PRIMARY LOW

TRANSVERSE
CESAREAN SECTION

(BREECH
MALPRESENTATION)
General Objectives:
To present a case of delivery of a newborn via Cesarian section utilizing
nursing skills and processes. that would provide essential knowledge and
skills in delivering quality healthcare to our patient.

Specific Objectives:
 To briefly review the indications for a cesarian delivery of a newborn.
 To investigate possible problems that will arise in a cesarian delivery
 To utilize the nursing process in addressing the possible problems in
cesarian delivery.
 To discuss thoroughly the signs and symptoms of manifested by the
patient
 Present anatomy and physiology related with our client’s condition
 To understand the classification, indication, contraindication, mechanism
of action, side effects, dosage and availability and nursing responsibilities
of the drug administered to our client Related to cesarean delivery
 Discuss the pathophysiology, etiology that has manifestation to our
patient’s condition
 Explain the relevance of laboratory findings concerning the illness process
and the client's condition.
 Discuss nursing care plans formulated specially based on client’s condition
 Formulate a comprehensive discharge plan realistic to the needs and
compliance of the client
OVERVIEW OF THE DISEASE:
Breech presentation refers to the fetus in the longitudinal lie with the
buttocks or lower extremity entering the pelvis first. A cesarean section in
breech presentation involves more complicated procedures than a cesarean
section in cephalic presentation because the former requires additional
manipulations for guiding the presenting part of the fetus, liberation of the
arms, and the after-coming head delivery. The three types of breech
presentation include frank breech, complete breech, and incomplete breech.
In a frank breech, the fetus has flexion of both hips, and the legs are straight
with the feet near the fetal face, in a pike position. The complete breech has
the fetus sitting with flexion of both hips and both legs in a tuck position.
Finally, the incomplete breech can have any combination of one or both hips
extended, also known as footling (one leg extended) breech, or double
footling breech (both legs extended).
SIGNS AND SYMPTOMS:
 Subcostal tenderness.
 Ballottable head in the fundal area.
 Softer irregular mass in the pelvis.
 Fetal heartbeat loudest above the umbilicus.
 On VE in labour, the sacrum, anus or foot can
be palpated through the fornix.
RISK FACTORS:
 You have been pregnant before.
 There is more than one fetus in the uterus (twins or more).
 There is too much or too little amniotic fluid.
 The uterus is not normal in shape or has abnormal growths
such as fibroids.
 The placenta covers all or part of the opening of the uterus
(placenta previa)
 The fetus is preterm.
ETIOLOGY:
Clinical conditions associated with breech presentation
include those that may increase or decrease fetal motility, or affect
the vertical polarity of the uterine cavity. Prematurity, multiple
gestations, aneuploidies, congenital anomalies, Mullerian
anomalies, uterine leiomyoma, and placental polarity as in
placenta previa are most commonly associated with a breech
presentation. Also, a previous history of breech presentation
at term increases the risk of repeat breech presentation at term in
subsequent pregnancies
COMPLICATION:
 Premature rupture of membranes and premature labour.
 Cord prolapse (higher risk with footling or complete breech - highest
risk with incomplete or footling breech (15-18%).
 Fetal head entrapment.
 Overly rapid descent of after-coming head, leading to rapid
compression/decompression causing intracranial haemorrhage.
 Cervical spine injuries associated with hyperextension.
 Delay in delivery, leading to asphyxia due to cord compression and
placental separation.
 Traumatic injuries including fractures of the humerus, femur or
clavicle, brachial plexus injury (Erb-Duchenne palsy).
MANAGEMENT FOR BREECH PRESENTATION:
 External cephalic version
 Elective caesarean section
 Trial of vaginal delivery
DEMOGRAPHIC DATA Name: Patient X
Age: 33
Sex: Female
Date of Birth: October 24, 1989
Address: Pinaripad Norte Aglipay Quirino
Civil Status: Married
Nationality: Filipino
Religion: Roman Catholic
Occupation: None
Educational Attainment: Highschool Graduate
Admitting Time: 7:30 PM
Admitting Date: 03/20/2023
Admitting Diagnosis: G3P2 PU 39 5/7 WEEKS AOG, NIL BREECH, MILD ANEMIA
PRESENTATION MILD ANEMIA
Final Diagnosis: G3P3 PU Delivered breech term live baby boy
(BW; 3300grams) AGA by Primary LTCS
under SAB for breech
presentation
Physician in charge: ARSM
Chief Complaint: Pt. came in for scheduled CS
PAST HISTORY:
The patient stated that she had experienced minor diseases, like common colds. and she takes vitamin ascorbic acid to protect her immune
system. The patient also said that She was gave birth to her two children in a normal delivery. Common adult illnesses experienced were
fever, cough, and colds which she self-medicated with over-counter drugs like paracetamol and Neozep.

PRESENT HISTORY:
prior to admission patient come in scheduled in OR for cesarean delivery because the baby is in breech position and she is also diagnosed
a mild anemia. The patient claimed that she is taking a medicine ferrous sulfate to prevent iron deficiency to treat or prevent anemia when
the amount of iron taken in from the diet is not enough and folic acid to prevent some major birth defects of the baby.
OBSTETRIC HISTORY:
G3P3
Menarche: 13 yrs old
Interval: every 28 days
Duration; 3-5 days
Amount: 2-3 pads /day
LMP: June 15, 2022
EDD: March 22, 2023
 Last menstrual period: June 15, 2022

MONTH DAY YEAR

6 15 2022

-3 +7 +1

3 22 2023
FAMILY HISTORY:
 PHYSICAL
ASSESSMENT
DATE OF ASSESSMENT: MARCH 21, 2023
General Appearance: Patient is well kempt, awake Normal
and alert
Level of Consciousness: Normal
 Alert
 Responsive
Oriented to time, place and person
Activity: using gadget Normal
Posture and Gait: lying supine position Normal

BP: 130/90mmHg Abnormal

Temperature: 36.4 °C Normal
Pulse Rate: 86bpm Normal
Respiratory rate: 20bpm Normal
O2 Saturation: 97% Normal
Weight: 76kg Normal
Height: 167cm Normal
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
HEAD INSPECTION  Head is symmetric, NORMAL
PALPATION round, erect, and in
midline and
appropriate related to
body size
(normocephalic); no
lesions are visible.

HAIR/SCALP INSPECTION  Scalp is white, clean, NORMAL

PALPATION free from masses,
lumps, dandruff and
no presence of lice
with no areas of
tenderness
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
upon palpation; hair is
black, short, smooth, and
shiny evenly distributed
and covers the whole
scalp.

FACE INSPECTION  Face is symmetric. NORMAL

 No involuntary
PALPATION movements noted;
temporal artery is
elastic and not tender;
temporomandibular
has no swelling,
tenderness, or
crepitation with
movement.
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION

EYES INSPECTION Iris is typically round, NORMAL

flat, and evenly colored;
Pupils are equal, round
and reactive to light, and
accommodation;
centered in the iris;
Eyeballs are
symmetrically aligned in
sockets without
protruding or sinking;
Bulbar conjunctiva is
clear, moist, and smooth.
Underlying structures are
clearly visible. Sclera is
white;
BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
Cornea is transparent, NORMAL
with no opacities;
oblique view shows a
smooth and overall moist
surface; the lens is free
of opacities; Lower and
upper palpebral
conjunctivae are clear
and free of swelling or
lesions; Palpebral
conjunctiva is free of
swelling, foreign bodies,
or trauma; Upper lid
margin is between the
upper margin of the iris
and the upper
BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
margin of the pupil; NORMAL
Lower lid margins rests
on the lower border of
the iris. No white sclera
is seen above or below
the iris; Upper and
lower lids close easily
and meet completely
when closed; Lower
eyelid is upright with no
inward or outward
turning; Eyelashes are
evenly distributed and
curve outward along the
lid margins;
BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
Eyebrows are black, NORMAL
symmetrical, thick, can
raise both symmetrically
and without difficulty,
evenly distributed and
parallel with each other.

Eyes are nearsighted, has ABNORMAL

an eye grade of 125 on
the left eye and 100 on
the right eye.
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
NOSE INSPECTION  Nose is the same as NORMAL
PALPATION the rest of the face; it
is in midline,
symmetrical, patent;
internal nares are
clean, dark pink with
few cilia.

EARS INSPECTION Ears are parallel, NORMAL

PALPATION symmetrical,
proportional to the size
of the head, bean-shaped,
helix is line with the
outer canthus of the eye,
BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
skin is the same color as NORMAL
the surrounding area and
clean; Ear canal is
pinkish, clean, with scant
amount of cerumen and a
few cilia; able to hear
whisper spoken 2 feet
away; there are piercing
found in the left ear and
right ear.
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
MOUTH INSPECTION Mouth opens and closes NORMAL
PALPATION fully (3-6cm between upper
and lower teeth); lower jaw
moves laterally 1-2cm in
each direction; Upper
molars are at rest directly
on the lower molars and the
front upper incisors is
slightly override the lower
incisors; 2 missing teeth in
the upper and lower; stained
teeth; jaws are aligned with
no deviation seen with
biting down; No lesions or
masses; Stensen ducts are
visible with flow of saliva
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
Slightly dark and Abnormal
dry lips ( smoking )

NECK INSPECTION  Proportional to the NORMAL

PALPATION size of the body and
head, symmetrical
and straight, no
palpable lumps,
masses or areas of
tenderness;
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION

THORAX AND INSPECTION  Chest contour is NORMAL

LUNGS symmetrical, spine is
PALPATION aligned no lumps, no
AUSCULTATION masses, and no
tenderness areas
Scapulae are
symmetric and non-
protruding. Shoulders
and scapulae are at
equal horizontal
positions; Spinous
processes appear
straight, and thorax
appears symmetric;
BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
 No tenderness, pain, NORMAL
or unusual sensations;
no palpable crepitus;
skin and
subcutaneous tissue
are free of lesions and
masses;

Wheezing sound
heard upon
auscultation.
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
BREAST INSPECTION  No Venous NORMAL
PALPATION congestion and
prominence of veins;
Montgomery
tubercles are
prominent. Breast
size is increased and
nodular. Breast are
more sensitive to
touch.
Hyperpigmentation of
nipples and areolae is
evident.
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
ABDOMEN INSPECTION  Flabby in size caused NORMAL
AUSCULTATION by pregnancy;
presence of striae and
PALPATION linea-nigra; free of
lesions or rashes;
 Umbilicus is midline
at lateral line; uterus
is below umbilicus;
bowel sounds is 5;
Venous hum is not
heard over the
epigastric and
umbilical areas;
BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
 No friction rub over NORMAL
liver or spleen is
present; Tympany is
heard at the last left
interspace; No
tenderness is elicited,
no fluid wave is
transmitted;
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
UPPER PALPATION  Symmetrical, with NORMAL
EXTREMETIES INSPECTION visible veins, fine hair
evenly distributed,
warm,and dry; palms
are pinkish, warm and
soft; 5 fingers in each
hand; both shoulders,
arms, elbows, hands
and wrists can be move
in different range of
motion with relative
ease.

 Capillary refill time

noted at 2 seconds
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
LOWER PALPATION  Skin is smooth, NORMAL
EXTREMETIES INSPECTION absence of varicose
veins, muscles
symmetrical, length
symmetrical, 5 toes in
each foot, both legs,
knees, ankles, and
toes can be moved in
different range of
motion with relative
ease;

 Presence of scars on ABNORMAL(mosquito

both legs bite)
 BODY PART TECHNIQUE USED FINDINGS INTERPRETATION
FEMALE INSPECTION Brownish vaginal NORMAL
GENITALIA discharge without blood
clots; Labia minora
appear symmetric, dark
pink, and moist
GORDON’S 11
FUNCTIONAL
PATTERNS
MARCH 21, 2023
 Interactions
Area of Data Before Admission During Admission Interpretation
Collection GORDON’S 11 FUNCTIONAL PATTERNS

Health Perception According to the patient, she smokes 1 pack of According to the patient, she is Patient is healthy
and Health cigarettes per day when she’s in Qatar, but when concerned about her incision and in terms of how
Management she got home and got pregnant, she started to repair but willing to accept and she perceives her
Pattern stop smoking and practice a healthy lifestyle, listen to all the health teachings of health
such as eating healthy foods like fruits and the doctors and nurses. management and
vegetables. When she’s sick, she goes to the
health perception
doctor to consult, then does some exercises at
to protect herself.
home when she has free time. Before pregnancy,
she takes ascorbic acid to protect her immune
system. During pregnancy, she takes ferrous
sulfate to treat or prevent anemia when the
amount of iron taken in from the diet is not
enough and folic acid to prevent birth defects.

Covid Vaccination:
Pfizer
1st – 2nd dose
1st dose of booster
 Interactions
Area of Data Before Admission During Admission Interpretation
Collection

Nutritional and According to the patient, during pregnancy, she has According to the patient, there is The patient’s
Metabolic no cravings. She has a good appetite and a regular no intake of fluids or solid foods condition affects
Pattern meal pattern. She eats vegetables such as eggplant, after surgery. her nutritional and
squash, and string beans and fruits such as apples, metabolic patterns
oranges, mangoes, and bananas. Before and during due to her surgery.
pregnancy, she drinks Bear Brand milk, which she
drinks three times a day: once in the morning, once
in the afternoon, and once in the evening. She also
drinks nine glasses of water per day to maintain
her healthy body.

Height: 167cm / 5’6

Before Pergnancy
Weight: 55kg
BMI: 19.5 NORMAL
During Pregnancy
Weight: 75kg
BMI: 26.6 OVERWEIGHT
 Interactions
Area of Data Before Admission During Admission Interpretation
Collection

Elimination Bowel: Bowel: There are changes

Pattern in her elimination
The patient defecates twice a day, in the morning There are no changes in her
pattern since she
and in the evening. defecation.
has a catheter.
Color: Brown Color: Brown
Consistency: Soft and pass easily Consistency: Soft and pass easily
Bladder:
Bladder:
The patient voids 10 times a day.
The patient has a catheter and it
Color: Pale Yellow
has 100ml amount of urine.
Color: Pale Yellow
 Interactions
Area of Data Before Admission During Admission Interpretation
Collection

Activity - According to the patient, her daily routine According to the patient, there Activity and
Exercise consists of walking around their compound every has been a change as a result of exercise are not
Pattern morning or when she goes to the canteen and her Cesarean delivery because she maintained due to
also dancing on TikTok. Since she is a is not allowed to do some tasks. her surgery.
housewife, she considers her household chores as
her daily activities. Her screen time is 5 hours a
day, spent watching TikTok videos and browsing
the internet.

Sleep - Rest According to the patient, she has a healthy According to the patient, she has The patient’s
Pattern sleeping routine of 9 hours per day. She goes to had difficulty getting to sleep sleep pattern was
bed at 10 p.m. and wakes up at 7:00 a.m. She since she was admitted. She disturbed.
also takes a nap for at least 1 hour during the day, sleeps at 11pm and wakes up at
and to fall asleep, she is watching TikTok videos. around 5am.
Her rest time is when she’s having her screen
time.
 Interactions
Area of Data Before Admission During Admission Interpretation
Collection

Cognitive- According to the patient, her sense of sight is
Perceptual blurred, with a grade of 125 in the left eye and a
Pattern grade of 100 in the right eye. During pregnancy,
she is sensitive to sautéed garlic and overly-
scented things, such as shirts and perfumes. The
rest of the senses, such as hearing, taste, and
touch, have no problems.
According to her physical The patient is
assessment, there are no changes portraying
in her sense of sight, hearing, cooperativeness.
taste, and touch, but she can
comprehend and respond to both
physical and verbal stimuli.

Self-Perception According to the patient, when she knows that According to the patient, she was The patient is
and Self- she’s pregnant again, it is one of the best gift that afraid when she knew that she conscious of her
Concept she could ever receive from above. She also would undergo a CS delivery, and condition; she has
Pattern becomes more health conscious to have a healthy she thinks that she cannot surpass the ability to
baby and becomes more productive. the surgery. establish a good
rapport and to be
a good mother
sooner.
 Interactions
Area of Data Before Admission During Admission Interpretation
Collection

Role- According to the patient, she is the first child of According to the patient, she is The patient has a
Relationship her parents and a former OFW in Qatar. In terms not able to do her responsibility good relationship
Pattern of being a good child and a worker, she builds as a mother due to her with her loved
strong relationships with all of her loved ones. hospitalization, but the ones.
Furthermore, she is excited to be a good mother relationship between her role as a
to her third child and ready to face the situation mother to her children and that of
of having an infant again. a child of her parents is strongly
connected.

Sexuality- According to the patient, they are sexually According to her, there are no The patient has no
Reproductive active. Her first sexual encounter was when she changes in her sexually changes in her
Pattern was 20 years old. Her LMP is June 15, 2022. reproductive pattern. sexually
There are no problems in her reproductive reproductive
system. pattern.
 Interactions
Area of Data Before Admission During Admission Interpretation
Collection

Coping-Stress According to the patient, she is not suffering According to the patient, she is The patient has
Tolerance from stress, but if she were, her coping always accompanied by her the ability to
Pattern mechanism would be to spend quality time with husband that’s why she is not manage her
her husband and family. stressed. stressors and
coping skills.

Value-Belief According to the patient, she is a Roman According to the patient, The patient is a
Pattern Catholic and also believe in pamahiin such as professional doctors and with the God-centered
"Bawal mag-ulam ng talong na violet at baka help of Almighty God, she can person based on
magsubi-subi” and "Bawal umupo sa hagdan." survive in her situation. her value and
Moreover, they also believe in herbal medicines belief pattern.
such as oregano and quack doctors (Albularyo).
She also said that despite the “pamahiin”, God is
the most powerful one who can save you in all
things.
COURSE IN THE
WARD
 Date Doctor’s Order Rationale
Please admit under For additional patient
the service of OB at management,
OB ward. monitoring, and
March 20, 2023 assessment.

Secure consent for To have ethical

this admission. considerations and
also to protect their
freedom to make
healthcare decisions.
 Date Doctor’s Order Rationale
Monitor Vital Sign q4° Vital sign monitoring is a critical
component of high quality
facility-based obstetric care
and often is the first step to
March 20, 2023 identify maternal complication
and intervene when needed.
Monitor Input and Monitoring of intake helps
Output qshift. ensure that the patient has proper
intake of fluid and other
nutrients. Monitoring of output
helps determine whether there is
adequate output of urine as well
as normal defecation.
 Date Doctor’s Order Rationale
Monitor FHT q2° Fetal heart rate monitoring allows
maternal-fetal medicine experts and
ObGyns to monitor the health of a
baby in late stages of pregnancy and
March 20, 2023 during labor, helping to determine
conditions in the uterus and how the
baby is doing.
NPO post midnight. Ordering NPO after midnight has
been a common practice to lower the
risk of aspiration of gastric contents
during general anesthesia, which is
due in part to suppression of laryngeal
reflexes from anesthesia.
 Date Doctor’s Order Rationale
IV Fluids Useful for daily maintenance of body
fluids and nutrition, and for
D5LRS 1L x 20gtts/min rehydration.
once NPO
March 20, Laboratory Test
2023 Serology Check for the presence or level of
specific antibodies in the blood.

Hematology Can help diagnose anemia, infection,

hemophilia, blood-clotting disorders,
and leukemia.
 Date Doctor’s Order Rationale
For scheduled CS Baby is in the breech
March 20, 2023 tomorrow. position (feet first).

Please inform Anesthesiologist and OR Nurses.

Refer
POST OP
ORDER’S
 Date Doctor’s Order Rationale
Vital sign q15 min x Routine checking for vital signs
2° the q° if stable. (especially blood pressure) during
the first two hours after delivery
is an important standard of quality
March 21, 2023 care that will help in the early
detection of a potential life-
threatening complication.

Regulate IVF at Postoperative intravenous

40gtts/min maintenance fluid therapy ensures
adequate organ perfusion,
prevents catabolism, ensures
electrolyte- and pH-balance.
 Date Doctor’s Order Rationale
NPO To lower the risk of aspiration of
gastric contents during general
anesthesia, which is due in part to
suppression of laryngeal reflexes from
March 21, 2023 anesthesia.

Medications
Reduces the risk of acid aspiration at
Omeprazole
emergency cesarean section.

To stop uterine hemorrhage (excessive

Methergine
bleeding from the uterus) that
sometimes happens after delivery.
Methergine works by contracting
(tightening) the uterus.
 Date Doctor’s Order Rationale
Keterolac To control post-operative pain.

Could alleviate anxiety and

Tramadol depression in the early postpartum
March 21, period.
2023 To relieve moderate to severe pain.
Nalbuphine It is also used with other
medications and anesthesic agents
before, during, and after surgery
and other medical procedures.
Cefuroxime To prevent the patient from getting
an infection.
 Date Doctor’s Order Rationale
IV Fluids

D5LRS 1L + Oxytocin 10 Useful for daily maintenance of body

IU x 8° fluids and nutrition, and for
rehydration and Oxytocin is a
March 21, 2023 hormone used to help start or
continue labor and to control
bleeding after delivery. It is also
sometimes used to help milk
secretion in breast-feeding.

D5NM 1L x 8° Indicated for parenteral maintenance

of routine daily fluid and electrolyte
requirements with minimal
carbohydrate calories from dextrose.
 Date Doctor’s Order Rationale
PLRS 1L x 10° Fluid you may receive if
you're dehydrated,
having surgery, or
receiving IV
March 21, 2023 medications.

Flat on bed for 8° You will need to stay in

bed until the anaesthetic
wears off.
 Date Doctor’s Order Rationale
Monitor Input and Recording of intake
Output q1° x 4° If helps to ensure that
there’s no 30ml/hour. the patient has a
March 21, 2023 proper intake of fluid
and recording of
output helps to
determine whether there
is an adequate output of
urine & normal
defecation.
Refer
ANATOMY AND
PHYSIOLOGY
PATHOPISIOLOG
Y
DRUG
STUDY
DRUG CLASSIFICA MECHANI INDICATION CONTRAINDIC ADVERSE NURSING
NAME TION SM ATION REACTION RESPONSIBI
OF LITY
ACTION
Generic Proton pump Inhibits Lessen Contraindicated •Dizziness -Explain the
Name: inhibitor proton pump bleeding with • headache side effects
Omeprazole activity by hypersensitivity to •Abdominal that may occur
binding to omeprazole it’s Pain -Ask the
Brand Name: hydrogen- component; use • diarrhea patient for a
Prilosec potassium cautiously, with • nausea possible
adenosine pregnancy •vomiting allergy
Dosage and triphosphate, lactation. •back pain reaction to the
Frequency: located at •weakness medicine
40mg SIV SD secretory •asthenia -Advise the
surface of •constipation patient to
gastric avoid alcohol
parietal cells, and foods that
to suppress may cause an
gastric acid increase in GI
secretion. irritation.
-
DRUG CLASSIFICATIO MECHANISM INDICATION CONTRAINDICATIO ADVERSE NURSING
NAME N OF ACTION N REACTION RESPONSIBILIT
Y
Generic Name: Nonsteroidal anti- May inhibits Ketorolac is a Contraindicated with •Headache -Observe the 10
Ketorolac inflammatory prostaglandin Non-steroidal anti- significant renal •Dizziness rights in
agents, nonopioid synthesis to inflammatory drug impairment, aspirin •Drowsiness administering the
Brand Name: analgesics produce anti- (NSAID) and has allergy •Nausea drug
Toradol inflammatory, antipyretic, •Vomiting - Assess and
analgesics, and analgesic and anti- •GI pain accurately record
Dosage and antipyretic inflammatory maternal vital
Frequency: effects. properties. It is signs
30mg Slow IV indicated for short -Assess the client
q8° ANST(-) x 3 term management history of allergy
doses of acute pain that to the drug to
requires the calibre avoid complication
of pain -Encourage client
management to report sever pain
offered by opioids for prompt
intervention
-Tell patient to
avoid activities
requiring alertness
because this drug
can cause
headache,
drowsiness, and
dizziness
DRUG CLASSIFICAT MECHANIS INDICATION CONTRAINDICAT ADVERSE NURSING
NAME ION M ION REACTION RESPONSIBIL
OF ACTION ITY

Generic Name: Analgesic Thought to Relief of Contraindicated with •Dizziness -Observe the 10
Tramadol (Centrally bind to opioid moderate to pregnancy; allergy to •Headache rights in
acting) receptors and moderately tramadol; acute •Samnolence administering
Brand Name: inhibits severe pain intoxication with •Nausea the drug
Ultram Opioid reuptake of alcohol, opioids, •Vomiting -note for any
Analgesic norepinephrin psychotropic drugs •Sleep Disorder hypersensitivity
Dosage and e and or other centrally •Dry Mouth reaction
Frequency: serotonin. acting analgesics; •Anxiety - Assess any
50mg Slow IV lactation. •Weakness history of
q8°x 3doses •Abdominal allergy with this
Pain drug
•Malaise -Explain the side
•constipation effect that may
occur
DRUG CLASSIFICATI MECHANIS INDICATION CONTRAINDICAT ADVERSE NURSING
NAME ON M ION REACTION RESPONSIBIL
OF ACTION ITY

Generic Name: Pharmacologic Unknown. For the relief of Contraindicated in •Nausea -Monitor vital
Nalbuphine class: Opioid Binds with moderate to patients •Vomiting signs
agonist- opioid severe pain hypersensitive to drug •Dry mouth -Assess the client
Brand Name: antagonist- receptors in or it’s components •Headache history of allergy
Nubain opioid partial the CNs, and in those with •Dizziness to the drug to
agonists. altering significant respiratory avoid
Dosage and perception of depression. complication
Frequency: Therapeutic and emotional
- Encourage
10mg SIV q6° class: response to
client to report
x 4 doses with Opioid pain
sever pain for
BP precaution analgesics.
prompt
intervention
-Explain the side
effect that may
occur
-
DRUG CLASSIFICATI MECHANIS INDICATION CONTRAINDICAT ADVERSE NURSING
NAME ON M ION REACTION RESPONSIBIL
OF ACTION ITY

Generic Name: Pharmacologic Methylergome To prevent and Contraindicated in •headache -Encourage

Methylergomet class: trine acts treat postpartum patients •nausea client to report
rine Ergot alkaloids directly on the hemorrhage hypersensitive to •vomiting sever pain for
smooth caused by methylergometrine or •dizziness prompt
Brand Name: Therapeutic muscle of the uterine atony or any component of the •drowsiness intervention
Methergine class: uterus and subinvolution. formulation •upset stomach -Assess any
Oxytocics increases the •diarrhea history of allergy
Dosage and tone, rate, and -hypertension; with this drug
Frequency: amplitude of toxemia of pregnancy - Assess the
1 amp IM rhythmic patient to avoid
contractions drinking
through caffeinated and
binding and alcoholic when
the resultant drinking this
antagonism of medication
the dopamine
D1 receptor
DRUG CLASSIFICATI MECHANIS INDICATION CONTRAINDICAT ADVERSE NURSING
NAME ON M ION REACTION RESPONSIBIL
OF ACTION ITY

Generic Pharmacologic Inhibits cell- Treatments Contraindicated in •nausea -Assess any

Name: class: Second wall of infections patients •vomiting history of
Cefuroxime Generation synthesis, caused by hypersensitive to •phlebitis allergy with
cephalosporin promoting bacteria drug or other •thrombophleb this drug
Brand Name: osmotic Cephalosporins. itis -Advise patient
Zinafec Therapeutic instability; •diarrhea receiving drug
class: usually •weakness IV to report
Dosage and Antibiotics bactericidal. •back pain discomfort at
Frequency: IV insertion
1.5 grams IV site
after skin test - Assess the
patient to
avoid drinking
caffeinated and
alcoholic when
drinking this
medication
DISCHARGE
PLANNING
 Encourage the patient or to continue taking the
home meds as directed in order to promote a
full recovery.
Medicine
Describe the importance of regularly taking of
prescribed medications including the potential
unpleasant effects of non compliance.

Promote moderate physical activity like

walking.
Exercise Maintain a quiet, pleasant environment to
promote relaxation.
 Provide clean and comfortable environment.
 Encourage patient to take multivitamins for
Treatment immunity.

Instruct the patient to limit her activity.

Health Advice patient to avoid lifting heavy objects.
Education Instruct the patient to promote adequate fluid
intake.
 Out-patient Instruct the patient to continue follow-up
Follow up visit check up to the doctor.

Instruct the patient to increase intake of

Diet nutritious food such as fruits and vegetables.
 Encourage the patient to have
faith and pray to God.
Spiritual Encourage the patient to spend
time of silence in a day for a
moment of prayer.
Strengthen faith and
communicate with God.