lyza cs slide
TRANSCRIPT
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DiagnosticExams
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Date Test with
normal
values
Rationale Result Interpreta
tion &
Significa
nce
Nursing
Responsibi
lities
Novem
ber 6,
2010
&
December 14,
2010
Hemoglo
bin
120-160
g/dL
- the purpose
of this test is
to know the
values of the
componentsof blood to
determine
bodies
reaction
towards
something
foreign in the
body
q126
g/dLNor
mal
q98g/dLLow
A low red
blood cell
count or
low
hemoglobin may
suggest
anemia,
which can
have
many
causes.
Advise the
client to eat
food rich in
iron such as
seafoodsand red
meat to
increase in
iron helps in
the
manufacture
of
hemoglobin.
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Erythroc
ytes
4.0-5.0
10^12L
-it is a
measure
of the
settling ofred blood
cells in a
tube of
blood
during one
hour. The
rate is an
indication
of
inflammati
on andincreases
in many
diseases.
3.87
10^12/L
Low
3.15
10^12
/L
Norm
al
-low
erythr
ocytes
is notusuall
y a
cause
for
concer
n, it
can be
seen
with
conditi
onsthat
inhibit,
Instruct the
client to
minimize
oral fluidintake to
prevent
further
fluid
retention.
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the normal
sedimentation of
RBCs, such as
polycythemia,
extreme
leukocytosis and
some protein
abnormalities.Some changes in
red cell shape
(such as sickle
cells in sickle cell
anemia) also lower
the erythrocytes.
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Mean
Corpusc
ular
Hemogl
obin
(MCH)
27.0-33.0 pg
-it is the average
amount of
hemoglobin
per red blood
cell in a blood
sample, used
to help
diagnose the
type (cause)
and severity
of anemia.
32.6 pg
Normal
31.2 pg
Normal
-within
normal
range of
mean
corpuscul
ar
hemoglob
ing is
normochr
omic
anemia (a
form of
anemia in
which the
concentra
tion of
hemoglobin in the
red blood
cells is
within the
standard
range)
Advise the
client to
always
follow the
doctors
order to
normally
maintain her
normal MCH
count.
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Mean
Corpuscu
lar
Volume
(MCV)80-96 fl
-is a blood test that
measures the
average red
blood cell
volume (size), isused to tell the
difference
between types
(causes) of
anemia.
100.0 fl
Normal
93.6 fl
Normal
-A high MCV,
indicating
macrocytic
anemia (is
an in whichthe
erythrocyte
s are
larger than
their
normal
volume),can have a
variety of
causes
including
alcoholism,
liver
disease,and
deficiencie
s of
vitamin
B12 and
folic acid
(folate).
Instruct the client
to avoid
alcohol intake
as to
decrease theMCV volume
and prevent
further liver
complications
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Mean
Corpus
cular
Hemoglobin
Concen
tration
(MCHC)
32-36 g/dL
-to know the
mean cell
hemoglobin
concentration, the
average
concentratio
n of
hemoglobin
in a given
volume of
blood, it is
used to help
diagnose the
type (cause)and severity
of anemia.
32.6 g/dL
Normal
-Normal
Mean
Corpusc
ularHemoglo
bin
Concent
ration is
associat
ed with
pernicio
us
anemia.
Advise the
client to
religiously
follow thedoctors
order as to
prevent
any
complicatio
ns from
happening.
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Leukocyte
5.0-10.0
10^9
-it measures the
number of
WBCs (also
called
leukocytes) inthe blood
which help the
body fight
infection, are
bigger than
red blood cells
and there arefar fewer of
them in the
bloodstream
11.5
10^9/
L
o High
25.7
10^9/
L
High
-a high White
Blood
Cell
count
(leukocytosis) may
signify an
infection
somewhe
re in the
body or,
lesscommonl
y, it may
signify an
underlyin
g
malignan
cy.
Encourage the
patient to
increase
Vitamin C
intake tostrengthen
the bodys
resistance
to
microorgani
sms. The
nurseshould
perform
proper hand
washing
before and
after coming
in contact
with patient
as to
prevent
further
spreading of
infection.
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Neutrophils
0.55-0.65 %
are the most
common type of
white blood cell,
comprising about
50-70% of all whiteblood cells. They
are phagocytic,
meaning that they
can ingest other
cells, though they
do not survive the
act. Neutrophils arethe first immune
cells to arrive at a
site of infection,
through a process
known as
chemotaxis.
0.70 %
o High
0.81 %
High
-Can increase
in
response
to bacterial
infection orinflammato
ry disease.
Severe
elevations
in
neutrophils
may becaused by
various
bone
marrow
disorders,
such as
chronicmyelogeno
us
leukemia.
Wash hands
before and
after being in
contact with
patient andinstruct
patient to
increase
intake of
foods rich
vitamin C
such orangesand
pineapples.
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Lymphocy
te
0.25-0.40
%
-a small white
blood cell
(leukocyte)
that plays a
large role in
defending
the body
against
disease.
Lymphocyte
s areresponsible
forimmune
responses.
0.20 %
q Low
0.07 %
Low
-Decreased
lymphoc
yte
levels
can
indicate
disease
s that
affect
the
immunesystem,
such as
lupus,
and the
later
stagesof HIV
infection
.
Increase
intake of
foods rich
in vitamin
C and
Vitamin E
such as
peanuts
and egg
yolks as
vitamin Eis an
antioxidant
that slows
down the
symptoms
of agingand
strengthen
s body
cells that
fight
infection.
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Monocytes
0.02-0.06 %
-a white blood cell
that has a
single nucleus
and can
ingest (take
in) foreign
material. (In
other words, a
monocyte is
thus a
mononuclear
phagocytethat circulates
in the blood.)
0.08 %
o High
0.07 %
High
-can increase
in
response
to
infection
of all
kinds as
well as to
inflammat
ory
disorders
.Monocyte
counts
are also
increased
in certain
malignant
disorders,
including
leukemia.
Encourage the
client to
minimize
sugar and
allergens on
their daily
diet as too
much sugar
can impair
white blood
cells up to
50% in avery short
period of
time.
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Eosinophils
0.01-0.05
%
-a type of
leukocyt
e (white
blood
cell) with
coarse
round
granules
of
uniform
size
within its
cytoplas
m and
typically
a
bilobate(two-
lobed)
nucleus.
0.02 %
Norma
l
0.04 %
Norma
l
High numbers of
eosinophils
(eosinophilia)
are usually
associated withAllergic
diseases
and infections
from parasites
such as worms.
A lower-than-
normal
eosinophilcount may be
due
to:
Alcohol
intoxication
Over production
of certainsteroids
in the body
(such
as cortisol)
Instruct the
client to
always
follow the
doctorsorders as to
maintain
the normal
values of
her
eosinophils.
Tell theclient to
avoid
eating raw
and street
food as it is
mostly
whereparasitic
worms
develops.
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Basophils
0.00-
0.005 %
-a type of
leukocyt
e (white
blood
cell) with
coarse
bluish-
black
granules
of
uniform
size
within
the
cytoplas
m and
typicallya
bilobate
(two-
lobed)
nucleus.
0.00 %
Nor
mal
It can
increase
in cases
of
leukemia,
chronic
inflammati
on, the
presence
of a
hypersen
sitivity
reaction
to food, or
radiation
therapy.
Administer
the
appropriat
e
medicatio
n for
allergic
reactions.
Advice the
patient to
avoid
eating
foods that
she is
aware of
being
allergic to.
0.01 %
Hig
ho
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Basophils
0.00-
0.005 %
-a type of
leukocyt
e (white
blood
cell) with
coarse
bluish-
black
granules
of
uniform
size
within
the
cytoplas
m and
typicallya
bilobate
(two-
lobed)
nucleus.
0.00 %
Nor
mal
It can
increase
in cases
of
leukemia,
chronic
inflammati
on, the
presence
of a
hypersen
sitivity
reaction
to food, or
radiation
therapy.
Administer
the
appropriat
e
medicatio
n for
allergic
reactions.
Advice the
patient to
avoid
eating
foods that
she is
aware of
being
allergic to.
0.01 %
Hig
ho
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Thrombocyt
e
150.0-
300.010^9/L
-to know the
numbers
, size,
and
health ofthrombo
cytes
209
10
^9/
L
Norm
al
218
10
^9/
L
No
rm
al
If platelet count is
normal and thus
indicates that
the bone
marrow isfunctioning
normally and the
platelets are not
being eaten
away rapidly.
Encourage
the patient
to
maintain a
healthylifestyle
and follow
the
doctors
order as
to
maintainthe normal
values of
her
thrombocy
tes.
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Generic Name: cephalexin
Brand name: Apo-Cephalex, Keflex, Novo-Lexin,
N
u-Cephalex, Panixine, Cefalin
Classification:
Therapeutic: anti-infective
Pharmacologic: first-generation cephalosporin
Date ordered: 12/13/10
Ordered dose of frequency: 500mg i tab
Route/ Dosage:
PO (Adults): Most infections-250-500 mg q 6 hr. Uncomplicated
cystitis, skin and soft tissue infections, streptococcal pharyngitis-
500 mg q 12 hr.
PO (Children): Most infections-25-50 kg/day divided by q 6-8 hr.
Uncomplicated cystitis, skin and soft tissue infections,
streptococcal pharyngitis-12.5-25 mg/kg q 12 hr. Otitis media-
18.75-255 mg/kg mg q 6 hr.
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Mechanism of Action:
Bind to bacterial cell wall membrane, causing cell death.
Therapeutic effects: bactericidal action against susceptible bacteria.
Spectrum:Active against many gram-positive cocci.
Indication: Treatment of skin and skin structure infections,
Pneumonia, Otitis media, urinary tract infections, Bone and joint infections,
Septicemia caused by susceptible organisms.
Contraindication: Hypersensitivity to cephalosporins. Serioushypersensitivity to penicillinase
Adverse Reactions/ Side effects: CNS:seizures (high doses). GI:
pseudomembranous colitis, diarrhea, nausea, vomiting, cramps. Derm:
rashes, pruritis, urticaria. Local: pain at IM site, phlebitis at IV site.
Drug interaction:
Drug-drug: Probenicid decreases excretion and increases blood
levels of renally excreted cephalosprins. Concurrent use of loop diuretics
or aminoglycosides may increase risk of renal toxicity.
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Nursing responsibilities:
Assess for infection at beginning and during therapy.
Before initiating therapy, obtain a history to determine previous useof and reactions to penicillin and cephalosporin
Obtain specimens for culture and sensitivity before initiating
therapy.
Observe patient with signs and symptoms of anaphylaxis and
advise patient to report signs of superinfection (furry overgrowth onthe tongue, vaginal itching or discharge, loose or foul-smelling
stools) and allergy.
Administer around the clock. May be administered on full or empty
stomach.
Advise patient to notify health care professional if fever anddiarrhea develop, especially if diarrhea contains blood, mucus, or
pus. Advise not to treat diarrhea without consulting health care
professional.
Advise patient not to take drugs with dairy of Caffeinated products.
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Generic Name: cefazolin
Brand name: Ancef
Classification:Therapeutic: anti-infectives
Pharmacologic: first-generation
cephalosporins
Date ordered: 12/11/10
Ordered dose of frequency: 1 gm IVTT q 6hours
Route/ Dosage:
IM, IV (Adults):
Moderate to severe infection-500mg 1g q 6-8 hr. Mild
infections with gram-positive cocci-250-500 mg q 8hr.
Uncomplicated UTI-1 g q 12 hr.
IM, IV (Children and infants): 6.25-25 mg/kg q 6 hr
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Mechanism of Action:
Bind to bacterial cell wall membrane, causing cell death.
Therapeutic effects: bactericidal action against susceptible
bacteria.
Spectrum:Active against many gram-positive cocci.
Indication: Preoperative prophylaxis
Contraindication: Hypersensitivity to cephalosporins.
Serious hypersensitivity to penicillinaseDrug interaction:
Drug-drug: Probenicid decreases excretion and increases
blood levels of renally excreted cephalosprins. Concurrent
use of loop diuretics or aminoglycosides may increase risk of
renal toxicity
Adverse Reactions/ Side effects: CNS:seizures (high
doses). GI: pseudomembranous colitis, diarrhea, nausea,
vomiting, cramps. Derm: rashes, pruritis, urticaria. Local: pain
at IM site, phlebitis at IV site.
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Nursing responsibilities:
Assess for infection at beginning and during therapy.
Before initiating therapy, obtain a history to determine
previous use of and reactions to penicillin and cephalosporin
Obtain specimens for culture and sensitivity before initiating
therapy.
Observe patient with signs and symptoms of anaphylaxis and
advise patient to report signs of superinfection (furryovergrowth on the tongue, vaginal itching or discharge, loose
or foul-smelling stools) and allergy.
Administer around the clock. May be administered on full or
empty stomach.
Advise patient to notify health care professional if fever and
diarrhea develop, especially if diarrhea contains blood,
mucus, or pus. Advise not to treat diarrhea without consulting
health care professional.
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Generic Name: cefuroxime
Brand name: Ceftin, Zinasef
Classification:Therapeutics: anti-infective
Pharmacologic: second-generation cephalosporin
Date ordered: home medication
Ordered dose of frequency: 500mg tab 3x a day
Route/ Dosage:PO (Adults and children >12 yr):
Most infections-250-500 mg q 12 hr.
UTI-125-250 mg q 12 hr
PO (Children
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Mechanism of Action:
Bind to bacterial cell wall membrane, causing cell death.
Therapeutic effects: bactericidal action against susceptible bacteria.
Spectrum: Similar to that of the first generation cephalosporin but active against
other gram-negative pathogens.Indication: Treatment of: Respiratory tract infections, Skin and skin
structure infections, bone and joint infections, urinary tract and gynaecologic
infection, septicaemia, Meningitis, Otitis media, Perioperative prophylaxis.
Contraindication: Hypersensitivity to cephalosporins. Serious
hypersensitivity to penicillinase
Drug interaction:Concomitant administration of probenecid with cefuroxime axetil tablets increases
the area under the serum concentration versus time curve by 50%. The peak
serum cefuroxime concentration after a 1.5-g single dose is greater when taken
with 1 g of probenecid (mean = 14.8 mcg/mL) than without probenecid (mean =
12.2 mcg/mL).
Drugs that reduce gastric acidity may result in a lower bioavailability of CEFTINcompared with that of fasting state and tend to cancel the effect of postprandial
absorption.
In common with other antibiotics, cefuroxime axetil may affect the gut flora,
leading to lower estrogen reabsorption and reduced efficacy of combined oral
estrogen/progesterone contraceptives.
Adverse Reactions/ Side effects: seizures,
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Nursing responsibilities:
Assess for infection at beginning and during therapy.
Before initiating therapy, obtain a history to determine previous
use of and reactions to penicillin and cephalosporin.Obtain specimens for culture and sensitivity before initiating
therapy.
Instruct patient to take medication around the clock at evenly
spaced times and to finish the medication completely, even if
feeling better.Advise patient to report signs of superinfection (furry overgrowth
on the tongue, vaginal itching or discharge, loose or foul-smelling
stools) and allergy.
Advise patient to notify health care professional if fever and
diarrhea develop, especially if diarrhea contains blood, mucus, orpus. Advise not to treat diarrhea without consulting health care
professional.
Cefuroxime tablets should be swallowed whole, not crushed.
Tablets may be taken without regard to meals. Suspension must be
taken with meals. Shake well eachtime before using
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Generic Name: lactulose
Brand Name: Cephulac, Cholac,Chronulac, Constilac,
Constulose, Duphalac, Enulose, Evalose,
Heptalac, Kritalose
Classification:
Therapeutic: laxativesPharmacologic: osmotic
Date ordered: 12/11/10
Ordered dose of frequency: 30ml
Route/ Dosage:
PO (Adults): 15-30 ml/day up to 60ml/day as
liquid or 10-20g as powder for oral solution
PO (Children): 7.5ml daily
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Mechanism of Action:
Increases water content and softens the stool. Lowers the
pH of the colon, which inhibits the diffusion of ammoniafrom the colon into the blood, thereby reducing blood
ammonia levels.
Therapeutic Effects: Relief of constipation. Decreased blood
ammonia levels with improved mental status PSE
Indication: treatment of chronic constipation in adultsand geriatric patients. Adjunct in the management of portal-
systemic (hepatic) encephalophaty (PSE)
Contraindication: Low-galactose diets
Drug interaction:
Drug-drug: Should not be used with other laxatives in the
treatment of hepatic encephalopathy
Adverse Reactions/ Side effects: belching, cramps,
distention, flatulence, diarrhea, hyperglycemia
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Nursing responsibilities:
Assist patient for abdominal distention,presence of bowel sounds, and normal pattern
of bowel functions.
Assess color, consistency, and amount of
stool produce.Monitor cause increased blood glucose levels
in diabetic patients
Monitor serum electrolytes periodically when
used chronically. May cause diarrhea with
resulting hypokalemia and hyponatremia.
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Generic Name: promethazine
Brand Name: Antinaus, Histanil,
Pentazine, Phenadoz,Phenergan, Promacot,Promet, Prorex
Classification:
Therapeutic: antiemetics,
antihistamines, sedative
Pharmacologic: phenothiazines
Date ordered: 12/11/10
Ordered dose of frequency: 12.5mg slow
1VTT stat
Route/ Dosage:Sedation during labor
IM,IV (Adults): 50 mg in early labor; when
labor is established, additional doses of 25-75
mg may be given 1-2 times at 4-hr intervals
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Mechanism of Action:
Blocks the effects of histamine.
Has inhibitory effect on the chemoreceptor trigger zone in the medulla,
resulting in antiemetic properties.Alters the effects of dopamine in the CNS.
Produces CNS depression by indirectly decreased sstimulation of the
CNS reticular system.
Indication: Treatment of various allergic conditions and motion
sickness. Preoperative sedation. Treatment and prevention of nausea
and vomiting. Adjunct to anesthesia and analgesia.
Contraindication: Hypersensitivity; Comatose patients; Prostatic
hypertrophy
Drug interaction: Drug-drug:Additive CNS depression with other
CNS depressants, including alcohol, other antihistamines and other
sedatives; Additive anticholinergic properties.Adverse Reactions/ Side effects: CNS: confusion, disorientation,
sedation, dizziness, fatigue, insomnia, nervousness. EENT: blurred
vision, diplopia. CV: hypertension, tachycardia, bradycardia,
hypotension. GI: constipation, dry mouth. Derm: rashes, photosensiivity.
MS:joint pain.
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Nursing responsibilities:Monitor blood pressure, pulse, and respiratory
rate frequently in patients receiving IV doses.
Assess patient for level of sedation after
administrationAssess allergy symptoms before and
periodically throughout the course of therapy.
Assess for nausea and vomiting before and
after administration.
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Generic Name: Ferrous sulfate, Folic
acid,
Pregnancy/lactation vitamins &/orminerals,
Vitamin B-complex
Brand Name: Hemarate
Classification: A11JB - Vitamins
with minerals ; Used as dietarysupplements.
Date ordered: 12/11/10
Ordered dose of frequency: 1 tab
bid
Route/ Dosage:
PO: 1 tab daily.
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Mechanism of Action: Iron is an essential component in
the physiological formation of hemoglobin, adequate amounts of
which are necessary for effective erythropoiesis and the
resultant oxygen transport capacity of the blood. A similar
function is provided by iron in myoglobin production. Iron also
serves as a cofactor of several essential enzymes, including
cytochromes that are involved in electron transport. Iron is
necessary for catecholamine metabolism and the proper
functioning of neutrophils.
Indication: Prevention & treatment of Fe deficiency anemia,
folate deficiency & for the lowering of plasma homocysteine.
Contraindication: Hemochromatosis, peptic ulcer, regional
enteritis, ulcerative colitis.
Drug interaction: Vitamins & Minerals (Pre & Post
Natal) / Antianemics
Adverse Reactions/ Side effects: Nausea, vomiting, bloating,
upper abdominal discomfort, diarrhea or constipation, staining of
teeth, darker stools.
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Nursing responsibilities:
Instruct the patient that drug should be
taken on an empty stomach (Best taken
between meals. May be taken w/ meals toreduce GI discomfort.).
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Generic Name: mefenamic acid
Brand name: Revalan
Classification: Decreases inflammation,
pain, and fever, probably through inhibition ofcyclooxygenase activity and prostaglandin
synthesis.
Date ordered: 12/11/10
Ordered dose of frequency:
500g/tab 1 tab q 6 hrsRoute/ Dosage:
Adults andChildren (14 yr or age and older)
:
Acute Pain
PO 500 mg, followed by 250 mg every 6 has needed. Usually not used more than 1 wk.
Primary Dysmenorrhea
PO 500 mg, followed by 250 mg every 6 h
starting with onset of bleeding and associated
symptoms.
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Mechanism of Action: inhibits reuptake of serotonin norepinephrine CNS.
Indication: Relief of moderate pain lasting less than 1 wk; treatment of
primary dysmenorrhea.Contraindication: Patients in whom aspirin, iodides, or any NSAID
has caused allergic-type reactions; preexisting renal disease; active
ulceration or chronic inflammation of GI tract.
Drug interaction: Anticoagulants
Increased risk of gastric erosion and bleeding.
CyclosporineNephrotoxicity of both agents may be increased.
CYP-450
Exercise caution when coadministering mefenamic acid with drugs known
to inhibit the isoenzyme 2C9.
LithiumSerum lithium levels may be increased.
Methotrexate
Increased methotrexate levels.
Salicylates
Additive GI toxicity.
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Nursing Responsibilities:
Inform patient not to use drug for longer than 1 wk. If given for
dysmenorrhea, instruct patient to begin taking drug with onset of bleeding
and associated symptoms.Warn patient about potential for bleeding, and advise patient to notify
other health care professionals that drug is being taken.
Advise patient to discontinue medication if rash develops and to contact
health care provider.
Instruct patient to report the following symptoms to health care provider:rash, visual problems, dark stools, decreased urinary output, persistent
headache or stomach pain and unusual bruising or bleeding.
Advise patient to avoid intake of alcoholic beverages.
Instruct patient that drug may cause drowsiness and to use caution while
driving or performing other activities requiring mental alertness.
Caution patient to avoid prolonged exposure to sunlight and to usesunscreen or wear protective clothing to avoid photosensitivity reaction.
Instruct patient not to take OTC medications, including aspirin and
ibuprofen or other prescription drugs, without consulting health care
provider.
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Generic Name: Ivermectin + Pyrantel
Ferrous Gluconate 250mg, Vit B12, intrinisic factor
7.5mcg, Vit C 50mg, Folic Acid 1mg, Sorbitol 25mg,copper Sulphate 200mcg, Manganese Sulphate
200mcg; caps, Ferrous Gluconate 129.5mg, Vit B1-
1mg, Vit B2-1mg, Vit B6-1.5mg, Nicotinamide 15mg,
biotin 300mcg/5ml; syp
Brand name: Sangobion
Classification:
B03AE10 - Various combinations ; Belongs to the
class of iron in other combinations. Used in the
treatment of anemia.
Date ordered:12/13/10
Ordered dose of frequency: 1 tab bid
Route/ Dosage:
Cap 1-2 cap daily. SyrProphylaxis 1 tsp
daily. Therapy 3-6 tsp daily.
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Mechanism of Action:
Ivermectin - Microfilaricidal; ivermectin binds selectively and with high affinity to
glutamate-gated chloride ion channels in invertebrate muscle and nerve cells ofthe microfilaria. This binding causes an increase in the permeability of the cell
membrane to chloride ions and results in hyperpolarization of the cell, leading to
paralysis and death of the parasite. Ivermectin also is believed to act as an
agonist of the neurotransmitter gamma-aminobutyric acid (GABA), thereby
disrupting GABA-mediated central nervous system (CNS) neurosynaptic
transmission.Although not macrofilaricidal, ivermectin may also impair normal intrauterine
development ofO. volvulus microfilariae and may inhibit their release from the
uteri of gravid female worms. Action on microfilariae is less abrupt but more
prolonged than that of diethylcarbamazine. Ivermectin promptly decreases skin
microfilarial counts, while the number of microfilariae in the cornea and anterior
chamber of the eye decreases more slowly.
Pyrantel - Not vermicidal or ovicidal; acts as a depolarizing neuromuscular
blocking agent, thereby causing sudden contraction, followed by paralysis, of the
helminths; also acts as a cholinesterase inhibitor and ganglionic stimulant;
helminths are rendered unable to maintain their position in the intestinal lumen
and are expelled from the body in the fecal stream by peristalsis.
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Indication:
Cap Fe-deficiency anemia & anemia during growth,old age & convalescence;megaloblastic
anemia during pregnancy, in sprue or parasitosis;
anemia due to general dietary insufficiency; anemia
prophylaxis in blood donors. Prevention ofmaternal constipation due to pregnancy & iron
intolerability. SyrFe-deficiency anemia in childn,
latent insufficiency of Fe & vit B; in chronic illnesses &
during convalescence.Contraindication:
Fe accumulation; disorders in Fe utilization.
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Drug interaction: Pyrantel - Because of similar
mechanisms of action (and toxicity), pyrantel is recommended not to be
used concurrently with morantel or levamisole. Observation for adverse
effects should be intensified if used concomitantly with an
organophosphate or diethylcarbamazine. Piperazine and pyrantel haveantagonistic mechanisms of action; do not use together.]
Ivermectin - the products that may interact with this drug include:
barbiturates (such as phenobarbital, butalbital), benzodiazepines (such as
clonazepam, diazepam, lorazepam), sodium oxybate (GHB), valproic acid.
Adverse Reactions/ Side effects:As mentioned, certain side effects are associated with using this
medication. Some of these side effects include diarrhea, nausea,
dizziness, skin rash, itching, vision problems, swelling of the lymph nodes,
and swelling of your hands, ankles, or feet. While these are considered
the most common side effects associated with using this medication, they
only affect a small amount of users. A number of severe side effects arealso associated with using ivermectin pyrantel. Some of these side effects
include sudden vision changes, bowel problems, urinary infections, lack of
coordination, confusion, weakness, eye swelling and pain, eye redness,
and convulsions. These side effects are also very rare and do not affect a
large amount of users.
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Nursing responsibilities:
Administer the medicine with meals.
Teach client proper breathing techniques.Monitor the clients hemoglobin count.
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Generic Name: nalbuphine
Brand name: Nubain
Classification:
Therapeutic: opioid
analgesics
Pharmacologic: opioid agonist/analgesics
Date ordered: 12/11/10
Ordered dose of frequency: 2.5mg
slow 1VTT stat
Route/ Dosage: IM,SQ,IV (Adults):
Usual dose is 10 mg q 3-6 hr
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Mechanism of Action: Binds to opiate receptors in the
CNS; Alters the perception of and response to painful stimuli
while producing generalized CNS depression
Indication: Moderate to severe pain. Also provides:analgesia during labor, sedation before surgery. Supplement
to balance anesthesia.
Contraindication: Hypersensitivity t nalbuphine or
bisulfites.
Drug interaction: Drug-drug: Use Additive CNS depression
with alcohol, antihistamines, and sedative.
Adverse Reactions/ Side effects: CNS: dizziness,
headache, sedation, confusion, dysphoria, euphoria, floating
feeling, hallucinations. EENT: blurred vision, diplopia. Resp:respiratory depression. CV: hypertension, orthostatic
hypotension, palpitations. GI: dry mouth, nausea vomiting,
constipation, ileus. GU: urinary urgency. Derm: clammy
feeling, sweating.
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Nursing responsibilities:Assess type, location, and intensity of
pain before and 1 hr after IM or 30 min
after administration.Assess blood pressure, Pulse, and
respirations before and periodically
duringadministration.
Assess previous analgesic history.
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Generic Name: oxytocin
Brand Name: Pitocin; Syntocinon.Classification: Endogenous
hormone with uterine stimulant
properties and vasopressive andantidiuretic effects.
Date Ordered:12/11/10
Ordered Dose: 5cc/hr, titrate q 20
mins with increase of 3 cc/hr untiluterine contrations q 2-3 mins, 60-90
sec duration
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Route/ Dosage:
A. Induction of Stimulation of Labor
Intravenous infusion (drip method) is the onlyacceptable method of administration for the induction
or stimulation of labor.
Accurate control of the rate of infusion flow is
essential. An infusion pump or other such device andfrequent monitoring of strength of contractions and
fetal heart rate are necessary for the safe
administration of oxytocin for the induction or
stimulation of labor. If uterine contractions become too
powerful, the infusion can be abruptly stopped, and
oxytocin stimulation of the uterine musculature will
soon wane.
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1) An intravenous infusion of non-oxytocin containing solution should be
started. Physiologic electrolyte solution should be used except under
unusual circumstances.
2) To prepare the usual solution for infusion, the contents of one 1-mLampul are combined aseptically with 1,000 mL of non-hydrating diluent.
The combined solution, rotated in the infusion bottle to insure thorough
mixing, contains 10 mU/mL. Add the container with dilute oxytocin
solution to the system through use of a constant infusion pump or other
such device, to control accurately the rate of infusion.3) The initial dose should be no more than 1-2 mU/minute. The dose may
be gradually increased in increments of no more than 1-2 mU/minute,
until a contraction pattern has been established which is similar to
norma1 labor.
4) The fetal heart rate, resting uterine tone, and the frequency, duration,
and force of contractions should be monitored.5) The oxytocin infusion should be discontinued immediately in the event
of uterine hyperactivity or fetal distress. Oxygen should be
administered to the mother. The mother and the fetus must be
evaluated by the responsible physician.
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B. Control of Postpartum Uterine Bleeding
1)Intravenous Infusion (Drip Method): To control
postpartum bleeding, 10-40 units of oxytocin may beadded to 1,000 mL of a non-hydrating diluent and
run at a rate necessary to control uterine atony.
2)Intramuscular Administration: 1 mL (10 units) of
oxytocin can be given after delivery of the placenta.C. Treatment of Incomplete or Inevitable Abortion
Intravenous infusion with physiologic saline solution,
500 mL, or 5% dextrose in physiologic saline
solution to which 10 units of Syntocinon (oxytocin)have been added should be infused at a rate of 20-
40 drops/minute.
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Mechanism of Action:
Uterine:
The uterine myometrium contains receptors specific to oxytocin.
Oxytocin stimulates contraction of uterine smooth muscle byincreasing intracellular calcium concentrations, thus mimicking
contractions of normal, spontaneous labor and transiently impeding
uterine blood flow. Amplitude and duration of uterine contractions
are increased, leading to dilation and effacement of the cervix. The
number of oxytocin receptors and, therefore, uterine response tooxytocin increases gradually throughout pregnancy, reaching its
peak at term.
For diagnosis of fetal distress and utero-placental insufficiency: By
comparing baseline and oxytocin-induced fetal heart rate patterns
and uterine contraction patterns, the oxytocin challenge test mayaid in determining if there is adequate placental reserve for
continuation of a high-risk pregnancy. The occurrence of a fetal
heart rate pattern exhibiting late decelerations with administration of
oxytocin may indicate utero-placental insufficiency.
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Lactation:
Stimulates smooth muscle to
facilitate ejection of milk frombreasts. Oxytocin does not
increase milk production.
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Indication:to stimulate uterine contraction and
improve uterine tonus in induction of
labour
treatment of postpartum hemorrhagetermination of pregnancy during the
second trimester
treatment of uterine atony followingabortion
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Contraindication:
Oxytocin injection (synthetic) is contraindicated in any of the following
conditions:
Significant cephalopelvic disproportion;
Unfavorable fetal positions or presentations which are undeliverable
without conversion prior to delivery, i.e., transverse lies;
In obstetrical emergencies where the benefit-to-risk ratio for either the
fetus or the mother favors surgical intervention;In cases of fetal distress where delivery is not imminent;
Prolonged use in uterine inertia or severe toxemia;
Hypertonic uterine patterns;
Patients with hypersensitivity to the drug;
Induction or augmentation of labor in those cases where vaginal
delivery is contraindicated, such as cord presentation or prolapse, total
placenta previa, and vasa previa.
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Side Effects:
Side effects with oxytocin are not common. Serious side effects
include:
an allergic reaction (shortness of breath; closing of the throat; hives;swelling of the lips, face, or tongue; rash; or fainting);
difficulty urinating;
chest pain or irregular heart beat;
difficulty breathing;
confusion;sudden weight gain or excessive swelling;
severe headache;
rash;
excessive vaginal bleeding; or
seizures.Other, less serious side effects may be more likely to occur. Talk to
your doctor if you experience
redness or irritation at the injection site;
loss of appetite; or
nausea or vomiting.
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Adverse Effects:
The following adverse reactions have been reported in the mother:
Anaphylactic reaction, Postpartum hemorrhage, Cardiac arrhythmia,
Fatal afibrinogenemia, Nausea, Vomiting, Premature ventricularcontractions, and Pelvic hematoma.
Excessive dosage or hypersensitivity to the drug may result in uterine
hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
The possibility of increased blood loss and afibrinogenemia should be
kept in mind when administering the drug.Severe water intoxication with convulsions and coma has occurred,
associated with a slow oxytocin infusion over a 24-hour period. Maternal
death due to oxytocin-induced water intoxication has been reported.
The following adverse reactions have been reported in the fetus or
infant:Due to induced uterine motility: Bradycardia, Premature ventricular
contractions and other arrhythmias, Permanent CNS or brain damage,
and Fetal death.
Due to use of oxytocin in the mother: Low Apgar scores at 5 minutes.
Neonatal jaundice, and Neonatal retinal hemorrhage.
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Nursing responsibilities:
Monitor and record uterine contractions, heart rate,
BP, intrauterine pressure, fetal heart rate, and bloodloss q15.
Be alert for adverse reaction
Monitor I/O. Antidiuretic effect may lead to fluid
overload, seizures, and comanever give oxytocin simultaneously by more than
one route.>have 20% solution magnesium sulfate
available for relaxation of the myometrium.>If
contractions are less than 2 minutes apart, if theyreabove 50mm Hg ,or if they last 90seconds or longer,
stop infusion, and turn patient on her side, and
notify prescriber.
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Generic Name: Lactated Ringers
Solution with 5% Dextrose(D5LR)Brand Name: Lactated Ringers
Solution with 5% Dextrose(D5LR)
Classification:
Hypertonic, Nonpyrogenic, parenteralfluid, electrolyte and nutrient
eplenisher
Date Ordered: 12/9/10, 12/10/10,
12/11/10, and 12/12/10Ordered Dose: 1 Liter @ 120 cc/hr
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Suggested Dose:
This solution is for intravenous use only.
Dosage is to be directed by a physician and is dependent upon age,weight, clinical condition of the patient and laboratory determinations.
Frequent laboratory determinations and clinical evaluation are essential to
monitor changes in blood glucose and electrolyte concentrations, and fluid
and electrolyte balance during prolonged parenteral therapy.
When a hypertonic solution is to be administered peripherally, it should be
slowly infused through a small bore needle, placed well within the lumen ofa large vein to minimize venous irritation. Carefully avoid infiltration.
Fluid administration should be based on calculated maintenance or
replacement fluid requirements for each patient.
The presence of calcium ions in this solution should be considered when
phosphate is present in additive solutions, in order to avoid precipitation.Some additives may be incompatible. Consult with pharmacist. When
introducing additives, use aseptic techniques. Mix thoroughly. Do not store.
Parenteral drug products should be inspected visually for particulate matter
and discoloration prior to administration, whenever solution and container
permit.
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Mode of Action:
5% Dextrose in Lactated Ringer's Injection provideselectrolytes and calories, and is a source of water for
hydration. It is capable of inducing diuresis depending on the
clinical condition of the patient. This solution also contains
lactate which produces a metabolic alkalinizing effect.
Sodium, the major cation of the extracellular fluid, functionsprimarily in the control of water distribution, fluid balance and
osmotic pressure of body fluids. Sodium is also associated
with chloride and bicarbonate in the regulation of the acid-
base equilibrium of body fluid. Potassium, the principal cation
of intracellular fluid, participates in carbohydrate utilization and
protein synthesis, and is critical in the regulation of nerve
conduction and muscle contraction, particularly in the heart.
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Chloride, the major extracellular anion, closely follows the metabolism of
sodium, and changes in the acid-base balance of the body are reflected
by changes in the chloride concentration. Calcium, an important cation,provides the framework of bones and teeth in the form of calcium
phosphate and calcium carbonate. In the ionized form, calcium is
essential for the functional mechanism of the clotting of blood, normal
cardiac function, and regulation of neuromuscular irritability.
Sodium lactate is a racemic salt containing both the levo form, which is
oxidized by the liver to bicarbonate, and the dextro form, which is
converted to glycogen. Lactate is slowly metabolized to carbon dioxide
and water, accepting one hydrogen ion and resulting in the formation of
bicarbonate for the lactate consumed. These reactions depend on
oxidative cellular activity.
Dextrose provides a source of calories. Dextrose is readily metabolized,may decrease losses of body protein and nitrogen, promotes glycogen
deposition and decreases or prevents ketosis if sufficient doses are
provided.
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Indication:
This solution is indicated for use in adults and pediatricpatients as a source of electrolytes, calories and water for
hydration.
Contraindication:
This solution is contraindicated where the administration of
sodium, potassium, calcium, chloride or lactate could beclinically detrimental.
Lactate administration is contraindicated in severe metabolic
acidosis or alkalosis, and in severe liver disease or anoxic
states which affect lactate metabolism.Solutions containing dextrose may be contraindicated in
patients with hypersensitivity to corn products.
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Side Effects:
Allergic reactions or anaphylactoid symptoms such as
localized or generalized urticaria and pruritis; periorbital,
facial, and/orlaryngeal edema, coughing, sneezing, and/ordifficulty with breathing have been reported during
administration of Lactated Ringer's and 5% Dextrose Injection,
USP. The reporting frequency of these signs and symptoms is
higher in women during pregnancy.
Reactions which may occur because of the solution or the
technique of administration include febrile response, infection
at the site of injection, venous thrombosis orphlebitis
extending from the site of injection, extravasation, and
hypervolemia.If an adverse reaction does occur, discontinue the infusion,
evaluate the patient, institute appropriate therapeutic
countermeasures, and save the remainder of the fluid for
examination if deemed necessary.
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Adverse Effects:
Reactions which may occur because of the solution or
the technique of administration include febrile
response, infection at the site of injection, venous
thrombosis or phlebitis extending from the site of
injection, extravasation and hypervolemia.
Too rapid infusion of hypertonic solutions may causelocal pain and venous irritation. Rate of administration
should be adjusted according to tolerance. Use of the
largest peripheral vein and a small bore needle is
recommended.
Symptoms may result from an excess or deficit of one
or more of the ions present in the solution; therefore,
frequent monitoring of electrolyte levels is essential.
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Hypernatremia may be associated with edema and
exacerbation of congestive heart failure due to the retention of
water, resulting in an expanded extracellular fluid volume.
Reactions reported with the use of potassium-containing
solutions include nausea, vomiting, abdominal pain and
diarrhea. The signs and symptoms of potassium intoxication
include paresthesias of the extremities, areflexia, muscular orrespiratory paralysis, mental confusion, weakness,
hypotension, cardiac arrhythmias, heart block,
electrocardiographic abnormalities and cardiac arrest.
Potassium deficits result in disruption of neuromuscular
function, and intestinal ileus and dilatation.
If infused in large amounts, chloride ions may cause a loss of
bicarbonate ions, resulting in an acidifying effect.
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Abnormally high plasma levels of calcium can result in depression,
amnesia, headaches, drowsiness, disorientation, syncope,
hallucinations, hypotonia of both skeletal and smooth muscles,dysphagia, arrhythmias and coma. Calcium deficits can result in
neuromuscular hyperexcitability, including cramps and convulsions.
Although the metabolism of lactate to bicarbonate is a relatively slow
process, aggressive administration of sodium lactate may result in
metabolic alkalosis. Careful monitoring of blood acid-base balance isessential during the administration of sodium lactate.
The physician should also be alert to the possibility of adverse
reactions to drug additives. Prescribing information for drug
additives to be administered in this manner should be consulted.
If an adverse reaction does occur, discontinue the infusion, evaluatethe patient, institute appropriate therapeutic countermeasures and
save the remainder of the fluid for examination if deemed necessary.
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Nursing responsibilities:
Always check the Intravenous fluid and make sure that it is
flowing at the right rate
Always check the IV site for any signs of edemaDo not administer unless solution is clear and container is
undamaged.
Caution must be exercised in the administration of parenteral
fluids, especially those containing sodium ions to patients
receiving corticosteroids or corticotrophin.
Solution containing acetate should be used with caution as
excess administration may result in metabolic alkalosis.
Solution containing dextrose should b used with caution in
patients with known subclinical or overt diabetes mellitus.Discard unused portion.
In very low birth weight infants, excessive or rapid
administration of dextrose injection may result in increased
serum osmolality and possible intracerebral hemorrhage
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MEDICATION
Health Teachings Rationale
Continue taking the vitamins and
medicines prescribed by the physician.
To ensure faster and proper recovery.
Caution patient to avoid prolonged
exposure to sunlight and to use
sunscreen or wear protective clothing
To avoid photosensitivity reaction.
Take medicines with an empty stomachif indicated.
So that the food will not interfere withthe drug mechanism.
Discontinue medication if a rash
develops and consult your physician.
This maybe a sign that you are allergic
to the drug
Complete the prescribed drug treatment. So as not to develop drug resistance.
Before taking the medicine make sure
you have the right dose and take it at
the right time
To avoid over dosage and under dosage
of the drug.
EXERCISE
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EXERCISE
Health Teachings Rationale
Tighter Abdominals -
Lie on your back in a straight line. Then exhale,
lowering the back, vertebra by vertebra. Repeat
sequence five times.
This exercise helps develop a strong back and
abdominals.
Chin-to-chest on postpartum day 2 To tighten and firm up abdominal muscles
Knee-to-abdomen when perineum has healed To strengthen abdominal and gluteal muscle
Stronger BackSit upright, knees bent, feet flat on the floor, back
straight, arms forward at shoulder level. Inhale, then
exhale and lean back halfway. Inhale again and sit up
slowly. Repeat five times.
This exercise strengthens the back and abdominals.
Flexible Body
Stand upright with arms raised, elbows slightly
relaxed. Inhale, then exhale and bend forward,
keeping back straight and swinging arms down and
back. Then relax your head and stretch your arms up
behind you. Inhale as you swing arms and body up
again, returning to your original position. Repeat
eight times. Go carefully and do not strain.
This exercise is good for thighs, hips, back, arms,
shoulders and neck.
TREATMENT
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TREATMENT
Health Teachings Rationale
Get patients to ambulate as soon as
possible after delivery.
To improve circulation and prevent the
development of thrombi.Instruct the client to abstain from sexual
intercourse until after the episiotomy is
healed and the lochia has ceased.
Due to childbirth the delicate tissues of
the vagina tissues are inevitably strained,
bruised and torn and it takes some
weeks for these injuries to heal up.
Counsel the patient that menstruation
returns 6 8 weeks if not breast feeding
and 3 4 months if the mother is
breastfeeding.
Through breastfeeding the sensation of
the baby sucking sends a message to the
brain to suppress the hormone that
stimulates ovulation.
The client may be able to experience asudden gush of blood when she first
rises.
Due to normal pooling in vagina when thewoman lies down to rest or sleep; gravity
causes blood to flow out when she
stands.
Encourage the client to lie in a Sims
position when sleeping
Sims position minimizes the strain in the
suture line.
HYGIENE
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HYGIENE
Health Teachings Rationale
Do not use soap on the breasts when
washing.
it tends to remove natural oils, which
increases the
chance of cracked nipplesInstruct to avoid garters or constricting
clothing.
Can impair circulation
Encourage client to shower as soon as she
can ambulate and to take tub baths if desired
after two weeks.
Recommended daily shower to promote
comfort and a sense of well-being.
Keep clean any areas where there have beenstitches, wash the episiorraphy generously
with water after using the restroom.
To prevent the microorganisms from invadingthe body.
In the event that the lochia is foul-smelling or
becomes persistent, one should seek
consultation right away.
This could be due to poor healing, infection,
or retained placental tissues.
Take home a squirt bottle and fill it with warm
water before either urinating or bowel
movement. After you have washed pat the
area dry instead of rubbing.
To ease the pain while voiding and defecating.
Wash hands before and after breastfeeding. The microorganism being transferred by a
dirty hand can cause illness to the baby.
OUT PATIENT
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OUT-PATIENT
Health Teachings Rationale
While the patient is staying at the
hospital be sure to provide acomfortable environment.
This will enable the patient to have
adequate rest and sleep.
Visit the hospital 1 2 weeks after of
discharge.
These visits provide an opportunity for
physical assessment as well as
evaluation of the mothers psychological
and informational needs and needs of
the family.
The patient may lose up to 20 pounds
within 10 days after delivery. It is best to
lose about pound per week, after that
be patient.
A well-balanced diet coupled with
exercise will help you return to you pre-
pregnant weight.
Consult a physician immediately if thepatient experiences fever after 24 hours
of childbirth.
Fever 24 hours after deliver is aindication that there might me an
infection.
Encourage the client to express her
feelings openly.
This helps the mother in coping with the
stress of childbirth and to prevent
depression from happening.
DIET
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DIET
Health Teachings Rationale
Do not diet or start an exercise plan
immediately after giving birth
You should allow your body to recover
first and then consult your doctor.
Take fiber as much as you can. After the
childbirth, you can experience
constipation and bowel problems.
Consuming sufficient amounts of fiber
helps both the constipation and bowel
condition.
Then it is essential for you to eat healthy
and balanced diet consist of more
calories (500 calories/day), liquid,calcium (2000 mg/day) and protein.
To provide the required nutrients to your
baby.
When breastfeeding alcohol
consumption is prohibited.
It makes the breast milk smell differently
and this will affects the babys sleep and
digestion.
Consume a lot of fruits and vegetables.
Make fruit (or veggie) smoothies, use
fruit or vegetable salsas or vegetable
reduction sauces (sauces made from
pured vegetables)
This supplies antioxidant for your body.