TAGUM DOCTORS COLLEGE, INC.

Mahogany St. Rabe Subv., Visayan Village, Tagum City, Davao Del Norte

Bachelor of Science in Nursing

Presented to the Faculty of Bachelor of Science in Nursing In Partial Fulfillment of the

Requirements in Related Learning Experience 109:

Submitted to:

Cherry T. Cariaga, RN, MAN

Submitted by:

Julom, John Llyod Purca, Trisha

Lanoy, Dannah Hanica B. Rio, Hannah Mae J.

Lazaro, Jane Claire D. Rodriguez, Kharl Vaughn P.

Lepasana, Red B. Salada, Lou Jazrelle C.

Molina, Cyrille P. Sarmiento, Dan B.

Panganiban, Kyth Jennelle A.

APRIL 2025
 TABLE OF CONTENTS

Cover Page

Table of Contents 1

Acknowledgement 2

I. Introduction 3

II. Objectives 5

III. Patient’s Data & Family Background/Health History 7

IV. Developmental Data 10

V. Definition of Complete Diagnosis 17

VI. Physical Assessment 19

VII. Anatomy and Physiology 22

VIII. Etiology and Symptomatology 29

IX. Pathophysiology 36

X. Doctor’s Order 39

XI. Diagnostic Exam 63

XII. Drug Study 68

XIII. Surgical Procedure 142

XIV. Nursing Theories 146

XV. Nursing Care Plan 148

XVI. Discharge Plan (M.E.T.H.O.D) 157

XVII. Recommendation 159

XVIII. References 161

XIX. Curriculum Vitae 153

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 ACKNOWLEDGMENT

We give our utmost gratitude to the Lord for His continuous guidance and
blessings, allowing us to successfully complete this case study. His grace has provided
us with the strength, knowledge, and perseverance needed to accomplish this task.
We extend our sincere appreciation to our Clinical Instructor, Ma’am Cherry T.
Cariaga, RN, MAN, for her constant support, patience, and expertise. Her guidance
has been instrumental in refining our clinical knowledge and sharpening our critical
thinking skills. Her dedication and encouragement have inspired us to strive for
excellence in our studies.
Our heartfelt thanks also go to the staff of Medical Mission Group Hospital for
their assistance and warm hospitality during our clinical exposure. Their support has
greatly contributed to our practical learning experience.
We are also grateful to Tagum Doctors College Inc. for giving us the opportunity
to apply our knowledge in a real-world clinical setting, enhancing our understanding
and competence.
We deeply appreciate the unwavering support of our families, whose love,
sacrifices, and encouragement have made our academic journey possible. Their belief
in our capabilities has motivated us to persevere.
Finally, we commend the efforts, dedication, and cooperation of each group
member. Their hard work and commitment have been key to the successful completion
of this case study.

2
 I. INTRODUCTION

Preeclampsia is a pregnancy-related hypertension disorder characterized by

elevated blood pressure and organ dysfunction, mainly affecting the kidneys and liver.
It occurs after 20 weeks of gestation and poses significant risks to maternal and fetal
health. The World Health Organization states that it complicates 2% to 8% of
pregnancies globally, leading to maternal and neonatal morbidity and mortality (WHO,
2021). Unmanaged preeclampsia can lead to severe complications like eclampsia,
HELLP syndrome, preterm birth, and fetal growth restriction (ACOG, 2022). The exact
cause of preeclampsia is unclear, but research suggests a combination of genetic,
immunological, and environmental factors contribute to its development (Phipps et al.,
2021). Early detection through routine prenatal care, blood pressure monitoring, and
urine protein screening reduces the risk of severe complications (McLaughlin et al.,
2021). In severe cases, medical management includes antihypertensive therapy,
corticosteroids, and preterm delivery (Magee et al., 2022).
Globally, disparities in healthcare access contribute to variations in
preeclampsia outcomes. High-income countries report better maternal and neonatal
survival rates due to advanced medical interventions, while low-resource settings face
challenges such as late diagnosis, limited access to prenatal care, and inadequate
healthcare infrastructure. In Sub-Saharan Africa and South Asia, preeclampsia-related
complications account for a significant proportion of maternal deaths, emphasizing the
need for improved healthcare policies and interventions (Say et al., 2021).
In the Philippines, preeclampsia remains a major public health concern. The
Department of Health (DOH, 2022) reports that hypertensive disorders are among the
leading causes of maternal mortality, with preeclampsia contributing to a significant
number of pregnancy-related deaths. Despite efforts to improve maternal healthcare
through the Responsible Parenthood and Reproductive Health Act (RA 10354), many
women, particularly in rural areas, still experience delayed diagnosis and inadequate
management due to socioeconomic barriers and healthcare disparities (Fleming et al.,
2021).
Locally, in Tagum City, Davao del Norte, a regional report published by the
Philippine Statistics Authority in 2020 noted that hypertensive diseases during
pregnancy were commonly observed, particularly among women over 35 and those
with existing comorbidities. The region's healthcare system faces challenges due to

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resource limitations and accessibility to specialized maternal care, which affects the
early detection and management of preeclampsia, leading to an increased risk of
complications.
This study on preeclampsia aims to enhance understanding of its risk factors,
early warning signs, and management strategies to improve maternal and fetal
outcomes. By emphasizing the importance of prenatal care, patient education, and
timely medical interventions, the study seeks to contribute to reducing complications
associated with hypertensive disorders in pregnancy. Furthermore, the research
highlights the need for policy reforms and healthcare programs that can help prevent
maternal morbidity and mortality linked to preeclampsia. Through increased
awareness and improved medical strategies, this study ultimately aims to promote
safer pregnancies and better maternal health outcomes.

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 II. OBJECTIVES

General Objectives

This study aims to enhance the understanding of preeclampsia and its

implications in pregnancy, with a focus on improving clinical decision-making, early
detection, management strategies, and prevention of complications. The goal is to
equip healthcare professionals with the essential knowledge and competencies to
ensure better maternal and fetal outcomes.

Specific Objectives

COGNITIVE

• To describe the etiology, risk factors, and pathophysiological mechanisms

underlying preeclampsia.
• To identify the early warning signs, clinical manifestations, and diagnostic
criteria for preeclampsia.
• To evaluate the maternal and fetal complications associated with varying
degrees of preeclampsia.
• To analyze the clinical reasoning behind treatment modalities and delivery
planning in preeclamptic patients.
• To review existing guidelines and evidence-based protocols for the
management of preeclampsia.

PSYCHOMOTOR

• To assess and interpret clinical data, including blood pressure, proteinuria

levels, laboratory tests, and fetal monitoring parameters in patients with
preeclampsia.
• To observe and participate in the administration of antihypertensive therapies
and magnesium sulfate protocols.
• To assist in preparing and supporting emergency interventions and delivery
procedures in severe preeclampsia cases.
• To participate in or simulate clinical scenarios focused on the timely and
accurate management of preeclampsia.

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AFFECTIVE

• To recognize the emotional, psychological, and social effects of preeclampsia

on pregnant individuals and their families.
• To cultivate empathy, sensitivity, and effective communication when providing
care to patients with preeclampsia.
• To advocate for patient education, emotional support, and continuity of care for
those at risk or diagnosed with preeclampsia.
• To encourage interprofessional collaboration and respect in the management
of high-risk obstetric cases.
• To promote awareness about the long-term health implications of preeclampsia,
including cardiovascular risks postpartum.

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 III. PATIENT’S DATA & FAMILY BACKGROUND/HEALTH HISTORY

A. Biographical Data
• Patient’s Code Name: P.C
• Age: 30 years old
• Nationality: Filipino
• Civil Status: Single
• Sex: Female
• Height: 149.86 cm
• Weight: 74 kilograms
• BMI: 33 (Obese)
• Occupation: None
• Religion: Roman Catholic
• Educational Attainment: College Graduate
• Room or Bed Number: GYNE-WB ROOM 202
• Date of Admission: March 18, 2025 at 11:40 pm
• Date of Discharge: March 25, 2025
• Vital signs upon Admission:
BP- 180/110 mmHg HR- 89 bpm

T - 36.6 Degrees Celsius SPO2- 98%

RR- 21 cycles per minutes

HEALTH HISTORY

B. Chief Complaint

Ms. P.C arrived at the emergency room with the chief complaint of Arrest in
Cervical Dilatation, Elevated BP.

B. Admitting diagnosis:
G1, PU 39-40 weeks AOG, CIL, Arrest in Cervical dilatation, CPD to consider
preeclampsia with severe feature, Borderline Oligohydramnios, GDM – MNT
controlled, Amniotomy x (12hrs)

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C. Patient's Present History:
PUFT delivered by low segment cesarian section to a live baby boy Cephalic G1P1
(1001). Preeclampsia severe. Cesarian scar is noted on the abdomen is clean and dry
with no signs of infection, blood pressure remains stable and normal 120/80 mmHg,
no other significant complications noted.

Diet: Soft Diet

D. Patient's Past History:

History of hospitalization due to elevated blood pressure at Carmen Hospital on
March 15, 2025. Family history of hypertension at mother side. No known allergies
and other significant medical conditions.

F. Final Diagnosis:

FINAL Dx: PUFT Delivered by LSCS to a live baby boy, Cephalic G1P1 (1001)
AS: 5-6-8 birth weight 3.4kgs Ballard score 39 weeks, arrest of cervical dilatation and
descent CPD fetal distress, Oligohydramnios, preeclampsia severe.

● Surgical procedure performed if any (date and time performed)

Low segment cesarian section, March 18, 2025

● Attending Physician: Dr. M, RMT, MD

E. FAMILY BACKGROUND HISTORY

Ms. P.C, a 30year-old primigravida, residing in PRK 2A St Nino Carmen City
and Cohabiting with Mr J, a 35-year-old male, recently delivered her first newborn at
Medical Mission Group Hospital and Health Services Cooperative of Tagum.

Ms. P.C comes from a family with a history of hypertension, she is the eldest
among 4 siblings, consisting of three sisters and one youngest brother. Hypertension
is present in her maternal lineage, affecting her grandmother and Mother. Her father
is deceased, though the cause of death remains confidential. Other than hypertension,
no other heredity health issues have been reported in the family.

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GENOGRAM

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 IV. DEVELOPMENTAL DATA

Erik Erikson's Psychosocial Development Theory outlines eight stages that

extend from infancy to late adulthood. Each stage involves a distinct conflict between
two opposing forces, significantly influencing personality development. Successfully
navigating these conflicts leads to the cultivation of virtues like hope, will, purpose,
and integrity. Conversely, failure to resolve these challenges can lead to adverse
effects such as mistrust, guilt, role confusion, and despair.

STAGES ACTUAL FINDINGS JUSTIFICATION

Trust vs. Mistrust Patient P.C. was breastfed ACHIEVED
(Infancy) 0-1 year old until the age of three but
This stage is the foundation was unaware of the reason. Patient P.C.’s attachment to her
for future relationships and Patient P.C. is closer to her father and ability to be
emotional stability. If trust is father, as he was the only comforted indicate that her
established, the child will one who could successfully needs for security and trust
grow up feeling safe and comfort her. were met, aligning with
confident. However, if Erikson’s concept of developing
mistrust develops, they trust through consistent and
may struggle with anxiety responsive care.
and insecurity in
relationships.
Autonomy vs. Shame According to Patient P.C., NOT ACHIEVED
and Doubt (Early she cannot make decisions
Childhood) 1-3 years old on her own, even in simple Patient P.C.’s lack of decision-
matters like choosing what making opportunities and her
to wear, as her parents parents’ control over her
During this stage, children decide for her. She also choices suggest limited
build self-esteem and shared that when she cried, encouragement of
independence as they she was often left alone independence. Additionally,
learn to complete tasks on because she would being left to cry without
their own, preparing them eventually stop on her own. responsive support may have
for future challenges. contributed to feelings of doubt
However, excessive doubt in her abilities. This aligns with

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or shame can lead to low Erikson’s theory, where
confidence and reliance on excessive control and lack of
others in later life. autonomy can lead to shame
and doubt in one’s own actions.
Initiative vs. Guilt (Play Patient P.C. did not engage ACHIEVED
Age) 3-6 years old much in play, as she
prioritized household Despite having limited playtime,
In this stage, children chores over playing. Patient P.C. feels confident in
develop a sense of initiative However, her parents were taking initiative and participating
and purpose, but if emotionally and physically in activities without guilt, as she
discouraged from exploring supportive. Patient P.C. receives encouragement and
and taking risks, they may does not feel guilty about support from her parents. This
feel guilt and inadequacy. joining activities because aligns with Erikson’s theory,
she knows her parents will which emphasizes that a
support her. nurturing environment fosters a
sense of initiative and
confidence in exploring new
experiences.
Industry vs Inferiority Patient P.C. is an honor ACHIEVED
(School Age) 7-11 years student, though not
old consistently. She does not Patient P.C.’s perseverance in
compare herself to others academics, confidence in
In this stage, children or feel discouraged when teamwork, and positive social
develop competence and she does not receive relationships indicate a
confidence through honors, as she continues to developed sense of industry.
achievements. Support persevere. According to She demonstrates resilience
fosters self-esteem, while Patient P.C., she knows and a willingness to continue
criticism or unmet how to handle herself in working hard despite setbacks,
expectations may lead to teamwork situations and aligning with Erikson’s theory
inferiority and self-doubt. has a good relationship that success in this stage
with her friends. fosters a sense of competence
and productivity.
Identity vs. Role Patient P.C. originally ACHIEVED

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Confusion (Adolescence) dreamed of taking an
12-18 years old accounting program Despite not being able to
because math is her pursue her preferred course,
During this stage, favorite subject. However, Patient P.C. has accepted her
adolescents explore their she pursued education path and remains adaptable.
identity and values. instead, as her uncle, who Her ability to find meaning in her
Support fosters self- supports her studies, current situation, graduate
awareness, while lack of decided on her program. early, and maintain a positive
guidance may lead to role Although she felt hurt by outlook demonstrates a strong
confusion and uncertainty this, she chose to go with sense of self.
about their future. the flow, believing that
even with set goals, there
are times when they cannot
be fulfilled. Despite this,
she successfully graduated
from college at the age of
20.
Intimacy vs. Isolation Patient P.C. initially ACHIEVED
(Early Adulthood) 19-29 thought she was straight
years old but had a seven-year Patient P.C. demonstrates the
relationship with a lesbian ability to form deep and
In this stage, young adults at age 22. A year after her meaningful relationships, both
seek meaningful breakup, she entered a romantically and with her family.
relationships built on trust relationship with a man. In Her openness in
and intimacy. Success her current relationship, communication and strong
leads to strong emotional she and her partner openly emotional bonds align with
connections, while failure communicate to resolve Erikson’s concept of intimacy,
may result in isolation and issues. She is open with indicating a successful
loneliness. her family, especially her resolution of this stage.
mother, whom she became
closer to after her father’s
passing and considers her
main source of support.

