes, specify: _______
2.4 Food consumption
(  ) Salty foods (  ) Vegetable and fruits
( ) Dairy foods ( ) Carbonated/Soft drinks
( ) Sweet foods

3. ELIMINATION
3.1 Urine (  ) Regular
( ) Irregular
3.2 Stool (  ) Regular
( ) Irregular
3.3 History of Constipation
Yes (  ) No ( )

3.4 History of Urinary Tract Infection (UTI)

Pregnant: Yes (  ) No ( )
3.5 Vaginal Discharge
(  ) Clear ( ) Gray ( ) Yellow/ Green
( ) White ( ) Red/Pink
4. ACTIVITY/ EXERCISE
4.1 Do you have active lifestyle? Like engaging with physical exercise?
Yes ( ) No (  )
4.2 Do you still work while pregnant?
Yes (  ) No ( )
4.3 Do you still do household chores while pregnant?
Yes (  ) No ( )
4.4 When doing workloads were you experiencing shortness of breath?
Most of the time (  ) No ( ) Often ( ) Sometimes ( )
5. SLEEP/ REST
5.1 Had enough sleep while pregnant
Yes ( ) No (  )
5.2 Reason of lack of sleep
Insomnia (  ) Noisy environment (  )
Nature of work ( ) Pregnancy discomfort (  )
Sleeping amenities ( ) Frequent urination ( )
6. SELF PERCEPTION/ SELF CONCEPT
6.1 Did your pregnancy affect your mood behavior/ instability and how you
perceive with your daily lifestyle?
Yes ( ) No ( )
6.2 Do you still find confidence on how you look?
Yes ( ) No ( )
7. ROLE-RELATION PATTERN
7.1 Are you financially independent?
Yes ( ) No (  )
If not, who is supporting you? ______
8. SEXUALITY-REPRODUCTIVE PATTERN
8.1 Were you able to have health education the sexual activity while you’re
pregnant?
Yes (  ) No ( )
9. COPING/ STRESS TOLERANCE
9.1 Do you have someone you can talk when in times of hardship?
Yes (  ) No ( )

9.2 Are you able to have support in:

(  ) Emotional
(  ) Physical
(  ) Financial
9.3 Were you able to cope up with stress every time?
Yes ( ) No (  )
9.4 How do you handle your stress?
Management done: ______Clean the house, watch Korean Drama________
10. VALUE-BELIEF
10.1 Do you have belief and practices in your religion that you are applying with
your pregnancy?
Yes ( ) No (  )
If yes, Specify: _________

Physical Examination

A. General Appearance

a. Body Built

Small
Medium

Large

b. Posture

Healthy Lordosis Forward head

Flat back Kyphosis

c. Odor

None

d. Physical Deformities

None

Clinical measurement

Height: 149cm

Weight: 65.5kg

BMI: 29.5 Overweight

B. Mental Status

GCS:14
b. emotional Status: Cooperative

c. language and communication: Use of Simple words

C. Integumentary System

Current skin problems

rashes

lesions

dryness

oiliness

drainage

bruises

swelling

increased pigmentation
6 LABORATORY AND DRUG STUDY

HEMATOLOGY
PARAMETER RESULT REFERENCE FINDINGS
VALUE
Hemoglobin H 156.0 123.0 - 153.0 g/L High hemoglobin level is most often caused by low oxygen levels in the
blood (hypoxia), present over a long period of time. It is concluded that
high Hb levels during pregnancy may indicate a fetus at risk because of
high viscosity of the mother's blood.
Hematocrit H 0.46 0.36 - 0.45 vol% When the hematocrit value is high, the proportion of red blood cells in the
blood is higher than normal. This can indicate: Dehydration. A disorder
that causes your body to produce too many red blood cells, such as
polycythemia vera.
Red Blood Cells 5.3 4.5 - 5.1 If the patient have a high red blood cell count, then they have something
H x10^12/L called erythrocytosis. This makes your blood thicker than it should be, and
it could increase your risk for blood clots.

