Case Presentation

Case presentation contents

▫ Patient profile ( Demographics and any ▫ Anatomy and relation to the affected area
pertinent data)

▫ Pathophysiology
▫ Patient Assessment Form

▫ Drug Studies

▫ Discussion of the case

▫ NCP

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Patient Profile
Patient Initials: I.U
Age: 30 years old
Sex: Female
Religion: RC
Civil Status: Married
Date of Visit: August 31,2021

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PATIENT
ASSESSMEN
T
FORM
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A. Heredo-familial Tendencies

▫ Husband has Hypertension and Diabetes Meletus

B. Childhood Disease:
▫ N/A

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C. Communicable Diseases:
▫ N/A
D. Menstrual History
▫ Menarche: @ 12 years old
▫ Flow: moderate
▫ Interval: regular
▫ Dysmenorrhea: Yes

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E. Medical and Surgical History:
▫ Medical (any serious illness or hospital confinement)
▫ N/A

▫ Surgical (abdominal or reproductive region)

▫ N/A

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Obstetrical History
Year Pregnancy Duration of Mode of LB/SB Sex/ Birth Place of Status of
Labor Delivery Weight Delivery Immunization

2014 1st 6 hours NSVD LB M, 3 kg/ 6.6 Hospital TT1, TT2, TT3,
Pregnancy lbs. TT4, and TT5

2017 2nd 2 hours NSVD LB M, 2.1 Hospital

Pregnancy kg/4.62 lbs.

2021 3rd
Pregnancy

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A. Physique:
▫ Sthenic

B. Patient’s emotional/ intellectual profile:

▫ Conscious, coherent, and cooperative

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C. Vital Signs
Temperature: 36.6°C
Pulse Rate: 72 bpm
Respiratory Rate: 15 cpm
Heartrate: 70 bpm
Blood Pressure: 100/70 mmHg
Height: 160 cm
Weight: 50 kg
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D. Skin
▫ Chloasma
▫ Warm and dry
▫ Light pink nail beds

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E. Face:
▫ Eyes
▫ Color of conjunctiva: Light pink
▫ Eyelids: No puffiness
▫ Lips
▫ Color: light pink, symmetrical halves
▫ Teeth
▫ N/A

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F. Neck
▫ N/A
G. Chest
▫ Nipples getting darker,
▫ Enlargement, tenderness, and tingling sensation

H. Lower
▫ N/AExtremity

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I. Abdomen
▫ Inspection
▫ Size: Compatible to AOG
▫ Shape: Globular
▫ Striae: present
▫ Linea negra: present
▫ Scars: absent

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I. Abdomen
▫ Palpation
▫ Height of fundus: 30 cm
▫ Fetal small parts: Left
▫ Fetal back: Right
▫ Lie: Longitudinal
▫ Presentation: Cephalic
▫ Status of presenting parts: Engaged
▫ Quickening: @ 19 weeks AOG
▫ Auscultation
▫ FHR and Location: 138 bpm @RLQ

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J. Bowel Pattern
▫ The patient is having a hard time defecating

K. Usual Sleep Pattern

▫ 6-7 hours

L. Past History/Familial Disease

▫ N/A

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Gestational Age Computation
LMP: January 7, 2021
Date of Visit: August 31, 2021
January 7
February 28
March 31
April 30
May 31
June 30
July 31
August 31
219 days or 31 weeks and 2/7 days AOG

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Assessment on Family Planning Method (s) Used:
▫ N/A

Current Medications/Supplements:
Name of Drug Classification Dosage

Caltrate Plus Vitamins Once a day

Iberet-Folic Vitamins Once a day

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IMPRESSIONS ON PRESENT PREGNANCY:
▫ Expectant Mother’s Reaction on Present Pregnancy
▫ Physical: The mother is tired, coherent, cooperative and conscious all
throughout the assessment
▫ Psychological: She was surprised to know that she became pregnant at
her
▫ Spiritual: The couple are Roman Catholics and usually goes to church
every Sunday.
▫ Financial: It is often hard for them to meet their financial
responsibilities.
▫ Expectant father’s reaction to the pregnancy
▫ The father is happy but anxious about the pregnancy

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RECOMMENDATIONS:
▫ Health Teaching: Fatigue among pregnant women
▫ Goal: After 35 minutes of health teaching, the patient will be able to define the
different concepts involving fatigue and perform the necessary intervention
needed.

▫ Possible Nursing Diagnosis

▫ Fatigue related to pregnancy as evidenced by “Kapoy jud ako pamati ug wala sad
lain na maka atiman sa akong mga anak sa balay” as verbalized
▫ Constipation related to pregnancy as evidenced by “maglisod ko ug kalibang ug di
na taga adlaw pareha sa-una.” as verbalized
▫ Heat exhaustion related to pregnancy as evidenced by reports of heat intolerance
▫ Anxiety related to pregnancy as evidenced by being anxious in the upcoming
labor.

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 DISCUSSION OF THE

2 CASE
Fatigue
What is Fatigue?

Fatigue (either physical, mental

or both) is a symptom that may
be difficult for the patient to
describe and words like
lethargic, exhausted and tired
may be used

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Fatigue in pregnant
women
▫ Fatigue is a common
discomfort experienced
during pregnancy and may
contribute to severe labor
pain and postpartum
depression.

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Anatomy and relation to
the affected area
▫ Fatigue is a specific form of human inadequacy in
which the individual experiences an aversion to
exertion and feels unable to carry on. Such feelings
may be generated by muscular effort; exhaustion of
the energy supply to the muscles of the body,
however, is not an invariable precursor. Feelings of
fatigue may also stem from pain, anxiety, fear, or
boredom. In the latter cases, muscle function
commonly is unimpaired.

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Pathophysiology of fatigue
To name a few:
▫ reduced decision making ability or cognitive processing
▫ reduced ability to do complex planning
▫ reduced communication skills
▫ reduced productivity or performance
▫ reduced alertness, attention and vigilance
▫ reduced ability to handle stress on the job
▫ reduced reaction time - both in speed or thought, as well as
the ability to react
▫ loss of memory or the ability to recall details

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3 NURSING CARE PLAN
For Fatigue
Nursing Care Plan
▫ Nursing Diagnosis

Assessment
Subjective Data:“Kapoy jud ako pamati
ug wala sad lain na maka atiman sa
akong mga anak sa balay”
Objective Data:feels tired all the time
Diagnosis
Fatigue related to pregnancy as evidenced
by “Kapoy jud ako pamati ug wala sad lain
na maka atiman sa akong mga anak sa
balay” as verbalized

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Nursing Care Plan
Nursing Goals

Short term goal: Long term goal:

After 8 hours of health teaching, the After 48 hours, the patient will be able to:
client will be able to:
▫ Verbalize what important tasks ▫ Know the interventions and coping strategies
during periods of fatigue have a
of fatigue
higher priority than nonessential
▫ Verbalize increased energy
activities.
▫ ▫ Describe energy-conserving techniques
Discuss what she thinks makes her
fatigue worst Identify the factors that worsen and improve
symptoms of fatigue

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 Nursing Care Plan
Nursing Outcome

Primary Intervention
Promotive:
Assess the patient’s ability to perform ADLs, instrumental activities of daily living (IADLs), and demands
of daily living (DDLs).
Rationale:Fatigue can restrict the patient’s ability to participate in self-care and do his or her role
responsibilities in the family and society, such as working outside the home.
Preventive:
Restrict environmental stimuli, especially during planned times for rest and sleep.
Rationale: Vivid lighting, noise, visitors, numerous distractions, and litter in the patient’s
physical surroundings can limit relaxation, disturb rest or sleep, and contribute to fatigue

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 Nursing Care Plan
Nursing Outcome

Secondary Intervention
Curative:
Support the patient in escalating levels of physical activity and exercise.
Rationale: Exercise can reduce fatigue and assist the patient build stamina for physical activity.

Promote sufficient nutritional intake:

Rationale: The patient will need properly balanced intake of fats, carbohydrates, proteins, vitamins,
and minerals to provide energy resources.

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 Nursing Care Plan
Nursing Outcome

Tertiary Intervention
Rehabilitative:

Aid the patient develop habits to promote effective rest/sleep patterns.

Rationale: Promoting relaxation before sleep and providing for several hours of uninterrupted sleep
can contribute to energy restoration.

Teach energy conservation methods. Collaborate with occupational therapist as needed.

Rationale: Organization and time management can help the patient conserve energy and reduce
fatigue.

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 Nursing Care Plan
Evaluation
For short term goal:
After 8 hours of nursing intervention, the client was able to verbalize what important tasks during periods of
fatigue have a higher priority than nonessential activities. The client was also able to discuss what she thinks
makes her fatigue worst and her concerns about fatigue.

For long term goal:

After 48 hours of nursing intervention, the client was able to know the interventions and coping strategies of
fatigue, and verbalize increased energy. The client was also able to identify the factors that worsen and improve
symptoms of fatigue and describe energy-conserving techniques.

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4 DRUG STUDY 1
Iberet-Folic-500
Drug Study 1 (Drug information)
Generic Name Minimum Dose Patient’s Dose
Multivitamins with iron 60 mg Ferrous Sulfate 525 mg
(equivalent to 105 mg of
elemental iron

Trade Name Maximum Dose Route

Iberet-Folic-500. 120 mg PO/Oral

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Drug Study 1 (Drug information and classification)
Frequency Contents:
Multivitamins with iron [Ferrous Sulfate* 525 mg (equivalent to 105 mg of elemental iron),
Vitamin C (Ascorbic Acid) 500 mg, Niacinamide 30 mg, Calcium
Availability/Form Pantothenate 10 mg, Vitamin B1 (Thiamine Mononitrate) 6 mg,
Vitamin B2 (Riboflavin) 6 mg, Vitamin B6 (Pyridoxine
Tablet
Hydrochloride) 5 mg, Vitamin B12 (Cyanocobalamin) 25 mcg, Folic
Acid 800 mcg.]

Pharmacologic Classification:
Vitamins
Therapeutic Classification:
Anti-anemics

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Drug Study 1 (Mechanism of action)
Pharmacodynamics: Iron is required to maintain optimal health, particularly for helping to form red blood cells
(RBC) that carry oxygen around the body.

Pharmacokinetics:
Absorption: GI Tract
Distribution: About 60% of iron is distributed in the erythrocytes
Metabolism: The metabolism of iron is complex. Normally, iron exists in the ferrous (Fe2+) or ferric
(Fe3+) state, but since Fe2+ is oxidized to Fe3+, which hydrolyzes to insoluble iron(III)hydroxides in neutral
aqueous solutions, iron binds to plasma proteins and is either transported or stored throughout the body.
Excretion:Oral iron is recycled, with some loss in the urine, sweat, and desquamation

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Drug Study 1 (Indication)
General Indication:
▫ Prevention/ Treatment of iron deficiency anemia

Patient’s Indication
▫ Prescribed for the prevention of iron deficiency during pregnancy.
▫ Promotes better blood circulation
▫ Promotes better development for the baby

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Drug Study 1 (Contradictions)
Food : Food taken in conjunction with oral iron supplements may reduce the bioavailability of the iron. However,
in many patient’s intolerable gastrointestinal side effects occur necessitating administration with food.

Drugs: ANTACIDS decrease iron absorption; iron decreases absorption of TETRACYCLINES, ciprofloxacin,
ofloxacin; chloramphenicol may delay iron's effects; iron may decrease absorption of penicillamine.

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Drug Study 1 (Side Effects)
Gastrointestinal disorders: Injury to mouth and pharynx (throat), mouth ulceration (in cases of incorrect use,
when tablets are chewed, suck or left in the mouth), esophageal ulcer (i.e ulcer on the tube that connects the
mouth with the stomach), nausea, vomiting, abdominal pain or discomfort hematemesis, blackening of stools,
diarrhea, constipation, ileus

Immune system disorders: allergic reaction from rash to anaphylaxis

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Drug Study 1 (Nursing Responsibilities)
Before Drug Administration:
▫ Always check the expiration date of the medication
▫ If the patient is intolerable with the gastrointestinal side effects, administer the medication with food.
▫ Check the right dosage
▫ Check if the medicine is the same with the doctor’s prescribed medication
▫ Explain to the patient the effect of the medication.

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Drug Study 1 (Nursing Responsibilities)
During Drug Administration:
▫ Let the patient drink water with the medicine for easy swallowing
▫ Ferrous sulfate should be taken on an empty stomach and with water or fruit juice. However, if the medication
upsets the patient’s stomach, she can take ferrous sulfate with food.

After Drug Administration:

▫ Always check for allergic reactions after the taking the medication
▫ Monitor bowel movements as constipation is a common adverse effect

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4 DRUG STUDY 2
Caltrate Plus
Drug Study 2 (Drug information)
Generic Name Minimum Dose Patient’s Dose
Multivitamin with minerals Calcium-400mg Calcium 600 mg
Vitamin D3- 100 IU Vitamin D3 200 IU

Trade Name Maximum Dose Route

Caltrate Plus. Calcium-2500 mg Vitamin D3- PO/Oral
100 micrograms (4,000 IU)

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Drug Study 2 (Drug information and classification)
Frequency Contents:
Multivitamins with iron Cholecalciferol (Vitamin D3) 200 IU, Calcium (as Calcium
Carbonate) 600 mg, Magnesium (as Magnesium Oxide) 50 mg, Zinc
Availability/Form (as Zinc Oxide) 7.5 mg, Manganese (as Manganese Sulfate
Monohydrate) 1.8 mg, Copper (as Cupric Oxide) 1 mg
Tablet

Pharmacologic Classification:
Dietary supplements
Therapeutic Classification:
Antacids

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Drug Study 2 (Mechanism of action)
Pharmacodynamics:
Calcium
Calcium is a major component of bone matrix and teeth. Additionally, various calcium channels are involved in
blood vessel constriction and relaxation, muscle contraction, nerve action potentials, and cardiac
electrophysiology.

Vitamin D
Vitamin D is well known as a hormone involved in mineral metabolism and bone growth. Its most dramatic effect
is to facilitate intestinal absorption of calcium, although it also stimulates absorption of phosphate and magnesium
ions.

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Drug Study 2 (Mechanism of action)
Pharmacokinetics:
Calcium
These vitamin D metabolites subsequently facilitate the active absorption of calcium and phosphorus in the small
intestine, serving to increase serum calcium and phosphate levels sufficiently to allow bone mineralization.
Conversely, these vitamin D metabolites also assist in mobilizing calcium and phosphate from bone and likely
increase the reabsorption of calcium and perhaps also of phosphate via the renal tubules.

Vitamin D
These vitamin D metabolites subsequently facilitate the active absorption of calcium and phosphorus in the small
intestine, serving to increase serum calcium and phosphate levels sufficiently to allow bone mineralization.
Conversely, these vitamin D metabolites also assist in mobilizing calcium and phosphate from bone and likely
increase the reabsorption of calcium and perhaps also of phosphate via the renal tubules.

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Drug Study 2 (Indication)
General Indication:
▫ Prevention & treatment of osteoporosis; Ca & vit D deficiency states.

Patient’s Indication
▫ Prescribed for the prevention of calcium and vitamin D deficiency during pregnancy.

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Drug Study 2 (Contradictions)

▫ This product is contraindicated in patients who are allergic (hypersensitive) to its active ingredient or any other
components listed in the Description
▫ -It is also contraindicated in patients who have renal insufficiency.
▫ Make sure the doctor knows if the patient is also using other supplements or medicines that contain Calcium.
Calcium can change the way other medicines work if the patient takes them at the same time. If the patient
needs to use other medicines, take them at least 2 hours before or 2 hours after the patient takes the calcium
supplement
▫ -Do not smoke cigarettes or cigars and do not drink large amounts of alcohol or caffeine (for example, more
than 8 cups of coffee).
▫ -Do not take the calcium supplement with a highfiber meal (such as bran, whole -grain cereal or bread, fresh
fruits).

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Drug Study 1 (Side Effects)

Calcium/Vitamin D Side effects: abdominal distension, abdominal pain, constipation, diarrhea,

eructation/burping, flatulence, nausea, vomiting, high level of calcium in blood (hypercalcemia), excessive loss of
calcium in urine (hypercalciuria) and kidney stone formation (nephrolithiasis).

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Drug Study 1 (Nursing Responsibilities)
Before Drug Administration:

▫ Always check the expiration date of the medication

▫ If the patient is intolerable with the gastrointestinal side effects, administer the medication with food.
▫ Check the right dosage
▫ Check if the medicine is the same with the doctor’s prescribed medication
▫ Explain to the patient the effect of the medication.

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Drug Study 1 (Nursing Responsibilities)
During Drug Administration:

▫ Let the patient drink water with the medicine for easy swallowing
▫ Avoid taking calcium carbonate with cereals or other foods high in oxalates. Oxalates combine with calcium
carbonate to form insoluble, nonabsorbable compounds.

After Drug Administration:

▫ Always check for allergic reactions after the taking the medication
▫ Check if the patient is suffering any abdominal discomfort after taking the medication

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5 FDAR
DAY 1
FDAR
Date and Focus Data, Action, and Response
Time
August 31,2021 Vitamins D: Feels tired all the time, “Kapoy jud ako pamati ug
wala sad lain na maka atiman sa akong mga anak sa balay” as verbalized

A:
• Assess the patient’s ability to perform ADLs, instrumental activities of daily
living (IADLs), and demands of daily living (DDLs)
• Restrict environmental stimuli, especially during planned times for rest and
sleep
• Support the patient in escalating levels of physical activity and exercise
• Promote sufficient nutritional intake
• Aid the patient develop habits to promote effective rest/sleep patterns
• Teach energy conservation methods.
• Collaborate with occupational therapist as needed
R: The patient now verbalizes having more energy than before.
_____________
____________________________________________________________N.S

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Thanks for
Listening
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