GENERIC MECHANISM CONTRAINDICATION INDICATIONS ADVERSE NURSING

NAME OF ACTION REACTION CONSIDERATION

Doxycycline Exerts Contraindicated in Infection caused by Loss of appetite If patient receives
bacteriostatic patients hypertensive to suspesceptible gram Nausea and large dose or
effect by drug or other positive and gram vomiting prolonged therapy
binding to the tetracyclines. negative organisms Diarrhea or if patient is high
30s and Use cautiously in (including haemophilus Rash at risk, watch for
possibly patients with impaired ducreyi, Sensitivity to the signs and symptoms
ribosomal renal or hepatic yersiniapestis,ranciscella sun of superinfection. If
subunits o function. tularensis and hives superinfection
microorganisms campylobacter fetus) occurs, drug should
and inhibiting be continued, and
protein appropriate therapy
synthesis. instituted.
Mefenamic Acid Anti- Known hypersensitivity Short term relief of mild Abdominal pain Assess patient who
Brand name: inflammatory; to mefenamic acid or to moderate pain. Constipation develop severe
Ponstan analgesic, and other NSAIDs Diarrhea diarrhea and
antipyretic Indigestion vomiting for
activities Gas dehydrarion and
related to Gross electrolyte
inhibition of bleeding/perforation imbalance.
prostaglandin Heartburn
synthesis; exact Nausea
mechanisms of
action are not
known.
Methylergonovine acts directly on Hypertension toxemia Following delivery of Hyper or Contraindicated in
maleate the smooth Pregnancy the placenta, for routine hypotension nausea, patients
Brand Name: muscle of the ( c a at c) management of uterine vomiting chest pain, hypertensive to
Methergine uterus and atony, hemorrhage, and dyspnea, headache, methylergonovine
increases the subinvolution of the hematuria, or any component
tone, rate, and uterus. For control of thrombophlebitis, of the formulation.
amplitude of uterine hemorrhage in water intoxication, Ergot alkaloids are
rhythmic the second stage of labor leg cramps, contraindicated
contractions following delivery of the dizziness. with potent includes
through binding anterior shoulder. protease inhibitors.
and the
resultant
antagonism of
the dopamine
D1 receptor.
Thus, it induces
a rapid and
sustained
tetanic
uterotonic
effect which
shortens the
third stage of
labor and
reduces blood
loss.
INTRODUCTION

Intrauterine fetal demise is the clinical term for stillbirth used to describe the death of a
baby in the uterus. The term is usually applied to losses at or after the 20th week of gestation.

Fetal demise is defined differently around the world, based on the gestational age and weight of
the fetus. In some places, the threshold can range from at least 16 weeks to at least 26 weeks
with a weight of at least 400 grams to at least 500 grams.

Pregnancies that are lost earlier are considered miscarriages and are treated differently by
medical examiners. Parents of a stillborn baby, for example, will receive a birth and death
certificate while those of a miscarried fetus will not.

To many who have experienced such loss, the line between a stillbirth and miscarriage can often
seem arbitrary but should in no way suggest that a parent's emotional response is any more or
less profound.

Patient’s Data

Admitting Diagnosis:

G6p5 IUFD PU 28,27 WEEKS

Lab diagnostic Result:

INTRAUTERINE FETAL DEATH IN UTERO

Brief OB History:
BP- 120/80mmHg RR- 21cpm
CR- 99bpm T- 36.5c

Medication: doxycycline, mefenamic acid, Methylergonovine maleate

Final Diagnosis:
Complication: None
Procedure: NSD with perineal support pnt partum cartage
ANATOMY AND PHYSIOLOGY

Everyone (adolescent boys and girls) who is about to enter puberty (the process of body changes

that cause a child’s body to become an adult body capable of reproduction) should be taught or

know the basic medical definition of menstruation and that it is a normal process that females go

through as their bodies prepare themselves for potential pregnancy. It is a part of the monthly

menstrual cycle (regular cycling of hormones) that occur in the female reproductive system that

makes pregnancy possible.

Medically, menstruation (also termed period or bleeding) is the process in a woman of discharging

(through the vagina) blood and other materials from the lining of the uterus at about one monthly

interval from puberty until menopause (ceasing of regular menstrual cycles), except during

pregnancy. This discharging process lasts about 3-5 days. The menstrual cycle is the hormonal

driven cycle; Day 1 is the first day of your period (bleeding) while day 14 is the approximate day

you ovulate and if an egg is not fertilized, hormone levels eventually drop and at about day 25; the

egg begins to dissolve and the cycle begins again with the period at about day 30. Menstruation

begins day 1 and normally ends days 3-5 of the menstrual cycle. The average age for a girl to get

her first period is 12, but the range of age is about 8 to 15 years old. Women usually have periods

until about ages 45 to 55.

The organs of the female reproductive system produce and sustain the female sex cells (egg cells

or ova), transport these cells to a site where they may be fertilized by sperm, provide a favorable

environment for the developing fetus, move the fetus to the outside at the end of the development
period, and produce the female sex hormones. The female reproductive system includes the

ovaries, Fallopian tubes, uterus, vagina, accessory glands, and external genital organs.

Uterus or Womb - is located at the lower pelvis, posterior to the bladder and anterior to the rectum.

It accommodates the embryo which develops into the fetus. It also produces vaginal and uterine

secretions which help the transit of sperm to the fallopian tubes. Uterus provides a place for

implantation and nourishment during fetal growth.

Fallopian tube - extends to the distal outward and backward of the ovaries. It channels ovum from

the ovary to the uterus. It is a place where fertilization occurs.

Ovaries - is located to the side of the uterus in the lower abdomen. It produces mature ova (egg

cells), estrogen and progesterone. It is also the organ for menstrual cycle.

episiotomy is a surgical cut made in the perineum during childbirth. The perineum is the muscular area

between the vagina and the anus. Your doctor may make an incision in this area to enlarge your vaginal

opening before you deliver your baby. An episiotomy used to be a normal part of childbirth, but it has
become much less common in recent years. In the past, an episiotomy was done to help prevent severe

vaginal tears during delivery. It was also believed that an episiotomy would heal better than a natural or

spontaneous tear. two most common types of episiotomy are midline episiotomy and mediolateral

episiotomy. Midline episiotomies are much more common in the United States and Canada. Mediolateral

episiotomies are the preferred method in other parts of the world. Both types have various advantages and

disadvantages. a midline episiotomy, the incision is made in the middle of the vaginal opening, straight

down toward the anusadvantages of a midline episiotomy include easy repair and improved healing. This

type of episiotomy is also less painful and is less likely to result in long-term tenderness or problems with

pain during sexual intercourse. There is often less blood loss with a midline episiotomy as well. The main

disadvantage of a midline episiotomy is the increased risk for tears that extend into or through the anal

muscles. This type of injury can result in long-term problems, including fecal incontinence, or the inability

to control bowel movements. a mediolateral episiotomy, the incision begins in the middle of the vaginal

opening and extends down toward the buttocks at a 45-degree angle. The primary advantage of a

mediolateral episiotomy is that the risk for anal muscle tears is much lower. However, there are much more

disadvantages associated with this type of episiotomy, including: increased blood loss more severe pain

difficult repair higher risk of long-term discomfort, especially during sexual intercourse area will first be

cleaned with soap. Your doctor will insert two fingers into your vaginal opening to protect the baby's head.

Then, a small incision will be made. Depending on the type of episiotomy being performed, the cut may be

straight down or at a slight angle from the vaginal opening. After the incision has been made, your doctor

will gently pinch the tissue just below the incision to prevent further tearing. Gentle pressure is also placed

against the top of the baby's head to keep it from coming out too quickly or abruptly. After delivery, the

vagina and perineum are cleaned and carefully examined. Your doctor will then check for any tearing in

the vaginal walls or cervix. all repairs are performed with suture, or surgical thread, that absorbs into the
body and doesn’t require removal. Thin sutures are used to close the rectal lining, while larger and stronger

sutures are used to repair the anal sphincter.

PATHOPHYSIOLOGY

PLACENTA
28 WEEKS UTEROPLACENTAL
DYSFUNCTION
ISSUFICIENCY
-LEADING TO FETAL THIRD TRIMESTER
CORD ACCIDENT
GROWTH RESTRICTION
CHRONIC VILITIS
PLACENTA ABRUPTION

AND OTHER FETAL

DISORDER

NO FETAL MOVEMENT
AND FETAL HEART INTRAUTERINE FETAL
TONE DEADTH
NURSING HEALTH HISTORY

BIOGRAPHICAL DATA
Patient M. L. V., 44 yrs old, female, filipino and currently residing at Tondo, Manila. She was admitted at
our institution on January 14, 2020

Chief Complaint
Decreased fetal movement

History of Present Illness

The patient had dizziness and back pain.

FAMILY HISTORY
The patient’s family has no history of HPN, Diabetes or any heredofamilial diseases on both sides.
Drug Study

GENERI MECHANI CONTRAINDICA INDICATI ADVERSE NURSING

C NAME SM OF TION ON REACTION CONSIDERAT
ACTION ION
Paraceta Thought to Contraindicated in Mild pain Hematologic: Use liquid for
mol produce patients or fever. Hemolytic Anemia. children and
analgesia by hypersentivity to Leukopenia,Neutro patients who
blocking drug. penia difficulty of
pain Use cautiously in swallowing.
impulses by patients with long Hepatic:
inhibiting term alcohol use Jaundice In children
synthesis of because therapeutic don’t exceed
prostaglandi doses cause Metabolic: five (5) doses in
n in the hepatoxicity in Hypoglycemia 24h.
CNS of these patient.
other Skin:
substances rash
that senitize
pain
receptors to
stimulation.
The drug
may relieve
fever
through
central
action in the
hypothalam
ic heat
regulating
center.
Ascorbic Increases
Acid protection
mechanism
of the
immune
system, thus
supporting
wound
healing.
ASSESSME DIAGNOS BACKGROU PLANNIN INTERVENTI RATIONA EVALUATI
NT IS ND G ON LE ON
KNOWLEDG
E
SUBJECTIV Fear Dysfunctional After 4-6 Monitor VS To get the After 4-6
E: related to uterine hours of baseline hours of
‘ natakot ako change in bleeding is nursing data nursing
bigla nalang health abdominal interventio intervention
may dinugo” status. bleeding in the n the Establish To gain the patient
as verbalized absence of patient rapport trust of the was able to
by the clinical or will report patient report fear
patient. ultrasonograph fear and and anxiety
ic evidence of anxiety are Encourage Provides are reduced to
Objective: structural reduced to patient to opportunity a manageable
abnormalities, a acknowledge for dealing level
Irritability inflammation, manageabl and express with
or pregnancy. e level. fears concern o
Restlessness Treatment is patient.
usually with
Increased oral Identify coping To be able
Tension contraceptives. strength of to focus for
Dysfunctional patient their own
Feeling of uterine capabilities.
helplessness bleeding
(DUB), the
VS taken as most common
follows: cause of
BP: 120/80 abnormal
RR: 19 uterine
PR:102 bleeding,
Temp: 36.9 occurs most
O2sat: 98 often >45
(>50%of
cases) and in
adolescents
(20% of cases.
The cause is
usually
estrogen