I.

Demographic Data

The client is C.R a 23 year old female from Carolina Sto. Nino, Antipolo Rizal a Filipino, Roman Catholic, born on December 10, 1988 at Bacolod City her educational attainment is only elementary graduate (G-6) her occupation is a house helper.

II.

Medical History Ineffective Coping

a. Chief Complaint:

b. History of Present Illness: The client feel depressed about the lost of her baby, because of overdue last January 18, 2012 at the Antipolo District Hospital the baby was already dead by the time it was delivered. Because of what happened she has this fear of not having a baby or if shes going to have a baby again she might think that its going to happen again. She is trying to be fine with the help of her husband, family and some of her friends.

c. History of Past Illness: The client experienced coughs and cold and other child illnesses such as mumps measles and chickenpox she has not undergone any major medical surgery. Taking otc drugs when needed.

d. Obstetric and Gynecologic history: The menarche of the client occurred when she was 13 years old. Her menstruation has an interval of 28 days and has duration of 4 days. She uses 3-4 napkins a daily due to regular moderate blood flow. Shes experiencing dysmenorrhea every menstrual period and just wait until the pain subside no dyspareunia and post coital bleeding shes not taking any pain reliever drugs. She had her first sexual intercourse with her husband last year has only one sexual partner. She had tried to use pills but decided to stop using it due to partners choice to have a baby.

Gordons Functional Health Pattern

Before Hospitalization Health Perception Pattern:

During Hospitalization

She doubted about her thought of being healthy She classified herself as a healthy living person she is still wondering why did it happen knowing that and didnt have any second thoughts to have a she is a healthy person. healthy baby too, and she said that a healthy person is not prone to any illnesses and rate her health as 8/10. Nutritional Metabolic Pattern: She eats foods that given by the hospital She eats normal daily food from breakfast to personnels and foods that her husband brought her dinner such as rice, vegetables, fish, fruits and from home. meat. Not taking any kind of Vitamins. Elimination Pattern: The client void 4 times a day with the same color The client voids as much as 7-8 times a day with yellow and defecate once a day normally brown in a color of yellow and defecate normally brown in color and firm. color and firm. Activity Exercise Pattern: Still, the client will take walking as her exercise The client takes that walking serves as her with the household choirs. exercise and doing the household choirs. Cognitive Perceptual pattern: The client still had the ability to read and write The client has the ability to read and write and still able to make any decisions but still confused in able to make a decision properly and can handle how to moved on and handle the loss of her baby any problem. situation. But the client sees that she can make this. Sleep-Rest Pattern: The client sleeps 2-5 hours she cant get her The client get her sleep easily she feels sleepy sleep easily, but not taking any sleeping pills and all the time. And can sleep 8-10 hours a day ant still trying to get a nap at afternoon. can take a nap at afternoon. Self-Perception Pattern: All the beautiful thoughts that she had at first are She had a lot of beautiful perception in life for the gone and she is very disappointed to what future with her family, husband and her baby shes happened but still hoping and trying to have a new having. beginning in life with her future family. Role Relationship Pattern: Shes still in the hospital but they decided to live She only lives with her husband and getting in his husbands mother so that she can talk to along with other people is not that hard for her. someone and avoid thinking about what happened to her baby to lessen her depression.

Sexuality-Reproductive Pattern: Decided to take a rest for a couple of months . She said that her first sexual intercourse was before having an intercourse with her husband. last year with her husband, on their first month she is using pills but decided to stop to have a baby Coping Stress Tolerance Pattern: In solving problem still as before but not always She said that in solving her problem she firsts because she states that not all problem are the analyze the problem and try to think whats the best same. Like now she still not knew how or what to thing to do and she therefore consult one of her think after what happened but she is hoping that she friends and family. can make it. Value Belief Pattern: Didnt get to church since she was admitted but She is a Roman Catholic get to church every still praying on her own. Sunday to thank God what she is having.

Laboratory Findings:
Clinical Pathological Findings Form

Hemoglobin(hgb) Hematocrit

Result 118 0.35

Normal values M; 14-18g/dl F: 12-16g/dl M:40 -64% F:37-47% M:4-6x1012/L F:4.5-5.5x1012/L M:5-10x109/L F:150-450x109/L 50-70% 25-40% 3-8% 1-4% 0-1% 0-5%

RBC count WBC count Platelet Neutrophils Lymphocytes Monocytes Eosonophils Basophils Stabs Others

16.0

0.79 0.21

Gynecology Ward

Parameter Test Bleeding Time Clotting Time ESR Reticulocyte Count ABO Blood Type RH Blood Type Malarial Smear

Result

Normal Values 1-3m 5-15m M:0-15mm/hr F:0-15mm/hr 0.5-1.5%

O (+) negative

Drug Study

Drug Amoxic illin

Mechanism of Action Amoxicillin inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall by binding to one or more of the penicillin-binding proteins (PBPs), thus inhibiting cell wall biosynthesis resulting in bacterialysis. Absorption: Rapidly and completely absorbed from the GI tract with peak plasma concentrations after 1-2 hr (oral). Not inactivated by gastric acid and presence of food does not impair absorption. Distribution: Wi dely distributed, CSF (small concentrations except when the meninges are inflamed), bile (high concentrations);

Classificat ion Amoxicilli n; Belongs to the class of penicillin with extended spectrum Used in the systemic treatment of infections.

Indication Infections due to susceptible strains of haemophil influenza e.coli proteus mirabilis neisserria gonorrhea streptococcus pneumonia enterococcus faecalis, streptococci non penicillin se- producing staphylococci. Helicobacter pylori infection in combination with other agents.Postex posure prophylaxis against. Bacillus anthracis

Contraindic ation Contraindi cated with allergies to penicilllins, cephalosp orins, or other allergens. Use cautiously with renal disorders, lactation.

Side effects Diarrhea, dizziness, heartburn, inso mnia nausea itching vomiting confusion, abd ominal pain easy bruising, bleeding, rash and allergic reactions. Individuals who are allergic to antibiotics in the class of cephalosporin may also be sensitive to amoxicillin.

Nursing Intervention Culture infected area prior to treatment; re-culture area if response is not as expected. Give in oral preparations only; amoxic illin is not affected by food Continue therapy for at least 2 days after signs of infection have disappeared ; continuation for 10 full days is recommend ed. Use corticosteroi ds or antihistamin es for skin reaction. Report any side effects If GI upset

crosses the placenta and enters the breast milk (small amounts). Protein-binding: 20%. Metabolism: Co nverted to a limited extent to penicilloic acid. Excretion: Via the urine within 6 hr by glomerular filtration and tubular secretion (as penicilloic acid and 60% unchanged drug); via the feces. May be removed by haemodialysis; 1-1.5 hr (elimination halflife).

occurs, take with meals.

Drug

Mechanism of Action MEFENAMIC ACID is a nonsteroidal antiinflammatory drug (NSAID) that exhibits antiinflammatory, analgesic, and antipyretic activities in animal models. The mechanism of action of

Mefena mic Acid

Nursing Interventi on MEFENA Carefully MEFENAMIC Constipati If patient MIC consider the ACID is on; have had ACID is a potential contraindicated diarrhea; a member of benefits and in patients with dizziness; stomach the risks known gas; ulcer or fenamate of MEFENAM hypersensitivity headache; bleeding group of IC ACID and to mefenamic heartburn; tell nonsteroid other acid. MEFENA nausea; healthcar stomach al antitreatment MIC e inflammato options ACID should not upset. provider. ry drugs before be given to (NSAIDs). deciding to patients who

Classificati on

Indication

Contraindication

Side Effects

MEFENAMIC ACID, like that of other NSAIDs, is not completely understood but may be related to prostaglandin synthetase inhibition. Absorption:Mefena mic acid is rapidly absorbed after oral administration. In two 500-mg single oral dose studies, the mean extent of absorption was 30.5 mcg/hr/mL (17%CV).1,2 The bioavailability of the capsule relative to an IV dose or an oral solution has not been studied. Following a single 1-gram oral dose, mean peak plasma levels ranging from 10-20 mcg/mL3 have been reported. Peak plasma levels are attained in 2 to 4 hours and the elimination half-life approximates 2 hours. Following multiple doses, plasma levels are proportional to dose with no evidence of drug accumulation. In a multiple dose trial of normal adult subjects (n=6)

use MEFENAMIC ACID. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.

have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylacticlike reactions to NSAIDs have been reported in such patients MEFENAMIC For relief of ACID is mild to moderate pai contraindicated for the treatment n in patients 14 years of of peri-operative pain in the age, when setting of therapy will coronary artery not exceed one week (7 bypass graft (CABG) surgery days). MEFENAMIC For treatment ACID is contraindicated of primary dysmenorrhe in patients with acute active a. ulceration or chronic inflammation of either the upper or lower gastrointestinal tract. MEFENA MIC ACID should not be used in patients with preexisting renal disease.

Instruct patient to avoid alcohol (includes wine, beer, and liquor) when taking this medicine since it can cause increases in stomach irritation. Use caution if the patient has a weakene d heart. It may cause increased shortness of breath or weight gain. Then recomme nd to talk with healthcar e provider or its own physician. Avoid

receiving 1-gram doses of mefenamic acid four times daily, steady-state concentrations of 20 mcg/mL were reached on the second day of administration, consistent with the short half-life. The effect of food on the rate and extent of absorption of mefenamic acid has not been studied. Concomitant ingestion of antacids containing magnesium hydroxide has been shown to significantly increase the rate and extent of mefenamic acid absorption Distribution: Mefen amic acid has been reported as being greater than 90% bound to albumin.9 The relationship of unbound fraction to drug concentration has not been studied. The apparent volume of distribution (Vzss/F) estimated following a 500-mg oral dose of mefenamic acid was 1.06 L/kg.2 Based on its physical and chemical

aspirin, aspirincontainin g products, other pain medicine s, other blood thinners (warfarin, ticlopidine , clopidogr el), garlic, ginseng, ginkgo, and vitamin E while taking. Talk with healthcar e provider. If patient is allergic to any medicine, especially aspirin, or have asthma. Make sure to tell about the allergy and how it affected the patient by consultin

properties, MEFENA MIC ACID is expected to be excreted inhuman breast milk. Metabolism:Mefena mic acid is metabolized by cytochrome P450 enzyme CYP2C9 to 3-hydroxymethyl mefenamic acid (Metabolite l). Further oxidation to a 3carboxymefenamic acid (Metabolite ll) may occur.10 The activity of these metabolites has not been studied. The metabolites may undergo glucuronidation and mefenamic acid is also glucuronidated directly. A peak plasma level approximating 20 mcg/mL was observed at 3 hours for the hydroxy metabolite and its glucuronide (n=6) after a single 1-gram dose. Similarly, a peak plasma level of 8 mcg/mL was observed at 6-8 hours for the carboxy metabolite and its glucuronide. Excretion:Approxim ately fifty-two

g its attending physician

percent of a mefenamic acid dose is excreted into the urine primarily as glucuronides of mefenamic acid (6%), 3hydroxymefenamic acid (25%) and 3carboxymefenamic acid (21%). The fecal route of elimination accounts for up to 20% of the dose, mainly in the form of unconjugated 3carboxymefenamic acid.3 The elimination half-life of mefenamic acid is approximately two hours. Half-lives ofmetabolites I and II have not been precisely reported, but appear to be longer than the parent compound.3 The metabolites may accumulate in patients with renal or hepatic failure. The mefenamic acid glucuronide may bind irreversibly to plasma proteins. Because both renal and hepatic excretion are significant pathways of elimination, dosage adjustments in patients with renal or hepatic dysfunction.

Drug Ferrous Sulfate

Mechanism of Classification Indication Action Elavates the Iron Prevention serum iron preparation. and concentration treatment which then helps for iron to form High or deficiency. trapped Dietary reticuloendothelial supplement cells for storage for iron. and eventual conversion to a usable form of iron.

Contraindication Side effect Hypersensitivity Severe Hypotension

Nursing Intervention Dizziness Advised Dyspnea patient to Nasal take Congestion medicine if Muscle prescribed. cramps Caution Flushing patient to make a slow changing position to minimize orthostatic hypotension. Instruct patient to avoid drinking alcoholic beverages. Instruct client to consult the physician if he felt some irregular heartbeat, dyspnea, swelling of hand and feet.

Physical Assessment

General Appearance: Conscious, pale looking and sad face. Vital Signs: Temp; 36.0C PR:66bpm RR:21bpm BP: 100/70 Skull -Generally round, with prominences in the frontal and occipital area. (Normocephalic). -No tenderness. Scalp -Lighter in color than the complexion. -Free from lice, nits and dandruff. -No tenderness -No lesions Hair - Black in color -Evenly distributed covers the whole scalp. -Thick and smooth. Face -Rounded shape -Face is symmetrical. -No involuntary muscle movements. -Can move facial muscles at will. Ears -The upper connection of the ear lobe is parallel with the outer canthus of the eye. -Skin is same in color as in the complexion. -No lesions noted on inspection. -The auricles are has a firm cartilage on palpation. -The ear lobes are bean shaped, parallel and symmetrical Abdomen -Contour rounded -Respiratory movement. -Skin color is uniform, no lesions. -Client have striae -No venous engorgement. -Contour is rounded. -presence of linea nigra

Arellano University College of Nursing 2600 Legarda St. Sampaloc Manila

In Partial fulfillment Of The Requirement In Nursing Care Management 102 (RLE)

A Mini Case Study

Submittedby: Combis Pauline Marie B. BSN II-4 Group 12 Submitted to: Dr. Elaine Detera Clinical Area: Antipolo District Hospital

Discharge Planning

Breast- cleanse the breast with water only to prevent drying. Uterus- Continue to return to its normal size. Bladder- Encourage the client to go to the comfort room for evey 4-6 hours. Bowel- Encourage the patient to drink a lot of fluid and promote high fiber foods. Lochia- Report if theres still a lochial discharge progression. Episiotomy-Report if theres any pain and irregular bood flow. Sex-Avoid sexual intercourse 4-7weeks after giving birth. Homans Sign-Elevate legs to increase blood flow. Emotion- Encourage and support client in evaluating lifestyle,occupation and leisure activities.