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 Generativity vs. Patient P.C. does not feel ACHIEVED
Stagnation (Middle Age) stuck despite leaving her
30-64 years old job as a supermarket Patient P.C. demonstrates
cashier in Manila. She runs generativity by pursuing
In this stage, adults focus a small boutique that business growth and financial
on contributing to society continues to provide for her stability, showing productivity
through work, family, and financially and is focused and commitment to progress
community involvement. on improving their rather than stagnation.
Success leads to a sense business.
of purpose and fulfillment,
while failure may result in
stagnation, feeling
unproductive, and lacking
personal growth.

Jean Piaget's Cognitive Development Theory proposes that children

progress through four distinct stages, each marking an advancement in their thinking
and understanding. He emphasized that learning is an active process shaped by a
child's interactions with their surroundings, enabling them to build knowledge rather
than passively receive information. His theory has greatly influenced education and
psychology, stressing the significance of developmental readiness in learning.

STAGES ACTUAL FINDINGS JUSTIFICATION

Patient P.C. mentioned ACHIEVED

SENSORIMOTOR that, according to her
STAGE mother, she used to enjoy Patient P.C.’s behaviors
Age: 0 to 2 years old playing with Barbie dolls, demonstrate sensory exploration
following objects with her and motor development, aligning
Infants explore the world eyes, and placing toys in with Piaget’s sensorimotor stage,
through senses and her mouth. where infants learn through
actions, developing object touch, sight, and mouthing
permanence objects.
(understanding that

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objects exist even when
unseen).
Patient P.C. mentioned ACHIEVED
PREOPERATIONAL that, according to her
STAGE mother, she was able to Patient P.C.’s development of
Age: 2 to 7 years old speak short but complete language, engagement in pretend
sentences at the age of play, and preference for
Children use symbols and three. She enjoyed role- independent studying align with
language but struggle with playing games like Piaget’s preoperational stage,
logic and perspective- “mama-mama” and where children enhance symbolic
taking, showing “doctor-doctor” and thinking, imagination, and early
egocentric thinking. preferred to study alone. problem-solving skills.

Patient P.C. stated that ACHIEVED

CONCRETE her favorite subject is
OPERATIONAL STAGE math because she enjoys Patient P.C.’s interest in problem-
Age: 7 to 12 years old solving problems. She solving and finding ways to earn
also looks for ways to earn money shows her growing ability
Logical thinking develops, money by selling charcoal to think creatively, use her
allowing children to and vegetables from her imagination, and understand
understand conservation grandmother’s own store. basic math concepts like numbers
(objects remain the same and value.
despite changes in
appearance) and solve
concrete problems.
Patient P.C. provided ACHIEVED
FORMAL insightful and strategic
OPERATIONAL STAGE responses when asked Patient P.C.’s ability to think
Age: 12 to Over years how she handled her critically, reflect on her
teaching demo. She challenges, plan for future
Abstract and hypothetical reflects on ways to solutions, and assert her opinions
thinking emerges, improve her life, prays for demonstrates abstract reasoning
enabling problem-solving, solutions to her problems, and problem-solving skills, which

14
 reasoning, and planning and defends her opinions, are characteristics of the formal
for the future. believing they are better. operational stage.
Maslow’s Hierarchy of Needs is a psychological theory that outlines human
motivation through a sequence of needs. It proposes that individuals are driven by
various levels of necessities, beginning with basic survival needs and advancing to
higher goals like personal growth and self-actualization. According to Maslow, people
must first meet their essential needs before pursuing more complex psychological and
self-development objectives.

STAGES ACTUAL FINDINGS JUSTIFICATION

ACHIEVED
PHYSIOLOGICAL Patient P.C. eats three
NEEDS times a day, can still Patient P.C. demonstrates that
(breathing, food, water, purchase her basic needs, her basic physiological needs,
shelter, clothing, sleep) and does not think about such as food, shelter, and rest,
her problems when she are met, allowing her to focus on
goes to sleep. other aspects of her life without
being preoccupied by immediate
survival concerns.
NOT ACHIEVED
SAFETY AND SECURITY Patient P.C. mentioned
(health, employment, that they are living in her While Patient P.C. has basic
property, family and social mother’s house. They safety needs like shelter and
ability) have a mini boutique that some financial support, her
helps them financially, but ongoing concerns about financial
she still worries about stability and the uncertainty of
finances because there income from the boutique show
aren’t always many that she has not fully achieved a
customers. sense of security in this area.

ACHIEVED
LOVE AND BELONGING Patient P.C. receives
(friendship, family, emotional and financial Patient P.C. demonstrates strong

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intimacy, sense of support from her mother connections with her family,
connection) and sibling, as one of her receiving both emotional and
siblings provides financial financial support, which fulfills her
assistance. need for love, belonging, and
close relationships.
ACHIEVED
SELF-ESTEEM Patient P.C. has
(confidence, achievement, confidence in herself and Patient P.C.’s confidence in her
respect of others, the need is proud to have abilities and pride in her
to be a unique individual) completed her college accomplishments, such as
degree, even though her finishing college and having a
program was not her first child, reflect a strong sense of
choice. She is also proud self-esteem. She values her
of becoming a mother. personal achievements and
embraces her experiences.
NOT ACHIEVED
SELF-ACTUALIZATION Patient P.C. stated that
(morality, creativity, she is still aiming to Although Patient P.C. has goals
spontaneity, acceptance, become financially stable related to financial stability,
experience purpose, because she is still business growth, and
meaning, and inner struggling despite having homeownership, she has not yet
potential) a small boutique. She fully achieved these objectives,
hopes to improve and indicating that she is still working
stabilize her business and towards realizing her potential
eventually build a house. and fulfilling her self-actualization
needs.

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 V. DEFINITION OF COMPLETE DIAGNOSIS

Final Diagnosis:
PUFT Delivered by LSCS to a live baby boy, Cephalic G1P1 (1001) AS: 5-6-8
birth weight 3.4kgs Ballard score 39 weeks, arrest of cervical dilatation and descent
CPD fetal distress, Oligohydramnios, preeclampsia severe.
PUFT:
Pregnancy Uterine Full Term, A "full-term" pregnancy, from a uterine
perspective, refers to a pregnancy that has reached a duration of 39 to 40 weeks. This
period is considered optimal for fetal development and is associated with better health
outcomes for the baby.
LSCS:
This stands for "Lower Segment Cesarean Section", a surgical procedure to
deliver a baby through an incision in the lower part of the mother's abdomen. This is
often performed when vaginal delivery is deemed unsafe or impossible.
Cephalic:
This describes the baby's presentation during delivery, meaning the head was
positioned first in the birth canal.
G1P1 (1001):
This is a medical shorthand for the mother's obstetric history G: Gravida
(number of pregnancies) – 1, P: Para (number of live births) – 1 (1001): This refers to
the number of term deliveries (1), preterm deliveries (0), abortions (0), and living
children (1).
AS:
Apgar Score, a quick assessment of a newborn's health at 1 and 5 minutes
after birth. It evaluates five factors: appearance, pulse, grimace, activity and
respiration.
Ballard Score 39 Weeks:
The Ballard score is a method to estimate a baby's gestational age based on
physical characteristics. A score of 39 weeks suggests the baby was born at or near
full term.

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Arrest of Cervical Dilatation and Descent:
This indicates that the cervix, the opening of the uterus, was not dilating or the
baby was not descending through the birth canal as expected. This is often a reason
for a Cesarean section.
CPD fetal distress:
Cephalopelvic Disproportion, occurs when the baby's head is too large to fit
through the mother's pelvis. This can be due to a large baby, a small maternal pelvis,
or a combination of both. Fetal distress, on the other hand, refers to a baby not
receiving enough oxygen in the womb. This can be caused by placental problems,
umbilical cord issues, maternal health conditions, or labor complications.
Oligohydramnios:
This is a condition where there is a lack of amniotic fluid surrounding the baby
in the womb. This can be caused by various factors and can lead to complications like
fetal distress.
Preeclampsia Severe:
This is a serious pregnancy complication characterized by high blood pressure
and protein in the urine. It can affect both the mother and the baby and often
necessitates early delivery.

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 VI. PHYSICAL ASSESSMENT

Body System Expected Findings Actual Findings Rationale

General appearance Awake, alert and Awake, alert and Indicates intact
oriented to person, oriented to person neurological status and
place, and time. place, and time. normal mental
Speech is clear and Able to respond to functioning.
coherent. questions
appropriately.

Vital Signs BP:120/80mmHg BP: 130/100mmHg

Slightly elevated BP:
RR:12-20 bpm RR:19 bpm
130/90 monitor for PIH.
PR:60-100 cpm PR:89 cpm
Other vitals within normal
Temp:36.5-37.5°C Temp: 36.6℃
limits.
Spo:295% SpO.: 97%

Integumentary Skin is Presence of stretch Stretch marks are

smooth marks on the common postpartum due
without lesions. abdomen. Skin warm to skin stretching. No
Turgor <2 seconds. and dry. signs of infection
No swelling or Turgor<2 seconds. present.
redness. No redness or
swelling.

Eyes Pupils equal PERRLA Sclera Indicates normal eye

reactive to light and white conjunctiva function and no
accommodation. pink. No jaundice systemic issues like
Sclera white, noted. anemia or liver
conjunctiva pink. dysfunction.

Ear, Nose, Mouth Lips pink without Lips and mucosa pink, Reflects good hydration,
and Throat lesions gums pink moist. No no infections and normal
teeth intact. No lesions or discharge ENT status.
discharge from Tonsils not enlarged.
ears or nose.

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 No swallowing
difficulty.

Cardiovascular Regular rate and Indicates effective

Regular S1 and S2.
rhythm No murmur circulation and
No murmurs or extra
heaves, or thrills. absence of
sounds. No visible
cardiovascular
pulsations or edema.
compromise.

Neurologic Alert and oriented Patient responsive Suggests normal

Sensation and alert. No motor or brain function, no
motor sensory deficits. neurological deficits.
function Normal coordination.
intact.

Respiratory Clear breath Breath sounds clear Reflects normal lung

sounds. bilaterally. Chest function and no
Symmetrical chest expansion equal. RR respiratory distress.
expansion. No within normal range.
adventitious
sounds.

Abdomen Scaphoid soft, Post Cesarean And Healing surgical site

non-tender. Normal scar noted clean indicates good
bowel sounds. No and dry with no signs recovery Active
masses or of infection Presence bowel sounds confirm
organomegaly. of stretch marks. resumed GI function.
Bowel sounds active.
No tenderness or
distension.

Renal Normal urine No costovertebral Indicates no signs of

output, clear urine, angle tenderness, kidney inflammation,
no pain or non-palpable bladder distension, or
urinary tract issues.

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 tenderness over bladder, and no
the kidneys. bladder masses.

Musculoskeletal Full range of motion Moves all Indicates intact mobility

no pain or deformity. extremities with and no musculoskeletal
ease. No joint pain issues.
or swelling No
asymmetry

Genitourinary No lesions Genitalia without Suggests no infection or

discharge, or lesions or swelling. complications in the
tenderness. No foul No abnormal genital tract.
odor. discharge or
foul smell.

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 VII. ANATOMY AND PHYSIOLOGY

Preeclampsia is a pregnancy-related condition marked by high blood pressure

and organ dysfunction, usually after 20 weeks of gestation. It primarily affects the
cardiovascular and renal systems but can also involve the nervous, reproductive,
endocrine, and hematologic systems. In this case, the patient, a full-term primigravida,
was diagnosed with severe preeclampsia and underwent a cesarean section due to
arrest of labor, cephalopelvic disproportion (CPD), oligohydramnios, and fetal distress.
These complications are closely linked to preeclampsia, which causes poor blood flow
to the placenta, affecting both mother and fetus. Understanding the normal anatomy
and physiology of these systems helps explain how preeclampsia leads to multiple
complications during pregnancy and delivery.

CIRCULATORY SYSTEM

FIGURE 1: CIRCULATORY SYSTEM

The cardiovascular system, composed of the heart, blood vessels, and blood,
is essential for transporting oxygen and nutrients throughout the body. During
pregnancy, it adapts through increased blood volume and cardiac output to support
the developing fetus.
• Oxygen-poor blood returns from the body to the right atrium of the heart.
• Blood flows through the right side of the heart and is pumped to the lungs.
• In the lungs, blood picks up oxygen and releases carbon dioxide.

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• Oxygen-rich blood returns to the left atrium of the heart.
• Blood flows through the left side of the heart and is pumped out to the body.
• Blood reaches all organs, including the placenta to support the baby.
In preeclampsia, as in this case, these changes are disrupted by widespread
vasoconstriction, endothelial damage, and hormonal imbalances, leading to
hypertension and decreased organ perfusion. Hormones such as angiotensin II,
endothelin, and thromboxane become elevated, promoting vasoconstriction, while
vasodilators like prostacyclin and nitric oxide are reduced. These imbalances
contribute to placental hypoperfusion, resulting in fetal distress, oligohydramnios, and
arrest of labor, as seen in this patient. The cardiovascular strain caused by increased
vascular resistance and blood pressure can endanger both maternal and fetal health.

NERVOUS SYSTEM

FIGURE 2: NERVOUS
SYSTEM

The nervous system serves as the body's central command and communication
network. Comprising the brain, spinal cord, and extensive network of nerves, it
facilitates rapid communication throughout the body via electrical signals. This system

23
governs essential functions, including respiration, movement, speech, and sensory
perception. Furthermore, it continuously monitors both internal and external
environments, enabling the body to generate appropriate responses to various stimuli
and situations.
Central Nervous System (CNS)
• Includes the brain and spinal cord.
• Controls body functions, thought processes, and responses.
• In preeclampsia, high blood pressure can lead to cerebral edema, headaches,
visual disturbances, or even seizures (progression to eclampsia).
Autonomic Nervous System (ANS)
• Regulates involuntary functions such as blood pressure and heart rate.
• In preeclampsia, overstimulation of the sympathetic nervous system can cause
vasoconstriction, worsening hypertension.
Peripheral Nervous System (PNS)
• Connects the CNS to the rest of the body.
• May be indirectly affected in severe preeclampsia due to reduced perfusion and
oxygen supply to tissues.

ENDOCRINE SYSTEM

FIGURE 3: ENDOCRINE SYSTEM

The endocrine system is made up of glands that produce hormones to regulate

many body functions such as growth, metabolism, blood pressure, and pregnancy.

24
During pregnancy, hormones from the brain, ovaries, adrenal glands, and especially
the placenta play a major role in supporting the mother and baby. In this case, the
patient had severe preeclampsia, a condition linked to hormonal imbalance, poor
placental function, and high blood pressure. Understanding the role of the endocrine
system helps explain how hormone changes contribute to complications like fetal
distress and the need for cesarean delivery.
Hypothalamus and Pituitary Gland
• Control hormone release that maintains pregnancy.
• Regulate blood pressure through hormones like ADH (antidiuretic hormone)
and oxytocin.
• In preeclampsia, hormonal imbalance may affect fluid balance and uterine
contractions.
Adrenal Glands
• Produce aldosterone and cortisol.
• Aldosterone helps control blood pressure by managing sodium and water
balance.
• In preeclampsia, aldosterone levels may be dysregulated, contributing to fluid
retention and hypertension
Placenta (during pregnancy)
• Functions as an endocrine organ by producing hormones like hCG,
progesterone, estrogen, and placental growth factor (PlGF).
• In preeclampsia, placental hormone production is impaired, causing poor
placental perfusion and contributing to fetal distress
Ovaries
• Produce estrogen and progesterone, essential for maintaining pregnancy.
• Work together with the placenta early in gestation; hormonal imbalance may
affect pregnancy outcomes.

FEMALE REPRODUCTIVE SYSTEM

The female reproductive system plays a central role as the patient is a full-term
primigravida who underwent cesarean section due to complications during labor. The
reproductive system, which includes the uterus, cervix, ovaries, fallopian tubes, and
vagina, is responsible for supporting pregnancy and childbirth. During normal labor,
the uterus contracts and the cervix gradually dilates to allow for vaginal delivery.
25
 FIGURE 4: FEMALE
REPRODUCTIVE
SYSTEM

Uterus - Hollow, muscular organ where the fetus develops. During pregnancy,
it expands to support fetal growth. In this case, poor uteroplacental blood flow due to
preeclampsia contributed to fetal distress and oligohydramnios.
Cervix - Lower part of the uterus that opens during labor. Normally dilates to allow
vaginal delivery. The patient experienced arrest of cervical dilatation and descent,
leading to LSCS.
Placenta - Connects fetus to uterine wall for nutrient and gas exchange. In
preeclampsia, placental perfusion is reduced, affecting fetal oxygen and growth.
Ovaries - Produce eggs and pregnancy-related hormones (e.g., estrogen,
progesterone). Hormones help maintain the pregnancy and prepare the uterus.

INTEGUMENTARY SYSTEM
The outermost layer of your body is called your integumentary system. It is
composed of the glands and nerves on your skin, as well as your hair, nails, and skin.
Your body is physically shielded from bacteria, infections, injuries, and sunlight by your
integumentary system. It also enables you to experience hot and cold skin sensations
and aids in controlling your body temperature.

26
 FIGURE 5.1: INTEGUMENTARY
SYSTEM

Skin: The biggest organ, acting as a barrier against germs, injuries, and sunlight. It
also helps control your body temperature and lets you feel things like hot and cold. It
has three layers:
Epidermis: The top, waterproof layer that gives your skin its color.
Dermis: The thicker middle layer with sweat and oil glands, and where your hair
grows.

Hypodermis: The bottom, fatty layer

that helps keep you warm.

FIGURE 5.2 : LOWER SEGMENT

CESAREAN SECTION
PROCEDURE

A Lower Segment Cesarean Section (LSCS) is a surgical procedure used to

deliver a baby through an incision made in the lower part of the uterus. The doctor cuts
through the skin, muscles, and the lower part of the uterus to safely remove the baby.
This method is commonly used when a normal vaginal delivery is not safe, like in this
case where the mother had severe preeclampsia, fetal distress, and arrest of labor.
After the surgery, the body starts a natural healing process, including inflammation,

27
tissue repair, and scar formation. However, conditions like preeclampsia can slow
down healing because of poor blood flow and swelling, which is why careful monitoring
and wound care are important after delivery.

28
 VIII. ETIOLOGY AND SYMPTOMATOLOGY

"Etiology" is the study of the cause or origin of a disease, whereas

"symptomatology" is the collection of symptoms that a patient with a specific disease
exhibit; in other words, etiology is the "why" of a disease, and symptomatology is the
"what" of symptoms that arise as a result of that disease.

ETIOLOGY

PREDISPOSING ACTUAL FINDING IMPLICATION

FACTOR
Gender The patient is a female. Being female inherently places
Therefore, being individuals at risk for pregnancy-
female related conditions such as
places her at risk for preeclampsia. Pregnancy-
experiencing severe induced hypertensive disorders
preeclampsia are more common in females
due to hormonal and vascular
changes, which can increase
the likelihood of severe
preeclampsia. Regular
monitoring is important to detect
complications early.
Age The patient is 30 years Individuals around the age of 30
old are in a moderate-risk category
for developing preeclampsia.
While the condition is more
prevalent in younger teens and
older women (over 40), those in
their late 20s to early 30s still
remain at risk, especially if other
factors like obesity or pre-
existing hypertension are
present. Blood pressure

29
 monitoring is crucial throughout
the pregnancy.
Primigravidity The patient obstetric First pregnancies (primigravida)
history is are associated with a higher risk
of preeclampsia. The body is
G1 adjusting to placental
P1 development for the first time,
T1 which can lead to abnormal
P0 vascular changes and poor
A0 placental implantation. Close
L1 prenatal monitoring, including
blood pressure and urine protein
checks, is essential to prevent
complications and ensure
maternal and fetal health.
Genetic Inheritance Hypertension is a A family history of hypertension
known condition raises the patient’s likelihood of
among certain family developing high blood pressure,
members, including the heart conditions, and
grandfather, father, and pregnancy-related issues such
the patient. as pre-eclampsia. Genetic
influences on blood vessel
function, salt sensitivity, and
hormonal regulation highlight
the importance of early
monitoring and adopting healthy
lifestyle habits for effective
prevention and control.
Uncontrolled 130/100 Uncontrolled hypertension is a
hypertension major risk factor for developing
preeclampsia. Elevated blood
pressure prior to or during
pregnancy can lead to

30
 complications such as
preeclampsia, as it affects blood
flow to the placenta, leading to
poor fetal growth and other
maternal health issues.
Individuals with a history of
hypertension should receive
careful monitoring, appropriate
medication, and lifestyle
modifications to manage their
blood pressure and reduce the
risk of pregnancy complications.

Precipitating Factor ACTUAL FINDING IMPLICATION

Pregnancy The patient is pregnant Preeclampsia is a critical
condition that may lead to organ
damage, severe high blood
pressure, and potentially life-
threatening complications for
both the mother and baby. It
raises the risk of preterm
delivery, fetal growth restriction,
and stillbirth.
High stress levels The patient verbalized High stress levels during
“sige kog huna-huna pregnancy can increase the risk
ug problema, maong of complications such as
stress kaayo ko” preeclampsia. Stress activates
the body's sympathetic nervous
system, leading to elevated
blood pressure and vascular
resistance, which can impact
maternal and fetal health.
Chronic stress can also

31
 contribute to poor sleep,
unhealthy eating habits, and
other lifestyle factors that
exacerbate hypertension. Stress
management techniques like
relaxation, support systems, and
counseling are crucial for
reducing risks during pregnancy.
Poor nutrition Patient stated she only Poor nutrition, particularly
eats fruits and inadequate intake of essential
vegetables sometimes nutrients such as calcium,
protein, and vitamins, can
increase the risk of
preeclampsia. A poor diet can
lead to poor placental
development and affect maternal
blood pressure regulation.
Ensuring proper nutrition
through a balanced diet rich in
fruits, vegetables, lean proteins,
and whole grains is vital for a
healthy pregnancy and the
prevention of complications like
preeclampsia.
Lack of exercise or Patient stated that she A sedentary lifestyle during
physical activity during rarely engages in pregnancy can increase the risk
pregnancy physical activity due to of developing hypertension and
constant fatigue. preeclampsia. Physical activity
helps regulate blood pressure,
improves circulation, and
reduces stress. Regular,
moderate exercise, such as
walking or prenatal yoga, can

32
 improve maternal health, reduce
the risk of developing
preeclampsia, and support
overall well-being during
pregnancy.
Consuming too much Patient stated that she Excessive caffeine intake during
caffeine drinks caffeinated pregnancy can raise blood
beverages more than pressure and increase the
twice a day. likelihood of complications like
preeclampsia. Caffeine acts as a
stimulant that can cause the
blood vessels to constrict,
potentially leading to elevated
blood pressure. Pregnant
individuals should limit caffeine
consumption to safe levels to
avoid increasing the risk of
hypertensive disorders and
promote overall maternal and
fetal health.
SYMPTOMATOLOGY

SIGNS AND ACTUAL FINDINGS IMPLICATION

SYMPTOMS
HIGH BLOOD Blood pressure Elevated blood pressure is a key
PRESSURE recorded at 160/100 feature of preeclampsia and can
mmHg upon lead to poor perfusion of the
admission. placenta, reducing the oxygen
and nutrient supply to the fetus. It
also increases the risk of
maternal complications such as
stroke, heart failure, or kidney
damage. Continuous monitoring
of blood pressure is essential for

33
 early detection and intervention
to prevent progression to severe
preeclampsia or eclampsia.
SEVERE HEADACHE Patient verbalized Persistent, severe headaches
“Sigeg sakit akong ulo are often caused by increased
nga bisag unsa nga blood pressure in preeclampsia.
pahuway dili jud This can signify that the brain is
mawala maam” under stress, which could lead to
neurological complications such
as stroke or eclampsia if left
unmanaged. Severe headaches
are an early warning sign that
should prompt immediate
medical evaluation to prevent
further complications, including
cerebral hemorrhage.
Nausea and Vomiting patient verbalize "Pila Nausea and vomiting,
ka adlaw ko gina luod particularly in the second or third
ug naga suka, Maam" trimester, can be a sign of
worsening preeclampsia. This
symptom is often associated with
liver dysfunction or elevated
blood pressure affecting the
digestive system. If left
unaddressed, it can lead to
dehydration, poor nutrient intake,
and an increase in maternal and
fetal risks. Close monitoring of
fluid balance and nutrition is
needed to prevent further
complications.
Fatigue Patient verbalize Fatgue during preeclampsia can
“Usahay maka feel ko happen because the blood

34
nga kapoy bisag walay vessels become narrow
gibuhat ug walay gana (vasoconstriction), which slows
sa pagbuhat ug gamay down the blood flow. When this
nga trabaho” happens, less oxygen and
nutrients reach important organs
like the brain and muscles. Since
the body isn't getting enough
oxygen, it can lead to feeling
very tired or weak, even without
doing much.

35
IX. PATHOPHYSIOLOGY

36
37
38
 X. DOCTOR’S ORDER

DATE DOCTOR’S ORDER RATIONALE REMAR

ORDERED KS

3/18/2025 - Please admit Px to -The patient (Px) is admitted to the labor DONE
11:18 PM labor room room for continuous monitoring of
maternal and fetal well-being, timely
interventions, and safe delivery
management.
- vsq4 - Vital signs (VS) every 4 hours (VSq4) DONE
are necessary to monitor the patient’s
condition, detect early signs of
complications and ensure timely medical
intervention during labor.
- Monitoring intake and output (I&O) DONE
- Monitor I&o qshift every shift helps assess fluid balance,
detect dehydration or overload, and
guide appropriate interventions for
patient stability.
- Monitoring fetal heart tones (FHT) and DONE
fetal heart movements (FHM) ensures
- Monitor FHT, FHM fetal well-being, detects distress early,
and guides timely interventions for a safe
delivery.
-NPO (nothing by mouth) is ordered to DONE
prevent aspiration, reduce the risk of
- NPO complications during procedures, and
prepare the patient for possible surgical
intervention if needed.
- Intravenous fluid (PNSS 1L) at a keep DONE
- IVF PNSS 1L @ KVO vein open (KVO) rate maintains vein
rate patency, ensures hydration, and allows
quick administration of medications or

39
 emergency interventions.
- Attaching all lab results ensures a DONE
complete assessment of the patient’s
- Please attach all labs condition, aids in diagnosis, and guides
appropriate medical management.
-Paracetamol 500 mg every 6 hours as DONE
-Meds: needed (PRN) is given to relieve
Paracetamol 500g tab headache, reduce pain, and improve
q6 PRN for headache patient comfort without significant
gastrointestinal or cardiovascular side
effects.
- A complete blood count (CBC) with DONE
- For CBC with PC platelet count (PC) helps assess overall
health, detect infections, anemia, clotting
issues, and monitor the patient’s
condition during treatment.

