PREECLAMPSIA

MEMBERS:

Clinical Instructor: PEDRO SY RAULLO, RN, MAN

INTRODUCTION
Preeclampsia

 is a pregnancy complication characterized by high

blood pressure and signs of damage to another
organ system, most often the liver and kidneys.
Preeclampsia usually begins after 20 weeks of
pregnancy in women whose blood pressure had
been normal.
 Left untreated, preeclampsia can lead to serious —
even fatal — complications for both you and your
baby.
S & SX MILD PREECLAMPSIA SEVERE PREECLAMPSIA

BLOOD PRESSURE 140/90; Systolic elevation of 160/110

30 mm/Hg
Diastolic elevation of 15
mm/Hg

Proteinuria +1 to +2 +3 to +4 in clean catch urine

300 mg/ L24 hour urine or 5 g/24 hour urine collection
collection
Edema Digital edema ( +1 +2) Pitting edema (+3 +4)
Dependent edema Generalized edema

Weight Gain 3 lb/week More rapid weight gain

Urinary Output Not less than 500 ml/24 hours Less than 500 ml/24 hours;
oliguria
Headache Occasional headache Severe headache
Reflexes Normal to +1 +2 Hyperreflexia,+3 +4
Visual Disturbances Absent Photophobia, blurring spots
before the eyes
Epigastric Pain (liver Absent Right upper quadrant pain
involvement) (aura to convulsion)
DEMOGRAPHIC DATA
Name: S. A.
Address: Baliaug, Bulacan
Age: 43
Civil Status: Married
Occupation: Municipal Employee
Educational Attainment: N/A
Chief Complaint: on and off labor pains with elevated blood pressure
Admitting Diagnosis: Pre-eclampsia G3P2(2002) PU 37 weeks AOG by utz prior
CS 2x
Present Diagnosis: preeclampsia resolved G3P3(3003) PU delivered via LTCS III
with BTL secondary to scarred uterus to live Bb. Girl
AS 8.9 BW 3000grams
Date and Time of Admission: April 19, 2021 and 5am
Attending Physician: Dra. Aileen Sebastian
CLINICAL HISTORY
History of Present Illness:

●Term 37 weeks AOG, 4 hrs prior to admission pt.

has on and off labor pains thus prompted hospital
admission. BP 190/120mmhg
●2-3 hours PTA pt experienced moderate to severe
labor pains
●OB History G3P2 ( T2 P0 A0 L2)
●LMP 08-03-2020
●EDC 05-10-2021
●+ edema lower extremities
Past Medical History (previous illness and hospitalization)

• Pt is only taking metoprolol if her BP is elevated for almost 1 yr

• She was hospitalized one time due to sudden bp elevation during her 30
weeks AOG
• Had 2 CS operation in her previous children
• No DM and Hypertension

ALLERGIES N/A
Family History
- her father’s side has family hx of hypertension and her mother died because
of vehicular accident

Social History
●Patient has history of smoking and drinking alcoholic beverages occasionally
Obstetrics and Gynecologic History

●Term 37 weeks AOG

●OB History G3P2 ( T2 P0 A0 L2)
●LMP 08-03-2020
●EDC 05-10-2021
THEORETICAL
FRAMEWORK
 3 Nuring Theorist and Their Theories

1. Intergration of Myra Estrin Levine’s Conservation Theory and

Elizabeth Lenz and Linda Pugh’s Theory of Unpleasant
Symptoms
2. Dorothea Orem's Self-Care Deficit Theory
3. Jean Watson's Theory of Human Caring (Theory of
Transpersonal Caring)
Intergration of Myra Estrin Levine’s Conservation Theory and Elizabeth Lenz
and Linda Pugh’s Theory of Unpleasant Symptoms
Nursing theory that can be applied to pregnant women with preeclampsia is
Levine’s conservation and unpleasant symptom theory. The applications of both
nursing theories not only help patients overcome these problems from the physical aspect
alone, but also overcome the problems from psychological, social, personal and situational
aspects so that comprehensive nursing care can be given.
Levine's conservation theory allows individuals to adapt to maintain its integrity with
conservation as a result. The main focus of conservation is the balance between supply and
energy needs in order to preserve all aspects of individual wholeness.
While the unpleasant symptom theory is applied in reducing the symptoms of
discomfort by increasing understanding about a set of symptoms of discomfort from various
contexts and providing useful information as well as showing the negative effects of symptoms
of discomfort.
Thus, the aim of nursing care in pregnant women with preeclampsia using Levine’s
conservation and unpleasant symptom theories, is that pregnancy can be maintained until
mature and preserve the well-being of mother and fetus.
In the case of Soledad who suffers from preeclampsia, the integration of Levine’s
Conservation and unpleasant symptoms theory works out and is mutually supportive
to meet the needs of Soledad with preeclampsia. Preeclampsia of Soledad will have
an impact toward her and her baby which makes her experience symptoms of
discomfort such as dizziness and anxiety. Therefore, Soledad needs nurse’s help to
improve her condition and prevent her and her baby from complications.
The interventions and implementations performed to Soledad are adjusted to the
problems that arise, according to the management of patients with preeclampsia
while employing the Levine’s Conservation and Unpleasant Symptoms nursing
theory.
All actions taken were to achieve Soledad’s energy conservation such as meeting the
need for nutrition, oxygenation, activity and rest, as well as preventing fatigue due to pain
and discomfort (dizziness).
All the actions taken to prevent Soledad’s fatigue need to be done at one time, in order
not to disrupt her rest.
All actions were also taken to fulfill Soledad’s conservation of structural integrity such as
improving her physical conditions, improving her maternal and fetal welfare, controlling
her blood pressure, and preventing her from seizures.
Actions are also undertaken to meet Soledad’s conservation of personal integrity such as
overcoming her anxiety, improving her knowledge of her illness and maintaining her
privacy.
There are also actions to fulfill Soledad’s conservation of social integrity such as how to
keep her communication and socialization undisturbed.
The final results of the evaluation are the improvement of nursing care quality and
Soledad’s condition, with stable hemodynamic, no seizure, controlled blood pressure,
healthy fetal condition, decreased her anxiety, and increased her independence.
Dorothea Orem's Self-Care Deficit Theory
Self-care is defined as the "activities a person initiates and performs in his own behalf in order to
maintain life, health, and wellbeing." The concept of self-care requires a reappraisal of the nursing focus
since the patients’ selfcare abilities (assets) rather than just disabilities (deficits) are assessed. The client
should know what nursing assessment has been made and should participate in determining desired
goals for health. A key concept for the nurse to grasp is that man, as a self-care agent, is capable of
making decisions and working towards goals with deliberate action. Parents become self-care agents for
their infants and children.
A self-care framework is useful in obstetric nursing when patients are eager to accept
responsibility for their own health via self-care actions. A model framework is presented for use by family-
centered obstetric nursing.
Orem’s conceptual framework for nursing provides a basis for holistic assessment of a client and
identifies the nurse’s function to assist individuals toward optimal self-care. The self-care framework is
particularly useful in obstetric nursing where patients are usually eager to accept and want responsibility
for their own health via self-care actions.
Orem’s self-care nursing framework, proposes a changed healthcare delivery system which is
client-oriented and focuses on increasing a person’s ability to maintain or improve health. In this system,
the nurse is the extension of the patients, and nursing and medicine cooperate and collaborate in
assisting individuals to obtain their optimal state of health. Nurses who have become advocates for
family-centered maternity care, for example, are usually working within a client-centered health-care
system.
In the case of Soledad who suffers from preeclampsia, using Orem’s self-care
framework, her nurse operates within a client-centered system which
encourages Soledad to be responsible for her own care. The philosophy
changes from "I am here to take care of you" (mater-nalistic) to "I am here to
assist you in taking care of yourself’ (helping relationship). Even if she is
undergoing preeclampsia or disabled because of the medical procedure done
to her (or her family members), she can be included in the decision-making
processes when actual self-care is not possible. Every effort must be made to
have her selfworth and dignity remain intact.
There is much that Soledad can do to take care of herself during and after
pregnancy. If she has any questions about diet, the use of drugs or nutritional
supplements, physical activity, and sexual intercourse during pregnancy, she
can talk with her doctor or other health care practitioner.
Jean Watson's Theory of Human Caring (Theory of Transpersonal Caring)
According to Watson (1997), the core of the Theory of Caring is that “humans
cannot be treated as objects and that humans cannot be separated from self, other,
nature, and the larger workforce.” Her theory encompasses the whole world of
nursing; with the emphasis placed on the interpersonal process between the care
giver and care recipient. The theory is focused on “the centrality of human caring and
on the caring-to-caring transpersonal relationship and its healing potential for both the
one who is caring and the one who is being cared for” (Watson, 1996).
The practice of Watson’s theory Human Caring could be a useful guide in giving
“nurturing and caring relationship” were the prime roadmaps in the care of the
pregnant woman. In addition, carative factor and the corresponding carative process
were effective in enabling to pregnant woman to arrive a stage of regaining hope. The
theory of Human Caring focuses on human characteristics that strive for healing and
love in stressful, physical or emotional conditions and makes it a suitable guide for
nurses in providing care that projects, hope, respect, trust, and compassion.
In the case of Soledad who suffers from preeclampsia, she unknowlingly
defined caring by what her nurse does for her and what her nurse is like as a
person during their interactions. These caring moment episodes between them
provide rich opportunities to further explore the connections between patient
experience and nurse caring behaviors in further defining the meaning of
quality nursing care given to her by her nurse.
Being in the state of preeclampsia, Soledad’s anxiety and fear are
heightened about herslef and her new baby’s health, but because her nurse is
providing care and bringing her and her baby to optimal their health. Her nurse
applies a holistic treatment approach which includes treating her mind, soul,
and spirit as well as her body. Her nurse takes time to have uninterrupted
moments with the her which Watson refers to this as “caring moments.” Her
nurse uses knowledge and intervention to promote her and her baby’s health
and healing.
Providing her with the 10 carative factors proves that caring regenerates
her life energies and potentiates her capabilities.
 PHYSICAL
ASSESSMENT
 BODY PARTS METHOD USE FINDINGS INTERPRETATION
Vital Signs
Armpit Auxillary Method 36.4℃ Normal - afebrile
Radial Artery Radial Method 85 bmp Normal - symmetrical, regular
and between 60-90 per
minute.
Apical Artery Apical Method 18 bmp Normal - normal apical pulse
rate for an adult is from 60 to
90 beats per minute.
Brachial Artery Cuff Method 190/120 Abnormal - Extremely high
blood pressure
Index Finger Oximeter Method 95% Normal - the level between 95
and 97% is considered
normal.
Lower Extremities
Skin Inspection, Palpation Swelling Evidence of Edema
Ankle Pitting Method (Palpation) Swelling Evidence of Edema
Feet Pitting Method (Palpation) 1-2+ pitting edema on both Evidence of Edema
feet
Legs Pitting Method (Palpation) Swelling Evidence of Edema
System
Neurovascular Glasgow Coma Scale Patient was noted Normal - Normal
conscious and coherent, Reflexes were noted.
GCS of 15/15 (E4, V5,
M6),
Respiratory Auscultation Normal breathing was Normal - no respiratory
noted, clear breath problem found
sounds on all lung
fields
Cardiovascular Auscultation Patient was noted with Normal - the patient
strong and steady has normal pulses.
pulses
GIT/GUT Internal Examination Soft and non-tender Abnormal - the normal
abdomen, Cervix was fetal heart rate is 110
open at 1-2 cm BPM to 160 BPM .
FHT of 168 bpm was
noted thru the fetal
monitor.
 ANATOMY
and
PHYSIOLOGY
Women have the duty of bringing forward life into the world, thus
the creation and the work of the female reproductive system. This
system performs a supernatural occurrence from the conception
of life until the birth of the developing life inside, and it is as it
were appropriate to be presented to the most characters and
supporting parts of this play.

Female Reproductive System

 The main function of the female reproductive system is to
produce eggs (ova) to be fertilised, and to provide the space
and conditions to allow a baby to develop. In order for this to
happen, the female reproductive system also has the
structures necessary to allow sperm from a man to meet the
ova of a woman.
INTERNAL STRUCTURES
Ovaries
Fallopian Tubes (Uterine Tubes)
FUNCTIONS
 The ovaries are the ultimate life-maker for the females.
 For its physical structure, it has an estimated length of 4 cm and width of 2 cm and is
1.5 cm thick. It appears to be shaped like an almond. It looks pitted, like a raisin, but is
grayish white in color.
 It is located proximal to both sides of the uterus at the lower abdomen.
 For its function, the ovaries produce, mature, and discharge the egg cells or ova.
 Ovarian function is for the maturation and maintenance of the secondary sex
characteristics in females.
 It also has three divisions: the protective layer of epithelium, the cortex, and the central
medulla.
 The fallopian tubes serve as the pathway of the egg cells towards the uterus.
 It is a smooth, hollow tunnel that is divided into four parts: the interstitial, which is 1 cm
in length; the isthmus, which is2 cm in length; the ampulla, which is 5 cm in length; and
the infundibular, which is 2 cm long and shaped like a funnel.
 The funnel has small hairs called the fimbria that propel the ovum into the fallopian
tube.
 The fallopian tube is lined with mucous membrane, and underneath is the connective
tissue and the muscle layer.
 The muscle layer is responsible for the peristaltic movements that propel the ovum
forward.
 The distal ends of the fallopian tubes are open, making a pathway for conception to
occur.
INTERNAL STRUCTURES FUNCTIONS
Uterus  The uterus is described as a hollow, muscular, pear-shaped organ.
 It is located at the lower pelvis, which is posterior to the bladder and anterior to the
rectum.
 The uterus has an estimated length of 5 to 7 cm and width of 5 cm. it is 2.5 cm deep in
its widest part.
 For non-pregnant women, it is approximately 60g in weight.
 Its function is to receive the ovum from the fallopian tube and provide a place for
implantation and nourishment.
 It also gives protection for the growing fetus.
 It is divided into three: the body, the isthmus, and the cervix. f
 The body forms the bulk of the uterus, being the uppermost part. This is also the part
that expands to accommodate the growing fetus.
 The isthmus is just a short connection between the body and the cervix. This is the
portion that is cut during a cesarean section.
 The cervix lies halfway above the vagina, and the other half extends into the vagina. It
has an internal and external cervical os, which is the opening into the cervical canal.
EXTERNAL STRUCTURES FUNCTIONS
Mons Veneris  The mons veneris is a pad of fat tissues over the symphysis pubis.
 It has a covering of coarse, curly hairs, the pubic hair.
 It protects the pubic bone from trauma.
Labia Minora  Lateral to the labia minora are two folds of fat tissue covered by loose connective tissue
and epithelium, the labia majora.
 Its function is to protect the external genitalia and the distal urethra and vagina from
trauma.
 It is covered in pubic hair that serves as additional protection against harmful bacteria
that may enter the structure.
Vestibule  It is a smooth, flattened surface inside the labia wherein the openings to the urethra
and the vagina arise.
Clitoris  The clitoris is a small, circular organ of erectile tissue at the front of the labia minora.
 The prepuce, a fold of skin, serves as its covering.
 This is the center for sexual arousal and pleasure for females because it is highly
sensitive to touch and temperature.
Skene’s Glands  Also called as paraurethral glands, they are found lateral to the urethral meatus and
have ducts that open into the urethra.
 The secretions from this gland lubricate the external genitalia during coitus.
EXTERNAL STRUCTURES FUNCTIONS
Bartholin’s Gland  Also called bulbovaginal gland, this is another gland responsible for the lubrication of
the external genitalia during coitus.
 It has ducts that open into the distal vagina.
 Both of these glands secretions are alkaline to help the sperm survive in the vagina.
Fourchette  This is a ridge of tissue which is formed by the posterior joining of the labia minora and
majora.
 During episiotomy, this is the tissue that is cut to enlarge the vaginal opening.
Perineal Body  This is a muscular area that stretches easily during childbirth.
 Most pregnancy exercises such as Kegel’s and squatting are done to strengthen the
perineal body to allow easier expansion during childbirth and avoid tearing the tissue.
Hymen  This covers the opening of the vagina.
 It is tough, elastic, semicircle tissue torn during the first sexual intercourse.
During preeclampsia significant
changes in following body parts
are reported;

 Fetoplacental unit
 Heart
 Blood
 Coagulation system
 Kidneys
 Liver
 Brain
 Eyes
Fetoplacental unit:
 In the uterus, hypertension-induced vasoconstriction decreases the
flow of uterine blood and vascular lesions occur in the placental bed,
which can lead to placental abruption.
 The reduction in blood flow to the choriodecidual areas reduces the
amount of oxygen that diffuses into the fetal bloodstream inside the
placenta via the cells of the syncytiotrophoblast and cytotrophoblast.
 The consequence is that the placental tissue becomes ischamic,
thrombosis of the capillaries in the chorionic villi, and defects occur
that lead to restriction of fetal development.
 With decreased placental activity, hormonal production is also reduced
and this has serious consequences for the fetus’s survival.
 This combination of factors frequently result in preterm labor and birth.
Heart:
 Tremendous demands are made upon the
heart during preeclamsia.
 It also must adjust to the demands of organs
systems with the increased workloads, such
as the kidneys and uterus.
 In addition, the heart is physically pushed
upward and to the left by the enlarging
uterus, which may cause systolic murmurs.
 In preeclampsia, cardiac contractility is
preserved but both steady and pulsatile
arterial load are increased inappropriately,
failing to decrease as would occur in normal
pregnancy, involving both conduit and small
vessels.
 Women who have preeclampsia are at
greater risk of having high blood pressure
later in life. They are also at double the risk
of having blood clots, a heart attack or
stroke within five to fifteen years after
pregnancy.
Blood:
 Hypertension and damage to endothelial cells impact capillary
permeability.
 The leakage of plasma proteins from the damaged blood vessel
causes plasma colloid pressure to decrease and edema to
increase in intracellular space.
 The reduced amount of intravascular plasma causes
hypovolemia and haemoconcentration, which is referred to as
elevated hematocrit,
 The lungs become congested with fluid in extreme cases, and
pulmonary edema occurs, oxygenation is hindered and
cyanosis takes place.
 The coagulation cascade is triggered with vasoconstriction and
disturbance of the vascular endothelium.
Coagulation system:
 Thrombocytopenia is produced by increased platelet intake and
may be responsible for the production of disseminated
intravascular coagulation.
 Fibrin and platelets are accumulated as the process
progresses, which can block blood flow to several organs,
especially the kidney, liver, brain and placenta.
Kidneys:
 Hypertension in the kidney contributes to vasospasm of the
afferent arterioles, resulting in reduced renal blood flow that
causes hypoxia and edema of the glomerular capillary
endothelial cells.
 Glomerulo-endotheliosis (glomerular endothelial damage)
enables proteins to fit into the urine, causing proteinuria,
predominantly in the form of albumin.
 Reduced creatinine clearance and increased serum creatinine
and uric acid levels are expressed in renal injury.
 Oliguria progresses as the condition worsens, suggesting
significant pre-eclampsia and damage to the kidneys.
Liver:
 Hepatic vascular bed vasoconstriction can result in hypoxia
and edema of liver cells.
 Edematous swelling of the liver in extreme cases causes
epigastic pain, which can lead to intracapsular haemorrhage
and, in extremely rare cases, liver rupture.
 Changed liver function is displayed by falling albumin level rise
in liver enzyme levels.
Brain:
 Hypertension combined with cerebrovascular endothelial
dysfunction increases the permeability of the blood-brain
barrier resulting in cerebral oedema and micro haemorrhaging.
 Clinically this is characterized by the onset of headaches,
visual distturbances and convulsions.
 If the mean arterial pressure (MAP, i.e. systolic blood pressure
plus twice the diastolic pressure separated by3) reaches 125
mmHg, cerebral flow autoregulation is impaired, resulting in
cerebral vasospasm, cerebral edema, and formation of blood
clots.
 This is known as hypertensive ecephalopathy, which may lead
to cerebral haemorrhage and death if left untreated.
Eyes:
 Preeclampsia is known to cause retinal vascular changes and
visual symptoms, including blurred vision, photopsia, diplopia
or even blindness; however, less is published about its effects
years later.
 Pregnancy hormones cause fluid retention which alters the
cornea to make it thicker, along with an increase in the fluid
pressure within the eyeball. This results in a blurred vision.
PATHOPHYSIOLOGY
Predisposing Factor:
Age: 43
Sex: Female
Family Hx: Hypertension
in her father side
PATHOPHYSIOLOGY OF Precipitating Factors:
PREECLAMPSIA Social HX: Patient has
history of smoking and
drinking alcoholic
beverages occasionally
Unknown Etiology

Decrease cardiac output

Endothelial cell damage

Vasospasm

Kidney effect
Vascular effect
Interstitial effect Decreased glomeruli filtration
rate and increased permeability
of glomeruli membranes. Vasoconstriction

Diffusion of fluid from Increased blood scrum urea,

blood stream into nitrogen, uric, acid, and
creatinine Poor organ perfusion
interstitial tissue

Decreased urine output and

proteinuria Increased blood pressure
Edema

PREECLAMPSIA
PROGNOSIS
 Resolution within days to weeks PP
 Consider essential HTN if it persists 12 weeks
 Prognostic issues include the risk of recurrent preeclampsia and related complications in
subsequent pregnancies and long-term maternal health risks.
 Recurrence — The recurrence risk varies with the severity and time of onset of the acute
episode .
 Women with early onset, severe preeclampsia are at greatest risk of recurrence (as high as 25
to 65 percent) .
 The risk is much lower (5 to 7 percent) in women who had nonsevere preeclampsia during the
first pregnancy, versus less than 1 percent in women who had a normotensive first pregnancy
(does not apply to abortions) .
 Long-term maternal risks:
 hypertension
• ischemic heart disease
• stroke
 venous thromboembolism
 Graded relationship between severity of preeclampsia and risk of future cardiac disease
TREATMENT
 Delivery remains the ultimate treatment for preeclampsia. Although maternal and fetal
risks must be weighed in determining the timing of delivery, clear indications for
delivery exist.
• When possible, vaginal delivery is preferable to avoid the added physiologic
stressors of cesarean delivery.
• If cesarean delivery must be used, regional anesthesia is preferred because it
carries less maternal risk.
• In the presence of coagulopathy, use of regional anesthesia generally is
contraindicated.
 MILD PREECLAMPSIA
Maternal and Fetal
Evaluation

≥ 34th to 36th weeks

≥ 37th weeks
Labor, premature ruptue membranes
Suspected abruption
Intrauterine growth restriction <10th percentile
Abnormal maternal/fetal testing
Oligohydramnious

NO YES

• Maternal / fetal testing YES

• Inpatient or outpatient DELIVERY

• Worsening maternal / fetal condition YES

• Labor / premature ruptue membranes
• ≥ 37th weeks
SEVERE •
•
Admit to Labor room
Maternal & Fetal Assessment
PREECLAMPSIA •
•
Consider MgSo4
Treat sever hypertension

Contraindications to conservative management:

• Persistent sysmptoms or severe hypertension
• Eclampsia ,pulmonary edema, HELLP syndrome
• Significant renal dysfunction, coagulopathy
• Abruption and Previable fetus
• Fetal compromise

PRESENT ABSENT

Delivery Initial 24-48 hour observation:

• Corticortesoids for lung maturaion
• Frequent Evaluation: VS, UOP
Develop • Daily lab evaluation for HELLP syndrome
Contraindications

Develop Ongoing inpatient management:

Contraindications • Daily maternal assessment
• Serial lab evaluation of renal function and for HELLP syndrome
Delivery at • Daily fetal assessment and evaluationa of serial growth and amniotic fluid
34 weeks volume
Medications
• Medications to lower blood pressure - These medications, called antihypertensives, are used to lower your
blood pressure if it's dangerously high. Blood pressure in the 140/90 millimeters of mercury (mm Hg) range
generally isn't treated. Although there are many different types of antihypertensive medications, a number of
them aren't safe to use during pregnancy. Discuss with your doctor whether you need to use an
antihypertensive medicine in your situation to control your blood.

• Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid medications can
temporarily improve liver and platelet function to help prolong your pregnancy. Corticosteroids can also help
your baby's lungs become more mature in as little as 48 hours

• Anticonvulsant medications. If your preeclampsia is severe, your doctor may prescribe an anticonvulsant
medication, such as magnesium sulfate, to prevent a first seizure.

Bed rest
• Bed rest used to be routinely recommended for women with preeclampsia. But research hasn't shown a
benefit from this practice, and it can increase your risk of blood clots, as well as impact your economic
and social lives. For most women, bed rest is no longer recommended.

Hospitalization
• Severe preeclampsia may require that you be hospitalized. In the hospital, your doctor may perform
regular nonstress tests or biophysical profiles to monitor your baby's well-being and measure the volume
of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply to the baby.
LABORATORY /
DIAGNOSTIC
EXAMINATION
 DATE OF LABORATORY OR
DIAGNOSTIC RESULTS LABORATORY
REFERENCE VALUE ACTUAL RESULTS SIGNIFICANCE /
OR DIAGNOSTIC PROCEDURE INTERPRETATION

April 19, 2021

5am - CBC RESULTS
Hematocrit 42-54 vol % 43.1 Vol % Normal - Having too few or too many red
blood cells can be a sign of certain
diseases.
Hemoglobin 14-18 g% 15.8 g% Normal - Having more tha of the
reference value indicates thrombocytosis
and having less thn the reference value
indicates thrombocytopenia
WBC Count 5,000- 10, 0000 /cumm 9,280 /cumm Normal -ain conditions, including lupus,
rheumatoid arthritis, vitamin deficiencies,
or aA low white blood cell count can be
an indicator of cert side effect of cancer
treatment.
Platelet Count 150- 400 x 10^3/cumm 201 10^3/cumm Normal - If your blood platelet count falls
below normal, you have
thrombocytopenia
MCV 80-97fL 84.5 fL Normal -if their MCV levels are greater
than 100 fl, they could experience
macrocytic anemia.
MCH 26-32 pg 31.3 pg Normal A person with a low MCH has
concentrations at or below 26 pg per cell
MCHC 31-36 g/dL 32.2 g/dL Normal shows that someone's red blood
cells do not have enough hemoglobin
RDW 13.9 Normal- If you score outside this range,
you could have a nutrient deficiency,
infection, or other disorder.
RBC Count 4.20 - 6.3m/uL 4.75 m/uL Normal -a decrease in the number of
red blood cells is called anemic
Segmenters 40-60% 53.9 % Normal -the high neutrophil count
may also result from blood cancer or
leukemia
Lymphocyte 20-40% 25.4 % Normal -Unusually high or low
lymphocyte counts can be a sign of
disease.
Monocyte 2-8 % 4.1 % Normal -Monocytosis or a monocyte
count higher than 800/µL in adults
indicates that the body is fighting an
infection.
Eosinophil 1-3% 2.1 % Normal - A count of more than 1,500
eosinophils per microliter of blood
that lasts for several months is called
hypereosinophilia.
Basophil 0-1% 0.1 % Normal - A low basophil level is
called basopenia.It can be caused by
infections, severe allergies, or an
overactive thyroid gland.
 DATE OF LABORATORY OR
DIAGNOSTIC RESULTS
REFERENCE VALUE ACTUAL RESULTS SIGNIFICANCE /
LABORATORY OR DIAGNOSTIC INTERPRETATION
PROCEDURE

April 19, 2021

6am - HBSAg
HBSAg Non-Reactive Normal - no hepatitis B
surface antigen was
found
Blood typing Type “O” positive O positive red blood
cells are not universally
compatible to all types,
but they are compatible
to any red blood cells
that are positive (A+,
B+, O+, AB+).
HbA1c 4.2 – 6.0% 4.3 Normal - no diabetis
 DATE OF LABORATORY OR
DIAGNOSTIC RESULTS
REFERENCE VALUE ACTUAL RESULTS SIGNIFICANCE /
LABORATORY OR DIAGNOSTIC INTERPRETATION
PROCEDURE

April 19, 2021

6:10am - swab test (RT-PCR) - SARS-CoV-2 Viral RNA RT- PCR
Oropharyngeal/ SARS-CoV-2(Causative Negative for SARS-
Nasopharyngeal swab agent of COVID-19)viral CoV-2(Causative agent
RNA NOT DETECTED of COVID 19)
 DATE OF LABORATORY OR
DIAGNOSTIC RESULTS
REFERENCE VALUE ACTUAL RESULTS SIGNIFICANCE /
LABORATORY OR DIAGNOSTIC INTERPRETATION
PROCEDURE

April 19, 2021

6:15am - URINALYSIS
PHYSICAL EXAMINATION
COLOR yellow Normal - yellow pigments called
urobilin or urochrome
TRANSPARENCY Slightly turbid
SPECIFIC GRAVITY 1.010 Indicate mild dehydration
PH 6.5 Normal urine pH is slightly acidic
PROTEIN (-) There is no detectable amount of
protein in the urine.
SUGAR (-) There is no detectable amount of
sugar in the urine.

MICROSCOPIC EXAMINATION
PUS CELLS 1-3 /hpf Normal - pus cells called pyuria 0-3 per high
power field is normal .

RED CELLS 0-1 /hpf Normal - there are red blood cells (RBCs) in the
urine. Often, the urine looks normal to the naked
eye. But when checked under a microscope, it
contains a high number of red blood cells.

EPITHELIAL CELLS many normal - to have one to five squamous epithelial

cells per high power field (HPF) in your urine.

MUCUS THREADS few A small amount of mucus in your urine is

normal.

BACTERIA moderate Moderate presence of bacteria can causing

a urinary tract infection (UTI)
 DATE OF LABORATORY OR
DIAGNOSTIC RESULTS
REFERENCE VALUE ACTUAL RESULTS SIGNIFICANCE /
LABORATORY OR DIAGNOSTIC INTERPRETATION
PROCEDURE

April 19,2021
6:20am - CHEST XRAY PA
Radiographic Report
-Lungs Fields are clear Normal - no lungs
problem
-Heart is not enlarged Normal - no heart
problem
-Diaphragm and sulci Normal - no diaphragm
are intact and sulci problem
-The rest of the Normal - no problem
visualized chest with the structure of the
structures are intact chest

IMPRESSION normal chest Normal - no chest

problem
 DATE OF LABORATORY OR
DIAGNOSTIC RESULTS
REFERENCE VALUE ACTUAL RESULTS SIGNIFICANCE /
LABORATORY OR DIAGNOSTIC INTERPRETATION
PROCEDURE

April 19,2021
6:20am - ECG

INTERPRETATION SINUS RHYTHM Normal rhythm of the

heart where electrical
stimuli are initiated in
the SA node
 MEDICAL
and
SURGICAL
MANAGEMENT
 MEDICAL REGIMEN / SURGICAL PROCEDURE RATIONALE
April 19, 2021 At 5am
DOCTOR’S ORDER
Admit to ROC To monitor health condition and for further observation.
Secure Consent For legal purposes
VS q1 and record To monitor VS of the pt
FHT q1 and record To monitor the FHT of the baby
Lboratory test (CBC, UA, CXR PA, ECG, HBSAg, To examine all LAB result
HbA1c, blood typing, and swab test (RT-PCR))
WOF seizure To monitor signs of seizure and untoward event
IVF: D5LR 1l x 30gtts/min To maintain fluid and electrolyte balance
Administration of Magnesium sulfate (4g deep IM each To prevent and control seizure
buttock x 1 dose now)
Administration of Cefuroxime 1.5g IV ANST now To prevent infection
Insert Foley catheter To drain the bladder
Inform Dra Yumol, for co management and Dr. Baluran For collaborative intervention
 MEDICAL REGIMEN / SURGICAL PROCEDURE RATIONALE
APRIL 20,2021 9AM
ANESTHESIA POST OP ORDER
PACU S/P LTCS III with BTL, SAB To numb the lower part of your body — allowing pt to remain awake
during the procedure.
O2 inhalation via NC till awake
Monitor vsq30mins x 2 hrs and then q1x 6hrs To evaluate any changes and safely monitor post-operative patients
by following correct frequency and duration.
Regulate present IVF @ 25gtts/min
IVFTF : 1. D5LR1L x 8 + 1 amp of diclofenac ANST To maintain fluid and electrolyte balance and reduces swelling
(inflammation) and pain.
2. D5LR 1L x 8 To maintain fluid and electrolyte balance
3. D5LR 1L x 8 To maintain fluid and electrolyte balance
Meds : Tramadol 50mg IV PRN To relieve pain.
Metoclopromide 40mg IV PRN To prevent nausea and vomiting from surgery.
Dipenhydramine 50mg IV PRN To relieve symptoms of allergy, hay fever, and the common cold.
I&O Q1 x 24hrs To maintain fluid and electrolyte balance
Flat on Bed x 6-8 hrs
WOF, bleeding, Dob, cyanosis, chest pain, headache, pallor, nausea, To prevent complications.
vomiting, pruritus, refer if any untoward s/sx
 MEDICAL REGIMEN / SURGICAL PROCEDURE
APRIL 20,2021 9PM
Flat on bed and NPO until 4am
generals liquid diet @ 5am
facilitate soft t diet @ 6am
moderate to high back rest once on diet progression
continue previous IVF series
continue cefuroxime 750mg IV q8 x 2 more doses
tranexamic acid 1 gr IV BID
Methylergonometrine 1 amp IM OD
Start oral meds: 1. cefuroxime 500mg/cap 1 cap BID
2. celecoxib 200mg/cap 1 cap BID
3. Amlodipine 5mg bid
Maintain on abdominal binder
v/s monitoring q1 x 3 hrs then q4
refer if BP is ≥ 150/90, and UO ≤ 30cc/hr
Encourage breastfeeding
Perineal wash
refer accordingly
RATIONALE
To maintain adequate respiratory function with no constricting external
compression on the respiratory system and to prevent aspiration.
To give pt more nutrition and allow pt’s body to heal from a procedure.
To help pt recover from surgery and illness and make chewing and
digesting food easier.
To maintain fluid and electrolyte balance.
To prevent and treat bacterial infections.
To reduce and prevent blood loss.
To prevent and treat bacterial infections.
To reduce pain and inflammation.
To treat high blood pressure (hypertension).
To help support pt’s abdomen and hips, strengthen her core muscles,
promote mobility, ease your back pain, and encourage good posture in
the postpartum period.
For close monitoring.
For collaborative intervention.
To prevent infection and clean the perineum area.
For collaborative intervention.
 MEDICAL REGIMEN / SURGICAL PROCEDURE RATIONALE
APRIL 21,2021 8AM
PREOPERATIVE TECHNIQUE
Induction of spinal anesthesia
Asepsis and antisepsis To maintain sterility conditions through good hygiene procedure and
prevent infection.
Transurethral catheterization To facilitate direct drainage of the urinary bladder.
Midline infraumbilical incision on the skin and carried down to the To deliver the baby faster and enhance postoperative recovery with
peritoneum minimal complications.
dissection of the vesicouterine flap at the lower uterine segment To enable the surgeon gain access to the lower uterine segment while
minimizing injury to the bladder.
transverse curvilinear incision at the LUS
Gentle extraction of a live bb girl To take out the baby safely from the uterus.
cord clamping and cutting To help stop bleeding from the blood vessels in the umbilical cord and
detach the baby from the uterus and be delivered.
inspection of the uterine cavity To investigate symptoms or other problems.
closure of the uterus in layer To allow wound healing and inflammatory response.
 MEDICAL REGIMEN / SURGICAL PROCEDURE RATIONALE
bleeders and adnexae checked

BTL done To prevent the ovum (egg) from being fertilized.

removal of instruments To prevent inadvertent retention of instruments in the surgical wound.
closure of the abdomen in layers The primary advantage of this method is that multiple suture strands
exist, so that if a suture breaks, the incision is held intact by the
remaining sutures.
top dressing done To absorb any leakage from the wound, provide ideal conditions for
healing, and protect the area until the wound is healed
I.E. done To check how far your cervix has opened, which will tell them how
advanced your labour is.
April 21,2021 at 5pm
continue soft diet To help pt recover from surgery and illness and make chewing and
digesting food easier.
Encourage increase oral fluid intake To ensure adequate organ perfusion, prevent catabolism, ensure
electrolyte- and pH-balance, and may be all that is required for
patients who undergo surgical procedures that do not significantly
alter the hemodynamic milieu.
consume IVF For patient’s recovery.
continue oral meds For fast recovery.
insert bisacodyl suppository @9pm if with no BM To increase Gi motility.
v/s q4 For close monitoring.
refer accordingly To collaborative intervention
 MEDICAL REGIMEN / SURGICAL PROCEDURE
April 21,2021 at 5pm
Let pt sit on bed
D/C foley catheter
increase oral fluid intake
Doctor’s visitation
April 22,2021 at 7am
Change of dressing - intact
instruct the pt for proper wound dressing
Instruct the pt to avoid salty and oily foods
encourage the pt for breastfeeding
TCB after 1 week for ff up check up
RATIONALE
To reduce pain.
To facilitate patients becoming mobile after surgery and to reduce the
risk of patients developing a urinary tract infection.
To ensure adequate organ perfusion, prevent catabolism, ensure
electrolyte- and pH-balance, and may be all that is required for
patients who undergo surgical procedures that do not significantly
alter the hemodynamic milieu.
To check the patient’s condition and discuss any important matters.
To clean the wound, prevent infection, provide ideal conditions for
healing, and protect the area until the wound is healed
To prevent infection and fast heling of the wound.
To prevent post-operative swelling.
To screen for neonatal jaundice.
 MEDICAL REGIMEN / SURGICAL PROCEDURE RATIONALE
Emergency LTCS with BTL The most effective treatment for preeclampsia is
delivery. Emergency LTCS is done to the patient since
she is experiencing High BP and the baby is at risk.

BTL is a surgical procedure that involves blocking the

fallopian tubes to prevent the ovum (egg) from being
fertilized.
DRUG STUDY
NAME OF DRUG CLASSIFICATION INDICATIONS (related to SIDE EFFECTS / NURSING RESPONSIBILITY
AND MECHANISM patient’s condition) ADVERSE EFFECTS (related to patient’s condition)
OF ACTION CONTRAINDICATIONS
(related to patient’s
condition)
Generic Name: Antianginal, INDICATIONS:  CNS: fatigue, dizziness,  Monitor periodic counts to detect
Metoprolol antihypertensive, MI Conservative depression, headache, adverse hematologic reactions.
insomnia, mental  Monitor liver function test and check for
Brand Name prophylaxis and management using
confusion, nightmares, signs and symptoms of hepatic
Dosage: treatment - metoprolol in preeclamptic short-term memory loss, dysfunction. 
Frequency: Inhibits stimulation of women provides blood hallucinations. vertigo.  Check for edema or weight gain to help
Route of beta1-receptor sites, pressure control.  CV: hypotension, determine if diuretic should be added to
Administration (per located mainly in the bradychardia, HF, regimen. 
patient): P.O. heart, resulting in CONTRAINDICATIONS: edema, palpitations,  Monitor blood pressure.
stroke.
decreased cardiac Despite the increased use  EENT: blurred vission,
excitability, cardiac of beta-blockers in tinnitus, rhinitis.
out_x0002_put, and pregnancy, there is only  GI: constipation,
myocardial oxygen limited information on their diarrhea, drug-induced
demand. These possible teratogenic hepatitis, dry mouth,
effects help relieve effects. Beta-blockers flatulence, gastric pain,
heartburn, ↑ liver
angina. Metoprolol could reduce enzymes, nausea,
also helps reduce uteroplacental blood flow vomiting
blood pressure by and could therefore lead  GU: erectile
decreasing renal to congenital anomalies in dysfunction, ↓ libido,
release of renin. the offspring. urinary frequency
 MS: arthralgia, back
pain, joint pain
 Resp: bronchospasm,
wheezing
 Misc: drug-induced
lupus syndrome
NAME OF DRUG CLASSIFICATION INDICATIONS (related to SIDE EFFECTS / NURSING RESPONSIBILITY
AND MECHANISM patient’s condition) ADVERSE EFFECTS (related to patient’s condition)
OF ACTION CONTRAINDICATIONS
(related to patient’s
condition)
Generic Name: Anticonvulsant - INDICATIONS:  CNS: drowsiness,  Before beginning any infusion of
Magnessium Sulfate Trigger cerebral Magnesium sulfate depressed reflexes, magnesium sulfate, the primary
Brand Name vasodilation, thus therapy is used to prevent flaccid paralysis, RN will obtain baseline vital signs.
Dosage: 4g reducing ischemia seizures in women with hypothermia  Obtain baseline fetal heart rate
Frequency: generated by cerebral preeclampsia. It can also  CV: hypotension, (FHR), deep tendon reflexes
Route of vasospasm during an help prolong a pregnancy flushing, (DTRs),
Administration (per eclamptic event. for up to two days. This bradycardia, clonus, bilateral breath
patient): IM each allows drugs that speed circulatory collapse, sounds, urinary output,
buttock up your baby's lung depressed cardiac and activity will be
development to be function assessed and docu-
administered.  EENT: diplopia mented in the Elec-
CONTRAINDICATIONS:  METABOLI C: tronic Health Record
Absolute or relative hypocalcemia (EHR).
contraindications to this  RESPI: respiratory  Include assessment of epigastric
medication include paralysis pain, visual disturbances, edema,
myasthenia gravis, severe  SKIN: diaphoresis  headache, level of
renal failure, cardiac consciousness, and lung auscultation
ischemia, heart block and prior to
pulmonary edema. start of infusion and every 2 hours
throughout infusion or more
frequently as condition indicates .
assessed hourly thereafter.
NAME OF DRUG CLASSIFICATION INDICATIONS (related to SIDE EFFECTS / NURSING RESPONSIBILITY
AND MECHANISM patient’s condition) ADVERSE EFFECTS (related to patient’s condition)
OF ACTION CONTRAINDICATIONS
(related to patient’s
condition)
 Fetal heart rate and uterine
activity assessment per the
Electronic Fetal Monitoring (EFM)
Guideline.
 Temperature is assessed every 4
hours, unless rupture of
membranes. Once membranes have
ruptured, temperature will be
assessed every 2 hours. If febrile (≥
100.4) provider will be
notified and temperature will be
assessed hourly thereafter.
 Strict intake and output will be
assessed throughout the
magnesium sulfate infusion.
NAME OF DRUG CLASSIFICATION AND
MECHANISM OF ACTION
Generic Name: Antibiotic -
Cefuroxime Interferes with bacterial
Brand Name cell wall synthesis
Dosage: 1.5g by inhibiting the final step
Frequency: in the cross-linking of
Route of Administration peptidoglycan strands.
(per patient): IV ANST Peptidoglycan makes the
cell membrane rigid and
protective. Without it,
bacterial cells
rup_x0002_ture and die..
INDICATIONS (related to
patient’s condition)
CONTRAINDICATIONS
(related to patient’s
condition)
INDICATIONS:
Cefuroxime is indicated for
the treatment of a variety
of infections including
acute bacterial otitis
media, several upper
respiratory tract infections,
skin infections, urinary
tract infections, gonorrhea,
early Lyme disease, and
impetigo.
CONTRAINDICATIONS:
Cefuroxime is
contraindicated in patients
with cephalosporin
hypersensitivity or
cephamycin
hypersensitivity.
Cefuroxime should be
used cautiously in patients
with hypersensitivity to
penicillin.
SIDE EFFECTS / NURSING
ADVERSE EFFECTS RESPONSIBILITY
(related to patient’s
condition)
 CV: phlebitis,  Monitor patient
thrombophlebitis carefully for signs and
 GI: diarrhea, symptoms of
pseudomembranous hypersensitivity
colitis, nausea, reaction. 
anorexia, vomitting.  Monitor for seizures
 Hematologic: when giving high
hemolytic anemia, doses. 
thrombocytopenia,  Check patient's
trnasient neutropenia, temperature and watch
eosinophilia. for other signs and
 Skin: maculopapular symptoms of
and erythematous superinfection,
rashes. urticaria, pain, especially oral or rectal
induration, sterile candidiasis.
abscesses,
temperature elevation,
tissue sloughing at I.M
injection site.
 Other: anaphylaxis,
hypersensitivity
reactions, serum
sickness.
NAME OF DRUG CLASSIFICATION AND
MECHANISM OF ACTION
Generic Name: Diclofenac Analgesic, anti-
Brand Name inflammatory -
Dosage: 18-25mg Blocks the activity of
Frequency: Physician cyclooxygenase, the
Route of Administration enzyme needed to
(per patient): P.O. synthesize prostaglandins,
which mediate
nflammatory response and
cause local pain, swelling,
and vasodila_x0002_tion.
By blocking
cyclooxygenase and
inhibiting prostaglandins,
diclofenac
reduces inflammatory
symptoms. This
mechanism also relieves
pain because
prostaglandins promote
pain transmission from
periphery to spinal cord.
INDICATIONS (related to
patient’s condition)
CONTRAINDICATIONS
(related to patient’s
condition)
INDICATIONS:
treatment of acute and chronic
pain associated with
inflammatory conditions
CONTRAINDICATIONS:
Increased risks of miscarriage
and malformations are
associated with NSAID use in
early pregnancy.
SIDE EFFECTS /
ADVERSE EFFECTS
 CNS: Aseptic meningitis, cerebral
hemorrhage, dizziness,
drowsiness, headache
 CV: Bradycardia and other
arrhythmias,
hypotension, vasculitis
 EENT: Glaucoma, hearing loss,
tinnitus
 ENDO: Hypoglycemia
 GI: Abdominal pain, constipation,
diarrhea,
dysphagia, elevated liver function test
results, esophageal ulceration,
flatulence,
 GI bleeding or ulceration, hepatic
failure, hepatitis, indigestion,
jaundice, nausea, perforation of
stomach or intestine
 GU: Acute renal failure, interstitial
nephritis
 HEME: Agranulocytosis, aplastic
anemia,
eosinophilia, leukocytosis,
leukopenia, pancytopenia, porphyria,
thrombocytopenia
 SKIN: Erythema multiforme,
exfoliative
dermatitis, pruritus, rash, Stevens-
Johnson
syndrome, toxic epidermal necrolysis
 Other: Anaphylaxis, angioedema,
fluid
retention, hyperkalemia,
hyperuricemia,
hyponatremia, lymphadenopathy
NURSING
RESPONSIBILITY
(related to patient’s
condition)
-Determining when to
administer analgesics
-Deciding which analgesic to
administer, if more than one is
ordered
-Determining the dose of the
analgesic medication to
administer, if a range is
prescribed
-Evaluating the effectiveness of
the analgesic
-Assessing for and managing
side effects of the medication
-Determining the need to
change the dose, timing, or
medication and reporting this
information to the healthcare
provider
-Using nursing interventions to
promote comfort and relieve
pain
NAME OF DRUG CLASSIFICATION AND INDICATIONS (related to SIDE EFFECTS / NURSING
MECHANISM OF ACTION patient’s condition) ADVERSE EFFECTS RESPONSIBILITY
CONTRAINDICATIONS (related to patient’s
(related to patient’s condition)
condition)
Generic Name: Antiemetic, upper GI INDICATIONS:  CNS: Agitation, anxiety, Monitor the signs and
Metoclopromide stimulant - Metoclopramide, a drug depression, dizziness, symptoms of
Brand Name Antagonizes the inhibitory frequently used for nausea drowsiness, metroclopramide
Dosage: 40mg effect of and vomiting in pregnancy, extrapyramidal reactions ( dizziness, nervousness,
Frequency: PRN dopamine on GI smooth is thought to be safe, but (motor restlessness, or headaches) after they
parkinsonism, tardive
Route of Administration muscle. This information on the risk of stop taking this drug. It
dyskinesia), fatigue,
(per patient): IV caus_x0002_es gastric specific malformations and headache, insomnia, can also cause other side
contraction, which fetal death is lacking. irritability, lassitude, effects. Allergy warning
promotes gastric emptying CONTRAINDICATIONS: neuroleptic malignant Metoclopramide can
and peristalsis, thus metoclopramide does not syndrome, panic reaction, cause a severe allergic
reducing cause congenital restlessness reaction. Symptoms can
gastroesophageal reflux. malformations. However,  CV: AV block, fluid include:( trouble breathing,
Metoclopramide also clinicians should be aware retention, heart failure, rash hives, swelling of
blocks dopaminergic that use of this dopamine hypertension, hypotension, your throat or tongue)
receptors in the antagonist can cause supraventricular tachycardia
chemoreceptor trigger maternal extrapyramidal  EENT: Dry mouth
zone, preventing symptoms.  ENDO: Galactorrhea,
gynecomastia
nausea and vomiting.
 GI: Constipation,
diarrhea, nausea
 GU: Menstrual
irregularities
 HEME: Agranulocytosis
 SKIN: Rash
 Other: Restless leg
syndrome
 CLASSIFICATION AND MECHANISM
NAME OF DRUG OF ACTION
INDICATIONS (related to SIDE EFFECTS / NURSING
patient’s condition) ADVERSE EFFECTS RESPONSIBILITY
CONTRAINDICATIONS (related to patient’s
(related to patient’s condition)
condition)
Generic Name: Antianaphylactic adjunct, INDICATIONS: To the mother: Monitor patient response
antidyskinetic, antiemetic,
Dipenhydramine antihistamine, antihistamines during to the drug, and arrange
Brand Name antitussive (syrup), antivertigo, CONTRAINDICATIONS: pregnancy is not linked to for adjustment of dosage
sedativehypnotic -
Dosage: 50mg Binds to central and peripheral H1 Hypersensitivity ; a certain birth defects to lowest possible effective
Frequency: PRN recep_x0002_tors, competing with neonates, lactation. CNS depression, doses if possible.
Route of Administration histamine for these sites and cardiovascular disease, dizziness, headache,
preventing it from reaching its site of
(per patient): IV action. By blocking histamine, urinary retention, sedation; dryness of
diphenhy_x0002_dramine produces increased ocular pressure mouth, thickened
antihistamine effects, inhibiting
respiratory, vascular, and GI smooth- are relative respiratory secretion,
muscle contraction; decreasing contraindications to the blurring of vision, urinary
capillary permeability, which reduces usage of antihistamines retention; GI disturbances;
wheals, flares, and itching; and
decreasing salivary and lacrimal blood dyscrasias..
gland secretions. To the baby: It can cause
Diphenhydramine produces
antidyski_x0002_netic effects, serious or even fatal side
possibly by inhibiting effects in infants. These
acetyl_x0002_choline in the CNS. It
also produces anti_x0002_tussive
side effects include rapid
effects by directly suppressing the heartbeat and
cough center in the medulla convulsions.
oblongata in the brain.
Diphenhydramine’s antiemetic
and antivertigo effects may be related
to its ability to bind to CNS muscarinic
receptors and depress vestibular
stimulation and labyrinthine function.
Its sedative effects are related to its
CNS depressant action.
NAME OF DRUG CLASSIFICATION AND INDICATIONS (related to
MECHANISM OF ACTION patient’s condition)
CONTRAINDICATIONS
(related to patient’s
condition)
Generic Name: Tramadol Analgesic - INDICATION: Tramadol is a
strong painkiller. It's used to
Brand Name Binds with mu receptors
treat moderate to severe pain.
Dosage: 50mg and inhibits the
Frequency: PRN reuptake of CONTRAINDICATION:
Route of Administration norepinephrine and to avoid hypersensitivity
(per patient): IV serotonin, reactions, and after surgery,
which may account for because of the adverse effects
tramadol’s analgesic associated with slowed activity
due to narcotics.
effect. Pregnant women must be
cautioned not to cut, crush or
chew these tablets if they are
prescribed this drug.
Recommended waiting 4 – 6
hours after receiving a narcotic
before breastfeeding the baby
if a narcotic is needed for pain
control.
And during pregnancy, labor or
lactation because of potential
adverse effects on the fetus or
neonate,. Including respiratory
depression.
SIDE EFFECTS / NURSING
ADVERSE EFFECTS RESPONSIBILITY
(related to patient’s
condition)
 CNS: Agitation, anxiety, Be alert for excessive
asthenia, depression, dizziness,
emotional lability, euphoria, sedation or somnolence.
fatigue, fever, allucinations, Notify physician or nurse
headache, hypertonia, hypoesthesia,
insomnia, lethargy, nervousness, immediately if patient is
paresthesia, restlessness, unconscious or extremely
rigors, seizures, serotonin syndrome, difficult to arouse. Monitor
somnolence, suicidal ideation, tremor,
vertigo, weakness other changes in mood
 CV: Chest pain, orthostatic and behavior, including
hypotension,
vasodilation euphoria, confusion,
 EENT: Blurred vision, dry mouth, malaise, nervousness,
nasal or and anxiety. Notify
sinus congestion, sore throat, vision
changes physician if these changes
 ENDO: Hot flashes become problematic.
 GI: Abdominal pain, anorexia,
constipation,
diarrhea, indigestion, nausea,
vomiting
 GU: Urinary frequency, urine
retention
 MS: Arthralgia; back, limb, or
neck pain
 RESP: Cough, dyspnea
 SKIN: Diaphoresis, dermatitis,
flushing,pruritus, rash
 Other: Flulike illness, physical
and psychological dependence
NAME OF DRUG CLASSIFICATION AND
MECHANISM OF ACTION
Generic Name: Antifibrinolytic -
Displaces plasminogen from
TRANEXAMIC ACID
Brand Name: surface of fib_x0002_rin by
binding to high-affinity lysine
Dosage: 100 mg/ml
site of
Frequency: physician plasminogen. This diminishes
Route of Administration dissolution
(per patient): of hemostatic fibrin, which
decreases bleed_x0002_ing.
INDICATIONS (related to
patient’s condition)
CONTRAINDICATIONS
(related to patient’s
condition)
INDICATIONS: Tranexamic acid is a
potent pharmaceutical agent that
suppresses fibrinolysis, and thus can
be used for managing hemorrhage in
pregnancy.
CONTRAINDICATIONS:
• -Tranexamic acid is a potent
pharmaceutical agent that
suppresses fibrinolysis, and thus
can be used for managing
hemorrhage in pregnancy. The
FDA's pregnancy category for
tranexamic acid is category B.
Tranexamic acid has been used to
decrease blood loss and treatment
of intra partum blood loss in
cesarean section also it has been
used for prevention and
management of postpartum
hemorrhage after vaginal bleeding,
regardless of whether the bleeding
is due to genital tract trauma or
other causes.
• tranexamic acid reduces the
amount of blood loss after delivery
during cesarean sections and
vaginal deliveries, and reduces the
requirement for blood transfusion.
Tranexamic acid seems to be safe
and effective in the prevention and
management of bleeding during
pregnancy.
SIDE EFFECTS /
ADVERSE EFFECTS
 CNS: Cerebral thrombosis,
dizziness,fatigue, headache,
migraine
 CV: Deep vein thrombosis
 EENT: Central retinal artery
and veinobstruction, feeling
of throat tightness,impaired
color vision, ligneous
conjunctivitis, nasal and
sinus congestion,
sinusitis,visual abnormalities
 GI: Abdominal pain,
diarrhea, nausea,vomiting
 GU: Acute renal cortical
necrosis
 HEME: Anemia
 MS: Arthralgia, back pain,
muscle crampsand spasms,
myalgia
 RESP: Dyspnea, pulmonary
embolism, respiratory
congestion,
 SKIN: Allergic skin reactions,
facial flushing
 Other: Anaphylaxis, multiple
allergies including seasona
NURSING
RESPONSIBILITY
(related to patient’s
condition)
• Monitor increased blood
coagulation, including venous
thrombosis (lower extremity
swelling, warmth, erythema,
tenderness) or arterial thrombosis
(extreme coldness in the hands
and feet, cyanosis, muscle
cramping). Watch for pulmonary
embolism (shortness of breath,
chest pain, cough, bloody sputum)
or arterial thrombosis that could
lead to MI or stroke. Notify
physician immediately, and
request objective tests (Doppler
ultrasound, others) if thrombosis is
suspected.
• Assess blood pressure and
compare to normal values. Report
low blood pressure (hypotension),
especially if patient develops
dizziness or syncope.
• Instruct patient to report other
troublesome side effects such as
severe or prolonged vision
abnormalities or GI problems
(nausea, vomiting, diarrhea).
NAME OF DRUG CLASSIFICATION AND INDICATIONS (related to SIDE EFFECTS / NURSING
MECHANISM OF ACTION patient’s condition) ADVERSE EFFECTS RESPONSIBILITY
CONTRAINDICATIONS (related to patient’s
(related to patient’s condition)
condition)
Generic Name:
Methylergonometrine
Brand Name
Dosage: 0.2 mg/ml in 1ml
vials
Tablets: 0.2 mg
Frequency: Physician
Route of Administration
(per patient): IM or I.V. & PO
NAME OF DRUG CLASSIFICATION AND
MECHANISM OF ACTION
Generic Name: celecoxib Nonsteroidal anti-inflammatory
Brand Name drugs (NSAIDs) -
Selectively inhibits the
Dosage:
enzymatic activity of
Frequency: cyclooxygenase-2 (COX-2),
Route of Administration the enzyme
(per patient): needed to convert arachidonic
acid to
prostaglandin. Prostaglandins
are responsible for mediating
the inflammatory
response and causing local
vasodilation,
swelling, and pain.
Prostaglandins also play
a role in peripheral pain
transmission to the
spinal cord. By inhibiting COX-
2 activity and prostaglandin
production, this NSAID
reduces inflammatory
symptoms and
relieves pain. Celecoxib’s
mechanism of
action in reducing the number
of colorectal
polyps is unknown.
INDICATIONS (related to SIDE EFFECTS / NURSING
patient’s condition) ADVERSE EFFECTS RESPONSIBILITY
CONTRAINDICATIONS (related to patient’s
(related to patient’s condition)
condition)
INDICATIONS:  CNS: Asceptic meningitis, cerebral - Assess range of motion, degree of
hemorrhage, depression, dizziness, swelling, and pain in affected joints
For reducing pain and fever,headache, insomnia, ischemic
before and periodically throughout
stroke,stroke, suicidal ideation,
inflammation. syncope, transientischemic attacks, therapy. Assess patient for allergy to
vertigo sulfonamides, aspirin, or NSAIDs.
 CV: Aortic valve incompetence, chest Patients with these allergies should
CONTNDICATIONS: pain,congestive heart failure, deep vein
thrombosis, fluid retention, not receive celecoxib. Assess patient
It may temporarily reduce hypertension, MI,palpitations, peripheral for skin rash frequently during
edema or gangrene,sinus bradycardia, therapy.
female fertility during tachycardia, thrombosis,unstable - May cause fetal harm. Advise
treatment and may also
angina, vasculitis, ventricular fibrillation,
females of reproductive potential to
ventricular hypertrophy
notify health care professional if
increase the risk of  EENT: Conjunctival hemorrhage,
deafness,labyrinthitis, nasopharyngitis, pregnancy is planned or suspected or
miscarriage or pharyngitis,rhinitis, sinusitis, vitreous
floaters
if breastfeeding. Advise women to
malformations. Also, avoid celecoxib in the 3rd trimester of
 ENDO: Hyperglycemia, hypoglycemia
pregnancy, may cause premature
 GI: Abdominal pain, diarrhea, elevated
Celecoxib passes into liverfunction test results, esophageal closure of the fetal ductus arteriosus.
breast milk. perforation, flatulence, GI bleeding or Use of celecoxib while pregnant, may
ulceration,hepatic failure, ileus,
indigestion, jaundice,nausea,
cause fetal renal dysfunction leading
pancreatitis, perforation of stomachor to oligohydramnios. May cause
intestine, vomiting reversible infertility in women
 GU: Acute renal failure, interstitial attempting to conceive; may consider
nephritis, ovarian cyst, proteinuria, UTI,
discontinuing celecoxib.
urinaryincontinence
 HEME: Agranulocytosis, aplastic - Watch for and immediately evaluate
anemia,decreased hematocrit and signs and symptoms of chest pain,
hemoglobin,leukopenia, pancytopenia, shortness of breath and weakness
prolonged APTT,thrombocytopenia - Monitor the patients renal function;
 MS: Arthralgia, back pain, elevated
renal insufficiency is possible in
serumCK level, epicondylitis, tendon
rupture patients. Long – term administration
 RESP: Bronchospasm, cough, may cause renal papillary necrosis
dyspnea,pneumonia, pulmonary and other renal injury.
embolism, upperrespiratory tract
infection
 SKIN: Erythema multiforme,
exfoliativedermatitis, phototoxicity, rash,
StevensJohnson syndrome, toxic
epidermal necrolysis, urticaria
 Other: Anaphylaxis, angioedema,
hyperkalemia, hypernatremia,
hyponatremia, sepsis
NAME OF DRUG CLASSIFICATION AND
MECHANISM OF ACTION
Generic Name: Amlodipine Antianginal, antihypertensive -
Binds to dihydropyridine and
Brand Name
nondihydropyridine cell
Dosage: membrane receptor sites on
Frequency: myocardial and vascular smooth-
Route of Administration muscle
cells and inhibits influx of
(per patient): extracellular calcium ions across
slow calcium channels.
This decreases intracellular
calcium level,
inhibiting smooth-muscle cell
contractions
and relaxing coronary and
vascular smooth
muscles, decreasing peripheral
vascular
resistance, and reducing systolic
and diastolic blood pressure.
Decreased peripheral
vascular resistance also
decreases myocardial workload,
oxygen demand, and possibly
angina. Also, by inhibiting
coronary
artery muscle cell contractions
and restoring blood flow, drug
may relieve
Prinzmetal’s angina
INDICATIONS (related to
patient’s condition)
CONTRAINDICATIONS
(related to patient’s
condition)
Indication :
For treating and reducing high blood
pressure (hypertension) to a prenant
woman.
Contraindication :
- contraindicated in patients with
known hypersensitivity to amlodipine
or its dosage form components. In
addition, amlodipine is relatively
contraindicated in patients with
cardiogenic shock, severe aortic
stenosis, unstable angina, severe
hypotension, heart failure, and
hepatic impairment.
- contraindicated during pregnancy
because of potential for serious
adverse effect on the fetus and during
the lactation because of potential
decreases in milk production and
effects on the neonate.
- use in pregnancy only if potential
benefit justifies the risk to the fetus.
Other antihypertensives are preferred
during pregnancy
- drug appears in human milk . patient
should discontinue breastfeeding or
discontinue the drug use.
- Amlodipine is not normally
recommended in pregnancy or when
breastfeeding.
SIDE EFFECTS / NURSING
ADVERSE EFFECTS RESPONSIBILITY
(related to patient’s
condition)
 CNS: Anxiety, dizziness, - Report any rhythm
disturbances or symptoms of
fatigue,
increased arrhythmias,
headache,lethargy, light-
headedness, including palpitations, chest
pain, shortness of breath,
paresthesia,somnolence,
fainting, and fatigue or
syncope, tremor
weakness.
 CV: Arrhythmias, - monitor patients carefully,
hypotension,
assess the patients history
palpitations,peripheral patients with history of allergy
edema to any of these drugs to
 EENT: Dry mouth, prevent hypersensitivity
pharyngitis reactions.
 ENDO: Hot flashes - monitor patients
carefully,some patients
 GI: Abdominal cramps,
abdominal pain, espcially those with sever
constipation, diarrhea, obsrtuctive coronary artery
esophagitis, indigestion, disease have developed
nausea frequency, duration or severity
of chest pain or acute
 GU: Decreased libido,
myocardial infarction or heart
impotence, urinary attack after initiation of calcium
frequency channel blocker therapy or at
 MS: Myalgia time of dosage increase.
 RESP: Dyspnea - monitor blood pressure
 SKIN: Dermatitis, frequently
flushing, rash - notify the physician if signs
 Other: Weight loss occur such as swelling of
hands and feet or shortness of
breath.
NAME OF DRUG CLASSIFICATION AND INDICATIONS (related to SIDE EFFECTS / NURSING
MECHANISM OF ACTION patient’s condition) ADVERSE EFFECTS RESPONSIBILITY
CONTRAINDICATIONS (related to patient’s
(related to patient’s condition)
condition)

Generic Name:bisacodyl Laxatives - INDICATIONS:  GI: Occasional  Monitor frequency &

suppository Works by increasing the Constipatio n, relief of abdominal discomfort, character of stool
Brand Name amount of fluid/salts in the evacuation in hemorrhoid soreness in anal  Monitor occurrence of
Dosage: intestines. This effect s, prep for barium enema, region  adverse reaction
Frequency: usually results in a bowel preoperativ e and post-
Route of Administration movement within 15 to 60 operative
(per patient): minutes. The normal
frequency of bowel
movements varies from
once daily to 1 to 2 times
weekly.
NURSING CARE
PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Decrease Cardiac output Short-term Independent:  Goal was met that
related to elevated blood After 15 to 20 mins. of after 15 to 20 mins of
“sumasakit ang batok ko pressure. nursing intervention,the • Monitor BP every 3 • To low the blood nursing
at madalas ako mahilo” client will have no to 5 mins. pressure of patient. intervention,the client
as verbalized by the pt. elevation in high blood had no elevation in
pressure above normal • Monitor EFM for • To monitor the fatal blood pressure
Objective: limits and will maintain heart rate. heart rate of baby. above normal limits
➢BP 190/120mmhg blood pressure within and will maintain
acceptable limits. • Provide calm, restful • sympathetic blood pressure within
surroundings, stimulation and acceptable limits.
minimize promotes relaxation.It .
Long-term environmental helps lessen  Goal was met that
After 3 days of nursing activity and noise after 3 days of nursing
interventions, the client interventions, the client
will maintain adequate Dependent: maintain an adequate
cardiac output . 1. As prescribe by the cardiac output .
physician:
A.Beta-Blocker • Lower blood pressure.
2. Encourage to maintain • To prevent
fluid intake minimum of dehydration.
1L/day as ordered.

3. Encourage patient to
decrease intake of • To prevent increase
caffeine,cola and sugar intake that may
chocolate. cause high blood
pressure.
Collaborative:
• Report any
unusualities in cardiac • facilitates to other
monitor. health care provider
for better
improvements.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Acute pain Short-term Indepenent Goal was met te
related to uterine Patient will Assess patient will
“Ang sakit ng contractions and maintain less maintain less
tiyan ko.” as stretching of than 2 pain on than 2 pain on
verbalized by the cervix and birth scale of 0-10. scale of 0-10.
pt. canal Dependent
Long-term Goal was met
Objectives: Patient will feel that the patient
Face grimace relaxed and Collaborative will feel relaxed
Restlessness comfortable. and comfortable.
Irritability
Pain scale: 9
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Excessive Fluid Short term: Independent: Rationale:  Goal was met that
Volume related to After 3 hours of • Monitored vital • For baseline data after After 3 hours
“namamanas ang decreasing plasma nursing intervention signs and record. and to note of nursing
mga binti at paa ko.” colloid osmotic the patient will be progress intervention the
as verbalized by the pressure allowing able to demonstrait • position the • To promote patient will be
pt. fluid shifts out of behaviors to patient comport of patient able to
vascular improved circulation. comportably. demonstrait
compartment as • To know what behaviors to
evidenced by edema • Encourage nursing improved
formation verbalization of interventions will circulation.
feelings. be perform.

• inspect skin for • Indicate areas of

Long term: changes in colour, poor  Goal was met that
Objectives: after 1 to 2 weeks of turgor, vascularity circulation/break after 1 to 2 weeks
 1-2+ pitting nursing interventions note rediness. down that may of nursing
edema on both the patient will be lead infection. interventions the
feet able to: patient no longer
1.stabilized fluid • monitor fluid • detects presence had leg edema
volume as evidence intake and of hydration or after following
by: balance input hydration of skin over hydration appropreate fluid
(I&O), vital signs and mucous that affect intake and
within patient’s membranes. circulation and measure on how
normal limits, stable tissue intergrity to reduce edema.
weight, and free of antthe cecullar
edema. level.
• Inspect • Edematous tissue
dependent are prone to
areasor edema. breakdown.
• elevated legs as Elevated
indicate. promotes venos
stasis, edema
formation.
• Suggest wearing • Prevent direct
loose fitting cotton dermal irritation
garments. and promotes
evaporation of
moisture on skin.

Dependent: Rationale:
• Maintain • Reduces total
fluid/sodium body
restrictions as water/prevents
indicated fluid
reccumulation.
• Apply cream or • Lotion and
ointment as ointment may be
prescribe. desired to relieve
dry craked skin.

Collaborative: Rationale:
• Consult dietician, • To promote
as needed. optimal wellness.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Risk for fetal
injury related to
reduced
placental
perfusion
secondary to
vasospasm.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Deficient Knowledge Short term: Independent: Rationale:  The goal was met
related to Lack of After 30 mins. of nursing • Provide information • May assist with further after 30 mins. of
“hindi ko po alam, kung exposure/unfamiliarity intervention the patient about additional learning/promote nursing intervention
ba itong nangyayare with information will verbalized learning process. learning at own pace. the patient had
saken.” as verbalized by resources understanding of • Motivate client by • To help client acquire verbalized as
the pt. condition/disease providing information relevant nformation evidenced by the
process and treatment. relevant to the response of patient to
situation. learning plan.
Objective: • Determine patient • which may differ and
 Irritable at times Long term: most urgent need from require adjustment in  The goal was met that
 teary eyed After 2 days of nursing both client and nurse teaching plan. after 2 days of nursing
intervention the patient viewpoint intervention in to the
will understand the • State objectives clearly • To meet learner’s need patient had understand
learning process plan. in learner’s term. to know. the learning process
• Provide mutual goal • Clarifies expectations plan.
setting and learning of nurse and patient.
contact.
• Determines patient • To know the patient
ability to learn. level of learning ability.
• Assess the level of the • To know the patient
patient’s capabilities coping ability towards
and the possibilities of the situation.
situation.

Dependent: