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The document discusses various causes of abdominal masses including cancers, cysts, enlarged organs, and inflammatory conditions. Location, symptoms, and test results help doctors determine the cause.

Cancers like colon, stomach, liver and kidney cancer. Cysts in organs like ovaries and pancreas. Enlarged organs like the liver, spleen and gallbladder due to conditions such as infections, diseases, or blockages.

Abdominal pain, diarrhea, constipation, bleeding, weight loss, and fullness. The location of the mass such as right/left upper/lower quadrant or around the belly button.

INTRODUCTION

An abdominal mass is a growth or swelling in the abdomen. An abdominal mass can have
a variety of causes, ranging from innocuous to life-threatening.
The majority of abdominal masses are discovered during routine physical examinations.
They frequently develop slowly, and you may not notice them. Based on the location of the mass
and your symptoms, your doctor will be able to narrow down the possible causes.This may
located in Right upper quadrant & lower quadrant, left upper quadrant & lower quadrant,
epigastric, which is just below your ribcage in the center of your abdomen and periumbilical,
which is the area around your belly button.
Abdominal masses can be caused by a lot of different conditions, including the following.
Cancers
 Colon cancer
 Stomach cancer
 Liver cancer
 Kidney cancer
 Neuroblastoma, a type of cancer that usually occurs in children
 Gallbladder cancer
 Uterine sarcoma
 Endometrial cancer
Cysts. Cysts are sacs that can form almost anywhere on your body. They can be filled with
semi-solid material or fluid. They are usually not cancerous. In rare cases, they can be. The types
of cysts that can cause abdominal masses include:
 Ovarian cysts
 Pancreatic pseudocysts, which is a fluid-filled sac but not a true cyst
 Pancreatic abscess, which is a type of infected cyst
 A benign, or harmless, cyst called a Peritoneal inclusion
Abdominal aortic aneurysm. The aorta is the largest blood vessel in your body. It runs from
your heart down the center of your chest and abdomen. An aneurysm is a bulge in the wall of an
artery where there is a weak spot. A ruptured abdominal aortic aneurysm can be a life-
threatening complication.
Enlarged liver. Your liver is usually behind your right rib cage and can't be felt. If your
doctor can feel it, it may mean you have hepatomegaly. This is a liver that is bigger than normal.
It can be caused by many different conditions, such as:
 Nonalcoholic fatty liver disease
 Alcoholic liver disease
 Blockage of the gallbladder or bile ducts
 Leukemia
 Lymphoma
 Heart failure
 A blockage in the veins that drain the liver
 Liver cancer
Enlarged spleen. Your spleen is about the size of a fist. Like your liver, it normally can't be
felt during an exam. There are a lot of conditions that can cause an enlarged spleen, which is
called splenomegaly. Some of these are:
 Hemolytic anemia, which is when your spleen destroys too many red blood cells
 Liver disease
 Leukemia
 Infections caused by a virus, bacteria, or fungus
Gallbladder inflammation. This condition is called cholecystitis. It's usually caused by a
gallstone blocking a duct. Cholecystitis can either be acute or chronic. Acute cholecystitis
happens suddenly with severe pain in your upper abdomen. Chronic cholecystitis is long-lasting
and can damage your gallbladder. In either case, the treatment is usually removing your
gallbladder.
Crohn's disease. This is a type of inflammatory bowel disease that causes chronic
inflammation of your gastrointestinal (GI) tract. Your GI tract refers to all of the organs involved
in digesting your food. Crohn's disease can affect any part of it. But, it typically affects the end
of the small bowel and the beginning of the colon.
Uterine fibroids.Fibroids can be large enough to distend a woman’s uterus or so small that
they are microscopic. These are noncancerous growths in the uterus. Most women will have
them at some point during their childbearing years. You may not have any symptoms or you may
have any of the following:
 Periods that last longer than a week
 Heavy bleeding during your period
 Pressure in your pelvic area
 Pain in your back or legs
 Constipation
 Frequent urination
An abdominal mass may vary in different symptoms like abdominal pain,
diarrhea, constipation, bleeding from your rectum, blood in your urine, weight
loss, and fullness in the abdomen. The doctor may diagnose abdominal mass based
on the test request like blood tests, urine tests, abdominal ultrasound, computed
tomography (CT) scan, and magnetic resonance imaging (MRI) scan. The
treatment for your abdominal mass will depend on its underlying cause. Some of
them are surgery, medicine, chemotherapy, and lifestyle changes.

MEDICAL MANAGEMENT
Hormonal management is considered the first line of medical therapy for patients with acute
abdominal uterine bleeding without known or suspected bleeding disorders. Treatment options
include IV conjugated equine estrogen, combine oral contraceptives and oral progestin.

Combined oral contraceptives and oral progestin, taken in multi-dose regimens, also are
commonly used for acute abdominal uterine bleeding. Food and drug administration labeling
information can be helpful in determining which patients may or may not be treated with oral
contraceptives or progestin alone. Other oral contraceptives and progestin formulations and dose
schedules may be equally effective.

Antifibrinolytic drugs, such as tranexamic acid, work by preventing fibrin degradation and are
effective treatments for patients with chronic abdominal uterine bleeding. They have shown to
reduce bleeding in these patients b 30-55%. Tranexamic acid effectively reduces intraoperative
bleeding and the need for transfusion in surgical patients and is likely effective for patients with
acute abdominal acute bleeding. Experts recommended using either oral or IV tranexamic acid
for treatment of acute abdominal uterine bleeding. Intrauterine tamponade with a 26F Foley
catheter infused with 30 ml of saline solution has been reported to control bleeding successfully
and also may be considered.

Patients with known or suspected bleeding disorders ma responded to the hormonal and non-
hormonal management options listed earlier in this section. Consultation with a hematologist is
recommended for these patients, especially if bleeding is difficult to control or the gynecologist
is unfamiliar with the other options for medical management. Desmopressin may help treat
abdominal uterine bleeding in patients with non Willebrand disease if the patient is known to
respond to that agent. It may be administered by intranasal, inhalation, intravenously, or
subcutaneously. This agent must be used with caution because of the risk of fluids retention and
hyponatremia and should not be administered to patients with massive hemorrhage who are
receiving IV fluid overload. Recombinant factor VIII and von Willebrand factor also are
available and may be required to control severe hemorrhage. Other deficiencies may need factor
specific replacement.

Patients with bleeding disorder or platelet function abnormalities should avoid non-steroidal anti-
inflammatory drugs because of their effect of platelet aggregation and their interaction with
drugs that might be affect liver function and the production of clotting factors.
DIAGNOSTIC EXAM

Whole abdomen (USG) and Transvaginal

IMPRESSION:
Upper limit liver size with diffuse parenchymal disease
Gallbladder polyp. Follow-up after 3 months is suggested
Splenomegaly
Nephromegaly with pelvocaliectasia, bilateral, which can be due to cysto-ureteral reflux
Unremarkable pancreas
Enlarged-sized uterus with lobulated contour and heterogenous parenchymal echopattern.
Clinical correlation is suggested to rule in the possibility of endometriosis.
Lobulated, heterogenous mass, anterior uterine body. Uterine myoma vs. uterine neoplasm.
Thickened endometrial stripe, which can be due to intercurrent endometritis. However the
possibility of endometrial neoplasm is not totally ruled out
Cystic structure, right adnexa such can represent an ovarian cyst.
Complex, predominantly csytic mass, left adnexa, which can be endometrioma or cystic ovarian
neoplasm.
Negative for para-aortic lymphadenopathy
Ascites
Chest x-ray and Endocervical biopsy- Waiting for result
Transvaginal and Abdominal Ct scan with contrast - Differ

Laboratory Results

Cbc /Complete blood count

Low level of Hgb, Hct and high level of WBC

Parameter Actual results Normal values

Jan 5 Jan 8

Hemoglobin 49 89 120-60g/L

Hematorcit 16.5 29.6 36-45%

WBC 13.63 14.59 4,500-11,000/


uL

DEVELOPMENTAL TASK
Patient X is a married woman with one daughter. She is 45 years old and has the task of
developing generativity according to Erik Erikson's developmental theory. The patient and her
husband have been together for 11 years, and the patient verbalizes that she had a joyful and
energetic childhood. After her school activities, they played with her schoolmates. She stated
also that she did not suffer from any childhood diseases, except for chicken pox and mumps, but
she cannot recall the dates. When she was 12 years old, her first menstruation cycle came with
regularity (up to 3–5 days), as she stated, and she experienced the enlargement of breast and
pubic hairs all over the body. Patient X has reached the stage of formal operation, according to
Jean Piaget's theory. In addition, patient X verbalized that she had her first relationship when she
was twenty years old. When they broke up three years later, she concentrated on her work and
also helped her parents with their daily needs. The patient possess the stage of late adolescence,
according to Sullivan theory. Then, at the age of 30, she met his loved ones, and at the age of 33,
she got married to her husband. At the age of 35, she got pregnant and gave birth at 28–29 weeks
of gestation via cesarean section due to placenta previa. Last year, in 2022, she suffered severe
vaginal bleeding, and she felt a mass in her lower abdomen.

COURSE IN THE WARD


Jan 5, 2025 (Day 1):
1 month PTA: Pt. started Having abdominal- pain with -worsening of condition promoted
concultation.
Laboratories:
CBC and platelet
Creatinine
Na k
Blood typing
Abdominal CT scan with contrace
IV: D5NSS 1L x 12
Meds:
pantoprazole 40mg OD
Tramadol 50mg q8° prn for pain.
- For transvaginal Sonography whole abdominal USG
- Transfuse 3 units of PRBC properly type and crossmatch
-Chiamin S. 300mL x 12 mL OD (Multivitamin + minerals)
-Referred to OB Gyne for co-management
-started ceftrioxone 2gm IV OD
-For pregnancy test now

Jan. 6, 2023(Day 2):


Patient is still w/ vaginal bleeding started Tranexamic Acid 1gram IV q 8°
OB Gyne Notes: History taken. pt is a 45 years old G¹ P¹ (0101), married, vendor who was
admitted due to abdominal pain. 2 months Prior to admission was noted to have an abdominal
mass which gradually increased in size accompaned by abdominal pain. She was also noted to
have heavy menstrual 10 days prior to admission consuming 5 diapers/day. Consult was done in
an emergency clinic in manila and was adviced consult to a higher institution.
G¹P¹(0101) D¹- 4 to 5 days
LMP: Dec. 26-31 A- 2 to 3 pads/day
PMP: Nov. 4th (-)use of contraceptive
G¹- CS I- preterm (-) dyspareunia
Placenta previa? (+) Weight loss
2013 at IPH
For biopsy of abdominal mass -awaiting
Menarche: 12y.o decision
I: 28-30 days
- facilitated blood transfusion. Continue
medications started or inhalation @ 4-5pm
- Referred to urologist

Jan 7, 2023(Day 3):


(+)Minimal vaginal bleeding: started
ceftriaxone to ciclodin 500mg BID
- For Chest xray
-. shifted Tranexamic Acid 1gm to oral
tranexamic acid 500mg/cap q 8°
-for CA 125

Jan 8, 2023(Day 4):


Repeat CBC with Platelet -Started meproz
40mg/ cap. Pologesic 1cap TID For Pain
- Hold Tramadol IV
- Started ferrous 1tab BID
- Urologist assessment was done
- R/O destructive uropathy
- Advised patient to cystoscopy stent
insertion should the mass with progress
Anemia correction
- Continue medications as ordered.

Jan. 9,2023(Day 5):


(+)Minimal vaginal bleeding
- Discussed the possibility of surgery once
biopsy results are in
- Advised operation in IUDMC or in a
government institution
- May be discharged on OB-Gyne point of
view
- follow up once with biopsy results
- Take home medications
Tranexamic acid 500mg/cap OD x 5days
Hemabate 1cap BID
Ferrous sulfate 1tab BID for 1week
Lactulose 30cc at bedtime
GORDON’S FUNCTIONAL HEALTH PATTERN

Before Hospitalization During Hospitalization Interpretation


1. Health “Maayos naman ako, ”Ngayon alam kong The patient perceived
Perception and malusog naman. Wala hindi ako healthy dahil her health in the state
Health akong mga allergies sa nagkasakit ako. Marami of good condition, but
Management katawan ngunit na akong hindi nagagawa during hospitalization
operahan ako ng CS last ngayon na nagagawa ko the patient perceived
2013 dahil sa severe naman dati,.Ngayon that she is not healthy.
vaginal bleeding” napagtanto ko na napaka Because of her
halaga pala talaga ng condition she cannot
kalusugan lalo pag nasa do anymore the things
ganito kang situwasyon she usually does.
kaya”

2. Nutrition “Tatlong beses akong “Ngayon hindi na ako She eats regularly
and kumakain sa isang araw masyadong nakakakain from before her
Metabolism dati at kung ano ano nawawalan ako ng gan hospital admission.
Pattern nalang ang mga dahil sumasakit ang tiyan She eats whatever
kinakain kong pagkain ko. Naka soft diet ako food she likes
dahil nga busy sa ngayon at iniiwasaan ko especially fatty foods.
pagtitinda hindi na ako na yung mga During
nakakapagluto sa bahay pinagbababawal na hospitalization, the
at mga matatabang pagkain saakin, sa patient has loss her
pagkain lagi ang ngayon ipinagbabawal appetite and hasn’t
kinakain ko” ang mga matatabang eaten a lot because her
pagkain, at mga pagkain abdomen is painful.
na may salitre” She stated also that
she is in a soft diet
and she avoiding
foods that is forbidden
to her like fatty and
food that has salitre.
3. Elimination “Wala akong problema “Okay parin naman kahit The patient stated her
Pattern sa pag ihi, pagdumi at papaano, wala parin urination and
wala rin akong namang pinagbago, defecates remains the
ginagamit na laxative ganon parin gaya ng same before and after
dahil nakakatae naman dati” hospitalization.
ako ng maayos, isang
beses sa isang araw”
4. Activity “Nagbebenta ako ng “Nahihirapan gumalaw According to the
and Exercise mga gulay, hindi naman kasi masakitt, limitado patient she sells
Pattern ako nahihirapang nalang yung mga galaw vegetables and usually
huminga wala naman ko ngayon” does the household
akong ubo. Okay na ako chores, that serve her
sa exercise habang daily exercise. During
nagbebenta at sa mga hospitalization, her
gawaing bahay movements have been
naigagalaw ko naman very limited due to
katawan ko” some pain she still
feels on her abdomen.
5. Cognition “Wala naman akong “Ngayon masakit lang The patient has no
and ibang problema bukod talaga itong na sa may sensory problems. She
Perception sa pagtitinda at sa anak part ng tiyan ko yun understands direction
Pattern ko. Hindi pa naman ako lang” very well and has a
gaano nawawalan ng good memory. She
memorya” has no complaints
aside from the pain in
her abdomen.
6. Sleep and “Nakakatulog naman “Simula nung na admit The sleeping pattern
Rest Pattern ako ng maayos at wala ako dito hindi na ako of the patient has
naman akong gamot na nakakatulog ng maayos completely changed
ginagamit para kasi sumasakit yung sa from before and
makatulog” may part ng tiyan ko” during hospitalization.
Before she used to
sleep well and didn’t
used sedatives drugs.
And suddenly it
changed in the
hospital, upon
admission the patient
cannot sleep well
because of her
abdomen is painful.
7. Self-
“Hindi naman sa “Nanghhinayang kasi The perspective of the
Perception andmasasabi kong perpekto sayang ang mga araw patient is always
Self-Concept ako sa buhay pero nan andito ako sa positive, she knows
Pattern masaya ako sa naging Hospital. Ang pananaw that God is the only
takbo ng buhay ko, mga ko ngayon ay maiksi lang reason she made it this
desisyon at pananaw ko ang buhay kaya dapat far. She doesn’t
wala naman akong enjoyin lang, mahalin complicate things and
pinagsisisihan dahil ang sarili at alagaan” stated that life is too
alam kong kagustuhan short, so just enjoy it.
lahat ito ng Diyos”
8. Roles and “Kasama ko ang “Nung na admit ako The patient lived with
Relationships pamilya ko sa iisang syempre umaasa nalang her family. She and
Pattern bahay at dalawa kami ng ako sa asawa ko dahil her husband work
asawa ko ang siya nalang mag isa ang together for their
nagtratrabaho para sa nagtratarabaho para family but due to
pamilya. Madalas yung saamin” hospitalization, she’ s
asawa ko ang nasusunod now depends on her
sa mga desisyon para husband because he is
saamin” the one who still
working.
9. Sexuality “Pag niyaya ako umo oo “Syempre hindi na The patient is sexually
and ako, asawa ko naman active tulad ng dati dahil active from which she
Reproduction yun at wala namang nandito nga kami sa consider love making
Pattern problema sa ganitong hospital” as an expression of
bagay, minsan sa pagod love, but due to her
pero hindi naman confinement the
hadlang kung talagang patient is sexually
kailangan. Atleast 2-3 inactive.
times a week siguro
basta hindi pagod”
10. Coping and “Pag nagkakaroon ako “Ngayong nasa ganitong The patient treats her
Stress ng problema dinadaan sitwasyon ako, positive problems by doing
Tolerance ko nalang sa paggawa lang ako sa buhay laging household chores.
Pattern ng mga gawaing bahay nasa isip ko na lahat ng During her
at nakakatulong siya ito ay pagsubok lang, hospitalization, she
para makalimutan ko kaya lumalaban lang ako remains positive even
yung mga problema ko” lagi dahil alam kong after being in this
hindi naman ako situation because she
papabayaan ng Diyos “ knows that God will
not forsake her.
11. Values “Roman Catholic ako ”Ngayon mas lalo akong The patient is Roman
and Belief ngunit dahil sa trabaho naniwala sa kanya dahil and
Pattern hindi na ako sa kabila ng mga she has a very strong
nakakapunta sa nangyari saakin, nandito belief in the Higher
simbahan para parin ako nabubuhay at Power. She believes
makapagdasal ng alam ko na hindi niya that God is her source
taimtim pero ganon pa ako papabayaan. Sa of strength and feels
man naniniwala ako na kanya talaga ako that she can go
may Diyos at lagi parin humuhugot ng lakas through everything if
naman akong ngayon” she stays believing in
nagpapasalamat sa God.
kanya “
PATIENT APPRAISAL
01/05/23 7 am – 7 pm
 Admitted a 45 y/o female c cc of abd’l mass under the service of Dr. Segundo
 S/E by ROD
 Secured consent signed by S.O.
 Hooked to IVF
 Initial VS taken and recorded
 Labs and dx facilitated
 Meds given as ordered
 AP (?)
 Endorsed

01/05/23 (10:00 am) 7 am – 7 pm


 D – Received pt. via stretcher – conscious and coherent – ongoing IVF PNSS 1L x 12° patent and infusing well, (-) DOB, (-) chest pain, (+)
pain on lower abdomen (-) desat not in distress
 A – Assessed pt. general condition, v/s taken and recorded. Due meds given. Ensure safety and comfort. Encouraged verbalization of health
concerns and feelings. WOF any untoward S/Sx. Seen at intervals.
 R – Still pain on lower abdomen. Endorsing for continuity of care

01/05/23 7 pm – 7 am
 Acute pain
 Received pt on bed, conscious and coherent c ongoing IVF patent and infusing well, (-) DOB, (-) chest pain, (-) desat, not in distress, (+) pain
on lower abdomen.
 Assessed pt., v/s taken and recorded, all due meds given, ensured safety and comfort, encouraged verbalization of feelings and concerns,
WOF any untoward S/Sx, seen c intervals, provided quiet rest & sleep.
 Endorsed

01/06/23 7 am – 7 pm
 Acute pain
 Received pt. on bed awake, conscious, coherent c ongoing IVF patent and infusing well, c tolerable abdominal pain, (-) DOB, (-) chest pain,
afebrile, not in CP distress
 Assessed status, monitored v/s and recorded, due meds given, monitored for untoward S/Sx, ensured safety, kept comfortable, kept watched,
encouraged (?), attended to needs

01/06/23 7 pm – 7 am
 Acute pain
 Received pt. on bed, conscious and coherent, c ongoing IVF patent and infusing well, (-) DOB, (-) Desat, (+) abdominal pain.
 Assessed pt., v/s taken and recorded, all due meds given, ensured safety and comfort, encouraged verbalization feelings and concerns,
provided adequate rest and sleep, WOF any untoward S/Sx, seen c intervals, all meds attended, kept watched.
 Endorsed