MCV 87 80.0 - 96 fL
MCH 30 27.0 - 33.0
picogram
MCHC 3.39 3.30 - 3.60 g/dL
Platelet Count 279.00 150.0 - 450.0
x10^9/L
White Blood 8.01 4.4 - 11.3
Cells x10^9/L
DIFFERENTIAL COUNT
Neutrophils 0.54 0.40-0.65 %
Lymphocytes H 0.39 0.28-0.35 % A high lymphocyte count can point to: Infection, including bacterial, viral or
other type of infection. It often indicate your body is dealing with an
infection or other inflammatory condition.
Monocytes H 0.07 0.02-0.06 % High monocyte count usually means your body is fighting some kind of
viral, bacterial, or parasitic infection, often linked to long-term infections,
blood disorders, or autoimmune conditions.
Eosinophils L 0.00 0.01-0.04 % A low eosinophil count, also known as eosinopenia, can result from
intoxication from alcohol or excessive production of cortisol, as in Cushing
disease. Cortisol is a hormone naturally produced by the body.
Basophils 0.00 0.00-0.01 %

Remarks: BLOOD TYPE “O” POSITIVE

Examination: PELVIC ULTRASOUND

ULTRASOUND REPORT:

Within an enlarged uterus is a single fetus in cephalic presentation with the following parameters:

BPD - 56.9mm (23 w 3 d)

HC - 209.4mm (23 w 0 d)
AC - 190.6mm (23 w 6 d)
FL - 42.8mm (24 w 0d)
EFW - 628gms
EDD by ultrasound: July 15, 2024 (+/- 2weeks)

Real time scan shows no cardiac nor musculoskeletal activities.

Amniotic fluid appears scanty.
Placenta is implanted anteriorly with grade 1 changes.

IMPRESSION:
-Intrauterine fetal demise is considered.
Examination Done: CHEST PA
EXAMINATION RESULT

Both lower lobe hazy infiltrates are noted.

Heart appears slightly enlarged.
Diaphragm and sulci are intact.
The rest are unremarkable.

IMPRESSION:
BOTH LOWER LOBE PNEUMONIA.
PROBABLE MILD CARDIOMEGALY
 DRUG STUDY

Name of Patient: Tuquero, Joymhie Age: 34 Hospital Number: 08293 Ward: OB Sex: F

Med. Dosage Frequency 3/22/24 3/23/24 3/24/24 3/25/24 3/26/24

Hydralazine 5mg IV now 2:40PM
Amlodipine 5mg OD 2:35PM 8:00 8:00
now then OD
HNBB 1amp q4 2:40PM 8:00AM 8:00AM 8:00AM
4:00PM 12:00NN 12:00NN 12:NN
8:00PM 4:00PM 4:00PM 4:00PM
12:00MN 8:00PM
4:00AM 12:00MN
4:00AM
Ceftriaxone 2mg TIV 7:00PM 7:00PM 7:00PM
OD
Azithromycin 500mg IV 7:10PM 7:00PM 7:00PM
OD x 5 days
NAC 600 mg in ½ glass 7:00PM 8:00AM 8:00AM 8:00AM
H2O BID 8:00PM 8:00PM
Hypoglycemia Protocol 7:00PM
CBG ≥100mg/dL – 20 cc (20cc)
D5050
≥80mg/dL – 30cc D5050
≥60mg/dL – 50cc D5050
Losartan 50mg now 9:00AM
then OD
 NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING
MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Hydralazine Classification: Indication: Adverse Effect: Nursing Consideration:

Hydrazinophthalazine  Chronic CNS: Anxiety.  Verify the
Brand Name: Derivatives hypertension Headache, depression, patient’s
Apresoline (Antihypertensive)  Hypertensive dizziness, peripheral identity.
Mechanism of Action: crisis neuritis increased  Check the
Dosage: As direct vasodilator,  Severe Essential GI: Nausea, vomiting, doctor’s order.
5mg dilates arterioles with Hypertension diarrhea,  Explain to the
Frequency: little effect on vein, Contraindication: anorexia Constipation, patient about
decreases systemic Hypersensitivity to Skin: Diaphoresis the purpose and
Route of resistance, which hydralazine; coronary pruritus, urticaria, rash. the importance
Administration: subsequently decrease artery disease; mitral CVS: Palpations, of the drug.
IV (Intravenous) blood pressure valvular rheumatic tachycardia, and  Administer the
heart disease is angina pectoris. right drug.
contraindication for its  Administer at
use. Side Effect: the right time
CVS: Pounding/ fast and right dose.
heartbeat.  Advice the
GI: nausea and loss of patient to get up
appetite slowly when
Skin: rash, mild itching, rising from
or skin discomfort. sitting or lying
position.
 Documentation
 NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING
MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Amlodipine Classification: Indication: Adverse Effect: Nursing Consideration:

Calcium Antagonist Amlodipine is used  Overdose may  Check for history
Brand Name: Mechanism of Action: alone or in combination produce of allergies.
Norvasc Amlodipine inhibits with other medications excessive  Check vital signs
calcium movement as management to peripheral before giving
Dosage: across cardiac and lower blood pressure by vasodilation, medicine.
5mg vascular smooth relaxing the blood marked  Instruct patients
Frequency: muscle cell membranes vessels so that the hypotension to take
OD during depolarization. heart does not have to with reflex medication
Route of It dilates coronary pump as hard. It is also tachycardia, and without regard
Administration: arteries, and peripheral used to treat certain syncope. to food.
PO arterioles. It decreases types of anginas (chest  more frequent However, take
total peripheral pain) and coronary or more severe the medication
vascular resistance and artery disease chest pain. with meals if
blood pressure by (narrowing of the blood  peripheral stomach upset
vasodilation vessels that supply edema. occurs.
blood to the heart)  rapid, pounding,  Inform the
Contraindication: or irregular patient that he
 Hypersensitivity heartbeat. may experience
to amlodipine or  Fainting. side effects such
to its dosage  Constipation as nausea and
form Side Effect: vomiting
components  Headache (instructed to
 Cardiogenic  Dizziness eat small,
 shock  Drowsiness frequent meals
 Severe aortic  Nausea if this happens)
stenosis  Bradycardia and headache
 Unstable  orthostatic (instructed to
angina hypotension adjust lighting,
 Severe  upset stomach. noise, and room
hypotension  flushing temperature).
 Heart failure  unusual fatigue  Inform patients
 Hepatic or weakness that amlodipine
impairment may make him
 Pulmonary feel dizzy or
congestion drowsy. Instruct
not to do
activities that
require
concentration
and alertness.
 Instruct the
patient to report
immediately.
 feelings of
shortness of
breath, irregular
heartbeat,
swelling of the
hands or feet,
pronounced
dizziness, or
constipation.
 NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING
MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

HNBB (Hyoscine-N- Classification: Indication: Adverse Effect: Nursing Consideration:

Butyl bromide – oral) Antispasmodic Drug Relief of smooth muscle  Tachycardia  Assessment for
Mechanism of Action: spasms of the  Anaphylaxis allergy to
Brand Name: Hyoscine-N-butyl gastrointestinal and  Heart failure metoclopramide.
Buscopan bromide is a genitourinary systems  Coronary heart  Assess for other
Dosage: quaternary ammonium and its associated pain disease contraindications
1 ampule antimuscarinic agent. or discomfort.  Cardiac .
It does not readily pass Contraindication: arrhythmia  Raise side rails as
Frequency: the blood-brain barrier.  Myasthenia  Hypertension a precaution
q4 It's a competitive gravies Side Effect: because some
Route of antagonist of the  Megacolon  Dry mouth patients become
Administration: actions of acetylcholine  Hypersensitivity  Nausea disoriented, and
IM (Intramuscular) and other muscarinic to drug contents  Decreased some develop
IV (Intravenous) agonists. The receptors  Narrow angle sweating. amnesia or
affected are those of glaucoma  Flushing become drowsy.
peripheral structures  Tachycardia  Blurred Vision  Educate patients
that are either  Constipation regarding desired
stimulated or inhibited  Dizziness and adverse
by muscarine, exocrine effects.
glands, smooth and  Educate the
cardiac muscle patient to avoid
hazardous
 NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING
MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Ceftriaxone Classification: Indication: Adverse Effect: Nursing Consideration:

Cephalosporin Lower respiratory Injection site  Instruct the
Brand Name: Ceftrisol Antibiotics infections caused by inflammation, rash, patient that if
Plus, Rocephin Mechanism of Action: Streptococcus pruritus, fever, their symptoms
Ceftriaxone is a 3rd pneumonia, eosinophilia, urticaria, do not improve
Dosage: generation broad – Staphylococcus aureus, anaphylaxis, colitis, within a few
2mg spectrum Haemophiles influenza, diarrhea, nausea, and days, or if they
Frequency: cephalosporin E. coli, Enterobacter vomiting, become worse,
OD antibiotic. It binds to 1 aerogenes. pseudomembranous check with your
Route of or more penicillin – Intra-abdominal colitis. doctor.
Administration: binding proteins (PBPs) infections caused by E.  This medicine
IV (Intravenous) inhibiting the final coli, Klebsiella may cause
transpeptidation step pneumoniae. serious allergic
of peptidoglycan Contraindication: reactions,
synthesis in the  Contraindicated including
bacterial cell walls, in patients anaphylaxis,
leading to bacterial cell hypersensitive which can be
lysis and death. to drug or other life-threatening
cephalosporins. and require
 Use cautiously immediate
in patients medical
hypersensitive attention. Call
to penicillin your doctor
 because of right away if
possibility of you have
cross-sensitivity itching; hives;
with other beta- hoarseness;
lactam shortness of
antibiotics. breath; trouble
 To reduce breathing;
development of trouble
drug-resistant swallowing; or
bacteria and any swelling of
maintain your hands,
effectiveness of face, or mouth
antibacterial after you receive
drugs, use drug this medicine.
only to treat or  Give health
prevent education about
infections Ceftriaxone that
proven or may cause
strongly diarrhea, and in
suspected to be some cases it
caused by can be severe.
bacteria. Do not take any
 Use cautiously medicine to
in patients with treat diarrhea
history of colitis, without first
renal checking with
insufficiency, or your doctor.
GI or Diarrhea
gallbladder medicines may
disease. make the
diarrhea worse
or make it last
longer. If you
have any
questions about
this or if mild
diarrhea
continues or
gets worse,
check with your
doctor.
 Give health
teaching about
Pancreatitis may
occur while you
are using this
medicine. Tell
your doctor
right away if
you have
sudden and
severe stomach
pain, chills,
constipation,
nausea,
vomiting, fever,
or
lightheadedness
 .

NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING

MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Azithromycin Classification: Indication: Adverse Effect: Nursing Consideration:

Macrolides Treatment of lower Mild to moderate  Tell the patient
Brand Name: Mechanism of Action: respiratory infections: nausea, vomiting, to take the drug
Zithromax Azithromycin is a Acute bacterial abdominal pain, as prescribed,
macrolide antibiotic exacerbations of COPD dyspepsia, flatulence, even after she
Dosage: under the azalide due to Haemophiles diarrhea, cramping; feels better.
500mg group. It inhibits RNA – influenzae, Moraxella angioedema,  Tell the patient
Frequency: dependent protein catarrhalis, cholestatic jaundice; to report
OD x 5 days synthesis by binding to Streptococcus dizziness, headache, adverse effect.
Route of the 50s ribosomal pneumonia; vertigo, somnolence;
Administration: subunit, preventing the community-acquired transient elevations of
IV (Intravenous) translocations of pneumonia due to liver enzyme values.
peptide chains. Pneumonia, Influenzas
Contraindication:
Contraindicated with
hypersensitivity to
azithromycin,
erythromycin, or any
macrolide antibiotic.
 Use cautiously with
gonorrhea or syphilis,
pseudomembranous
colitis, hepatic or renal
impairment, lactation.

NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING

MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

NAC (N-Acetyl Classification: Indication: Adverse Effect: Nursing Consideration:

Cysteine) Mucolytic Agents  Acetaminophen Anaphylaxis and  Assessment
Mechanism of Action: toxicity hypersensitivity History: Allergy
Brand Name: NAC by itself also binds  Post liver reactions causing to
Mucomyst to the toxic transplant. flushing, urticaria, acetaminophen,
metabolites and  Acute liver failure angioedema, nausea, impaired
Dosage: scavenges free  Adjunctive vomiting, tachycardia, hepatic
600mg in ½ glass H2O radicals. It also therapy in hypotension, function, chronic
Frequency: increases oxygen patients with bronchospasm, chest alcoholism,
BID delivery to tissues, abnormal or viscid tightness, disagreeable pregnancy,
Route of increases mucous secretions odor, drowsiness, lactation
Administration: mitochondrial ATP in fever, hemoptysis,  Physical: Skin
PO production, and alters bronchopulmonar increased volume of color, lesions; T;
the microvascular tone y diseases, bronchial secretions. liver evaluation;
to increase the blood pulmonary CBC, LFTs, renal
flow and oxygen complications of function tests
delivery to the liver surgery, and cystic  Interventions
and other vital organs. fibrosis.  Do not exceed
Contraindication: the
In patients with a prior recommended
history of hypersensitivity dosage.
to any of the ingredients.  Consult
Also, in asthmatics and physician if
patient with history of needed for
bronchospasm. children < 3 yr; if
needed for
longer than 10
days; if
continued fever,
severe or
recurrent pain
occurs (possible
serious illness).
 Avoid using
multiple
preparations
containing
acetaminophen.
Carefully check
all OTC
products.
 Give drug with
food if GI upset
occurs.
 Discontinue
drug if
 hypersensitivity
reactions occur.
 Treatment of
overdose:
 Monitor serum
levels regularly,
N-acetylcysteine
should be
available as a
specific
antidote; basic
life support
measures may
be necessary.
 Teaching points
 Do not exceed
recommended
dose; do not
take for longer
than 10 days.
 Take the drug
only for
complaints
indicated; it is
not an anti-
inflammatory
agent.
 Avoid the use of
 other over-the-
counter
preparations.
They may
contain
acetaminophen,
and serious
overdosage can
occur. If you
need over-the-
counter
preparation,
consult your
health care
provider.
 Report rash,
unusual
bleeding or
bruising,
yellowing of skin
or eyes, changes
in voiding
patterns.
 NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING
MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Losartan Classification: Indication: Adverse Effect: Nursing Consideration:

Antihypertensive  Hypertension: Patients with  Assess vital signs,
Brand Name: Cozaar Mechanism of Action: Losartan with Hypertension or left especially blood
Inhibits Thiazide ventricular pressure.
Dosage: vasoconstriction and diuretics, hypertrophy.  Assess client
50mg aldosterone-secreting calcium channel  CNS: Dizziness, history for any
Frequency: action of angiotensin II blockers, and Asthenia, contraindications
OD by blocking angiotensin ACEI are used as Fatigue, .
Route of II receptor on the the initial Headache,  Assess for
Administration: surface of vascular therapy for Insomnia hypersensitivity.
PO smooth muscle and stage1  CV: Edema,  Advise client to
other tissue cells. hypertension. Chest pain. report all adverse
Combination  EENT: Nasal reactions and to
therapy is congestion, immediately
employed to Sinusitis, report swelling of
achieve blood Pharyngitis, face, eyes, lips, or
pressure targets Sinus Disorder. tongue, or
in patients with  GI: Abdominal breathing
an pain, Nausea, difficulty.
atherosclerotic Diarrhea,  Monitor patient’s
heart disease Dyspepsia, or BP closely to
risk of higher indigestion. evaluate
than or equal to  Respiratory: effectiveness of
10%. In the Cough therapy. (When
 absence of used alone, the
comorbidities drug has less
such diabetes, effect on BP in
ischemic heart patients who are
disease, black, than in
cerebrovascular patients of other
illness, heart races.
failure, and  Encourage to
chronic renal take adequate
disease, fluid intake.
angiotensin II
receptor
blockers (ARBs)
are effective as
monotherapy.
 Hypertension
with left
ventricular
hypertrophy:
Losartan blocks
the angiotensin
II-induced
remodeling of
the heart in
people with high
blood pressure
and left
ventricular
hypertrophy. It
 lessens these
patients' risk of
having a stroke.
Contraindication:
 Contraindicated
in patients
hypersensitive
to drugs.
 Use cautiously
in patients with
impaired renal
or hepatic
function.
 It may interact
with other
medications,
including
nonsteroidal
anti-
inflammatory
drugs (NSAIDs)
and certain
diuretics.
 Patients with a
history of
angioedema (a
type of severe
allergic
reaction)
 associated with
previous use of
an ARB should
not take
losartan.

NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING

MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Generic Name: D5050 Classification: Indication: Adverse Effect: Nursing Consideration:

Glucose – Elevating Treatment of severe  Significant:  Check blood
Dosage: Agents hypoglycemia Electrolyte glucose level 15
Intravenous Adult 10- Mechanism of Action: Contraindication: imbalance (e.g. minutes after
25g (40-100 mL of 25% Glucose, the natural  Hypersensitivity hypokalemia), injection.
soln or 20- 50 mL of sugar occurring in to glucose, corn, hypersensitivity If blood glucose
50% soln) as a single blood, is the primary or corn anaphylaxis). level is still < 3.3
dose via central vein, source of energy in products. dehydration, mmol/liter or <
repeat, if necessary, in cellular metabolism.  Patient w/ severe reactions 60 mg/dl,
severe cases. It is converted readily severe (e.g. administer a
Child: 0.5-1 to fat which provides a dehydration  CV: Localized second dose or
g/kg/dose. rich store of energy in  Glucose- phlebitis, venous give oral
Max: 25 g/dose concentrated form, and galactose irritation and glucose,
Route of it also promotes malabsorption thrombosis, according to the
Administration: glycogen deposition in syndrome thrombophlebitis patient's clinical
IV (Intravenous) the liver.  Ischemic stroke. . condition.
 Admin of  Resp: Pulmonary  Do not
 hypertonic soln vascular administer
in patients (esp precipitates and tramadol via IM
if dehydrated) oedema. or SC injection.
intracranial or  Hepatic: Hepatic  Monitor serum
intraspinal failure, cirrhosis, and urine
hemorrhage. w/ cholestasis, glucose, serum
 diabetic coma steatosis, electrolytes,
 delirium increased intake, and
tremens. bilirubin and output (1 & 0),
hepatic enzyme, caloric intake
cholecystitis,
cholelithiasis.
 Genitourinary:
Diuresis.
 Endocrine:
Glycosuria,
hyperosmolar
syndrome,
hypervolemia.
 Dermatologic:
Rash.
 Others: Catheter
infection, sepsis,
chills, fever,
infusion site
reactions (e.g.
erythema and
pain).
  Potentially Fatal:
Severe
hyperglycemia
and
hyponatremia

NAME OF DRUGS CLASSIFICATION INDICATION AND ADVERSE EFFECT/SIDE EFFECT NURSING

AND MECHANISM CONTRAINDICATION CONSIDERATION
OF ACTION

IVF of D5LR Classification: Indication: Adverse Effect: Nursing

Glucose – Elevating  Treatment for  Immune System Disorders Consideration:
Brand Name: Agents people needing Hypersensitivity/infusion Before:
Dextrose in Mechanism of extra calories reactions, including  Verify
Lactated Ringer’s Action: who cannot anaphylactic/anaphylactoi patient’s
Hypertonic tolerate fluid d reactions, and the identity.
Dosage: solutions are overload. following manifestations:  Assess
1 liter to run for those that have  Treatment of angioedema, chest pain, patient’s
20gtts/minute. an effective shock. - Source chest discomfort, condition
osmolarity greater of water and decreased heart rate, hydration
Route of than the body electrolytes and tachycardia, blood pressure status.
Administration: fluids. This pulls calories or as an decreased, respiratory  Check for the
IV (Intravenous) the fluid into the alkalinizing distress, bronchospasm, correct fluid to
vascular by agent. dyspnea, cough, urticaria, be given.
osmosis resulting  Parenteral rash, pruritus,erythema,  Utilize sterile
in an increase replacement of flushing, throat irritation, infusion set.
vascular volume. extracellular paresthesia, hypoesthesia  Do not
It raises losses of fluid oral, dysgeusia, nausea, administer
intravascular and anxiety, pyrexia, headache. unless the
osmotic pressure electrolytes,  Metabolism and Nutrition solution is
and provides fluid, with or without  Disorders: Hyperkalemia clear and
electrolytes, and minimal  Local: Condition Infusion containers
calories for energy carbohydrate site reactions, including undamaged.
calories. phlebitis, infusion site  Check for the
Contraindication: inflammation, infusion site right drug to
 Hypersensitivity swelling, infusion site administered
to any rash, infusion site  Regulate IV
components pruritus, infusion site fluid as
 Contraindicated erythema, infusion site prescribed.
in patients with pain, infusion site burning.  Properly label
a known the IV Fluid
hypersensitivity  Observe
to sodium aseptic
lactate. technique.
 Contraindicated  Check for
in Newborns patient’s
(<= 28days of comfort.
age),  Don’t stop
 heart failure hypertonic
 Renal solutions
Impairment abruptly.
 Sodium After:
Retention  Document and
 Pulmonary Record.
Edema  Check for the
 presence of
bubbles in the
IV tube.

NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING

MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Nicardipine Mechanism of Action: Indication: Adverse Effect: Nursing Consideration:

Inhibits calcium ion  Chronic stable  CNS: Headache, Before:
from entering the angina dizziness.  Inform the
"slow channels" or  management of  CV: Flushing, prescriber if you
select voltage-sensitive essential palpitation, are or intend to
areas of vascular hypertension. tachycardia, become
smooth muscle and Contraindication: peripheral pregnant.
myocardium during  In cancer pts. with edema, Breast-feeding
depolarization, bone metastasis increased is not
producing a relaxation and in pts. with angina. recommended.
of coronary vascular ventricular  Skin: Rash  Inform the
smooth muscle and fibrillation,  GI: Nausea, dry prescriber of all
coronary vasodilation; hypercalcemia, mouth prescriptions,
increases myocardial hypophosphatemia  GU: Polyuria OTC
oxygen delivery in , or renal calculi.  MS: myalgia, medications, or
patients with weakness. herbal products
vasospastic angina.  Other: you are taking,
Diaphoresis and any
allergies you
 have.
During:
 Report
immediately
any swelling,
redness,
burning, or pain
at infusion site.
 Do not crush or
chew sustained
release forms,
swallow whole.
 Take non-fatty
food. Avoid
caffeine and
alcohol.
After:
 May cause
orthostatic
hypotension
(change
position slowly
from sitting or
lying to
standing, or
when climbing
stairs).
 NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING
MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Salmeterol + Classification: Indication: Adverse Effect: Nursing Consideration:

Fluticasone Propionate Corticosteroids (Anti- for the regular  CNS: Irritability,  Monitor patient
asthma) treatment of asthma Headache response to the
Brand Name: Seretide Mechanism of Action: (Reversible Obstructive  Respiratory: drug (improved
SERETIDE contains Airways Disease) in Rebound breathing).
salmeterol and adults, adolescents and congestion,  Monitor for
fluticasone propionate children aged 4 years epistaxis, local adverse effects
which have differing and over, where use of infection. (nasal irritation,
modes of action. a combination product Side Effect: fever, GI upset).
Salmeterol protects (bronchodilator and  soreness in the  Evaluate the
against symptoms; inhaled corticosteroid) mouth, effectiveness of
fluticasone propionate is appropriate.  throat or the teaching
improves lung function Contraindication: tongue, plan (patient
and prevents patients with a history  hoarseness, can name drug,
exacerbations of the of hypersensitivity to  headache, dosage, adverse
condition salmeterol xinafoate,  muscle cramps, effects to watch
fluticasone propionate  pain in joints, for, specific
or any of the excipients  increase in heart measures to
 listed in Section 6.1 List rate, avoid them, and
of excipients. SERETIDE  pneumonia. measures to
should not be initiated take to increase
in patients during an the effectiveness
exacerbation, or if they of the drug).
have unstable or  Monitor the
acutely deteriorating effectiveness of
asthma. other measures
to ease
breathing.

NAME OF DRUGS CLASSIFICATION INDICATION AND ADVERSE EFFECT/SIDE NURSING

AND MECHANISM CONTRAINDICATION EFFECT CONSIDERATION
OF ACTION

Paracetamol Classification: Indication: Adverse Effect: Nursing Consideration:

Analgesics and It's typically used to relieve  Nausea  Check that the
Brand Name: Antipyretics mild or moderate pain,  Vomiting patient is not
Biogesic Mechanism of such as headaches,  Constipation taking any other
Action: toothache, medication
Paracetamol has a or sprains, and reduce Side Effect: containing
central analgesic fevers caused by  Tiredness paracetamol.
effect that is illnesses such as colds and  Breathlessness  There are no
mediated through flu.  Liver and kidney known harmful
activation of Contraindication: damage effects when used
descending  Hypersensitivity to  Heart disease and during
serotonergic paracetamol stroke (if you have pregnancy.
pathways. Debate  Hepatic and renal high blood  Small amounts
exists about its failure pressure. may pass into
primary site of breast milk.
action, which may However, there
be inhibition of are no known
prostaglandin (PG) harmful effects
synthesis or through when used by
an active metabolite breastfeeding
influencing mothers.
cannabinoid  Alcohol increases
receptors. the risk of liver
damage that can
occur if an
overdose of
paracetamol is
taken. The
hazards of
paracetamol
overdose are
greater in
persistent heavy
drinkers and in
people with
alcoholic liver
disease.
 Evaluate
therapeutic
response.
 NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING
MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Salbutamol+Bromhexi Classification: Indication: Adverse Effect: Nursing Consideration:

ne+ Guaifenesin Mucolytics (treatment  Bronchial The following side  Ensure drug
of wet cough) asthma, effects sometimes effectiveness.
Brand Name: Pecof SF Mechanism of Action:  Emphysema occur: Avoid combining
Bromhexine  Atelectasis  Gastrointestinal other drugs in
Hydrochloride  acute & chronic tract: Nausea, the nebulizer to
decreases the viscosity bronchitis Vomiting, avoid the
of sputum and  pulmonary TB Heartburn, formation of
increases mucociliary  whooping cough Abdominal precipitates and
clearance. This helps in  pneumonia discomfort, potential loss of
various respiratory  broncho-spastic Diarrhea. effectiveness of
conditions. Guaifenesin conditions.  Central nervous either drug.
helps loosen and clear Contraindication: system:  Proper drug
the bronchial passages caution in patients of Exhaustion, delivery. Dilute
of thickened mucus and hyperthyroidism, faintness; concentrate
aids expectoration. diabetes mellitus, Somnolence, with sterile
clouding of water for
serious cardiovascular consciousness injection if
disorders, hypertension, (stupor); buildup
and peptic ulcers. These Numbness, becomes a
are generally mild and Dizziness, problem that
rare. Headache. could impede
 Cardiovascular drug delivery.
system:  Proper use of
Palpitations. nebulizer.
Side Effect: Review use of
These are generally the nebulizer
mild and rare. Skeletal with patients
muscle tremor receiving
particularly of the dornase alfa at
hands, palpitations and home to ensure
muscle cramps are seen the most
occasionally. Slight effective use of
tachycardia, headache the drug.
and peripheral  Proper storage.
vasodilation have been Patients should
reported after large be cautioned to
doses. store the drug in
the refrigerator,
protected from
light.
 Dornase alfa
use. Caution
cystic fibrosis
patients
receiving
 dornase alfa
about the need
to continue all
therapies for
their cystic
fibrosis because
dornase alfa is
only a palliative
therapy that
improves
respiratory
symptoms.
 health
education.
Provide
thorough
patient
teaching,
including the
drug name and
prescribed
dosage,
measures to
help avoid
adverse effects,
warning signs
that may
indicate
problems, and
 the need for
periodic
monitoring and
evaluation, to
enhance patient
knowledge
about drug
therapy and to
promote
compliance.
 Provide support.
Offer support
and
encouragement
to help the
patient cope
with the disease
and with the
drug regimen.

NAME OF DRUGS CLASSIFICATION AND INDICATION AND ADVERSE EFFECT/SIDE NURSING

MECHANISM OF CONTRAINDICATION EFFECT CONSIDERATION
ACTION

Magnesium Sulfate Classification: Indication: Adverse Effect: Nursing Consideration:

Anti- convulsant  Eclampsia  CNS: toxicity,  Keep IV calcium
Brand Name: Mechanism of Action:  Pre-eclampsia weak or absent available to
Sulfamag Cofactor of many  Acute asthma deep tendon reverse
enzyme systems exacerbation reflexes, magnesium
involved in Contraindication: paralysis, intoxication.
neurochemical  Impaired renal drowsiness,  Test knee-jerk and
transmission and function. stupor. patellar reflexes
muscular excitability;  Heart block,  CV: slow, weak before each
prevents seizures by myocardial pulse; additional dose. If
clocking damage. arrhythmias; absent, notify
neuromuscular  Myasthenia hypotension; prescriber and
transmission; attracts gravis. circulatory give no more
and retains water in  Drug collapse; magnesium until
the intestinal lumen interaction: flushing. reflexes return;
and distends the bowel Nifedipine,  Gi: diarrhea. otherwise,
to promotes mass anesthetic  Metabolic: patient may
movement and relieve drugs. hypocalcemia. develop
constipation.  Respiratory: temporary
respiratory respiratory failure
distress. and need
 Skin cardiopulmonary
diaphoresis. resuscitation or IV
 Other: administration of
hypothermia calcium.
Side Effect:  Check
 Feeling of magnesium level
warmth after repeated
 Lethargy doses. Monitor
 Facial flushing levels hourly in
 Hypotension patients with
severe
 Sweating hypomagnesemia
 Confusion . Normal plasma
 Intense thirst magnesium level
is 1.5 to 2.5
mEq/L.
 Monitor fluid
intake and
output. Output
should be 100 mL
or more during a
4-hour period
before dose.
 Monitor renal
function.
 Patients with
prolonged
exposure to
magnesium
sulfate who have
impaired renal
function are at
risk for aluminum
toxicity.
 Look alike-sound
alike: Don't
confuse
magnesium
sulfate with
manganese
sulfate.
7 NURSING CARE PLAN

The nursing care plan focuses on three problems.

Assessment Diagnosis Planning Intervention evaluation

Objective

Data: