Post on 03-Apr-2018
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NGeneral Objective:
After establishing the nurse patient interaction and providing care to the client
and by a thorough assessment and careful study of the clients condition. Students will
gain knowledge and develop skills enhance attitude through the utilization of the
nursing process on the care management of patient with --------------------------------
Specific Objectives:
To define what is ----------------
Present a theoretical framework for the study in relation to a nursing approach
applied to a patient with --------------------.
To know the nursing history, personal data, health history and physical and
functional assessment.
To present the anatomy and physiology
To expound the normal physiology and pathophysiology of the case
To present the laboratory examinations carried out duty for the client, including
its findings..
To discuss the pharmacological management of the disease.
To lay at hand the nursing care plan and the bounds to which the end are
accomplished.
To evaluate the quality of nursing care rendered to the patient
To enhance the knowledge and skills in the delivery of the nursing process
Show a Discharge Planning that the client may use upon discharge to the
hospital.
I. INTRODUCTION
A. Background of the study
a. Incidence, race, gender, age, ratio and proportion
About a fifth of women over 35 have fibroids. Myomas, commonly referred to as
uterine fibroids, are the most common benign (non-cancerous) tumors in women.
Approximately 75% of women will have fibroids at some point in their lives, and a third
of these women will have symptoms severe enough to need treatment
B. Rationale for choosing the case
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-------------------. Hence, we have chosen this case to gain more information
about the occurrence of such illness, its causative factors, and preventive actions and
how to care for a patient with such condition.
C. Significance of the Study
The significance of this study is to enhance/gain knowledge, to develop
skills and to apply the right attitudes of the student nurses in rendering and giving care
to the patient with ----------, its importance and implication. This study will serve as
guidelines in assessing and providing proper nursing care to patient with the same
problem or disease.
These are other significance of the study that would support the above statement:
1. to define and understand what is --------------
2. To know the nursing history, personal data, health history and physical and
functional assessment of the patient
3. To expound the anatomy and physiology and pathophysiology of the case
4. To present the laboratory examinations carried out duty for the client, including
its findings.
5. To discuss the pharmacological management of the disease.
6. To lay at hand the nursing care plan and the bounds to which the end are
accomplished.
7. to enhance the knowledge and skills in the delivery of the nursing process
8. Show a Discharge Planning that the client may use upon discharge to the
hospital.
D. Scope of Limitation
The study will only focus on ----------------------------which is indicative to the
clients health condition and its underlying nursing care relevant for the client within
----------duty at Quezon Medical Center
E. Conceptual and Nursing Theory
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Theoretical Framework:
VIRGINIA HENDERSON THEORY OF NURSING: 14 Basic Needs
Virginia Henderson conceptualized the 14 Fundamental Needs of humans. These are:
Breathing normally.
Eating and drinking adequately
Eliminating body wastes
Moving and maintaining a desirable position
Sleeping and resting
Selecting suitable clothes
Maintaining normal body temperature by adjusting clothing and modifying the
environment
Keeping the body clean and well groomed to promote integument (skin)
Avoiding dangers in the environment and avoiding injuring others
Communicating with others in expressing emotions, needs, fears, or opinions.
Worshiping according to ones faith
Working in such a way that one feels a sense of accomplishment
Playing or participating in various forms of recreation
Learning, discovering or satisfying the curiosity that leads to normal
development and health, and using available health facilities.
Since the diagnosis of our patient is----------we relate Hendersons Theory
because the internal and external surroundings may affect the patient.We
should Identify patients s ability to meet her own needs with or without
assistance, taking into consideration strength, will or
knowledge.-------------------------------------------------------------
As a nurse our goal is to give comfort, care and maintain optimal health care
that can aide our patient for her fast recovery.
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F. Related Literature of the study
Myoma Of The Uterus Definition
The fibroids are benign growths of muscle tissue from the uterus. They are in the formof nodules and occur in different parts of the uterine wall and rarely in the cervix..Fibroids account for many medical visits, tests, medications, and medical procedures.
They are also a major reason for work absences and reduced quality of life.
To determine if you have uterine fibroids, you must consult your physician. Fibroidscan be painful and uncomfortable. Most commonly, symptoms include cramping,abdominal pain, heavy menstrual bleeding, anemia, frequent urination, constipationand a distended stomach.
Myoma Of The Uterus Causes
Myoma is formed from cells that no longer divide properly. These cells then begin to
multiply excessively. Myoma growth depends on the function of the ovaries; children
and postmenopausal women show no (new) myomas.
Myoma of The Uterus Other causes: Hormonal disorders (increased estrogen)
The family suggests predominantly to genetic causes
External factors such as radioactive radiation may play a role
It quickly grows during pregnancy period or when taking birth control pills,
where the body produces more estrogen and stops during menopausal orduring a low level of estrogen.
synthetic chemicals are the reasons for the development of myoma that comes
from our food usually from commercial cattle and chicken, laundry detergents,and lotions that imitate estrogen.
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Myoma Of The Uterus Symptoms At the beginning, the fibroids are asymptomatic
Menstrual disorders caused by: proliferation of the uterine lining, impaired
contractility of the uterus caused by nodules on the uterine wall, disorders ofhemostatic mechanisms.
Irregular periods, intense or prolonged
In early menopause, fibroid growth may accelerate due to increased production
of estrogen, which also causes irregular periods, heavy and thick part.
Type pain and contraction deaf tiraillantes
Myomas that develop in the peritoneal cavity are usually asymptomatic.
When the myoma displaces adjacent organs because of its size, pain colic can occur.
When the fibroid puts pressure on the pelvis, impaired bladder function and urinary
urgency may occur. If the fibroid puts pressure on the rectum, it can result in
constipation. Growth of the myoma in the lower back causes back pain.
Myoma Of The Uterus Diagnosis
History taking into account the patients symptoms Myoma can be suspected during a routine gynecological examination
The consistency of the tumor, its relationship to the uterus and the number of
nodules are suspected of being myoma
Ultrasound examination to locate the myoma
Exploration of the uterus to rule out other tumors, polyps or abnormalities of the
uterus
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Exclusion of pregnancy or malignancy (tissue sample analysis)
Myoma Of The Uterus Treatment Options
Drug: hormonal treatment, that is to say, a progestin therapy, sometimes
allows the absorption of the myoma. Combined hormone therapy may beuseful for a regression of myoma and to prepare for subsequent surgery.
Specific hormone by GnRH analogues.
Surgical removal of myomas by abdominal incision above
the vagina or by laparoscopy (withconcomitant abdominal exploration)
Removal of the entire uterus (hysterectomy) through the vagina or by
laparotomy (abdominal incision)
Embolization (vessel sealing irrigating myoma under local anesthesia) is used
to shrink themyoma
Myoma Of The Uterus Possible Complications
Approximately one third of all myomas result in potentially
serious complications: infertility, recurrent miscarriages. In rare
cases, a myoma becomes malignant (approx. 0.1%). Myomas should however be
subject to regular medical checks.
Uterine myomas present during pregnancy can cause miscarriage.
Examinations (Diagnostic)
Myoma may be suspected during a routine gynecological examination
The consistency of the tumor, its relationship with the uterus and the number ofnodules are suspected of myoma
Ultrasound examination to locate the myoma
Exploration of the uterus to exclude other tumors, polyps or abnormalities of the
uterus
Exclusion of pregnancy or malignancy (analyzes tissue samples)
Treatment/ surgical interentionThe old-fashioned way was to perform a D&C (dilatation and curettage). This
involves a gentle scraping of the uterine lining. Unfortunately, this may miss the polypcompletely, since this procedure is done solely by feel. As the scraping instrumentgoes by, it will likely just push the polyp out of the way without grabbing it.Hysteroscopes now allow us to look right at the polyp as we grasp it or cut it awayfrom the uterine lining. This ensures that the polyp (or, in some cases, multiple polyps)is removed.
TOTAL ABDOMINAL HYSTERECTOMY BILATERAL SALPHINGOOOPHORECTOMY
This is the removal of the uterus including the cervix as well as the tubes andovaries using an incision in the abdomen.
Hysterectomy is the surgical removal of the uterus. Hysterectomy may betotal, as removing the body and cervix of the uterus or partial, also calledsupracervical.
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Salphingo refers specifically to the fallopian tubes that connect the ovaries tothe uterus.
Oophorectomy is the surgical removal of an ovary or ovaries.
Hysterectomy is also referred to as surgical menopause.Operative Position:
Supine
Indications:
Cancer
Dysfunctional uterine bleeding
Endometriosis
Non- malignant growths
Persistent pain to the Pelvis
Previous injury to the uterus
Postpartum obstetrical hemorrhage
Risk and Side Effects:
Increased bladder function problems
Greater risk of developing Cardiovascular problems such as atherosclerosis
Risk for developing osteoporosis
Preoperative Management:
The lower half of the abdomen and the pubic and perineal regions may be
shaved.
These area are cleaned with Povidine iodine.
To prevent contamination and injury to the bladder or intestinal tract, theintestinal tract and the bladder need to be empty. An enema and antisepticdouche may be prescribed the evening before the surgery.
Preoperative meds may be administered before the surgery.
Postoperative Management:
Monitor closely peripheral circulation
Rationale: To prevent thrombophlebitis and DVT ( noting varicosities,promoting circulation, using elastic compression stockings)
Monitor Input and Output
Rationale: Voiding problems may occur due to the fact that the surgical site isclose to the bladder
Indwelling catheter may be inserted
Potential Complications:
Hemorrhage
Deep Vein Thrombosis and Pulmonary Embolism
Bladder Dysfunction
Nursing Interventions:
Relieving AnxietyRationale: Explanations are given about the physical preparations and
procedures that are performed
Improving Body Image
Rationale: Patient may have strong emotional reactions to having ahysterectomy and strong personal feelings related to the diagnosis. Nurse who
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exhibits interest, concern, and willingness to listen to the patients fears will helpthe patient progress through the surgical experience
Relieving Pain
Rationale: Assess intensity of pain and administer analgesia as prescribed
Health Teachings:
Diaphragmatic Breathing Exercise
Foot and leg exercise
Incentive Spirometry
Coughing
Turning
Tell patient to resume activity gradually
Avoid straining and lifting
Early ambulation
General Liquid Diet post op
Effects:
It may cause infertility that affects emotionally for married women. Females
with this kind of ailment suffer the following: prolonged and very heavy menstruation,painless abdominal swelling, pain in the back of the legs, pelvic pain, constipation
,vaginal discharges, and complication during pregnancy.
Prescribe synthetic medicines for myoma such as steroids that can later resultto risky side effects in the different organs in the body. A type of myoma, uterinefibroid has significantly high chances to develop into uterine cancer.
II.Clinical Summary
A. General Data Profile
Name: Pt. XAddress:Birthday:Birth Place:Nationality:Religion:
Occupation:Date of Admission:Admitting Diagnosis:Attending Doctor:Dra. Macapagal.
B. Chief Complaint
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.
C. Nursing History
a) Childhood illness:
Influenza
b) Immunization:
Complete
c) Allergies :
With no known allergiesNo allergies to food
d) Accident: None
e) Hospitalization:
f) Medication used
g) Travel:
The usual route of travel is within the community of --------------
D. Family History
Legend:
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APPENDIX BGENOGRAM
- Female
- Male
- Cardiovascular Disease, Hypertension and Diabetes Mellitus
- Uterine Myoma and History of Hysterectomy- Hypertens
- Patient
E. Social History- Include theories of growth and development
.
PSYCHOCIAL THEORY ACCORDING TO ERIK ERIKSON
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STAGE AGE CENTRAL TASK INDICATORS OF
POSITIVE RESOLUTION
INDICATORS OFNEGATIVE
RESOLUTION
MIDDLEADULTHOOD
40-
60
GENERATIVITY
VS
STAGNANATION
FOCUSES ON
WORK OR
CAREER
COMMITMENT
ON FAMILY
STATUS AND
PARENTHOOD
FAILURE IN
CAREER
DISASTER
SELF-
ABSORPTION
According to this theory, middle adulthood focuses on work, career, and rightparenting. Based on this stage of Erikson, she has reached the task generativity and
stagnation. It correlates with his way of living up to now and experiencing the self-
absorption or stagnation. At his age, he has no career although before he was always
on impermanent work. Now, he focuses on being a mother to her childrens.
F. Environment/ Living condition
The environment where he lives is in almost their entire neighborhood knows
each other,-------------------Regarding the hospital environment at the Quezon Medical
Center where he was confined, it is not crowded; they have well ventilation which does
not interfere with his sleeping pattern and resting period.
G. Physical Assessment
Parameters Normal
Findings
Actual
Findings
Interpretation
GeneralAppearance
Concious,coherent
and
oriented
Not in
respiratory
distress
Cooperative
----------
Skin With good
skin turgor
------------ ----------
Hair Evenly
distributed
-------------
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Nails With good
capillary
refill of 2-3
seconds
With clean
and short
nails
With poor
capillary
refill of 4-5
seconds
--------------------
-
Skull & Face Generally
round, with
prominence
s in thefrontal and
occipital
area.
No
tenderness
noted upon
palpation.
Round
shped face
Nose in the
midline and
no
Discharges
Both nares
are patent
Eyes No eye
discharges
With
reddish
sclera
With
positive
blink relflex
No
impairment
of vision
With pale
conjunctiv
a
-----------------
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Ears The ear
lobes are
bean
shaped,
parallel,
and
symmetrical
.
The
auricles are
has a firm
cartilage on
palpation
The pinnarecoils
when folded
No
discharges
or lesions
noted at the
ear canal
Withmoderate
sense of
hearing
Mouth Pimkish lips
; without
missing
teeth; with
pink gums;
no foul
odor; with
symmetrical
contour
Dry lips
and pale
lips
The
patien-----------
-------------,
Muscoloskelet
al
(Upper &
Lower
Extrimities)
Both
extremities
are equal in
size.
Have the
samecontour with
prominence
s of joints.
No
involuntary
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movements
.
No edema
Color iseven.
Abdomen In
symmetrical
contour
No
abdominal
distention
Flat, roundand non-
tender
abdomen
upon
palpation.
H. Patterns of functioning
Functional Health
Pattern
Before
Hospitalization
During
Hospitalization
Interpretation
Health
managementpattern
SelfMedication
3rd time to behospitalized
He is justseekingmedicalattention inseverecases thatneededimmediateattention.
Nutritional/
Metabolic
a. number of meals aday
b. Appetite
3-4 times aday
w/ very goodappetite
3 times aday
w/ slightlypoorappetite
The numberof his mealshe is takingper day isdecreasedthan before
he washospitalizedand hisappetitedecreasesalso as wellas his waterintake.
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c. Glass of water perday
d. Body built
e. Height and weight
10 glasses ofwater
w/ normal body
built
5'4 and 55kg.
5 glasses ofwater
slightlysmaller thanbefore
5'4 and 54kg.
Decreasedin weightwas theresult ofthis.
Elimination
a. frequency ofurination
b. amount of urine /day
c. frequencyof bowel
d. consistency offeces
e. amount ofdefecated per day
10 times a day
moderate
Once a day
Formed
Moderate
8 times a day
Moderate
Irregular
The amount
of hisurinationdecreasedbut theamount of itis still thesame asbefore.
He has nofrequency ofhis boweleliminationthan before.
Activity and
Exercisea. Exercise
b. Fatigability
c. ADL
Active exerciseeveryday
not easily gettired
independent
non active
easily gettired
independent
He is easilyget tiredthan before,thats whyhe is notactive indoing someexercisesandbecause ofhiscondition.
Cognitive/
perceptuala. Orientation oriented to time oriented to
Thecognitiveand
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b. responsiveness
place andperson
responds
appropriately toverbal andphysical stimuli
time placeand person
responds
appropriatelyto verbal andphysicalstimuli
perceptualstatus of thepatient isstill intactand normal.
Thecondition ofthe patientis notaffected hisrecognitionandresponse.
Roles/ relationship
a. as a wife
b. as a mother
with goodrelationship tohis wife
with goodrelationship todaughter andson
with goodrelationship tohis wife
with goodrelationship todaughter andson
He still hasa good
relationshipwith hisfamily.
SELF
PERCEPTION/SELF CONCEPT
have a selfworth/importance
have a selfworth/importance
He still hasa self worthin spite ofhiscondition hestill that lifeis importantthat shouldbe livedpurposely.
COPING/STRESS He seeks forsome advice tohis friends andrelatives whenhe hasproblems,burdens andstresses.
He is alwaystalking withhis family andwife to lessenhis stresses.
He hasgood copingtechniques.
VALUES/BELIEFS He hasawareness theGod really exist
Hisawareness toGod becamestronger than
before
Even if hesufferedfrom hiscondition,
the patientneverforgets Godinstead hisawarenessbecamestrongerthan before.
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I. Course in the ward
On ---------------a 53y/o man was admitted with the complaint of -------------three
hours prior to admission and with BP of-------------. He was admitted under supervision
of Dra------------- to undergo treatment and further observation. His initial vital signs
was 35.5c, 66 pulse rate, 20 breaths per min and BP of----------------. Dra
------------ordered TPR every shift and record to determine changes in his
condition------------. The doctor ordered D5LR 1L @ 30gtts/min to infuse to provide
electrolytes and fluids in our body right in the state of hospitalization with decreased
appetite. Then the doctor ordered different laboratory tests and diagnostic test as
follows:
CBC to determine hgb, hct and RBC count and to assess the bloods ability to
carry oxygen. To determine the WBC count w/c signifies infection when
elevated.
Urinalysis to detect UTI and sugar in urine
With orders made as to administer the following medication:
----------------------------------------------------------------------------
------------------------------------------------------------------------------
-------------------------------------------------------------------------
On june -------------------------
On june ----------------------------
On june ---------------------
-
On june -------------------------------
On june ---------------------------------
J. Laboratory Diagnostic Procedures
June--------------
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Urinalysis - Macroscopic
Component Result NormalRange
Interpretation Implications NursingResponsibilities
Color YELLOW PALEYELLOW
toAMBER
ABNORMAL Clear Urine-ifa person hasbeen drinkingan excess ofwater ordiuretics suchas coffee orbeer, theurine mayhave little orno color.Nothing toworry about ifit happensoccasionally.Pale yellow isthe normalcolor of urine.Dark Colored-Liverproblems or
jaundice cancause theurine tobecomeconsistently adark yellowcolor. Be sureyou havebeen drinkingenough fluidsbefore
jumping toconclusions.
NursingResponsibilitiesfor Urinalysis:
A. Before theProcedure1. Explainthe procedureto the patientssignificantother.2. Obtainmaterialsneeded in theprocedure.3. Advisethe significantother to washperineal areaprior tocollection ofspecimen.
B. During the
Procedure1. Collect afresh urinespecimen in aurine container.2. Obtainclean catchmidstreamurine ifpossible.
C. After theProcedure1. Transfer the urinespecimen tothe laboratorypromptly.2.
Document theprocedure.
3. Attachthe result in thepatients chart.
Transparency SlightlyTurbid
Clear toSlightTurbid
NORMAL Turbid(cloudy) urinemay becaused by
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either normalor abnormalprocesses.Normalconditions
giving rise toturbid urineincludeprecipitationof crystals,mucus, orvaginaldischarge.
Abnormalcauses ofturbidity
include thepresence ofblood cells,yeast, andbacteria.
SpecificGravity
1.010 1.010 1.025
NORMAL --Albuminuria,dehydration,diarrhea,glycosuria,vomiting.-Diabetes
insidipus,overhydration, renaldisease.
Reaction(pH)
5 4.6 8.0 NORMAL - -Alkalosis,chronic renalfailure,diuretic use,gastricsuction,salicylate
intoxication,UTI,vegetablediet, vomiting.-Acidosis,
dehydration,starvation,UTI
Urinalysis Microscopic
Component Result NormalRange
Interpretation Implications NursingResponsibilities
RBC 2-3 NEGATIVE NORMAL Red cells and
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or RARE hemoglobinmay enter theurine from the
kidney orlower urinary
tract. Testingfor blood inthe urinedetects
abnormallevels ofeither redcells or
hemoglobin,which may be
caused by
excessive redcelldestruction,glomerulardisease,kidney or
urinary tractinfection,
malignancy,or urinary
tract injury.
WBC 4-6 NEGATIVEor RARE The presenceof white bloodcells in the
urine usuallysignifies a
urinary tractinfection,such as
cystitis, orrenal disease,
such as
pyelonephritis.
EpithelialCell
+ FEW NORMAL -sloughingoff of agingtissue.
-strong andactivedegenerationof kidneytubules. Infemales itindicatescontaminationfrom vaginaldischarges.
MucusThreads
++ FEW ABNORMAL -chronicinfection ofthe urethra orthe bladder.
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-it indicatesnopathologicalsymptoms.
Bacteria +++ FEW ABNORMAL -infection.
-normal fora healthyindividual.
Crystals
Component Result NormalRange
Interpretation Implications NursingResponsibilities
AmmoniumUrates
++ FEW ABNORMAL AmmoniumUratescrystals are
precipitatedwhen freeammonia ispresent as aresult ofbacterialaction onlongstandingspecimens.They are
often seenwhenphosphatesare presentin thespecimen.
Ammoniumuratecrystals canbe found inseveral
differentforms; theycan appearassheaves offineneedles, asdumbbells,and as"thornapple"
crystals,which areyellow,opaque,sphere-likebodies withirregular,
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spine-likeprojections.They can bedissolvedby heating
and by theaddition ofacetic acid,which, uponstanding,results intheformation ofcolorlessuric acidcrystals.
Chemical Test
Component
Result NormalRange
Interpretation
Implications NursingResponsibiliti
es
Sugar NEGATIVE
NEGATIVE
NORMAL -Cushingssyndrome, DM
and pregnancy.- none.
Albumin POSITIVE NEGATIVE
ABNORMAL
-CHF,glomerulosclerosis, lupuserythematous,multiplemyeloma,nephroticsyndrome.
- none.
June-----------------------------
Blood Chemistry
Component
Result
NormalRange
Interpretation
Implications Nursing Responsibilities
Trueglucose
FBS
5.9106
3.10-6.40m
mol55-
NORMAL -DM,cushingssyndrome,acute
Nursing Responsibilities for
Blood Chemistry:
A. Before the
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115mg/dl
pancreatitis,severe liverdisease.-Insulin
overdose,
Addisonsdisease,hepaticdisease,hypothyroidism,Pancreatictumor,pituitaryhypofunction,
postgastrectomy.
procedure:
1. Check the
Doctors order.
2. Identify the
patient.
3. Check the vital
signs.
4. Decrease
patients
anxiety by
explaining the
procedure and
why it has to
be performed.
5. For blood
sample,
instruct that the
medical
technician willperform
venipuncture to
extract blood.
6. Acknowledge
questions
regarding the
safety of the
procedure.
B. During the
procedure:
1. If the test is to
be done at
bedside,
remain with the
patient.
2. Assist with the
collection of
specimen if
allowed.
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C. After the procedure:
1. Check the site
for bleeding,
cyanosis, or
swelling.
2. Apply pressure
and warm
compress.
3. Check vital
signs for any
changes.
4. Document the
data (attach
result in the
chart).
Creatinine
132.6
1.5
64-124mm
ol/l0.7-
1.4mg/dl
ABNORMAL
-Impairedrenalfunction,dehydration,
cancer,heart failure,shock.-Decreasedmusclemass,debilitation.
TotalCholest
erol
4.7182
3.40-5.18mmol/l
130-200mg/
dl
NORMAL-Hypercholes-
terolemia,biliarycirrhosis,HPN,hypothyroidism, MI,pregnancy,hyperlipidemia,uncontrolledDM.
-Anemia,hyperthyroidism,malnutrition,malabsorption,starvation.
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Triglyceride
0.870
0.50-1.86mmol/l45-
165mg/
dl
NORMAL-Hypercholes-terolemia,biliary
cirrhosis,HPN,hypothyroidism, MI,pregnancy,hyperlipidemia,uncontrolledDM.
-Anemia,hyperthyroid
ism,malnutrition,malabsorption,starvation.
June-------------------
Complete Blood Count
Component Result NormalRange
Interpretation
Implications NursingResponsibilitie
s
Hemoglobin
14.8g/dl
8.7 to11.2mmol/
L14 to18g/dl(male)
NORMAL -COPD, hemo-concentration,heart failure, highaltitudes,polycythemia.
-Hemolyticreactions,hemorrhage, IDA,renal disease,sickle celldisease, systemiclupuserythematous.
Nursing
Responsibiliti
es for
Complete
Blood count:
A.Before the
procedure:
Check the
Doctors order.
Identify the
patient.
Check the vital
signs.
Decrease
patients
anxiety by
explaining the
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procedure and
why it has to
be performed.
For blood
sample,
instruct that the
medical
technician will
perform
venipuncture to
extract blood.
Acknowledge
questions
regarding the
safety of the
procedure.
B. During the
procedure:
If the test is tobe done at
bedside,
remain with the
patient.
Assist with the
collection of
specimen if
allowed.
C. After the
procedure:
Check the site
for bleeding,
cyanosis, or
swelling.
Apply pressure
and warm
compress.
Check vital
signs for any
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changes.
Document the
data (attach
result in the
chart).
Hematocrit 45.360%
42% to52%
0.42 to0.52
(male)
NORMAL -Dehydration,eclampsia, highaltitudes,polycythemia,congenital heartdisease, burns.
- Anemia, bonemarrow
dysfunction,cirrhosis,hemorrhage,hemolyticreactions,malnutrition,overhydration,pregnancy.
WBC 10100 5 to10,000/uL
5.0 to
10.0 x109/L
ABNORMAL
-inflammatoryand infectiousprocess,
leukemia,andtissue, necrosis.
-bone marrowfailure,chemotherapyand drug toxicity,overwhelminginfection,autoimmunedisease.
Differential
CountNeutrophils 86% 40% to
60%ABNORMA
L-bacterial or
acute infection,collagendiseases,CushingsSyndrome,eclampsia, gout,inflammatorydisease,ketoacidosis,
myelocytucleukemia, stress.
-Addisonsdisease, aplasticanemia,overwhelminginfection,
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radiation therapy.
Lymphocytes
14 35% to40%
ABNORMAL
-Chronicinfections,hepatitis,lymphocyctic
leukemia,mononucleosis,multiple,myeloma, viralinfection.
-Adrenocorti-Costeroidtherapy,leukemia, lupuserythematous,sepsis, whole
bodyirridation,prednisone therapy.
Blood Type O+
FSR O+
CLOTTING & BLEEDING TIMEPerformed on: November 12, 2009Purpose:
Clotting Time- are used to determine the integrity of the coagulation pathways, andplatelet function. In general, the common tests for the intrinsic or common pathways
are the activated partial thromboplastin time (APTT) and activated coagulation time(ACT). One-stage prothrombin time (OSPT) is usually used to evaluate the extrinsic orcommon pathways, and platelet count, clot retraction, bleeding time and activatedcoagulation time reflect platelet numbers and function.Bleeding Time- This test measures the time taken for blood vessel constriction andplatelet plug formation to occur. No clot is allowed to form, so that the arrest ofbleeding depends exclusively on blood vessel constriction and platelet action.
Clotting Time Bleeding TimePatients value: 3 minutes and 28 seconds
Patients value: 1 minute and 50 secondsNormal value: 2 6 minutes
Normal value: 1 -3 minutesImplications: No significant findings found.
PLATELET & PROTHROMBIN TIMEPerformed on: ---------------------------------------------Purpose: These tests will detect most coagulation protein problems. A relationbetween thrombocytopenia and time on bypass also was reported. The clinical picture,
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bleeding time, prolonged partial thromboplastin time test, and plasma prothrombintime test lead to the diagnosis.
Platelet and Prothrombin TimePatients value: 11.3Control value: 12.3
Implications: No significant findings found.
PREGNANCY TESTPerformed on: --------------------------Purpose: to determine whether or not a woman is pregnant.
Pregnancy Test - HCGPatients value: Positive
Implications: Increase HCG which is released by the trophoblastic cells of thefertilized ovum is a reliable marker of pregnancy.CHEST PA
Performed on: November 12, 2009Purpose: Chest X-rays can also reveal fluid in your lungs or in the spacessurrounding your lungs, enlargement of your heart, pneumonia, emphysema, cancerand many other conditions. Some people have a series of chest X-rays done overtime, to track whether a particular health problem is getting better or worse.
Findings: ---------------------------Conclusion: ------------------------------
ULTRASOUNDPerformed on:
----------------------Purpose: Ultrasound is performed routinely during pregnancy. Early in the pregnancy(at about seven weeks), it might be used to determine the size of the uterus or thefetus, to detect multiple or ectopic pregnancy, to confirm that the fetus is alive (orviable), or to confirm the due date.
Uterus: 16.1 x 11.6 x 7.4 cm antevertedCervix: 4.2 x 3.8 x 3.1 cm without Nabothian cystEndometrium: 2.3 cmRight ovary: not visualizedLeft ovary: 4.1 x 2.8 x 2.8 cm lateralOthers: no free fluid from the cul de sac
Remarks:
The uterus is anteverted with regular contour and inhomogenous myometrium.
Well circumiscribed heterogenous structure noted within posterior myometrium
measuring 7.0 x 7.2 x 5.5 cm suggestive of an intramural myoma withsubmucous component.
Cervix is closed and homogenous.
Endometrium is thickened and heterogenous suggestive of blood clots.
Impression:
Enlarged anterverted uterus with thickened endometrium
Uterine myoma
Implications: Results of the ultrasound suggest that the patient has a myomadescribed to be intramular and at the same time with submucous components. Byintramural, it means that the myoma is located within the uterine wall, while havingsubmucous components suggests that it lies just beneath the endometrium, the innermost layer of the uterus.
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ELECTROCARDIOGRAMPerformed on: November 12, 2009Purpose:Electrical impulses in the heart originate in the SA node and travel through the intrinsicconducting system to the heart muscle. The impulses stimulate the myocardial musclefibers to contract and thus induce systole. The electrical waves can be measured atselectively placed electrodes (electrical contacts) on the skin. Electrodes on differentsides of the heart measure the activity of different parts of the heart muscle. An ECGdisplays the voltage between pairs of these electrodes, and the muscle activity thatthey measure, from different directions, also understood as vectors. This display
indicates the overall rhythm of the heart and weaknesses in different parts of the heartmuscle. It is the best way to measure and diagnose abnormal rhythms of the heart,particularly abnormal rhythms caused by damage to the conductive tissue that carrieselectrical signals, or abnormal rhythms caused by levels of dissolved salts(electrolytes), such as potassium, that are too high or low.
Rate:Atrial: 89Ventricular: 89
Rhythm: SinusAxis: +30o
PR Interval: 0.16 secondsQRS:
0.08 secondsQT Interval: 0.32 secondsP wave: uprightORS: normal R wave progressionTransitional zone: V3 V4T Wave: uprightST segment: isoelectricInterpretation:Sinus rhythm, within normal limits
Implications: There were no significant findings noted.
K. Impression/ Diagnosis
Cerebrovascular accident hemorrhage right middle cerebral artery
Hypertension
iii. Clinical Discussion of the disease
1. Anatomy and Physiology
http://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Electrodehttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Electrode7/28/2019 Ob Cssepres
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INTERNAL FEMALE ORGANSThe internal organs of the female consists of the uterus, vagina, fallopian tubes, andthe ovariesa. Uterus. The uterus is a hollow organ about the size and shape of a pear. It servestwo important functions: it is the organ of menstruation and during pregnancy it
receives the fertilized ovum, retains and nourishes it until it expels the fetus duringlabor.Location: The uterus is located between the urinary bladder and the rectum. It issuspended in the pelvis by broad ligaments.Divisions of the uterus: The uterus consists of the body or corpus, fundus, cervix, andthe isthmus. The major portion of the uterus is called the body or corpus. The fundusis the superior, rounded region above the entrance of the fallopian tubes. The cervix isthe narrow, inferior outlet that protrudes into the vagina. The isthmus is the slightlyconstricted portion that joins the corpus to the cervix.Walls of the uterus: The walls are thick and are composed of three layers: theendometrium, the myometrium, and the perimetrium. The endometrium is the inner
layer or mucosa. A fertilized egg burrows into the endometrium (implantation) andresides there for the rest of its development. When the female is not pregnant, theendometrial lining sloughs off about every 28 days in response to changes in levels ofhormones in the blood. This process is called menses. The myometrium is the smoothmuscle component of the wall. These smooth muscle fibers are arranged. Inlongitudinal, circular, and spiral patterns, and are interlaced with connective tissues.During the monthly female cycles and during pregnancy, these layers undergoextensive changes. The perimetrium is a strong, serous membrane that coats theentire uterine corpus except the lower one fourth and anterior surface where thebladder is attached.b. Vagina.
Location: The vagina is the thin in walled muscular tube about 6 inches long leadingfrom the uterus to the external genitalia. It is located between the bladder and therectum.Function: The vagina provides the passageway for childbirth and menstrual flow; itreceives the penis and semen during sexual intercourse.c. Fallopian TubesLocation: Each tube is about 4 inches long and extends medially from each ovary toempty into the superior region of the uterus.Function: The fallopian tubes transport ovum from the ovaries to the uterus. There isno contact of fallopian tubes with the ovaries.Description: The distal end of each fallopian tube is expanded and has finger-likeprojections called fimbriae, which partially surround each ovary. When an oocyte isexpelled from the ovary, fimbriae create fluid currents that act to carry the oocyte intothe fallopian tube. Oocyte is carried toward the uterus by combination of tubeperistalsis and cilia, which propel the oocyte forward. The most desirable place forfertilization is the fallopian tube.d. OvariesFunctions: The ovaries are for oogenesis-the production of eggs (female sex cells)and for hormone production (estrogen and progesterone).
BLOOD SUPPLYThe blood supply is derived from the uterine and ovarian arteries that extend from theinternal iliac arteries and the aorta. The increased demands of pregnancy necessitatea rich supply of blood to the uterus. New, larger blood vessels develop toaccommodate the need of the growing uterus. The venous circulation is accomplishedvia the internal iliac and common iliac vein.
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FACTS ABOUT THE MENSTRUAL CYCLEMenstruation is the periodic discharge of blood, mucus, and epithelial cells from theuterus. It usually occurs at monthly intervals throughout the reproductive period,except during pregnancy and lactation, when it is usually suppressed.a. The menstrual cycle is controlled by the cyclic activity of follicle stimulating hormone(FSH) and LH from the anterior pituitary and progesterone and estrogen from theovaries. In other words, FSH acts upon the ovary to stimulate the maturation of a
follicle, and during this development, the follicular cells secrete increasing amounts ofestrogen.b. Hormonal interaction of the female cycle are as follows:Days 1-5. This is known as the menses phase. A lack of signal from a fertilized egginfluences the drop in estrogen and progesterone production. A drop in progesteroneresults in the sloughing off of the thick endometrial lining which is the menstrual flow.This occurs for 3 to 5 days.Days 6-14. This is known as the proliferative phase. A drop in progesterone andestrogen stimulates the release of FSH from the anterior pituitary. FSH stimulates thematuration of an ovum with graafian follicle. Near the end of this phase, the release ofLH increases causing a sudden burst like release of the ovum, which is known as
ovulation.Days 15-28. This is known as the secretory phase. High levels of LH cause the emptygraafian follicle to develop into the corpus luteum. The corpus luteum releasesprogesterone, which increases the endometrial blood supply. Endometrial arrival ofthe fertilized egg. If the egg is fertilized, the embryo produces human chorionicgonadotropin (HCG). Thehuman chorionic gonadotropin signals the corpus luteum tocontinue to supply progesterone to maintain the uterine lining. Continuous levels ofprogesterone prevent the release of FSH and ovulation ceases.OVULATION
Ovulation is the release of an egg cell from a mature ovarian follicle. Ovulationis stimulated by hormones from the anterior pituitary gland, which apparently causes
the mature follicle to swell rapidly and eventually rupture. When this happens, thefollicular fluid, accompanied by the egg cell, oozes outward from the surface of theovary and enters the peritoneal cavity. After it is expelled from the ovary, the egg celland one or two layers of follicular cells surrounding it are usually propelled to theopening of a nearby uterine tube. If the cell is not fertilized by union of a sperm cellwithin a relatively short time, it will degenerate.
HORMONESEstrogen
Estrogens are a group of steroid compounds functioning as the primary female
sex hormone. Like all steroid hormones, estrogens readily diffuse across the cellmembrane. Once inside the cell, they bind to and activate estrogen receptors which inturn up-regulate the expression of many genes.
The three major naturally occurring estrogens in women are estrone (E1),estradiol (E2), and estriol (E3). Estradiol (E2) is the predominate form in nonpregnantfemales, estrone is produced during menopause, and estriol is the primary estrogen ofpregnancy.
http://en.wikipedia.org/wiki/Estronehttp://en.wikipedia.org/wiki/Estradiolhttp://en.wikipedia.org/wiki/Estriolhttp://en.wikipedia.org/wiki/Estronehttp://en.wikipedia.org/wiki/Estradiolhttp://en.wikipedia.org/wiki/Estriol7/28/2019 Ob Cssepres
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Estrogens are produced primarily by developing follicles (Graafian follicles) inthe ovaries, the corpus luteum, and the placenta.Follicle-stimulating hormone (FSH)and luteinizing hormone (LH) stimulate the production of estrogen in the ovaries.Some estrogens are also produced in smaller amounts by other tissues such as theliver, adrenal glands, and the breasts. These secondary sources of estrogens are
especially important in postmenopausal women.While estrogens are present in both men and women, they are usually presentat significantly higher levels in women of reproductive age. They promote thedevelopment of female secondary sexual characteristics, such as breasts, and arealso involved in the thickening of the endometrium and other aspects of regulating themenstrual cycle.
Structural promote formation of female secondary sex characteristics decelerate height growth accelerate metabolism (burn fat) reduce muscle mass
stimulate endometrial growth increase uterine growth increase vaginal lubrication thicken the vaginal wall maintenance of vessel and skin reduce bone resorption, increase bone formation morphic change (endomorphic-> mesomorphic ->ectomorphic)
protein synthesis increase hepatic production of binding proteins
coagulation increase circulating level offactors2, 7, 9,10,plasminogen
decrease antithrombin III increase platelet adhesiveness Lipid
increase HDL, triglyceride decrease LDL, fat deposition
Fluid balance salt (sodium) and water retention
Hormones
increase cortisol, SHBG Gastrointestinal tract
reduce bowel motility
increase cholesterol in bile Cancer
support hormone-sensitivebreast cancers Lung function
promotes lung function by supporting alveoli(in rodents but probably inhumans).
ProgesteroneProgesterone acts with estrogen to bring about the menstrual cycle. During
pregnancy, it quiets the muscles of the uterus so that an implanted embryo will not beaborted and helps prepare breast tissue for lactation. Progesterone is produced byanother glandular structure in the ovaries, the corpus luteum. The corpus luteum
produces both estrogen and progesterone, but progesterone is secreted in largeramounts Ovaries are stimulated to release their estrogens and progesterone in acyclic way by the anterior pituitary gonadotropic hormones.Progesterone is sometimes called the "hormone of pregnancy", and it has many rolesrelating to the development of the fetus:
Progesterone converts the endometrium to its secretory stage to prepare the
uterus for implantation. At the same time progesterone affects the vaginalepithelium and cervical mucus, making it thick and impermeable to sperm. If
http://en.wikipedia.org/wiki/Ovarian_folliclehttp://en.wikipedia.org/wiki/Corpus_luteumhttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Follicle-stimulating_hormonehttp://en.wikipedia.org/wiki/Luteinizing_hormonehttp://en.wikipedia.org/wiki/Ovaryhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/wiki/Breasthttp://en.wikipedia.org/wiki/Manhttp://en.wikipedia.org/wiki/Womanhttp://en.wikipedia.org/wiki/Secondary_sexual_characteristichttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Menstrual_cyclehttp://en.wikipedia.org/wiki/Secondary_sex_characteristicshttp://en.wikipedia.org/wiki/Heighthttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Vaginal_lubricationhttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Mesomorphichttp://en.wikipedia.org/wiki/Ectomorphichttp://en.wikipedia.org/wiki/Ectomorphichttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Coagulation_factorhttp://en.wikipedia.org/wiki/Factor_IIhttp://en.wikipedia.org/wiki/Factor_VIIhttp://en.wikipedia.org/wiki/Factor_IXhttp://en.wikipedia.org/wiki/Factor_IXhttp://en.wikipedia.org/wiki/Factor_Xhttp://en.wikipedia.org/wiki/Factor_Xhttp://en.wikipedia.org/wiki/Plasminogenhttp://en.wikipedia.org/wiki/Antithrombinhttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/High_density_lipoproteinhttp://en.wikipedia.org/wiki/Triglyceridehttp://en.wikipedia.org/wiki/Low_density_lipoproteinhttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Cortisolhttp://en.wikipedia.org/wiki/SHBGhttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/w/index.php?title=Hormone-sensitive&action=edit&redlink=1http://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Cervix#Cervical_mucushttp://en.wikipedia.org/wiki/Spermhttp://en.wikipedia.org/wiki/Ovarian_folliclehttp://en.wikipedia.org/wiki/Corpus_luteumhttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Follicle-stimulating_hormonehttp://en.wikipedia.org/wiki/Luteinizing_hormonehttp://en.wikipedia.org/wiki/Ovaryhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/wiki/Breasthttp://en.wikipedia.org/wiki/Manhttp://en.wikipedia.org/wiki/Womanhttp://en.wikipedia.org/wiki/Secondary_sexual_characteristichttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Menstrual_cyclehttp://en.wikipedia.org/wiki/Secondary_sex_characteristicshttp://en.wikipedia.org/wiki/Heighthttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Vaginal_lubricationhttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Somatotypehttp://en.wikipedia.org/wiki/Mesomorphichttp://en.wikipedia.org/wiki/Ectomorphichttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Coagulation_factorhttp://en.wikipedia.org/wiki/Factor_IIhttp://en.wikipedia.org/wiki/Factor_VIIhttp://en.wikipedia.org/wiki/Factor_IXhttp://en.wikipedia.org/wiki/Factor_Xhttp://en.wikipedia.org/wiki/Plasminogenhttp://en.wikipedia.org/wiki/Antithrombinhttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/High_density_lipoproteinhttp://en.wikipedia.org/wiki/Triglyceridehttp://en.wikipedia.org/wiki/Low_density_lipoproteinhttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Cortisolhttp://en.wikipedia.org/wiki/SHBGhttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/w/index.php?title=Hormone-sensitive&action=edit&redlink=1http://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Cervix#Cervical_mucushttp://en.wikipedia.org/wiki/Sperm7/28/2019 Ob Cssepres
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pregnancy does not occur, progesterone levels will decrease, leading, in thehuman, to menstruation. Normal menstrual bleeding is progesterone-withdrawalbleeding.
During implantation and gestation, progesterone appears to decrease the
maternal immune response to allow for the acceptance of the pregnancy.
Progesterone decreases contractility of the uterine smooth muscle. In addition progesterone inhibits lactationduring pregnancy. The fall in
progesterone levels following delivery is one of the triggers for milk production. A drop in progesterone levels is possibly one step that facilitates the onset of
labor. It raises epidermal growth factor-1 levels, a factor often used to induce
proliferation, and used to sustain cultures, ofstem cells. It increases core temperature (thermogenic function) during ovulation.
It reduces spasm and relaxes smooth muscle. Bronchiare widened and mucusregulated. (Progesterone receptors are widely present in submucosal tissue.)
It acts as an antiinflammatory agent and regulates the immune response.
It reduces gall-bladderactivity. It normalizes blood clotting and vascular tone, zinc and copperlevels, cell
oxygen levels, and use of fat stores for energy. It may affect gum health, increasing risk of gingivitis (gum inflammation) and
tooth decay. It appears to prevent endometrial cancer(involving the uterine lining) by
regulating the effects of estrogen.
2. Pathophysiology(book based and client based)
http://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Gestationhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Lactationhttp://en.wikipedia.org/wiki/Lactationhttp://en.wikipedia.org/wiki/Labor_(childbirth)http://en.wikipedia.org/wiki/Epidermal_growth_factor-1http://en.wikipedia.org/wiki/Stem_cellhttp://en.wikipedia.org/wiki/Stem_cellhttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Progesterone_receptorhttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Gall-bladderhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Endometrial_cancerhttp://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Gestationhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Lactationhttp://en.wikipedia.org/wiki/Labor_(childbirth)http://en.wikipedia.org/wiki/Epidermal_growth_factor-1http://en.wikipedia.org/wiki/Stem_cellhttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Progesterone_receptorhttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Gall-bladderhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Endometrial_cancer7/28/2019 Ob Cssepres
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3.Drug Study
4.ncp
Drug
Name
Indication
s
Action ContraindicationsAdverse
Reactions
Nursing
Responsibilities
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DISCHARGE PLAN
Medications
---------------------
---------------------
Environment
- instructed to provide a clean environment- advised to have things accessible for the client- instructed to have a clean and quiet home conducive for resting
- advised to listen to light music for relaxation- advised to have a safe home and free from any health hazards
Treatment
- advised to take medications at the right route, dose and time- advised to take medications as prescribed- instructed not to stop medication if not prescribed by the doctor
Health Teachings
- advised to have adequate rest and sleep- instructed to do deep breathing exercise when she feels pain and anxious.- encouraged patient to ambulate- instructed not to do strenuous activities- encouraged eating the proper diet as advised by the doctor.- advised to keep incision site clean and dry- advised to have diversional activities- instructed to take the medications at the right route, route dose and right time.
- encouraged verbalizing when in pain
OPD Check-up
Follow up check up after 1 week.
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Diet
High in protein and rich in vitamin C to promote healing
Regular calcium intake for fast bone recovery High fiber diet to prevent constipation
Increased fluid intake