3/18/2025 - Anesthesia Post OP - Post-operative anesthesia orders DONE

12:21 PM order ensure proper pain management, monitor
for complications, and support a smooth
recovery after surgery.
-Transferring the patient to the Post DONE
- To PACU then to Anesthesia Care Unit (PACU) allows for
room once fully awake close monitoring of vital signs and
recovery from anesthesia before ensuring
safe transfer to the room.
-NPO with sips of water prevents DONE
- NPO, may have sip of dehydration while minimizing the risk of
water aspiration, especially post-anesthesia or
before procedures.
-vsq5 mins x3 then - Frequent vital sign monitoring ensures DONE
q15 mins vs then early detection of complications allowing
q30mins x3 then q

40
hourly x3 then q4 timely intervention during the critical post-
operative or post-delivery period.
-IVF; PNSS 1L -PNSS 1L at 80cc/hr maintains hydration, DONE
@80cc/hr supports circulatory stability, and ensures
adequate fluid balance, especially post-
operatively or in cases of restricted oral
intake.
-Meds - The prescribed medications serve DONE
1. MagSO4 4g(4g essential roles in the patient’s
magSO4 +100cc management. Magnesium sulfate
pnss) to run 1L 20 (MagSO₄) is administered as a loading
units then dose followed by a maintenance infusion
Maintenance dose: to prevent and control seizures in
PNSS 1L +10g preeclampsia/eclampsia, requiring close
MagSO4 @1g run / monitoring for signs of toxicity such as
150cc/hr respiratory depression and loss of deep
Watch out for: tendon reflexes. Ketorolac, a nonsteroidal
-seizures (seizure anti-inflammatory drug (NSAID), is given
precaution) for moderate to severe pain relief,
- headache reducing inflammation without causing
-Abdominal pain sedation. Tramadol, a centrally acting
-magso4 toxicity opioid analgesic, is administered slowly
2. Ketorolac 30mg unit via IV to manage pain while minimizing
q6 side effects like nausea and dizziness.
3. Tramadol 50mg in Metoclopramide is used to prevent
10 units PNSS, slow IV nausea and vomiting, particularly from
q6 anesthesia or opioid use, while also
4. Metoclopramide promoting gastric motility. Ranitidine, a
10mg unit q8 histamine-2 receptor antagonist, helps
5. Ranitidine 50mg reduce gastric acid secretion, preventing
IVTT q8 ulcers and acid reflux, especially in
6. Ampicillin 2qm IVTT patients on NPO status. Lastly, ampicillin,
q6 a broad-spectrum antibiotic, is given to

41
 prevent or treat infections, particularly in
postpartum or post-surgical patients,
reducing the risk of maternal and
neonatal complications. Each of these
medications plays a crucial role in
ensuring patient safety, comfort, and
recovery.
-Monitoring intake and output (I&O) DONE
every shift helps assess fluid balance,
-I&O qshift detect dehydration or fluid overload, and
guide appropriate medical interventions
for optimal patient management
- Oxygen inhalation at 2–4 L/min
ensures adequate oxygenation, prevents DONE
- O2 inhalation (2- hypoxia, and supports respiratory
4L/min function, especially in patients with
compromised oxygen levels or at risk of
distress. DONE
- Keeping the patient flat in bed for 6
hours helps prevent complications such
- Flat on bed x 6 hours as hypotension, dizziness, or spinal
headache, especially after procedures
like spinal anesthesia or epidural
anesthesia. This position promotes
proper recovery and reduces the risk of
cerebrospinal fluid (CSF) leakage. DONE
- refer - Referral ensures that the patient
receives specialized care, further
evaluation, or appropriate management
from the relevant healthcare provider to
optimize treatment outcomes. DONE
-Repeating a complete blood count
-Rpt CBC,PC (CBC) and platelet count (PC) is essential

42
 for monitoring the patient’s overall
hematologic status, detecting potential
complications such as anemia, infection,
or thrombocytopenia, and assessing the
effectiveness of ongoing treatment. This
is particularly important in post-operative,
postpartum, or critically ill patients to
Dr. Gaviola- pedia ensure early identification of blood loss,
sepsis, or coagulation disorders, allowing
for timely medical interventions.

3/19/2025 - RBS stat post OR-CS - Checking random blood sugar (RBS) DONE
1:09 AM immediately after a cesarean section
(CS) helps assess blood glucose levels,
detect hypoglycemia or hyperglycemia,
and guide appropriate management,
especially in patients with gestational
diabetes, pre-existing diabetes, or stress-
induced hyperglycemia. Maintaining
stable glucose levels is crucial for optimal
post-operative recovery and wound
healing.

3/19/2025 - SOFT DIET - A soft diet is prescribed to facilitate easy DONE

digestion and prevent gastrointestinal
discomfort, especially after surgery,
childbirth, or medical conditions affecting
swallowing or digestion. It helps the
patient gradually transition to a regular
diet while reducing the risk of bloating,
nausea, or irritation.
-Administering PNSS (Plain Normal DONE
Saline Solution) at 80 drops per minute,
-IVF to 80 qtts PNSS to followed by PNSS at SRSF (Slow

43
follow at SRSF Regulated Standard Flow), ensures
adequate hydration, electrolyte balance,
and circulatory stability, especially in
post-operative or post-partum patients.
This helps prevent dehydration, maintain
perfusion, and support recovery, while
the regulated flow prevents fluid overload
and associated complications.
- DC Magso once - Discontinuing magnesium sulfate DONE
consume (MagSO₄) once fully administered
prevents excessive magnesium levels,
reducing the risk of toxicity (e.g.,
respiratory depression, loss of deep
tendon reflexes). It ensures that the
patient receives the necessary
therapeutic effect without complications.
- Discontinuing ranitidine, DONE
-Discontinue metoclopramide, and tramadol indicates
ranitidine, that the patient no longer requires gastric
metoclopramide, acid suppression, anti-nausea treatment,
tramadol or pain management with opioids. This
helps prevent unnecessary medication
use, potential side effects, and drug
interactions while ensuring patient safety
and promoting recovery.
- continue ketorolac for - Continuing ketorolac on a PRN basis DONE
PRN ensures effective pain management while
minimizing unnecessary medication use.
As a non-opioid analgesic, it helps control
moderate to severe pain with reduced risk
of sedation, respiratory depression, or
opioid dependence, supporting patient
comfort and recovery.

44
 - Continuing ampicillin at the same dose
- Continue ampicilin ensures ongoing infection prevention or DONE
same dose treatment, particularly in a post-cesarean
section (CS) patient, reducing the risk of
postoperative infections, sepsis, or
wound complications.
- Removing the Foley catheter helps
- May remove foley restore normal bladder function, reduces DONE
catheter the risk of urinary tract infections (UTIs),
and promotes early mobilization and
recovery, especially in a post-cesarean
section (CS) patient.
- Allowing the patient to ambulate
- May ambulate promotes circulation, prevents blood DONE
clots, enhances bowel function, and
supports overall recovery, especially after
a cesarean section (CS)
- Applying an abdominal binder provides
- Abdominal binder support to the surgical site, reduces pain DONE
please change and discomfort, and promotes proper
dressing then PRN posture and mobility after a cesarean
section (CS). Regular dressing changes
help prevent infection, promote wound
- DR. L Prudencio healing, and maintain hygiene, with PRN
changes ensuring timely intervention if
the dressing becomes soiled or loose.

3/19/2025 - May start mefenamic - Starting mefenamic acid 100mg TID DONE
12:50 PM acid 100mg tab TID provides effective non-opioid pain relief
and anti-inflammatory action, helping
manage post-cesarean section (CS) pain
while reducing the need for stronger
analgesics like opioids.

45
 - Dolcet (Tramadol + Paracetamol) is DONE
-Start Dolcet 1tab TID prescribed TID PRN for severe pain after
PRN for severe pain a cesarean section (CS), combining an
opioid analgesic (Tramadol) with a non-
opioid pain reliever (Paracetamol) for
effective pain management, reducing
inflammation while minimizing the need
for stronger opioids. DONE
- refer -Referral ensures that the patient
receives appropriate specialized care,
further evaluation, or medical
intervention, promoting optimal recovery
and preventing complications.

3/19/2025 - DC all IV - Stopping IV therapy signifies the patient DONE

1:28 PM can tolerate oral intake, reducing the risk
of IV-related complications while
supporting mobility and recovery.
-Diet as tolerated (DAT) allows for a DONE
- DAT gradual progression of oral intake based
on the patient’s tolerance and recovery,
ensuring adequate nutrition while
preventing gastrointestinal discomfort.
- Discharging the patient indicates stable DONE
- May go home vital signs, adequate pain control, normal
recovery progress, and no post-surgical
complications, ensuring safe transition to
home care.
- Continue meds at - Continuing Co-amoxiclav 625mg PO DONE
home BID ensures infection prevention by
⚫ Co-amoxiclab 6 providing broad-spectrum antibiotic
PO BID coverage, reducing the risk of
⚫ Mefenamic acid postoperative infections. Mefenamic acid

46
 500g PO for TID 500mg PO TID helps manage pain and
⚫ Losartan 50g inflammation after surgery, promoting
comfort and faster recovery. Losartan
50mg is maintained to control blood
pressure, preventing complications such
as hypertension-related stress on the
healing process.

3/19/2025 - MGH still in -The patient remains in MGH for DONE

7:00 PM continued monitoring, treatment, and
recovery support, ensuring stability and
preventing complications before
discharge.

3/20/2025 - Hold MGH - Delaying MGH discharge ensures DONE

8:30 AM continued monitoring, proper
management of ongoing concerns, and
prevention of complications, ensuring the
patient’s stability before discharge.
- CBC PC Chest X-ray -CBC and platelet count (PC) help assess DONE
PAC infection, anemia, or clotting
abnormalities, ensuring proper
postoperative recovery. A chest X-ray
evaluates lung status, detecting possible
post-surgical complications like
pneumonia or fluid accumulation. PAC
(Pre-Anesthesia Clearance) ensures the
- Refer to Dr. patient is fit for procedures requiring
Prudencio anesthesia, minimizing risks and
ensuring safety.

3/21/2025 - Furosemide 40mg IV -Administering furosemide 40mg IV now DONE

1:25 PM now provides rapid diuresis, helping manage
fluid overload, hypertension, or

47
 pulmonary congestion by promoting
excess fluid and sodium excretion,
preventing complications such as edema,
heart failure, or respiratory distress.
- I&O per void -Monitoring I&O per void in a post-CS DONE
postpartum patient ensures proper
bladder function recovery, detects urinary
retention or excessive fluid loss, and
helps assess for postpartum
complications like hemorrhage or
dehydration.
- Insert Fc it 4hrs w/o -Inserting a Foley catheter (FC) if there is DONE
urine output it okay no urine output for 4 hours helps assess
main service urinary retention, kidney function, and
fluid balance, preventing complications
such as bladder distention, post-surgical
urinary retention, or acute kidney injury.
This ensures proper monitoring and
management of the patient’s urinary
status in the main service.
- Moderate high back -Positioning the patient in a moderate DONE
rest high back rest improves lung expansion,
breathing, and circulation, reduces the
risk of atelectasis or aspiration, and
enhances comfort, especially post-CS, by
relieving pressure on the abdomen and
incision site
- refer accordingly - Referring accordingly ensures that the DONE
patient receives specialized care, further
evaluation, or necessary interventions
from the appropriate healthcare team,
promoting optimal recovery and
preventing complications.

48
3/21/2025 - Cefuroxime 750mg - Administering cefuroxime 750mg IV DONE
2:00 PM IV now now provides broad-spectrum antibiotic
coverage, preventing or treating
postoperative infections, especially in
post-cesarean section (CS) patients,
reducing the risk of wound infections,
endometritis, or sepsis.

3/21/2025 - PNSS to KVO - Keeping PNSS (Plain Normal Saline DONE

2:10 PM Solution) at KVO (Keep Vein Open) rate
ensures IV access is maintained for
medication administration or emergency
intervention, preventing vascular collapse
and ensuring hydration support if needed.

3/21/2025 - Suggest BT 1 unit -Suggesting 1 unit of PRBC (Packed Red DONE

5:00 PM prbc of patient Blood Cells) based on the patient’s blood
bloodtype type helps manage blood loss, anemia, or
to run for 4 hrs low hemoglobin levels, ensuring
adequate oxygen delivery to tissues.
Running it over 4 hours allows for safe
administration, reducing the risk of fluid
overload or transfusion reactions while
closely monitoring the patient’s response.
- Secure 1 unit PRBC -Securing 1 unit of PRBC ensures timely DONE
of patient bloodtype blood transfusion for managing anemia,
Therapeutics blood loss, or low hemoglobin levels,
improving oxygen delivery and tissue
perfusion. This supports postoperative
recovery and prevents complications
such as hypoxia or hemodynamic
instability.
-cefuroxime 750mg -Administering cefuroxime 750mg IVTT DONE
IVTT q8 every 8 hours provides broad-spectrum

49
 antibiotic coverage, preventing or treating
postoperative infections in a post-
cesarean section (CS) patient. It reduces
the risk of surgical site infections,
endometritis, and sepsis, ensuring a safe
recovery.
-hold ampicilin -Holding ampicillin prevents unnecessary DONE
antibiotic use, reduces the risk of
antibiotic resistance, adverse reactions,
and drug interactions, and ensures the
patient receives the most appropriate
antibiotic therapy, such as cefuroxime, for
optimal infection control.
-hold losartan 50mg IV -Holding losartan 50mg IV once daily DONE
OD for now temporarily prevents excessive blood
pressure reduction, which could lead to
hypotension, dizziness, or decreased
organ perfusion, especially in a
postoperative or hemodynamically
unstable patient. This allows for careful
monitoring and reassessment before
resuming antihypertensive therapy.
- ↓ Mefenamic acid - Reducing mefenamic acid 500mg IV to DONE
500mg IV to TID PRN TID PRN minimizes the risk of
for now gastrointestinal irritation, renal strain, or
excessive pain medication use, while still
providing adequate pain relief as needed.
This ensures safe dosing and better
tolerance for the patient.
- Hold co-amoxiclab -Holding Co-amoxiclav 625mg IV BID DONE
625mg IV BID for now prevents unnecessary antibiotic use,
reducing the risk of antibiotic resistance,
adverse effects, and drug interactions,

50
 while ensuring the patient receives the
most appropriate antibiotic therapy
based on current clinical needs.
- vitamin C + zinc tab -Supports wound healing, boosts DONE
OD immunity, and enhances iron absorption,
aiding in postoperative recovery and
infection prevention.
- FeSoy + FA tab OD -Helps replenish iron stores, prevent DONE
anemia, and support red blood cell
production, which is essential for
postpartum recovery and compensating
for blood loss during delivery.
-Furosemide 40mg -Administering furosemide 40mg IVTT DONE
IVTT q12 with BP every 12 hours promotes diuresis,
precaution helping manage fluid overload,
hypertension, or edema in post-surgical
or postpartum patients. BP precautions
are necessary to prevent hypotension,
electrolyte imbalances, and dehydration,
ensuring patient safety during treatment.
- Paracetamol 500mg - Administering paracetamol 500mg PRN DONE
PRN for headache for headache provides safe and effective
pain relief, reduces fever and discomfort,
and minimizes the need for stronger
analgesics, ensuring patient comfort
without significant side effects.
-Levodopropizine -Administering Levodropropizine DONE
(cevotics) 90mg IV (Cevotics) 90mg IV BID helps suppress
BID non-productive cough by acting as a
peripheral antitussive, reducing airway
irritation and discomfort without causing
central nervous system depression,

51
 ensuring better respiratory comfort and
recovery.
- Continue patient -Continuing patient management ensures DONE
management ongoing monitoring, treatment, and
necessary interventions, promoting
optimal recovery, preventing
complications, and addressing any
emerging health concerns to ensure
patient stability and well-being.
- WOF unusuality -Watching out for unusualities (WOF) DONE
allows for early detection of
complications, such as infection,
-thank you hemorrhage, vital sign instability, or
-Dr. Prudencio adverse drug reactions, ensuring timely
intervention and improved patient
outcomes.

3/21/2025 -Ok for blood -Approving blood transfusion ensures DONE

7:00PM transfusion adequate oxygen delivery, corrects
anemia, and stabilizes hemodynamic
status, especially in cases of significant
blood loss or low hemoglobin levels,
promoting optimal recovery and
preventing complications.

3/21/2025 - Furisemide 40mg -Giving furosemide 40mg IVTT after DONE

7:30: PM IVTT POST BT blood transfusion helps prevent fluid
overload, especially in patients prone to
heart failure or pulmonary edema, by
promoting diuresis and maintaining
optimal fluid balance for a safe
transfusion process.

3/21/2025 - Schedule for 2D echo - Scheduling a 2D echocardiogram for a DONE

52
9:30 PM post-cesarean section (CS) patient helps
assess cardiac function, fluid status, and
potential postpartum complications such
as pulmonary edema, hypertension-
related cardiac strain, or underlying heart
conditions. This ensures early detection
and appropriate management for optimal
recovery
- no antiplatelet for -Holding antiplatelet therapy postpartum DONE
now considering reduces the risk of excessive bleeding or
postpartum postpartum hemorrhage, as coagulation
changes during pregnancy and delivery
increase bleeding susceptibility. This
ensures patient safety while monitoring
for stability before resuming therapy if
needed.
- Cardiomyopathy vs -cardiomyopathy from Type 2 ACS DONE
type 2 ACS sec to secondary to anemia is essential for
anemia proper diagnosis and management.
Cardiomyopathy affects heart structure
and function, while Type 2 ACS results
from oxygen supply-demand imbalance
due to anemia, causing myocardial
ischemia. Accurate assessment through
echocardiography, cardiac markers, and
clinical evaluation ensures targeted
treatment and complication prevention.
- please refer to cardio -Referral to Dr. Golea’s cardio service DONE
service of Dr. Golea’s ensures specialized evaluation and
choice management of potential postpartum
cardiac complications, allowing for timely
intervention and optimal care.

53
 - Transfer to ICU for -ICU transfer allows close monitoring and DONE
monitoring immediate intervention for potential
complications.

3/21/2025 - Refer to Dr. Llanos -Referral to Dr. Llanos ensures DONE

10:00 PM - Transfer to ICU specialized assessment and
management, while ICU transfer allows
for close monitoring and immediate
intervention for potential postpartum
complications.

3/21/2025 - Give MagSO 1g + -Administering MagSO₄ 1g + 10mL PNSS DONE

11:20 PM 10pnss via slow IVTT via slow IVTT push (3-5 min) helps
push in 3-5 minutes prevent and control seizures in
postpartum patients at risk for eclampsia,
ensuring safe administration to avoid
toxicity. DONE
- start trimag tab TID -Starting Trimag tablet TID helps maintain
magnesium levels, support
neuromuscular function, and prevent
deficiency-related complications.

3/22/2025 - Give nicardipine 2mg -Administering nicardipine 2mg IVTT now DONE
6:19 AM IVTT now helps rapidly lower blood pressure in
cases of severe hypertension, reducing
the risk of stroke, eclampsia, or organ
damage, while ensuring controlled and
safe BP reduction

3/22/2025 - Start losartan -Starting losartan 50mg now, then once DONE
9:09 AM 50mg/tab now then daily (OD) helps control hypertension,
OD reduce cardiac workload, and prevent
postpartum complications such as stroke,
heart failure, or kidney damage, ensuring

54
 long-term blood pressure management.

3/22/2025 - Continue meds -Continuing medications ensures ongoing DONE

11: 05 AM treatment effectiveness, symptom
management, and prevention of
complications, supporting optimal
recovery and stable postpartum health.

3/22/2025 - Nicardipine 2mg Nicardipine 2mg IVTT now provides rapid DONE
1:31 PM IVTT now blood pressure control in cases of severe
hypertension, reducing the risk of stroke,
eclampsia, or organ damage.
- Start amlodipine 5mg - Starting amlodipine 5mg OD ensures DONE
tab OD long-term blood pressure management,
preventing hypertensive complications
and promoting cardiovascular stability
postpartum.

3/22/2025 - Start nicardipine drip; Starting a nicardipine drip (10mg + DONE

3:54 PM 10mg pluss 100cc 100cc PNSS, initial rate 10cc/hr,
pnss X 10cc/hr, increasing by 5cc/hr every 15 min until
increase increment of BP reaches 150/90 mmHg) allows for
5cc/hr q15min to controlled and gradual blood pressure
achieve BP reduction, minimizing the risk of sudden
150/90mmHg hypotension while effectively managing
severe hypertension.
- Hold amlodipine for - Holding amlodipine for now prevents DONE
now excessive BP lowering while titrating
nicardipine, ensuring safe and
responsive hypertension management.

3/22/2025 - IVF PNSS 1L @ KVO -Maintaining IVF PNSS 1L at KVO rate DONE
4:21 PM rate ensures adequate hydration and venous
- VSQ4 access for medication administration.
- I&O qshift and record Monitoring vital signs every 4 hours

55
 (VSQ4) allows for early detection of
complications, while tracking intake and
output (I&O) every shift helps assess fluid
balance, kidney function, and overall
hemodynamic stability, ensuring proper
postpartum recovery.
- Please facilitate 2D -Facilitating 2D echo and IVT - ProBNP in DONE
echo For IVT - a post-cesarean section (CS) patient
PROBNP helps evaluate cardiac function, fluid
balance, and potential postpartum
complications like hypertension-related
heart strain or heart failure, ensuring
timely diagnosis and management.
-Additional medication -Administering pantoprazole prevents DONE
Pantoprazole 40mg gastric irritation and stress ulcers, while
IVTT ODAC trimetazidine and ISDN support cardiac
Trimetazidine 35mg IM function and reduce workload, essential
BID for postpartum recovery, especially in
ISDN 5mg hypertensive or cardiac-compromised
Senokot forte IM patients. Senokot Forte aids in bowel
movement, preventing postpartum
constipation caused by reduced mobility
and medications.
- Please facilitate BT of -Facilitating 1 unit PRBC transfusion once DONE
1 unit PRBC of SBP ≤ 140 mmHg helps restore
patient blood type to hemoglobin levels, improve oxygen
run for 4 hours once delivery, and prevent anemia-related
SBP ≤ 140 mmHg complications, while ensuring safe
administration by avoiding hypertensive
risks.
- Continue titration of -Continuing nicardipine drip titration DONE
nicardipine drip allows for controlled blood pressure
management, ensuring a gradual

56
 reduction to the target BP while
preventing sudden hypotension or
hypertensive complications.
- Repeat CBC PIT S K -Repeating CBC, PIT, S, and K post-BT DONE
6hrs post BT ensures effective transfusion, monitors
blood counts, and detects imbalances or
reactions.
- May give norgesic -Administering Norgesic Forte TID PRN DONE
forte tab now TID for headache provides pain relief and
PRN for headache muscle relaxation, helping alleviate
postpartum tension headaches and
musculoskeletal discomfort.
- continue meds and -Continuing medications and DONE
management management ensures ongoing treatment
- WOF unusuallity & effectiveness and recovery support.
refer Watching out for unusual signs (WOF)
and referring as needed allows for early
detection and prompt intervention in case
of complications.
- May DIC nicardipine -Discontinuing nicardipine drip if SBP DONE
drip if SBP remains <140 mmHg for 2 hours prevents
persistently < excessive blood pressure lowering,
140mmHg X 2hours reducing the risk of hypotension and
associated complications while
maintaining hemodynamic stability.

3/22/2025 LABS: for TSH FT3, -Testing TSH, FT3, and FT4 helps assess DONE
7 :12 PM FT4 thyroid function, which can impact
- S/F 2D echo postpartum recovery, cardiovascular
status, and metabolism. A 2D echo
evaluates cardiac function, detecting
potential postpartum cardiovascular
complications for timely management.

57
 - Nicardipine drip to -Titrating nicardipine drip to 15 gtts/min DONE
15qtts to titrate to ensures controlled BP reduction,
effect to even BP maintaining a target of 150/90 mmHg to
150/90mmHg prevent hypertensive complications.
- Facilitate BT Facilitating blood transfusion (BT) helps
correct anemia, improve oxygen delivery,
and support overall recovery.
- MEDS -Paracetamol 300mg IV provides pain DONE
Paracetamol 300mg IV and fever relief, while Diphenhydramine
Diphydramine 25g IV 25mg IV helps manage allergic reactions
Hydrocoutine 100g IV or hypersensitivity. Hydrocortisone
- Post BT 100mg IV reduces inflammation and
Furocide 40g IV prevents transfusion-related reactions.
-Magso4 drip; 2mg + Post-BT Furosemide 40mg IV promotes
200cc D5W x 24hrs diuresis, preventing fluid overload after
transfusion. Magnesium sulfate
(MagSO₄) drip (2g + 200cc D5W over
24hrs) helps prevent seizures in at-risk
postpartum patients and maintains
magnesium balance.

3/22/2025 - IVF to follow same -Continuing IV fluids at the same rate DONE
8:00 PM fluid & rate ensures adequate hydration and
-refer hemodynamic stability, while referral
allows for specialized assessment and
timely intervention if complications arise.

3/23/2025 - Rounds for Dr. -Rounds with Dr. Prudencio ensure DONE
12:30 NN Prudencio proper evaluation and management
- Suggest to start updates. Starting Bisoprolol 5mg
bisoprolol( biscore) (Biscore) only with cardiology clearance
5mg 1tab if only with helps control heart rate and blood
cardio service pressure, reducing cardiac workload and
preventing postpartum cardiovascular

58
 complications.
- Facilitate repeat CBC -Repeating CBC and platelet count 6 DONE
platelet 6hrs post BT hours post-BT helps assess transfusion
effectiveness, monitor hemoglobin levels,
and detect potential transfusion-related
reactions or platelet abnormalities.
- ↓O2 to PRN to -Adjusting O₂ to PRN helps maintain DONE
maintain O2 sat ≥ 95% saturation ≥ 95%, ensuring adequate
oxygenation while preventing
unnecessary oxygen use and
dependency.
- ↓ Furoscimide to -Reducing furosemide to 40mg IVTT OD DONE
40mg IVTT OD w/ BP helps manage fluid balance while
precaution minimizing excessive diuresis, with BP
precautions to prevent hypotension and
electrolyte imbalances.
- Facilitate 2D echo -Scheduling a 2D echo for tomorrow DONE
tomorrow enables timely evaluation of cardiac
function, aiding in the early detection and
management of postpartum
cardiovascular concerns.
- Continue med and -Continuing medications and DONE
management management ensures ongoing treatment
- WOF unusuality & efficacy and recovery support. Monitoring
refer for unusual signs (WOF) and referring as
needed allows for early detection and
prompt intervention in case of
complications.

3/23/2025 - To consume -Consuming the nicardipine drip ensures DONE

5:09 PM nicardipine drip continuous blood pressure control,
preventing hypertensive complications
and maintaining hemodynamic stability.

59
 - Bisoprolol 5mg 1 tab -Bisoprolol 5mg OD helps control heart DONE
OD rate and blood pressure, reducing cardiac
workload and preventing hypertension-
related complications, especially in
postpartum patients with cardiovascular
concerns.
-Catapres 75mg 1tab -Catapres 75mg 1 tab OD PRN for BP DONE
OD PRN for BP >140/90 mmHg helps manage
>140/90mmHG postpartum hypertension in Cesarean
section (CS) patients, preventing
hypertensive complications like
preeclampsia, stroke, or cardiac strain,
while ensuring safe, controlled BP
regulation.
- Continue meds -Continuing medications ensures ongoing DONE
- Facilitate 2D echo treatment effectiveness, while facilitating
- Refer accordingly a 2D echo aids in cardiac assessment.
- [Link] Referral to Dr. Pelegrino allows for
specialized evaluation and appropriate
management.

3/24/2024 - Rounds for Dr. -Rounds with Dr. Prudencio ensure DONE
10:55 AM Prudencio proper monitoring, assessment, and
adjustment of the patient’s post-CS
management plan, addressing any
concerns or complications promptly.
- IVF TF: PNSS 1L -Keeping PNSS at KVO rate maintains DONE
@KVO rate hydration and IV access, while facilitating
- Still for 2D echo today today’s 2D echo ensures prompt cardiac
please facilitate assessment for potential postpartum
complications. DONE
- Repeat chest x-ray -Repeating a chest X-ray (PA view) helps
PA assess lung status and detect any post-

60
 - Repeat serum CS complications such as fluid overload
magnesium or infection. Checking serum magnesium
levels ensures adequate magnesium
levels, especially if on MagSO₄ therapy, DONE
to prevent toxicity or deficiency-related
complications.
- Continue meds -Continuing medications ensures ongoing
- refer accordingly treatment and recovery, while referring
-Dr. Prudencio accordingly allows for specialized care
and timely intervention if complications
arise.

3/25/2025 - Delay 2D echo result -Delaying the 2D echo result review until DONE
10:08 AM once available available ensures accurate assessment
and clinical correlation, allowing for
informed decision-making in the patient’s
management.

3/25/2025 - Mgh anytime from -Discharge anytime from MCU service DONE
2:15 PM MCU service indicates that the patient is stable, has
completed necessary post-CS
management, and is fit for home care,
ensuring a safe transition with continued
outpatient monitoring if needed.
- Home meds -Sultamicillin 750mg BID after meals DONE
Sultamicillin 750 helps prevent and treat postpartum
2x/day after meal infections, ensuring effective bacterial
coverage while reducing gastrointestinal
side effects by taking it with food.
- Advice to come for -Advising a follow-up check-up ensures DONE
follow up check up proper monitoring of post-CS recovery,
early detection of complications, and
assessment of wound healing, infection,
or other postpartum concerns.

61
3/25/2025 - MGH
2:15 PM - Home meds -Bisoprolol 5mg OD helps control blood DONE
Bisoprolol 5mg 1tab , pressure and reduce cardiac workload.
tab OD
- Xerox all labs - Xeroxing all labs ensures proper DONE
documentation and continuity of care.

- A low-salt, low-fat diet supports heart

-low salt low fat diet DONE
health and prevents hypertension or fluid
-Advised.
retention. Follow-up is advised to
monitor post-CS recovery and overall
well-being.

62
 XI. DIAGNOSTIC EXAM

HEMATOLOGY
Name: P,C,O Age/ Gender:30/F Analysis Date: 3/19/25 12:57am
TEST Normal Values Result Interpretation
Hemoglobin F: 12.0 - 16.0 g/dL 11.9 Low – Mild anemia. Could be due
to blood loss (e.g., from delivery or
surgery), iron deficiency, or chronic
disease.
Leukocytes F: 4-10 x 10 9/L 12.89 High – Suggests possible infection,
inflammation, stress response, or
post-operative condition.
Erythrocytes F: 4.0-5.4 x 10 12/L 4.30 Normal
Neutrophils 55-65% 89 High – Suggest possible bacterial
infection, acute inflammation, or
stress (possibly related to delivery
or post-op infection).
Lymphocytes 25-35% 5 Low – Possible due to acute
infection, stress response, or
corticosteroid effect.
Monocytes 4-12% 5 Normal
Eosinophils 2-4% 1 Low – Possible due to acute stress
or infection; not concerning on its
own but supports the overall
inflammatory pattern.
Packed cell volume F: 37-43% 39.2 Normal
(Hct)
Thrombocytes 150-400 x 10 9/L 197 Normal
MCV (MEAN 80-100 fl 91.2 Normal
CORPUSCULAR
VOLUME)
MCH (MEAN 27-34 pg 27.7 Normal
CORPUSCULAR

63
HEMOGLOBIN)
MCHC (MEAN 32-36 g/dl 30.3 Low – Suggests hypochromia; may
CORPUSCULAR be linked to iron deficiency anemia.
HEMOGLOBIN
CONCENTRATION)

HEMATOLOGY
3/21/25 2:22pm
Test Normal Values Results Interpretation
Hemoglobin F: 12.0 - 16.0 g/dl 9.1 Low – Anemia, possibly due to
blood loss (perioperative or
antepartum), nutritional deficiency,
or chronic disease (e.g., PUD or
preeclampsia)
Leukocytes F: 4-10 x 10 9/L 8.38 NORMAL
Erythrocytes F: 4.0-5.4 x 10 12/L 3.26 Low – Consistent with anemia,
likely normocytic
Neutrophils 55-65% 73 Elevated – Neutrophilia, possibly
reactive to inflammation, infection
(e.g., RTI), or post-surgical stress
Lymphocytes 25-35% 15 Low – Lymphocytopenia, likely due
to physiological stress or systemic
inflammation
Monocytes 4-12% 8 NORMAL
Eosinophils 2-4% 4 NORMAL
Packed cell volume F: 37-43% 30.1 Low – Anemia, reflects decreased
(Hct) oxygen-carrying capacity
Thrombocytes 150-400 x 10 9/L 206 NORMAL
MCV (MEAN 80-100 fl 92.4 NORMAL
CORPUSCULAR
VOLUME)
MCH (MEAN 27-34 pg 27.9 NORMAL

64
CORPUSCULAR
HEMOGLOBIN)

MCHC (MEAN 32-36 g/dl 30.2 Low – Mild hypochromia,

CORPUSCULAR borderline; may point to chronic
HEMOGLOBIN anemia or volume changes
CONCENTRATION)

MISCELLANEOUS
3/21/25 09:15pm
TEST REFERENCE RESULT INTERPRETATION
RANGE
Troponin I (TOSOH) <0.06 ng/ ml 0.15 ng/ml Elevated – Suggestive of
myocardial strain or injury. In the
context of severe preeclampsia,
this could reflect cardiac strain, left
ventricular dysfunction, or
microvascular ischemia

BLOOD CHEMISTRY
3/21/25 8:53pm
TEST NORNAL VALUES RESULT IMPLICATION
CREATININE F: 53-97 umol/L 65.15 NORMAL
MAGNESIUM 0.7-1.0 mmol/L 0.66 Low – Hypomagnesemia; may
contribute to muscle cramps,
arrhythmias, or worsen
preeclampsia
SODIUM 135-155 mmol/L 142.34 NORMAL
POTASSIUM 3.4-5.3 mmol/L 3.78 NORMAL
CALCIUM 1.03-1.32mmol/L 1.31 NORMAL

65
 MISCELLANEOUS
3/22/25 10:19pm
TEST NORMAL VALUES RESULT INTERPRETATION
FT3 (TOSOH) 2.17-3.34 pg/ml 2.28 pg/ml Normal
FT4 (VIDAS) Euthyroidism 9-20 9.64 pmol/L Normal
pmol/L
Hyperthyroidism >24
pmol/L
Hypothyroidism <8
pmol/L
TSH (TOSOH) 0.38-4.3 uIU/ml 7.457 uIU/ml Elevated TSH with normal FT4
suggests Subclinical
Hypothyroidism. May require
monitoring postpartum or treatment
if symptomatic.

IMMUNOLOGY
3/23/25 9:19am
TEST NORMAL VALUES RESULT INTERPRETATION
Pro-BNP <125 pg/mL 3982.23 Elevated – Indicates ventricular
strain or heart failure. In context of
severe preeclampsia, this suggests
possible volume overload, cardiac
stress, or early peripartum
cardiomyopathy. Requires cardiac
evaluation.

HEMATOLOGY
3/23/25 9:225pm
TEST NORMAL VALUES RESULT INTERPRETATION
Hemoglobin F: 12.0-16.0 g/dl 13.7 Normal
Leucocytes F: 4-10 x 10 9/L 12.16 HIGH- May indicate infection,
inflammation, stress, or other

66
 underlying condition.
Erythrocytes F: 4.0-5.4 x 10 12/L 4.81 Normal
Neuthrophils 55-65% 86 HIGH- Suggests bacterial infection
or inflammation.
Lymphocytes 25-35% 10 LOW- Can occur in stress,
infection, or immune suppression.
Monocytes 4-12% 3 Slightly low- May be insignificant,
but could also be a response to
acute infection.
Eosinophils 2-4% 1 LOW- Often seen in acute bacterial
infections or stress conditions.
Packed Cell F: 37-43% 43.0 Normal
Volume (Hct)
Thrombocytes 150-400 x 10 9/L 346 Normal
MCV (MEAN 80-100 fl 89.4 Normal
CORPUSCULAR
VOLUME)

MCH (MEAN 27-34 pg 28.5 Normal

CORPUSCULAR
HEMOGLOBIN)

MCHC (MEAN 32-36 g/dl 31.9 Slightly low- May suggest early
CORPUSCULAR hypochromia or borderline iron
HEMOGLOBIN deficiency. Monitor if symptomatic.
CONCENTRATIO
N)

BLOOD CHEMISTRY
2/23/25 10:47pm
TEST NORMAL VALUES RESULT INTERPRETATION
POTASSIUM 3.4-5.3 mmol/L 3.70 Normal

67
 XII. DRUG STUDY

Name of Drawing Classificati Dosage/ Indication Mechanism Side Nursing Responsibilities

Drug on Time of Action Effects
/Route
Generic Pharmacol Dosage: For the Works by [Link], Before Administration
Name: ogic Class: 5mg management selectively 2. Dizziness [Link] rapport with the patient
Bisoprolol Beta- (tablet) of blocking beta- or • Explain the purpose of the medication
Fumarate Blocker hypertension, 1 adrenergic Lightheaded and ensure cooperation.
(specifically the treatment receptors in ness, [Link] the 5 rights of medication
, a selective Time: OD of heart failure, the heart, 3. administration (Right Patient, Drug, Dose,
beta-1 (once and the leading to a Bradycardia Time, Route).
adrenergic daily) reduction of the decrease in (slow heart • Prevents medication errors and ensures
antagonist) risk of heart rate and rate) patient safety.
Brand cardiovascular contractility, [Link] 3. Review the patient's medical history,
Name: Therapeutic Route: events in which hands and including any history of asthma,
Concor Class: Oral patients with ultimately feet heart block, or other cardiovascular
Antihyperte coronary artery reduces [Link] or conditions.
nsive and disease. blood gastrointesti R: Understanding the patient's
antianginal pressure and nal medical background helps identify
agent improves discomfort contraindications and assess the
heart function [Link] appropriateness of bisoprolol

68
in patients of breath therapy.
with [Link] 4. Measure and document baseline
hypertension disturbance blood pressure and heart rate.
and heart s R: Establishing baseline values is
failure. [Link] crucial for monitoring the drug's
n or mood effects and detecting any adverse
changes reactions.
5. Inform the patient about the purpose
of bisoprolol, potential side effects,
and the importance of adherence to
the prescribed regimen.
R: Patient education promotes
understanding, compliance, and
proactive reporting of side effects.
6. Review the patient's current
medications for potential interactions
with bisoprolol.
R: Identifying drug interactions can
prevent adverse effects and ensure
safe medication administration.
During Administration

69
 7. Ensure the medication is given at the
correct dose and time, following the
prescribed route (oral).
R: Adherence to the prescribed
regimen is essential for effective
treatment and minimizing risks.
8. Continuously assess blood pressure
and heart rate during administration,
especially if given intravenously or in
a new setting.
R: Bisoprolol can cause bradycardia
and hypotension; monitoring
ensures patient safety and allows for
timely intervention if needed.
9. Watch for any immediate side effects,
such as dizziness, fatigue, or
respiratory issues.
R: Early detection of side effects allows for
prompt management and enhances patient
safety.
After Administration

70
 10. Regularly check blood pressure and
heart rate after administration,
especially during the first few hours.
R: Ongoing monitoring helps detect any
delayed adverse effects or complications.
[Link] the patient’s response to the
medication in terms of blood pressure
control and any side effects experienced.
R: Evaluating effectiveness helps
determine if the treatment plan needs
adjustment and ensures optimal patient
care.
[Link] all assessments, patient
responses, and any side effects
experienced.
R: Accurate documentation is vital for
continuity of care and communication
among healthcare providers.
Generic Drug Class: Dosage: For the Acts as a [Link] Before Administration
Name: Cough 90mg treatment of cough s [Link] rapport with the patient
Levodrop Suppressa (tab) cough. It is a suppressant 2. • Explain the purpose of the medication

71
ropizine nt cough by inhibiting Gastrointest and ensure cooperation.
Time: BID suppressant the cough inal [Link] the 5 rights of medication
Therapeutic (6AM- that works by reflex in the disturbance administration (Right Patient, Drug, Dose,
Class: 6PM) acting on the central s Time, Route).
Antitussive cough center in nervous [Link] mouth • Prevents medication errors and ensures
Brand agent Route: the brain to system and [Link] patient safety.
Name: Oral reduce the reducing [Link] [Link] the correct dosage, route, and
Cevotics urge to cough. sensitivity in reactions check for any allergies.
It is often used the bronchial 6. Nausea R: Ensures safe administration and
in cases of dry mucosa, [Link] prevents allergic reactions.
cough making it an [Link] [Link] the purpose of Levodropropizine
associated with effective non- discomfort as a cough suppressant and possible side
respiratory narcotic [Link] effects (e.g., drowsiness, GI upset).
conditions, option for [Link] R: Enhances patient understanding and
such as managing dry ns adherence
bronchitis or cough. During Administration
other upper 5. Administer as prescribed, ensuring
respiratory proper technique (e.g., oral, using
tract infections. the correct measuring device).
R: Maximizes therapeutic
effectiveness.

72
 6. Observe the patient for any signs of
adverse reactions during
administration.
R: Enables early intervention if side
effects occur.
7. Provide reassurance and remain
available to address any questions
or discomfort during administration.
R: Reduces patient anxiety and promotes
cooperation.
After Administration
8. Assess changes in cough frequency
and intensity, and note any
improvement or persistence of
symptoms.

R: Helps determine if the medication is

effective and if further adjustments are
needed.

9. Record the time, dose, route of

administration, and patient response

73
 in the medical record. Communicate
any concerns or notable findings to
the healthcare team.
R: Supports continuity of care and
facilitates timely modifications to the
treatment plan if necessary.
10. Remind the patient about
precautions (e.g., avoiding activities
that require full alertness if drowsy)
and instruct them on when to report
new or worsening symptoms.
R: Promotes ongoing self-care and
helps in early detection of any
issues.
Generic Therapeutic Dosage: Short-term Inhibits • Abdominal Before Administration
Name: Class: 30mg/mL management prostaglandin or stomach 1. Establish rapport with the patient
Ketorolac nonsteroida of pain synthesis, pain (mild or • Explain the purpose of the medication
Trometha l Time: producing moderate) and ensure cooperation.
mine antiinflamm Q6H peripherally 2. Observe the 5 rights of medication
atory (6am, mediated • bruising at administration (Right Patient, Drug,
agents, 12pm, analgesia. place of Dose, Time, Route).

74
Brand non-opioid 6pm, Also has injection. • Prevents medication errors and ensures
Name: analgesics 12am) x antipyretic • diarrhea. patient safety.
Ketoroba 24hrs and anti- • dizziness 3. Assess the patient’s pain level using
s Pharmacol inflammatory • a pain scale.
ogic Class: Route: IV properties drowsiness. • Determines the need for medication.
pyrrolizine • headache. 4. Check for a history of peptic ulcer
carboxylic • disease, gastrointestinal (GI)
acid indigestion. bleeding, kidney disease, or
nausea aspirin/NSAID allergies.
• Ketorolac increases the risk of GI
irritation, ulcers, and bleeding.
5. Monitor baseline vital signs,
especially blood pressure (BP).
• NSAIDs can cause fluid retention and
increase BP.
6. Check renal function (BUN,
creatinine).
• Ketorolac can cause kidney impairment,
especially with prolonged use.
During Administration
7. Administer IV as prescribed (30mg

75
 Q6H at 6 AM, 12 PM, 6 PM, 12 AM
for 24 hours).
• Ensures proper dosing and effective pain
relief.
8. Give IV push slowly over at least 15
seconds.
• Reduces the risk of injection site
reactions and side effects.
9. Monitor for dizziness, drowsiness,
nausea, and headache.
• Common side effects of NSAIDs.
10. Observe for signs of GI bleeding
(black stools, abdominal pain,
vomiting blood).
• Early detection prevents complications.
11. Assess for signs of bruising or
bleeding tendencies.
• Ketorolac affects platelet function and
may increase bleeding risk.
After Administration
12. Document the administration,

76
 including dose, route, time, and
patient response.
• Ensures accurate recordkeeping and legal
documentation.
13. Reassess pain level after
administration.
• Determines medication effectiveness.
14. Monitor urine output and kidney
function.
• Prevents nephrotoxicity, especially in
patients with chronic hypertension.
15. Observe for signs of allergic
reactions (rash, swelling, difficulty
breathing). • Allows early
intervention if needed.
16. Educate the patient to report severe
stomach pain, unusual bruising, or
signs of bleeding.
• Prevents complications related to GI
irritation and bleeding.

77
Generic Therapeuti Dosage: For the disrupting Mild to Before Administration
Name: c 500mg treatment of bacterial cell Moderate [Link] rapport with the patient
Co- Classificati bacterial wall synthesis Effects: • Explain the purpose of the medication
amoxicla on: infections such (amoxicillin) and ensure cooperation.
Gastrointest
v Time: BID as respiratory and [Link] the 5 rights of medication
Antibacteri inal upset
6am-6pm tract infections, preventing administration (Right Patient, Drug, Dose,
al agent (nausea,
urinary tract bacterial Time, Route).
vomiting,
infections, skin resistance to • Prevents medication errors and ensures
Pharmacol
diarrhea)
Brand and soft tissue amoxicillin patient safety.
ogical
Name: Route: infections, (clavulanic 3. Obtain a thorough medical history,
Classificati Skin
Ritemed PO dental acid) including allergies, previous
on: reactions
infections, and reactions to antibiotics, and current
(rash,
Antibiotic bone and joint medications.
itching)
(Penicillin- infections. R: This helps identify any potential
type) Serious allergic reactions or
Effects contraindications to Co-Amoxiclav,
Beta
(Rare): ensuring patient safety.
lactam/ 4. Inform the patient about the purpose
Beta- Severe
of the medication, potential side
lactamase allergic effects, and the importance of
inhibitor reactions
completing the course.
combinati (anaphylaxi

78
on s) R: Educating the patient promotes
adherence to the treatment regimen
Significant
and helps them recognize side
liver issues
effects that may require medical
and severe
attention.
skin
During Administration
reactions
5. Perform hand hygiene before
handling the medication.
R: Hand hygiene is essential to
prevent the transmission of
infections and maintain a sterile
environment.
6. Administer Co-Amoxiclav as
prescribed (oral) and ensure proper
dilution and infusion rate if given
intravenously.
R: Administering the medication
correctly ensures optimal absorption
and effectiveness while minimizing
the risk of adverse reactions.
7. Observe the patient for any

79
 immediate adverse reactions during
administration, such as allergic
reactions or infusion-related
reactions.
R: Early detection of adverse
reactions allows for prompt
intervention, which can be critical in
preventing serious complications.
8. Document the administration time,
dosage, route, and any observations
made during the process.
R: Accurate documentation is
essential for maintaining a clear
medical record, ensuring continuity
of care, and providing legal
protection.
After Intervention
9. Continue to monitor the patient for
therapeutic effects and any side
effects or adverse reactions (e.g.,
gastrointestinal upset, rash, or signs

80
 of anaphylaxis).
R: Ongoing monitoring helps assess
the effectiveness of the treatment
and identify any complications early,
allowing for timely interventions.
[Link] education about the
importance of completing the full course of
antibiotics, even if symptoms improve, and
advise the patient to report any unusual
symptoms or side effects.
R: Educating patients about adherence to
antibiotic therapy helps prevent the
development of antibiotic resistance and
ensures complete resolution of the
infection.
Generic Pharmacol Dsage: For the Works by Sedation or Before Administration
Name: ogic Class: 75mg management stimulating Drowsiness [Link] rapport with the patient
Clonidine of alpha-2 • Explain the purpose of the medication
HCI Centrally Time: OD hypertension, adrenergic Dry Mouth and ensure cooperation.
Acting (Once attention deficit receptors in [Link] the 5 rights of medication
Alpha-2 daily) hyperactivity the central Constipation administration (Right Patient, Drug, Dose,

81
 Adrenergic disorder nervous Time, Route).
Brand Agonist (ADHD), opioid system, Bradycardia • Prevents medication errors and ensures
Name: Route: withdrawal which (slow heart patient safety.
Catapres Oral symptoms, reduces rate) [Link] the patient's medical history,
certain types of sympathetic including any history of hypertension, heart
pain, Tourette outflow, Hypotension conditions, or other relevant health issues.
syndrome, leading to (low blood R: Understanding the patient's background
menopausal decreased pressure) helps identify potential contraindications or
symptoms, and norepinephrin necessary precautions.
some sleep e release, Withdrawal 4 Measure and document baseline blood
disorders. lower heart Symptoms pressure and heart rate.
rate, and (if R: Establishing baseline values is essential
vasodilation, discontinue for monitoring the effects of the medication
ultimately d abruptly) and detecting any adverse reactions.
resulting in 5. Provide information about the
reduced Nausea medication, its purpose, potential
blood side effects, and the importance of
pressure and adherence.
Headache
sedation. R: Education empowers patients
and families, promoting
understanding and compliance with

82
 the treatment plan.
Therapeutic During Administration
Class: 6 Continuously assess blood pressure and
Antihyperte heart rate during administration
nsive (used R: Clonidine can cause hypotension and
to treat high bradycardia; monitoring ensures patient
blood safety.
pressure) 7 Ensure the medication is given at the
and also correct dose and time, following the
classified prescribed route (oral).
as a R: Adherence to the prescribed regimen is
medication crucial for effective treatment and
for minimizing risks.
Attention 8. Observe the patient for any
Deficit immediate side effects, such as
Hyperactivit sedation or dry mouth.
y Disorder R: Early detection of side effects
(ADHD) in allows for timely intervention and
pediatric management.
patients. After Administration
9. Regularly check blood pressure and

83
 heart rate after administration,
especially during the first few hours.
R: Ongoing monitoring helps detect
any delayed adverse effects or
complications.
10. Assess the patient’s response to the
medication in terms of blood
pressure control or improvement in
ADHD symptoms.
R: Evaluating effectiveness helps
determine if the treatment plan
needs adjustment.
11. Observe for signs of withdrawal if the
patient is discontinuing clonidine or if
there are changes in the treatment
plan.
R: Preventing and managing
withdrawal symptoms is essential for
patient safety and comfort.
[Link] all assessments, patient
responses, and any side effects

84
 experienced.
R: Accurate documentation is vital for
continuity of care and communication
among healthcare providers.
Generic Therapeutic Dosage: To treat Binds to mu - •constipatio Before Administration
Name: Class: 50mg moderate - to - opioid n 1. Verify the Doctor’s Order
Analgesics (vial) moderately receptors. •lightheaded R: Ensure the correct dosage, frequency,
Tramadol severe pain Inhibits ness and route of administration according to the
Pharmacol Time: reuptake of • dizziness physician's prescription.
Brand ogic Class: Q8H serotonin and • fainting 2. Assess for Allergies and
Name: Opioid (6am, norepinephrin •stomach Contraindications
SITIDOL agonists 12pm, e in the CNS. upset R: Check the patient’s history for any
10pm) • weakness allergies to tramadol or opioids and assess
• Seizure for contraindications such as severe
Route : IV • headache respiratory depression or seizure disorders.
• 3. Pain Assessment
somnolence R: Determine the patient’s level of pain,
• anxiety location, and type to assess the need for
tramadol and establish a baseline for future
evaluations.
4. Vital Signs

85
R: Check baseline vital signs (blood
pressure, heart rate, respiratory rate) to
ensure the patient is stable, as tramadol
can cause respiratory depression,
especially in those with respiratory issues.
5. Patient Education
R: Explain the purpose of tramadol, which
is to manage moderate to severe pain.
Inform the patient about possible side
effects (e.g., drowsiness, nausea,
dizziness) and the importance of reporting
severe adverse reactions like breathing
difficulties or confusion.
During Administration
6. Ensure Proper Administration
R: If administered intravenously, ensure a
slow injection to minimize the risk of
dizziness, hypotension, and respiratory
depression.
7. Monitor for Immediate Adverse
Reactions

86
R: Watch for signs of sedation, dizziness,
confusion, or agitation, which are common
with tramadol, especially when the patient
is lying down. Additionally, monitor
respiratory rate, as tramadol can cause
respiratory depression, especially when
combined with other sedatives or in opioid-
naive patients.
8. Assess for Possible Drug Interactions
R: Observe the patient for signs of
serotonin syndrome (e.g., agitation,
hallucinations, hyperreflexia, tremors, or
fever), particularly if the patient is on SSRIs,
SNRIs, or MAO inhibitors.
After Administration:
9. Monitor for Side Effects
R: Monitor for drowsiness, dizziness,
confusion, or difficulty waking up, as these
are common, especially early after
administration. Also, monitor for nausea,
vomiting, constipation, or dry mouth, which

87
are common side effects.
10. Pain Reassessment
R: Reassess the patient’s pain after 30 to
60 minutes (depending on the route) to
evaluate the effectiveness of tramadol and
adjust the pain management plan
accordingly.
11. Ensure Patient Safety
R: Since tramadol can cause drowsiness
and dizziness, assist the patient when
moving and advise them to stay in bed to
prevent falls.
12. Evaluate Renal Function
R: Tramadol is metabolized in the liver and
excreted by the kidneys. Monitor for signs
of renal or hepatic dysfunction, especially if
the patient has pre-existing conditions.
13. Document Administration and
Response
R: Accurately record the time, dosage,
route, pain assessment before and after

88
 administration, and any observed side
effects or adverse reactions.
Generic Therapeuti Dosage: Metoclopramid Works by CNS: Before Administration
Name: cal Class: 10mg e is indicated antagonizing • Drowsin [Link] rapport with the patient
Metoclopr Antiemetic, for the dopamine ess • Explain the purpose of the medication
amide Prokinetic treatment of receptors in • Restless and ensure cooperation.
Time: q8 nausea and the ness [Link] the 5 rights of medication
vomiting chemorecept • Headach administration (Right Patient, Drug, Dose,
Brand Pharmacol associated with or trigger e Time, Route).
Name: ogical Route: IV gastroesophag zone of the • Confusio • Prevents medication errors and ensures
Plazimide Class: eal reflux medulla, n patient safety.
Dopamine disease increasing • dizzines 3. Check for contraindications such as
Antagonist, (GERD), gastric s gastrointestinal bleeding, bowel
Serotonin diabetic motility, and obstruction, Parkinson’s disease,
Agonist gastroparesis, accelerating epilepsy, or a history of tardive
and gastric CV: dyskinesia.
chemotherapy. emptying. • Cardiac
R: Metoclopramide increases
Arrhyth
gastrointestinal motility and dopamine
mias
blockade, which can worsen certain
• Hypoten
conditions.
sion

89
 4. Verify if the patient has any known
allergies to metoclopramide and
GI: assess for interactions with CNS
• Diarrhea depressants, antipsychotics, or
• Nausea other dopamine antagonists.
• Abdomi
R: Prevents allergic reactions and adverse
nal Pain
drug interactions that may lead to
• Constip
excessive sedation or extrapyramidal
ation
symptoms.

5. Assess blood pressure, heart rate,

and level of consciousness before
administration.

R: Metoclopramide can cause hypotension,

drowsiness, or dizziness, which may
require dose adjustments.

