ectopic ppt aug6

8/7/2019 Ectopic Ppt Aug6

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ECTOPIC

PREGNANCY


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Introduction

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DRUG STUDY


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o Generic Name: Cefuroxime sodium

o Classification: Cephalosporin

o Prescribed Dosage: 750 mg

o Frequency: q 8 hrs

o Route of Administration: IVTT (-) ANST

o Mechanism of Action: Second- generationcephalosporin that inhibits cell- wall synthesis,

promoting osmotic instability; usually

bactericidal.


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o Indication: Perioperative prevention

o Contraindication: Contraindicated in pts

hypersensitive to drug or other cephalosporins. Use

cautiously in pts hypersensitive to penicillin

because of possibility of cross- sensitivity with

other beta- lactam antibiotics.

o Adverse Reactions:CV: phlebitis, thrombophlebitis

o GI: nausea, anorexia, vomiting, diarrhea

o Hematologic: thrombocytopenia

o Skin: pain, temperature elevation, tissue sloughingat IM injection site

o Other: hypersensitivity reactions, anaphylaxis


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o Nursing Responsibilities:

o Instruct pt to take drugs as prescribed, even after

she feels better.

o Instruct pt to notify prescriber about rash or

evidence of superinfection.

o Advise pt receiving drug IV to report discomfort at

IV insertion site.

o Tell patients to notify prescriber about loose stools

or diarrhea.


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o Generic Name: Tranexamic Acid

o Brand Name: Cyklopropan

o Prescribed Dosage: 5 mLo Frequency: q 4 hrs

o Route of Administration: IVTT

o Mechanism of Action: Blocks the breakdown of

blood clots, which prevents bleeding.


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o Indication: To prevent severe bleeding

o Contraindication: Contraindicated in pts allergic

to drug. Use cautiously in pts who have hx of stroke,bleeding in brain, and blood clot.

o Adverse Reactions:

o CNS: severe headache

o EENT: blurring of vision

o GU: diarrhea

o GI: nausea, vomitingo Skin: pain, redness, swelling at injection site


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Nursing Responsibilities:

o

Encourage sleep to pt.o Instruct pt. to report immediately any adverse

reaction, for this may interfere to clients health.

o Encourage religious taking of meds with

precacution.


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o Generic Name: Tramadol Hydrochloride

o Brand Name: Ultram

o Classification: Opioid ; Analgesics

o Prescribed Dosage: 100 mg q 4H

o Frequency: PRN

o Route of Administration: IVTTo Mechanism of Action: Unknown. A centrally acting

synthetic analgesic compound not chemically

related to opioids. Thought to bind to opioid

receptors and inhibitt reuptake of nonepiniphrineand serotonin


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o Indication: moderate to moderately severe pain

o Contraindication: hypersensitive to drugs;

breastfeeding mothers; use cautiously in patientsat risk for seizures and increased ICP, renal andhepatic impairment.

o Adverse Reactions:

CNS: dizziness, vertigo, headache, anxiety, sleep d/o andseizures

CV: vasodilation

EENT: visual disturbances

GI: constipation, nausea, vomiting, abdominal pain,anorexia, diarrhea

GU: proteinuria, urinary frequency, urinary retention

Musculoskeletal: hypertonia

Respi: respiratory depression

Skin: diaphoresis, pruritus, rash


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o Reassess pt's level of pain at least 30 min after

administration

o Monitor CV and respiratory status. Withhold dose

and notify prescriber if respiratory decrease/rate is

below 12 breaths/min

o Monitor bowel and bladder function. Anticipate

need to laxatives

o Monitor pts. At risk for seizures. Drug may reduce

seizure threshold.o Warn pt. not to stop the drug abruptly.

o For better analgesic effect, give drug before onset

of intense pain.


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o Generic Name: Ranitidine Hydrochloride

o Brand Name: Zantac

o Classifications: Anti-ulcer drugs

o Prescribed Dosage: 50 mg

o Frequency: q 6 hrs for 4 doses

o Route of Administration: IVTTo Mechanism of Action: Competitively inhibits

action of histamine on the H2 at receptor sites of

parietal cells, decreasing gastric acid secretion.


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o Indication: Duodenal and gastric ulcer (short term

treatment)

o Contraindication: Contraindicated in patientshypersensitive to drug and to those with acute

porphyria. Use cautiously in patients with hepatic

dysfunction. Adjust dosage in patients with renal

impairments.

o Adverse Reactions: GI: diarrhea or constipation

CNS: malaise, headache, vertigo

EENT: blurred vision

Hepatic: jaundice

Other: Burning and itching at infection site, anaphylaxis


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o Assess pt. for abdominal pain. Note presence of

blood in emesis, stool, or gastric aspirate

o Instruct patient to take meds without regard to

meals because absorption is not affected by food.

o

Urge patient to avoid cigarette smoking, becausethis may increase gastric acid secretion and may

worsen disease.

o Instruct patient to immediately report abdominal

pain and blood in stools and emesis.


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o Generic Name: Atropine Sulfate

o Brand Name: Atropen, Sal-Tropine

o Classification: Anti arrhythmics

o Prescribed Dosage:

o Route of Administration:

o Mechanism of Action: An anticholinergic thatinhibits acetylcholine at the parasympathetic

neuroeffector junction, blocking vagal effects on

the SA and AV nodes, thereby enhancing

conduction through the AV node and increasingthe heart rate.


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o Indication:Preoperatively to diminish secretions

and block cardial vagal reflexes

o Contraindication: Contraindicated withhypersensitivity to the drug.

o Contraindicated in those with unstable CV status

in acute hemorrhage.

o Adverse Reactions:o CNS: headache, disorientation, insomnia, dizziness

o CV: palpitations

o GI: dry mouth, thirst, constipation

o EENT: blurred vision, photophobia

o GU: urine retention

o Other: Anaphylaxis


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o Monitor fluid intake and urine output. Drug causes

urine retention and urinary hesitancy.

o Take as prescribed, 30 minutes before meals;

avoid excessive dosage.

o

Instruct patient to report serious or persistentadverse reactions promptly.

o Inform patient about potential for sensitivity of the

eyes to the sun and suggest the use of sun glasses.


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o Generic Name: Bisacodyl

o Brand Name: Dulcolax

o Classification: Laxatives

o Prescribed Dosage: 10-15mg

o Route of Administration: PO

o Mechanism of Action: Stimulant laxative thatincreases peristalsis, probably by direct effect on

smooth muscle of the intestine, by irritating the

muscle or stimulating the colonic intramural

plexus. Drug also promotes fluid accumulation incolon and small intestines.


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o Indication: Relieve constipation and prepare the

bowel for diagnostic or surgical procedures

requiring the bowel to be empty.

o Contraindication: Hypersensitivity to drug or any

component of the formulation and in those with

rectal bleeding,gastroenteritis,intestinal

obstruction,abdominal pain, nausea, vomiting, or

other symptomz of appendicitis or acute surgical

abdomen.


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o Adverse Reactions: Central nervous system: muscle weakness with excessive use

Endocrine & metabolic: Electrolyte and fluid imbalance (metabolic

acidosis or alkalosis, hypocalcemia)

Gastrointestinal: Mild abdominal cramps, nausea, vomiting, rectal

burning

Musculoskeletal: tetany


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y Give drugs at times that dont interfere with

schedules activities or sleep

y Advise pt to report adverse effects to prescriber.

y Encourage pt to increase food intake esp foods

rich in fiber.y Instruct pt to take drug with a full glass of water or

juice.


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o Generic Name: Promethazine Hydrochloride

o Brand Name: Rocephin

o Prescribed Dosage: 1-2g

o Route of Administration: IM

o Mechanism of Action: Phenothiazine derivative

that competes with histamine for H-1 receptor siteson effector cells. Prevents, but doesnt reverse,

histamine- mediated responses. At high doses, drug

also has local anesthetic effect.


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o Indication: Adjunct to analgesics for routine pre-

operative or post- operative sedation

o Contraindication: Contraindicate d to pts hypersensitiveto drug, and to those who have experienced adverse

reactions to phenothiazines

o Adverse Reactions: CNS: sedation, confusion, sleepiness,

dizziness, disorientation

o CV: hypotension, HPN

o EENT: blurred vision

o GI: nausea, vomiting, dry mouth

o

GU: urine retentiono Hematologic: leukopenia, thrombocytopenia

o Metabolic: hyperglycemia

o Skin: photosensitivity, rash


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o Monitor pt for altered mental status and muscle

rigidity.

o Instruct pt to take oral form with food or milk.

o Warn patients that this kind of med have knownCNS effects thus warning her to avoid alcohol and

hazardous activities that require alertness.

o Warn patients about possible photosensitivity

effects. Advise use of sunblock.


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y UTERINE FALLOPIAN TUBE

y Uterine fallopian tube form the initial part of the

duct system. They receive the ovulated oocyte and

provide a site where fertilization can occur. Each ofthe tube is about 10cm (4inches) long to empty into

the superior region of the uterus.


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y Cleavage is a rapid series of mitotic divisions that

begins with the zygote and ends with the blastocyst.

The zygote begins to divide about 24hours after

fertilization and continues to divide as it travelsdown the uterine tube. Three to four days after

ovulation, the preembryo reaches the uterus and

floats freely for two to three days, nourished by

secretions of the endometrial glands. At the lateblastocyst stage, the embryo is implanting into the

endometrium; this begins at about day 7 after

ovulation.


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NURSING CARE

PLAN


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Readiness for enhanced learningCUES OBJECTIVE INTERVENTION RATIONALE EVALUATION

Subjective-

Naunsa diay

ko?

Objective-

>expressed

interest to knowabout her

condition

>frequent

questioning

STO: Within 2-3 hrs

after health teaching,

the pt will be able to

verbalize

understanding of

information gained.

LTO: Within 3 days of

care, the pt will be

able to use

information to develop

individual plan to

meet healthcare

needs.

1. Verified clients

knowledge about

her current

condition.

2. Determined

motivations/

expectations forlearning

3. Provided

information

appropriate to

clients learning

style.

4. Discussed ways toverify accuracy of

informational

resources.

5. Ascertained

preferred methods

of learning such as

visual,and auditory.

-Provides opportunity to

assure accuracy and

completeness of

knowledge base for

future learning.

-Provides insight useful

in developing goals and

identifying informationneeds.

-Increases learning and

retention of material.

-Encourages

independent search for

learning opportunities

while reducing

likelihood of acting onerroneous or unproven

data that could be

detrimental to clients

well-being.

-identifies best

approaches to facilitate

learning process.

Outcome fully met:

the pt. verbalized

understanding of

information gained

within 2 hrs after

being renderedhealth teaching.


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Risk for InfectionCUES OBJECTIVE INTERVENTION RATIONALE EVALUATION

ObjectiveRisk factors:

>skin tissue trauma

>inadequate

secondary

defenses:

decreased

hemoglobin- 80(normal 120- 150)

and decreased

Hematocrit level-

0.24 (0.37- 0.45)

>altered peristalsis

>increased

environmentalexposure to

pathogens

>latest v/s: T=-

37.3

BP- 120/70

PR- 88bpm

RR- 26cpm

STO:

After 20 minutes of

client teaching, the

patient/SO(s) will be

able to identify ways

to prevent/reduce

risk of infection likestressing proper

hand hygiene.

LTO:

After 3 days of

rendering nursing

care, the patient will

be able to verbalizeunderstanding of

individual causative/

risk factors

1. Monitor vital signs everyhour or as ordered

2. Note risk factors for

occurrence of infection.

3. Stress proper hand

hygiene by all caregivers

between therapies/clients.

4. Recommend

routine/preoperative body

shower/scrubs, when

indicated.

5. Instruct client/SO(s) in

techniques to protect the

integrity of the skin, care

for lesions and prevention

of spread of infection, such

as cleansing the skin with

tepid water.

6. Discussed ways to reduce

potential for postoperativeinfection.

7. Assist in changing wound

dressing as indicated

using proper technique for

changing or disposing of

contaminated materials.

8. Administer prophylactic

antibiotics as ordered.

-Hyperthermia mayindicate infection

-To consider situational

risk factors.

-Its the first line defense

against healthcare

associated infections

(HAI).

-To reduce bacterialcolonization.

-To strengthen first line

of defense.

-Give client/SO(s) post-

op care knowledge.

-To keep the wound

clean and prevent

nasocomial infection.-To prevent and control

infection.

Outcome fully Met.

Pt was able to

demonstrate

behaviors to prevent

infection such as

hand washing and

proper hygiene.


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Impaired Skin Integrity r/t mechanical factors specifically

surgical incision below the umbilical area

CUES OBJECTIVE INTERVENTION RATIONALE EVALUATION

Subjective:P- wound

Q- throbbing

R- localized

S- 2/10, mild

T- duration of 1

min; frequent; upon

movement; gradual

Objective:

>With surgical

incision below

umbilicus

>with dry and intact

dressing

>with latest v/s:

T- 37.3

BP- 120/70

PR- 88bpm

RR- 26cpm

STO:Within 8 hours of

duty, patient will be

able to participate in

prevention

measures like

keeping surgical

incision clean anddry.

LTO:

After 3 days of care,

patient will be able

to demonstrate

preventive

measures that

display progress of

healing of surgical

incision without

complications.

1.Monitored Vital Signs2.Checked and regulated

IVF to prescribed rate

4.Monitored Intake and

Output

5.Assessed wound

characteristics

6.Kept surgical incisionclean and dry

7.Repositioned patient on

regular schedule to

prevent bed sores.

8.Encouraged early

ambulation

9.Assisted staff in

changing the dressing

10. Taught patient and

SO the importance of

proper hand washing.

-to establish baselinedata.

-to prevent cardiac

overload.

-to checked for

electrolyte imbalance.

- to check for

complications such asinfection, dehiscence,and evisceration.

- to assist bodys

natural process of

repair.

- to prevent bed sores.

- to promote

circulation and reduce

risks associated withimmobility.

-to prevent infection

-for infection control.

Outcome Partially Met.Patient and her SO

were able to

demonstrate behaviors

related to prevention

of complications due

to impaired skin

integrity that is properhand washing, minimal

handling of dressing,

and maintaining the

surrounding area

clean and dry.


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Ineffective Tissue Perfusion r/t decreased Hgb

concentration in bloodCUES OBJECTIVE INTERVENTION RATIONALE EVALUATION

Laboratory results:

Hgb = 80

Hct = 0.24

Decrease in hgb

and hct level may

indicate anemia.

Behavioral

changes:

Restlessness

STO:Within 8 hours after

health teaching, pt

will be able to

verbalize

understanding of

condition, therapy

regimen, side effectsof medications, and

when to contact

healthcare provider.

LTO:

Within 3 days after

being rendered heath

teaching, the client

will be able to

demonstrate

behaviors/lifestyle

changes to improve

circulation such as

relaxation

techniques,.

1. Evaluate for signs ofinfection.

2. Note customary baseline

data (e.g. usual BP, weight,

mentation, ABGs, and

other appropriate

laboratory study values).

3. Measure capillary refill;

palpate forpresence/absence and

quality of pulses.

4. Perform assistive/active

ROM exercises.

5. Encourage early

ambulation when possible.

6. Discourage

sitting/standing for long

periods, wearing

constrictive clothing,

crossing legs.

7. Administer medications

with caution.

8. Demonstrate/ encourage

use of relaxation

techniques.

-Provides comparisonwith current findings

-To identify the

severity of ineffective

tissue perfusion.

-To serve as baseline

data.

-Enhances venousreturn.

-Enhance venous

return.

-These restrict blood

flow.

-Drug response, half-

life, toxic levels may

be altered by

decreased tissue

perfusion.

-To decrease tension

level.

Outcome Met.Patient verbalized

understanding of

condition, therapy

regimen, side

effects of

medications, andwhen to contact

health provider.


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MANAGEMENTS


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Medical Managements

Pre-operative:

y Secure consent.

y TPR for 4H

y NPO

y Labs: CBC, U/A, UTZ

y I & O q shift.

y Administer the following medications:

7/30

y Cefuroxime 750 mg IVTT q 8 hrs (-) ANST

y Ranitidine 50 mg IVTT q 6 hrs for 4 doses

y Tramadol HCl 100 mg IVTT q 4 hrs for 4 doses

y Tranexamic acid 5 ml IVTT q 4 hrs for 3 doses

y Promethazine HCl 50 mg IM

y Atropine SO4 5 mg


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Post operative:

y Take O2 sat

y NPO with V/S q 2 H

y Transfuse available blood as settled RBC

y Encourage early ambulation and turning to sides. Start bladder training.

y Remove FBC after 3 voidings.

y Refer if without urine output after removal.y Prepare for dressing.

y Administer the following medications:

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y Cefuroxime 750 mg IVTT q 8 hrs (-) ANST

y Ranitidine 50 mg IVTT q 6 hrs for 4 dosesy Tramadol HCl 100 mg IVTT q 4 hrs for 4 doses

y Paracetamol 300 mg IVTT q 4 hrs prn

8/01

y Bisocodyl +1 supplement rectum now

y

Ranitidine 50 mg amp now


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Surgical Management

Date of operation: 8/10/09

Operation performed: Pelvic Laparatomy

Surgical techniques: Induction of CA Asepsis/

antisepsis. Infraumbilical midline vertical abdominal

incision deepened down the fascia.


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Nursing Managements

y Monitor v/s to serve as baseline data.

y Regulate IV to desired rate to prevent cardiac overload.

y Perform environmental care to maintain therapeutic

environment

y Provide bedside care to promote comfort.

y Encourage adequate rest periods to regain strength.

y Stress early ambulation and frequent position change to

facilitate early recovery.

y Encourage eating nutritious foods and increase fluid intakefor faster healing, boost the immune system and prevent

dehydration.

y Encourage faithful therapeutic regimen.

y Administer medications as ordered.


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DISCHARGE

PLAN


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y Diet

- Instruct patient to eat

adequate nutritious

foods according to the

food guide pyramid.

- Encourage patient to

return to a regular diet as

soon as tolerated.

y Health Teaching

- Instruct patient to performmouth care after meal.

- Instruct patient to

maintain proper hygiene

by taking a bath

regularly.


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y Schedule for Next Visit

- Instruct SO and patient tovisit physician if

symptoms or condition is

not relieved through

home medication ormanagement.

- Instruct SO to schedule

regular check-ups to

monitor patients

condition.

y Spiritual

- Encourage patient and SOto attend mass regularly

and pray every day.

- Encourage patient to

communicate and prayw/ SO frequently.

- Encourage patient to join

ministries or any church

groups.


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ectopic ppt aug6

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