01/07/22 7 am – 7 pm
 F – Acute pain
 D – Received on bed awaked and responsive c ongoing IVF patent and infusing well, afebrile, not in distress, (-) desat, (-) DOB still c
abdominal pain @ PS /10
 A – Assessed, v/s taken and recorded, all due meds given as ordered, WOF any undue S/Sx, all needs attended, seen c intervals
 9 am – Hooked 2nd unit of PRBC ↔ Blood transfusion reaction.
 4 pm – Hooked 3rd unit of PRBC.; Referred to Dr. Mercell
 R – Still c ongoing BT of 3rd (?). Endorsed

01/07/23 7 pm – 7 am
 F – Acute pain
 D – Received pt. on bed, conscious and coherent, c ongoing IVF patent and infusing well, afebrile, not in distress, (-) DOB, (-) Desat, still c
abdominal pain @ pain scale 5/10
 A – Assessed pt., v/s taken and recorded, all due meds given as ordered, WOF any untoward S/Sx, ensured safety and comfort, encouraged
verbalization of feelings and concerns, all needs attended, seen c intervals, kept watched
 R – still c abdominal pain but tolerable
 Endorsing for continuity of care

01/08/23 7 am – 7 pm
 Acute pain
 Received pt. on bed conscious and coherent, c ongoing IVF patent and infusing well, afebrile still with episode of abdominal pain, not in
distress
 Assessed pt., v/s taken and recorded, due meds given, all needs attended, seen at intervals, ensured safety and comfort, watched out for an
untoward S/Sx, kept watched
 Endorsing for continuity of care

01/08/23 7 pm – 7 am
 F – Acute pain
 D – Received on bed awake and responsive c ongoing IVF patent and infusing well, afebrile not in distress, (-) desat, (-) DOB still c
abdominal @ pain scale 5/10
 A – Assessed pt., v/c taken and recorded, all due meds given, ensured safety and comfort, encouraged verbalization of feelings and concerns,
provide adequate rest and sleep, WOF any untoward S/Sx, seen c intervals, all needs attended, kept watched
 Endorsing for continuity of care

01/09/23 7 am – 7 pm
 F – Readiness for enhance healthcare management
 D – Received on bed, conscious and coherent, c IVF of D5NSS 1L @ 100 cc x 12°, patent and infusing well, (+) minimal abdominal pain as
verbalized by pt., (+) neck mass, (-) desat, (-) DOB not in distress
 A – Assessed pt., v/s taken and recorded, all due meds given, encouraged to verbalize feelings and concerns, watched out for any untoward
S/Sx, seen at intervals, needs attended
 R – Still c minimal abdominal pain, endorsed for continuity of care

01/09/23 7 pm – 7 am
 F – Knowledge deficit r/t present condition
 D – Received on bed c IVF patent (?), (?) pain, not in CP distress
 A – (?)
 R – Endorsed

01/10/23 7 am – 7 pm
 F – Readiness for enhance healthcare management
 D – Received pt. on bed conscious and coherent c ongoing IVF patent and infusing well, (+) minimal abdominal pain as verbalized, (+) neck
mass, (-) desat, (-) DOB, not in distress
 A – Assessed v/s taken and recorded, all due meds given, encouraged to verbalized feelings and concerns regarding her health condition,
watched out for any untoward S/Sx, seen c interval, kept safety and comfort, all needs attended

PHYSICAL ASSESSMENT
Patient: X
Age: 45 years old / Female
Date of assessment: January 09, 2023 @10: 00 am
Diagnosis: Abnormal Uterine Bleeding , Pelvic Mass T/C Malignancy with compression symptoms, secondary to anemia
General Survey:

Patient X is seen in lying position on her bed with her relative beside.
Glasgowcoma scale is 15/15, E4V5M6. Patient has good posture and in positive mood as always, greeted us (student nurses) as we approach her.
Body structure is hair, Face, finger, eyelids, teeth and lower quadrant. Weight loss is not evaluated due to patient is not weighed recently. Initial
vital signs are: BP: 120/80 mmHg, T: 37.1 ºC, PR: 70 bpm, RR: 20 cpm, taken August 17, 2015 @ 3:20 pm prior to interview.

Body Part Normal Actual Techniques Used Interpretation

Findings Findings
Head Even distribution, Thick, black with Inspection Patient can’t fully
- Hair thick hair white hair due to aging wash her body
process.
Silky, resilient hair Evenly distributed because of her
No infection or but not well current status. So
Infestation combed hair. she was assisted by
Hair is dry and Her husband while
Coarse cleaning her body
No lesions, on bed. Hair
Infection, dandruff and becomes dry
infestation noted. because the scalp
doesn’t make
enough oil to
moisturize the hair.

- Skull Normocephalic and Normocephalic and Inspection- Essentially normal


symmetrical Symmetrical Palpation

Smooth, with
Smooth, uniform Uniform
consistency, consistency, no
absence of nodules presence of
or masses nodules or masses

Symmetric or Asymmetrical facial Inspection Essentially normal


- Face slightly features.
asymmetric facial With pale looking
no noted edema or
features hallowness
Absence of edema
or hollowness
Skin color light to deep
brown
Eyes
- External Eye Eyebrows- Hair evenly Inspection Essentially Normal
Structure even distribution of distributed with
hair, intact skin skin intact
symmetrical Symmetrically
alignment, equal aligned with equal
movement Movement
Eyelashes- Evenly distributed
Even distribution Hair
of hair, curled Skin intact
slightly outward Lids close
Eyelids- Symmetrically
.
Pale eyelid due to disease
process
Skin intact, no
discharge, no
discoloration
Lids close
symmetrically

- Internal Eye Sclera appears white White in color Inspection Essentially Normal
Structure Shiny, smooth, and Shiny and smooth but
pink or red in color pale upon observation No
palpebral conjunctiva edema noted Transparent,
Lacrimal sac and shiny
nasolacrimal duct- and smooth. Details of iris
are visible.
Absence of edema or
Blinks when touched
tearing
Constricts and dilates
Cornea- equally with the
Transparent, shiny, presence of light.
smooth; Constricts with light and
Details of iris are dilates without the
visible light
Blinks when touched Eyes can move co-
ordinately and
Pupils-
symmetrically with both
Black in color; equal eyes.
in size; normally 3-7 Patient no difficulty in
mm in diameter; reading. No reading
round smooth border; glasses needed.
iris flat and round
Six ocular
movements-
Both eyes coordinate,
move in unison, with
parallel alignment
Visual acuity-
Able to read
Newsprint 20/20
Ears- Auricles- Color same as Inspection Essentially Normal
Color same as facial skin
facial skin Symmetrical and
Symmetrical and aligned with outer canthus
aligned with outer in eye
canthus in eye No difficulty in

Mobile, firm and hearing. Can hear


not tender; pinna whispered voices

recoils after it is
folded
External ear canal-
Can hear ticking
off the clock when
placed on both
ears. Should be
symmetrical.

Nose and Sinuses External nose- Symmetric and Inspection Essentially Normal
straight
Symmetric and Palpation
No discharge or
straight
Absence of flaring
discharge or flaring
Uniform in color No
Uniform color tenderness,
Sinuses- masses palpated
Absence of
Tenderness

Teeth and Gums 28-32 whitish teeth Incomplete teeth. Inspection Poor dental
with smooth 2 tooth molar hygiene is
surfaces and edges. considered as the
No decayed areas, main cause of tooth
no missing teeth discoloration.
Tissue is smooth Yellowish teeth Inadequate
and moist without lesion noted. brushing and
Tissue, gums, and flossing to remove
Tongue should be tongue are pink and plaque and stain-
pink, moist, and no lesion noted producing
moderate size with Patient determined substances like
papillae present different tastes and coffee and tobacco
Tongue can no changes in taste noted. can cause tooth
determine between discoloration.
different tastes Foods like coffee,
Gums is tea can cause also
pink and no lesions discoloration.

Neck Muscles equal in Neck muscle equal Inspection Essentially Normal


size; head centered in size and head Palpation
centred
Not palpable No palpable lymph nodes
lymph nodes
Trachea in central
of neck

Trachea in central
of neck

Thorax and Lungs Symmetric chest, Symmetric, Chest Inspection


wall intact.
Chest wall intact, Palpation
With tattoos at the back.
Absence of With noted small scar at
tenderness and right thorax. Vesicular
masses, Spine breath
sound when
vertically aligned,
auscultated With
Full and symmetric 20 cpm
chest expansion
Vesicular,
Broncho-vesicular, Essentially normal
and bronchial
breath sounds
Heart No lift or heave at Auscultated at Auscultation Essentially Normal
apical area apical area with S1
S1 usually heard at all usually heard at all sites;
sites; S2 usually heard at S2 usually
all sites heard at all sites No
heart murmurs
noted

Abdomen Uniform in color Audible Skin uniform in Inspection Essentially normal


bowel color.
sounds

Genitourinary Tract No pain in Skin uniform in color Inspection Essentially normal


urinating, yellowish urine, (+ ) palpate tenderness at
Auscultation
no
her left lower quadrant at Percussion
blood in urine.
the abdomen. Palpation
Extremities Upper extremities- Skin complexion is, Inspection Essentially Normal
Skin generally uniform uniform with all body
Skin turgor – 1 sec parts, skin is intact.
Lower extremities Skin turgor – 1sec
Uniform color both left
and right legs
Dry foot noted

Fingernails -
Convex curvature, 180 degrees angle; Inspection, Essentially Normal
angle about 180 smooth in texture Palpation
degrees; smooth
texture
Highly vascular Nails appear to be pink Inspection Essentially Normal
and pink in color and highly vascular
Capillary refill – 1- 2 sec Cut fingernails in hands
but uncut fingernails in
toes
Capillary refill of 1
second.
(+) pale
Cranial Nerves
I. Olfactory – able to Can identify scent of bed Inspection Essentially normal
identify familiar side food.
scent

II. Optic- able to read No difficulty upon Making the patient read Essentially normal
newspaper with one reading. No the written word by
eye at a time reading glasses student nurses, also some
used. text messages from
cellular phone.

III. Oculomotor- Constriction of both Using penlight Movement of eyes are


constriction of both pupils when a bright light also normal which shows
pupils when a bright was shined on one of it. that cranial nerves III, IV,
light was VI are functioning well.
shined on one of it.
IV. Trochlear- Client The client was able to Inspection Essentially normal
should be able to move eyeballs obliquely
move
eyeballs
obliquely
V. Trigeminal- The client blinked By using sterile Essentially normal
Client blinks when the sclera is touched gauze
whenever sclera is by a sterile pad gauze Inspection
lightly
touched; able to feel
the wisp of cotton
over the area
touched;
able to
discriminate blunt
and sharp stimuli
The client was able to
move eyeballs laterally Movement of eyes are
VI. Abducens- also normal which shows
Client should be that cranial nerves III,
able tomove
IV, VI are functioning
eyeballs laterally
well.
VII. Facial- Client The client was able Inspection Essentially normal
should be able to do to do different facial
different expressions such as
facial expressions frowning and smiling. No
such as smiling, signs of
frowning and hemiplegia.
raising
of eyebrows; able to
Identify different
tastes such as sweet,
salty and
bitter taste
VIII. Acoustic- Client should Patient has no Interview Essentially normal
be able to hear loud trouble hearing or
and soft spoken understanding verbal
words; able to hear commands
ticking of
watch on both ears
IX. Glosso- Patient can identify the Inspection Essentially normal
pharyngeal- Client Food what she is eating.
should be able to No difficulty in
identify swallowing.
different tastes
such as sweet,
salty and
bitter taste; able to
move tongue from
side to side and up
and down; able to
swallow without
difficulty,
with(+) gag reflex
X. Vagus- Client should be Patient can Inspection Essentially normal
able to swallow swallow food. No
without difficulty; hoarseness in
has absence speech heard.
of hoarseness in
speech

XI. Spinal The client was able Inspection Essentially normal


accessory- Client to shrug shoulders and
should be able to turn head from side to
shrug side against resistance from
shoulders and nurse’s hands
turn head from
side to side
against resistance from
nurse’s hands
XII. Hypoglossal- Client The client was able to Inspection Essentially normal
should be able to protrude tongue at
protrude tongue at midline and move it side
midline to side.
and move it side to
side

Neurological Language- Interview


System No defects in Patient can express Essentially normal
the power to The thoughts
express clearly, sometimes
oneself crack some jokes.

through Responds to simple


speech verbal commands
Responds to such as rising of
simple verbal right and left arms.
commands
Orientation- Patient oriented to Interview Essentially normal
Oriented to time and to the part
time, place of day, where s he is
and person and whom she is
with.

Memory- Oriented in time, Interview Essentially normal


place and person.

Immediate Could recall name of


student nurses

Recent Could recall the


date of her
operation and
admission.
Remote Can remember past events
memory years ago like, where he
attended high
school, his
birthday, and the recent
president.

Muscle Strength  5/5: no Upper extremities: Inspection and Essentially normal


contraction 5/5 or normal examining the strength by
strength giving force opposite to
 5/5: muscle Lower extremities: Right gravity.
flicker, but no leg is 5/5 or normal
movement strength

 5/5: movement Left leg is 5/5 or


possible, but not Normal strenght
against gravity
(test the joint in t
its horizontal
plane)

 5/5: movement

possible against
gravity, but not
against resistance by the
examiner

 5/5: movement
possible against
some resistance by
the examiner

 5/5: normal
strength
ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY

The uterus is a hollow organ that sits behind the urinary bladder and in front of the rectum.
The top of the uterus above the openings of the fallopian tubes is called the fundus, and the region below the openings is called the uterine body.
The uterus tapers down into the uterine isthmus and finally the cervix, which protrudes into
the vagina.
Zooming into the cervix, there are two openings, a superior opening up top, and an inferior
opening down below, both of which have mucus plugs to keep the uterus closed off except
during menstruation and right before ovulation.
The uterus is anchored to the sacrum by utero-sacral ligaments, to the anterior body wall by round ligaments, and it’s supported laterally
by cardinal ligaments as well as the mesometrium,
which is part of the broad ligament.
The wall of the uterus has three layers: the perimetrium, which is a layer continuous with
the lining of the peritoneal cavity, the myometrium, which is made of smooth muscle that contracts
during childbirth to help push the baby out, and the endometrium, a mucosal layer, that
undergoes monthly cyclic changes.
The endometrium is itself made up of a single layer of simple columnar epithelium, which
has ciliated and secretory cells, that sit on top of connective tissue, or stroma.
There any many grooves in the stroma which is lined by the epithelium and these are the
uterine glands which secrete a glycogen rich fluid that’s essential for the developing
embryo during early pregnancy.
The menstrual cycle

The main phases in the menstrual cycle are the prolifera-


tive phase, secretory phase and menstrual phase. During

the proliferative phase, the endometrium responds to the

endocrine environment to undergo extensive prolifer-


ation. This phase is variable in length and oestradiol

is the dominant hormone. At ovulation, the oocyte is


released from the dominant ovarian follicle. The follicle
then transforms into the corpus luteum, which secretes
progesterone and leads to a progesterone-dominant
secretory phase, typically lasting 14 days. During this
phase, in the presence of high levels of oestradiol and
progesterone, the cells of the endometrium undergo
morphological and functional changes, a process

known as decidualization. With the demise of the cor-


pus luteum in the late secretory phase, progesterone and

oestradiol levels decline, and the cells of the endome-


trium are no longer maintained. As a consequence of

progesterone withdrawal, there is a coordinated spatial


and temporal response in the upper functional layer
of the endometrium that culminates in menstruation.
Local cellular and molecular events include endometrial

apoptosis, inflammatory mediator influx and the induc-


tion of matrix metalloproteinase (MMP) expression.

The peri-menstrual phase encompasses endometrial


transition from the secretory phase, through menstrual

breakdown and repair, to regeneration in the prolifera-


tive phase. The ovarian equivalent of the peri-menstrual
phase is the luteofollicular transition36,41

NURSING HEALTH HISTORY


HISTORY OF PRESENT ILLNESS

1 month prior to admission, the patient started having abdominal pain with accompanying body weakness and worsening of condition
promoted consultation. History taken, patient is a 45 y/o G1P1 (0101) married vendor who was admitted due to abdominal pain. 2 months prior
to admission, the patient was noted to have an abdominal mass which gradually increased in size accompanied by abdominal pain. She also
noted to have heavy menstrual, 10 days prior to admission the patient consuming 5 diapers per day, consultation was done in an emergency
clinic in Manila and was advised to consult to a higher consultation.

PAST MEDICAL HISTORY

Mrs. X has no history of childhood illness, even though she cannot recall if she was fully immunized. Her first menstruation started when
she was 12 years old and had a heavy bleeding for 4 to 5 days consuming 2 to 3 pads a day but didn't suffer dysmenorrhea and dyspareunia. She
suffered LBM and coughs sometimes but she took over the counter medications, like Loperamide tablets for LBM and Ascof for cough. She had
a cesarean section on her first born in 2013 because of severe vaginal bleeding and hypogastric pain, and was diagnosed at Isabela Provincial
Hospital with a case of Placenta Previa. She claimed that she has no allergies with foods and medications. She was immunized Covid vaccine
with Pfizer up to the second dose in 2022, no history of covid infection yet.
Furthermore, patients have fun eating meats and meat products like tocinos, sausages and barbecues in the streets. She added that eating in
fast food chains is their easy access to get their foods and some canned goods and thus, she believes that on these foods she get the disease. The
patient claimed that their life is full of stressful stimuli because of many transactions in their daily activities as a vendor.

FAMILY HISTORY

Mrs. X Grandfather and Grandmother have died but she didn't not know the cause of death. Her father has died because of kidney failures
and is diagnosed with chronic kidney failure but not medicated with no history of hypertension and diabetes. Her mother was still alive with
previous hospitalization due to vehicular accident with minor injuries. Her mother has no maintenance medications and no comorbidities.
NURSING CARE PLAN

ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION


DIAGNOSIS INTERVENTION
Subjective data: Acute pain After 2 hours INDEPENDENT: After 2 hours of
“masakit po dito related to of nursing Assess and record To have a baseline nursing intervention
sa may bandang infection intervention vital signs data the patient was able
baba ng tiyan ko” the patient able
as verbalized by will be able Perform a The patient
the patient. to: comprehensive experiencing pain is Report pain is
assessment of pain. the most reliable relieved or
Objective data: Report pain is Determine the source of information controlled with a
Pain scale of relieve or location, about their pain. pain scale of 5/10 to
5/10 control with a characteristics, onset, Their self-report on 1/10
(+) restlessness pain scale of duration, frequency, pain is the gold
(+)guarding 5/10 to 1/10 quality, and severity standard in pain
behavior of pain via assessment as they
Facial expression assessment. can describe the
of pain location, intensity,
and duration.
Assess clients Clients perception of
perceptions of pain, and expression of
along with behaviors pain are influenced
and cultural by age, cognitive and
expectation behavioral factors.
regarding of pain
Perform pain To demonstrate
assessment each time improvement in
pain occurs. status or to identify
Document changes. worsening of
underlying condition
DEPENDENT:
Administer analgesic To maintain
as ordered by the acceptable level of
physician pain

COLABORATIVE:
Provide for Promotes active role
individualized and enhances senses
physical therapy or of control.
exercise program
that can be continued
by client after
discharge

ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION


DIAGNOSIS INTERVENTION
Subjective data: Imbalanced Long term INDEPENDENT: GOALACHIEVED.
“ sumasakit po nutrition less Assess eating To ascertain After 2 days of
dito sa may than body After 2 patterns and treatments/interventi nursing intervention,
bandang tiyan requirements weeks of food/fluid choices to ons that may be the client was able
ko kaya di po related to nursing any health-risk needed in addition to to:
ako makakain insufficient intervention, factors and health weight management. Verbalized accurate
nang maayos” dietary the client goals knowledge of
as verbalized intake as will be able To identify condition and
by the client. evidenced by to: Review contributing factors. understanding of
weight loss Daily activities and treatment regimen.
Objective data: Demonstrate exercise program
(+)Lethargic appropriate Helps client Verbalized
(+)Weight loss changes in Provide information determine nutritional commitment to
BMI - <18.5 lifestyle and regarding poor needs. mutually agree upon
behaviors, dietary habits. goals and treatment
To assist client in
including plan.
eating Encourage client to finding healthy
choose nutritious options.
patterns,
food foods such GOALPARTIALLY
quantity/qual vegetables, fruits and CHIEVED
ity and low-fat foods Promotes wellness LONG TERM
exercise . and it is also an
Encourage After 2 weeks
program. integral port of
involvement in weight reduction. of nursing
Maintain planned exercise intervention, the
weight at a program of client’ client was able to:
satisfactory choice and within Demonstrate
level for physical abilities. To assist client is appropriate changes
height, body adopting healthy in lifestyle and
build,age  Encourage client  to eating habits. behaviors,including
and gender. eliminate food that is eating patterns, food
rich in fats and quantity/quality and
SHORT cholesterol and exercise program
TERM: discuss its
After 2 days purpose/impact
of nursing To evaluate effective
intervention. COLLABORATIVE nutrition
The client
will be able Collaborate with
to: physician or dietitian
or nutrition team.
Verbalize
accurate
knowledge
of condition
and
understandin
g of
treatment

ASSESSMEN NURSING PLANNING NURSING RATIONALE EVALUATION


T DIAGNOSIS INTERVENTION
Subjective Ineffective After 8 INDEPENDENT: After 8 hours of
data: tissue hours of Monitor and Record To have a baseline nursing intervention
“nanghihina po perfusion nursing Vital Signs. data note any the client was able to
ako at nahihilo” related to intervention abnormal findings demonstrate
as verbalized anemia the client behaviors and
by the client will be able Maintain on bed rest Restricted activity lifestyle change to
to : reduces oxygen improve circulation
Objective data: demands of the heart
Demonstrate and other organs.
(+) weakness behaviors
(+) fatigue and lifestyle Assess patient
To have a baseline
change to general condition.
data and note any
Low improve abnormal findings.
hemoglobin circulation
level 89 Encourage quiet and
To conserve energy
(normal 120- restful atmosphere
and lower tissue
160mg/dl) oxygen demands.
Low hematocrit Provide safety by
raising side rails Weakness, fatigue
level 29.6
and restlessness are
(normal 36-
signs of hypoxia
45%)
which may cause
injury to the patient
Monitor laboratory
studies such as
Normal values
hemoglobin,
indicate adequate
hematocrit and RBC
tissue perfusio

DEPENDENT:
Administer IV fluids
as ordered. Maintain circulating
volume to maximize
tissue perfusion.
Blood
component therapy Blood transfusion
(Blood transfusion) increases the
as ordered. patient’s
blood volume

ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION


DIAGNOSIS INTERVENTION
Subjective Powerlessnes After 8 hours INDEPENDENT After 8 hours of
data: s related to of nursing Assess for feelings of These moods may be nursing intervention
“Nanghhinayan low self intervention apathy, hopelessness, an element of the patient was able
g kasi sayang esteem the patient and depression. powerlessness to:
ang mga araw will be able
na nandito ako to: Encourage This approach Verbalized positive
sa Hospital.” as verbalization of creates a supportive self appraisal in
verbalized by Verbalize feelings, thoughts, environment and current situation
the patient positive self and concerns about sends a message of
appraisal in making decisions caring.
Objective data: current
(+) irritability situation Encourage This will aid patient
(+) feel verbalization of to recognize inner
powerless feelings, thoughts, strengths.
(+) defensive bout mand concerns
aaking decisions
The perception of
Encourage an
powerlessness may
increased negate the patient’s
responsibility for attention to areas in
self. which self-care is
attainable; however,
the patient may
require significant
support systems and
resources to
accomplish goals.
COLLABORATIVE:
Refer to support May need/desire
groups for additional assistance
counselling or to resolve current
therapy as problems, long-
appropriate. standing issues or
troubled
relationships.
ASSESSMEN NURSING PLANNING NURSING RATIONALE EVALUATION
T DIAGNOSIS INTERVENTION
Subjective Fluid volume
data: excess

Objective data:
DRUG DRUG DOSAGE, MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING
CLASS ROUTE, AND OF ACTION EFFECT RESPONSIBILITIES
FREQUENCY
Generic Analgesic 50mg IV q8 Bind to opioid Moderate to Hypersensitivity, acute Nausea, vomiting, Before
Name: receptors and severe pain intoxication with any anorexia,
Tramadol inhibit reuptake CNS depressant, alcohol, constipation Assess the
of asthma, respiratory cramps, light- level of pain for
Brand norepinephrine headedness, location, type, and
depression
Name: and serotonin dizziness, character
ConZip sedation, and
respiratory Monitor input and
depression. output

During

Dilute and administer


IV slowly

Assess respiratory
status frequently

After

Evaluate therapeutic
response :decrease in
pain

Inform the patient to


report any allergic
reaction
DRUG STUDY
DRUG DRUG DOSAGE, MECHANISM OF INDICATIO CONTRAINDICATIO ADVERSE NURSING
CLASS ROUTE, ACTION N N EFFECT RESPONSIBILITIES
AND
FREQUENC
Y
Generic Name: Analgesic PO TID Phenyltoloxa-mine Moderate to Hypersensitivity to confusion, Before
Acetaminophen combination acts as an adjuvant severe pain acetaminophen or hallucinations,
and analgesic, which phenyltoloxamine. unusual Assess the
Phenyltoloxa-mine augments the thoughts or level of pain for
analgesic effect of behaviour; location, type ,and
Brand Name: acetaminophen. It little or no character
Dologesic also potentiates the urinating; or
effects of other nausea, upper Ensure the patient
drugs, such as stomach pain, had taken food or
codeine and itching, tired milk to prevent GI
codeine feeling, loss of upset
derivatives. appetite, dark
urine, clay- During
colored stools,
Ensure safety
and jaundice
measures: side rails,
(yellowing of
night light, and call
the skin or
bell within reach
eyes).
Monitor for possible
allergic reactions

After

Evaluate therapeutic
response: decrease in
pain

Inform the patient to


report any allergic
reaction
DRUG DRUG DOSAGE, MECHANISM INDICATI CONTRAINDICAT ADVERSE NURSING
CLASS ROUTE, OF ACTION ON ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Antibiotics 2 grams IV Inhibits cell- Bacterial Hypersensitivity Gl: Before
Name: OD wall synthesis, Infection pseudomembranous
Ceftriaxone promoting colitis, diarrhea Assess injection site
osmotic Hematologic:
Brand Name: instability, eosinophilia, Do skin testing in the
Pneumosolv usually thrombocytosis, intradermal area
bactericidal leukopenia. Skin:
During
pain, induration
tenderness at the Check the patency of
injection site, rash. the IV site and IV line
Other:
hypersensitivity Monitor patient for
reactions, serum possible adverse effect
sickness
anaphylaxis. After

Inform the patient to


report any signs of
bleeding.

Instruct the patient to


report any pain at the
IV site
DRUG DRUG DOSAGE, MECHANISM OF INDICATI CONTRAINDICAT ADVERSE NURSING
CLASS ROUTE, ACTION ON ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Antibiotics 500 mg PO Inhibits bacterial Bacterial Hypersensitivity to CNS: seizure, Before
Name: BID DNA synthesis Infection fluoroquinolones confusion, Assess for infection
Ciprofloxacin mainly by blocking Headache , prior to and during
DNA restlessness therapy.
Brand Name: gyrase ;bactericidal GI: pseudo-
Ciclodin . Membranous Obtain specimen for
colitis, diarrhea, culture and sensitivity
Nausea, test before giving the
vomiting first dose.
GU:
crystalluria , During
interstitial Take the drug on an
nephritis empty stomach
Musculoskeletal
Give the drug with
:
plenty of fluids to
Tendon rupture
reduce the risk of urine
Skin: rash toxic
crystals
epidermal
necrolysis After
. Advise patient to avoid
caffeine to prevent the
increase of caffeine
effects

Encourage the patient


to report severe side
effects
DRUG DRUG DOSAGE, MECHANISM INDICATI CONTRAINDICAT ADVERSE NURSING
CLASS ROUTE, OF ACTION ON ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Antianemic 1 tab PO Stimulates red Iron Peptic ulcer, regional GI: Nausea, Before
Name: BID blood cell deficiency enteritis, ulcerative heartburn,
Ferrous production. colitis; hemolytic anorexia, Confirm that the client
sulfate anemias (in absence constipation, does have an iron
diarrhea, deficiency anemia
of iron deficiency),
Brand Name: epigastric pain,
hemochromatosis, Explain the purpose of
Feosol abdominal
hemosiderosis, iron therapy
distress, black
patients receiving
stools.
repeated During
transfusions, Special
Administer the drug with
pyridoxine- Senses:
a full glass of water
responsive anemia; Yellow-brown
cirrhosis of the liver discoloration Do not crush the tablet
of eyes and when administering
teeth (liquid
forms.) After

Arrange for periodic


monitoring of hematocrit
and hemoglobin levels

Inform the patient to


report any severe adverse
reaction

DRUG DRUG DOSAGE, MECHANISM INDICATI CONTRAINDICAT ADVERSE NURSING


CLASS ROUTE, OF ACTION ON ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Antianemic 1 cap BID Stimulates red Iron Peptic ulcer, regional GI: Nausea, Before
Name: blood cell deficiency enteritis, ulcerative heartburn, Confirm that the client
Iron+Folic production. colitis; hemolytic anorexia, does have an iron
Acid + anemias (in absence constipation, deficiency anemia
Vitamin B of iron deficiency), diarrhea,
complex epigastric pain, Explain the purpose of
hemochromatosis,
abdominal iron therapy
Brand hemosiderosis,
distress, black
Name: patients receiving During
stools.
Hemarate repeated Administer the drug with
FA transfusions, Special a full glass of water
pyridoxine- Senses:
responsive anemia; Yellow-brown Do not crush the tablet
discoloration when administering
cirrhosis of the liver
of eyes and
After
teeth (liquid
Arrange for periodic
forms.)
monitoring of hematocrit
and hemoglobin levels

Inform the patient to


report any severe adverse
reaction
DRUG DRUG DOSAGE , MECHANISM INDICATI CONTRAINDICAT ADVERSE NURSING
CLASS ROUTE OF ACTION ON ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Proton pump 40 mg IV Inhibits proton Reduce the Hypersensitivity to GI: Diarrhea, Before
Name: inhibitor OD pump activity by amount of proton pump flatulence,
Pantoprazole binding stomach inhibitor abdominal Assess GI symptoms
hydrogen- acid pain. CNS: epigastric/
Brand Name: potassium Headache, abdominal pain,bleeding,
Pantoloc adenosine insomnia. and anorexia
triphosphate at Skin: Rash.
the secretory Assess IV site
surface of
During
gastric parietal
cells to suppress Flush the IV line
gastric acid with D5W, NS, or LR
secretion.
After

Monitor for possible


induced adverse effect

Assessed the effectiveness


of the drug

Flush the IV line


with D5W, NS, or LR
after each dose
DRUG DRUG DOSAGE , MECHANISM INDICATI CONTRAINDICAT ADVERSE NURSING
CLASS ROUTE OF ACTION ON ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Proton pump 40 mg PO Inhibits proton Reduce the Hypersensitivity to Nausea ,Vomit Before
Name: inhibitor OD pump activity by amount of proton pump ing , Diarrhea,
Esomeprazol binding stomach inhibitor Constipation , Instruct patient to take a
e Gastro hydrogen- acid Upset capsule before meals.
resistant & potassium stomach ,
Levosulpiride adenosine Stomach pain Explain the purpose of the
Sustained triphosphate at ,Headache ,flat drug
release the secretory ulence ,sleepin
During
capsule surface of ess.
gastric parietal Instruct the patient to
Brand Name: cells to suppress swallow the capsule as a
Meprozole gastric acid whole: Do not chew ,
secretion. crush or break it

After

Encourage the patient to


report the severe adverse
effect
DRUG DRUG DOSAGE, MECHANISM INDICATIO CONTRAINDICAT ADVERSE NURSING
CLASS ROUTE, OF ACTION N ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Laxative 1 Acts  Constipation Hypersensitivity to CNS: Before
Name: suppository directly on the laxative Muscle 
Bisacodyl per rectum  intestine by weakness Assess the patient for
increasing  GI: Nausea, abdominal distention,
Brand motor  vomiting, presence of bowel
Name: activity;  anorexia, sound ,and usual pattern
Dulcolax thought to  diarrhea, rectal of bowel function.
irritate colonic burning (supp)
intramural META: During
plexus; Protein-
Lubricate before insertion,
increases water losing 
in the colon enteropathy,  the patient should retain
alkalosis,  for 30 minutes
hypokalemia, After
tetany,
electrolyte and Inform patient to have
fluid adequate fluid intake
imbalances including at least 6–8
glasses/d.

Evaluate therapeutic
response :decrease in
constipation
DRUG DRUG DOSAGE, MECHANISM INDICATIO CONTRAINDICAT ADVERSE NURSING
CLASS ROUTE, OF ACTION N ION EFFECT RESPONSIBILITIES
AND
FREQUEN
CY
Generic Laxative 30 cc PO at Acts  Constipation Hypersensitivity to CNS: Before
Name: bed time directly on the laxative Muscle 
Lactulose  intestine by weakness Assess the patient for
increasing  GI: Nausea, abdominal distention,
Brand motor  vomiting, presence of bowel sound
Name: activity;  anorexia, and usual pattern of bowel
Cephulac thought to  diarrhea, rectal function.
irritate colonic burning (supp)
intramural META: During
plexus; Protein-
Mix with half a glass of
increases water losing 
in the colon enteropathy,  water , milk or fruit juice
alkalosis,  to improve the taste
hypokalemia, After
tetany,
electrolyte and Inform patient to have
fluid adequate fluid intake
imbalances including at least 6–8
glasses/d.

Evaluate therapeutic
response :decrease in
constipation
DISCHARGE PLAN
 Watch for any signs of bleeding
 Encourage the patient to have an operation
 Advice for diversional activities
 Educate the patient home medicines
 Educate the patient’s diet
 Advice to have a daily exercise
 Educate the patient to reduce the salt intake
 Do a deep breathing technique for relaxation
 Encourage to read a book
 Educate the patient about self hygiene

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