6. Explain the purpose of

metoclopramide, expected effects
(relief of nausea, improved gastric
emptying), and possible side effects

90
 (drowsiness, restlessness). R:
Enhances patient cooperation and
promotes adherence to therapy.

During Administration

7. Give metoclopramide orally 30

minutes before meals for
gastroparesis or IV slowly over 1-2
minutes to prevent rapid adverse
reactions.

R: Ensures proper absorption and

minimizes the risk of side effects like
dizziness or hypotension.

8. Monitor for restlessness,

drowsiness, dizziness, or
extrapyramidal symptoms
(involuntary muscle movements,
tremors). R: Early detection
allows for prompt intervention to
prevent worsening symptoms.

91
9. If administering IV, observe for signs of
phlebitis or irritation at the injection site.
R: Prevents complications like vein
inflammation or extravasation injury.

10. Encourage the patient to remain seated

or in bed after administration, especially if
drowsy or dizzy.

R: Reduces the risk of falls due to sedation

or hypotension.

After Administration

11· Advise the patient to avoid alcohol and

activities requiring mental alertness until
they know how the medication affects them.
R: Prevents increased sedation and
promotes safe medication use.

12. Record the dose, route, time, patient

response, and any adverse effects

92
 observed.

R: Ensures continuity of care and provides

a reference for evaluating treatment
effectiveness.
GENERI THERAPE Dosage: used to treat works by Common Before Administration
C NAME: UTICAL 750mg bacterial inhibiting Side [Link] rapport with the patient
CLASS: (tablet) infections, bacterial cell Effects: • Explain the purpose of the medication
Sultamicil including wall synthesis and ensure cooperation.
Nausea and
in antibiotics respiratory, through [Link] the 5 rights of medication
vomiting
Time: BID urinary, skin, ampicillin administration (Right Patient, Drug, Dose,
BRAND PHARMAC (6am- soft tissue, while Time, Route).
Diarrhea
NAME: OLOGICAL 6pm) gynecological, sulbactam • Prevents medication errors and ensures
CLASS: and intra- blocks beta- Abdominal patient safety.
Unacyn abdominal lactamase pain [Link] the patient’s pain level using a
beta- infections. enzymes, pain scale.
Skin rash
lactam Route: enhancing its • Determines the need for medication.
antibacteri Oral effectiveness 4. Check for allergies to penicillins,
Headache
als against cephalosporins, or beta-lactam
resistant antibiotics. R: Prevents potential
bacteria. allergic reactions, including
anaphylaxis.

93
Less
[Link] renal and hepatic function tests
Common
(e.g., BUN, creatinine, liver enzymes).
but Serious
Side
R: Sultamicillin is eliminated through the
Effects:
kidneys and metabolized in the liver,
requiring dose adjustments in impaired
Allergic
patients.
reactions
(hives,
[Link] temperature, respiratory rate,
swelling,
WBC count, and assess the infection site.
anaphylaxis
) R: Helps determine the severity of infection
and monitors for sepsis.
Clostridioide
s difficile- [Link] the purpose of the drug, expected
associated effects, and possible side effects (e.g.,
diarrhea nausea, diarrhea, rash).

Hepatotoxici R: Enhances adherence and allows early

ty (elevated recognition of adverse effects.
liver
During
enzymes,

94
jaundice) [Link] 30 minutes before or after meals
to enhance absorption.
Stevens-
Johnson R: Ensures proper absorption and
syndrome minimizes irritation.
(rare severe
[Link] for signs of allergic reactions
skin
(rash, swelling, dyspnea, anaphylaxis)
reaction)
within the first 30 minutes.
Blood
R: Early detection allows for immediate
disorders
intervention, such as stopping the drug and
(leukopenia,
administering epinephrine if needed.
thrombocyto
penia)
[Link] for nausea, vomiting, diarrhea,
headache, or dizziness.

R: Allows for timely management of mild to

moderate side effects.

After Administration

[Link] for reduction in fever, WBC

95
count, and infection symptoms.

R: Ensures the drug is effective and

determines if therapy adjustments are
needed.

[Link] for Clostridioides difficile-

associated diarrhea, liver dysfunction
(jaundice), or blood disorders
(thrombocytopenia).

R: Prevents severe complications that may

require discontinuation of the drug.

[Link] prescribed for home use, instruct the

patient to complete the full course, take
at the correct times, and report severe side
effects.

R: Prevents antibiotic resistance and

ensures treatment success.

[Link] dose, route, time, patient

96
 response, and any side effects.

R: Ensures continuity of care and informs

the healthcare team for further evaluation.
Generic Therapeutic Dosage: used to treat Cefuroxime is • Nausea Before Administration
Name: class: 750mg various a bactericidal • Abdomin 1. Verify the Doctor’s Order
Cefuroxi Antibiotics bacterial agent that al pain or R: Confirm the correct dosage, frequency,
me Time: infections. It is acts by cramps and route of administration in the
Pharmacol 6am- effective inhibition of • Rash physician’s prescription.
Brand ogical 2pm- against a range bacterial cell • Itching 2. Assess for Allergies
Name: class: 10pm of gram- wall • Hives R: Check the patient's history for allergies
Zinacef Second- positive and synthesis. • Fever to cephalosporins or penicillins to prevent
generation Route: IV gram-negative Cefuroxime • Diarrhea allergic reactions or anaphylaxis.
cephalospo bacteria. has activity in • Headach 3. Obtain Baseline Vital Signs
rins the presence e R: Measure and document baseline vital
of some beta- • Dizzines signs (temperature, pulse, blood pressure,
lactamases, s and respiratory rate) to monitor for any
both • Drowsin changes post-administration.
penicillinases ess 4. Assess Renal Function
and • R: Cefuroxime is primarily excreted through
cephalospori the kidneys, so check renal function (e.g.,
nases, of serum creatinine, BUN).

97
Gram- 5. Assess the IV Site
negative and R: Inspect the IV insertion site for signs of
Gram- infiltration, phlebitis, or infection before
positive administration.
bacteria. During Administration:
6. Administer Properly
R: Ensure proper dilution and rate of
infusion to prevent adverse reactions
(typically infused over 30 minutes to avoid
phlebitis or vein irritation).
7. Monitor for Immediate Adverse
Reactions
R: Observe for signs of allergic reactions,
such as rash, itching, swelling, or difficulty
breathing.
8. Patient Education
R: Inform the patient about possible side
effects (e.g., gastrointestinal disturbances,
rash). Encourage the patient to report any
unusual symptoms immediately, especially
signs of an allergic reaction or persistent

98
diarrhea
After Administration
9. Monitor Vital Signs
R: Continue to monitor temperature, heart
rate, and blood pressure, especially if fever
or infection is present.
10. Assess for Side Effects
R: Watch for any common side effects such
as gastrointestinal discomfort, diarrhea, or
skin rashes.
11. Evaluate Effectiveness
R: Assess the patient’s response to
therapy, including improvement in infection
symptoms.
12. Provide Education
R: Instruct the patient to complete the full
course of therapy even if they start feeling
better to prevent resistance.
13. Document the Administration
R: Record the date, time, dosage, route,
and any observed patient responses or

99
 adverse reactions in the patient's chart.
Generic Pharmacol Dosage: For the Mefenamic Common Before Administration
Name: ogical 100mg management acid exerts its Side [Link] rapport with the patient
Mefenami Class: (TAB) of mild to analgesic and Effects: • Explain the purpose of the medication
c Acid Nonsteroid moderate pain, anti- and ensure cooperation.
al Anti- Time: TID including inflammatory Nausea, [Link] the 5 rights of medication
Inflammator (6-12-6) headaches, effects Vomiting, administration (Right Patient, Drug, Dose,
y Drug toothaches, primarily by Diarrhea, Time, Route).
Brand (NSAID) Route: musculoskelet inhibiting the Constipation • Prevents medication errors and ensures
Name: PO al pain, and enzyme , patient safety.
Therapeuti dysmenorrhea, cyclooxygena Indigestion [Link] the patient’s pain level using a
c Class: as well as for se (COX), or pain scale.
Analgesic the treatment which leads heartburn, • Determines the need for medication.
and Anti- of inflammatory to a decrease Abdominal 4 Assess the patient's medical history,
inflammator conditions in the pain, including any history of gastrointestinal
y Agent such as synthesis of Dizziness, issues, renal impairment, cardiovascular
arthritis. prostaglandin Headache, conditions, and allergies.
s—hormone- Drowsiness, R: Understanding the patient's medical
like background helps identify any
substances Serious contraindications or potential risks
that mediate Side associated with mefenamic acid, ensuring

100
pain, Effects: safe administration.
inflammation, Peptic 5. Check for any current medications
and fever— ulcers, that the patient is taking to identify
thereby Gastroint potential drug interactions,
reducing pain estinal especially with other NSAIDs,
and bleeding, anticoagulants, or medications
inflammation Increase affecting renal function.
in the body. d risk of R: Mefenamic acid can interact with
heart various medications, leading to
attack or increased risk of side effects or
stroke, reduced efficacy. This assessment
Kidney helps prevent adverse drug
damage interactions.
or 6. Inform the patient about the purpose
impairm of mefenamic acid, how to take it,
ent, and potential side effects.
Liver R: Patient education promotes
dysfuncti adherence to the medication
on or regimen and prepares the patient to
elevated recognize and report any adverse
liver effects.

101
enzymes During Administration
, [Link] that mefenamic acid is taken with
Allergic food or milk to minimize gastrointestinal
reactions irritation.
(rash, R: Taking the medication with food can help
itching, reduce the risk of gastrointestinal side
swelling, effects, such as nausea or ulcers.
anaphyla [Link] the patient for any immediate
xis - rare) adverse reactions during and shortly after
administration.
R: Early detection of side effects, such as
allergic reactions or gastrointestinal
distress, allows for prompt intervention and
enhances patient safety.
9. Record the time, dose, route, and any
relevant observations in the patient's
medical record.
R: Accurate documentation is essential for
continuity of care and helps other
healthcare providers track the patient's
response to the medication.

102
After Administration
[Link] the patient's pain level after a
specified period following administration
(usually within 30-60 minutes).
R: Evaluating the effectiveness of
mefenamic acid helps determine if the
medication is providing adequate pain relief
and if further intervention is needed.
[Link] monitor the patient for any
delayed side effects, such as
gastrointestinal bleeding, renal function
changes, or signs of allergic reactions.
R: Early identification of side effects allows
for timely management and reduces the
risk of serious complications.
[Link] education about the
medication, including the importance of
adhering to the prescribed regimen and
recognizing signs of adverse effects.
R: Ongoing education empowers patients
to take an active role in their care and

103
 enhances their ability to manage their
health effectively.
Generic Therapeuti Dosage: Ampicillin is By binding to • Nausea Before Administration
Name c class 2am used to treat specific • Vomiting [Link] a thorough assessment of the
Ampicillin Antibiotics certain penicillin- • Stomach patient, including medical history, allergies,
Pharmacol Time: Q6 infections that binding pain and current medications.
Brand ogical 12,6,12,6 are caused by proteins • Diarrhea R: To identify any potential allergies (e.g.,
Name class bacteria (PBPs) • Rash penicillin allergy) or contraindications that
Ampicin Aminopenic Route- located inside • Swollen, could lead to adverse reactions.
illins IVTT the bacterial black, or [Link] the medication order, including the
cell wall, "hairy" drug name, dosage, route, and frequency.
Ampicillin tongue R: To ensure the correct medication is
inhibits the • Vaginal administered and to prevent medication
third and last itching or errors.
stage of discharg [Link] the patient about the medication,
bacterial cell e its purpose, potential side effects, and the
wall importance of adherence.
synthesis. R: To promote understanding and
Cell lysis is cooperation, which can enhance treatment
then outcomes and reduce anxiety.
mediated by [Link] the medication in a clean

104
bacterial cell environment, following proper protocols for
wall autolytic dosage calculation and administration.
enzymes R: To maintain sterility and accuracy,
such as minimizing the risk of contamination and
autolysins; it dosing errors.
is possible
that Ampicillin
interferes with
an autolysin During Administration:
inhibitor. 5. Ensure the "Five Rights" are followed:
Right patient, right medication, right dose,
right route, and right time.
R: To prevent medication errors and ensure
patient safety.
6. Observe the patient for any immediate
adverse reactions during administration.
R: Early detection of allergic reactions or
side effects can lead to prompt intervention,
improving patient safety.
[Link] the administration of the
medication, including the time, dose, route,

105
and any observations.
R: Accurate documentation is essential for
continuity of care and legal accountability.
After Administration
[Link] the patient for any side effects or
adverse reactions after administration.
R: Early identification of side effects allows
for timely management and intervention.
[Link] education regarding the
medication, including what to expect and
when to report side effects.
R: Ongoing education helps patients
understand their treatment and encourages
adherence.
10. Conduct follow-up assessments to
evaluate the effectiveness of the
medication and the patient’s response.
R: To determine if the medication is
achieving the desired therapeutic effect and
to make necessary adjustments to the
treatment plan.

106
 [Link] any adverse reactions or
concerns to the healthcare team and
document them appropriately.
R: Effective communication ensures that all
team members are aware of the patient’s
status and can collaborate on care.
Generic Therapeutic Dosage: Treatment of Inhibits the •headache. Before Administration
Name: Class.: 2mg hypertension, transport of •upset 1. Establish rapport with the patient
Nicardipi Antianginal including calcium into stomach •Ensure cooperation and explain the
ne s hypertensive myocardial • dizziness purpose of the medication.
Antihyperte Time/Fre urgency and and vascular or 2. Observe the 5 rights of medication
n sives quency: hypertensive smooth lightheadeD administration (Right Patient, Drug,
Brand 25cc/hr emergency muscle cells, ness Dose, Time, Route) .
Name: Pharmacol resulting in •excessive • Prevents medication errors and ensures
Cardene ogic Class : inhibition of tiredness . patient safety .
SR Calcium Route: excitation - •flushing . 3. Assess baseline vital signs, especially
channel IVTT contraction •numbness. blood pressure (BP) and heart rate (HR)
blockers coupling and •fast .
subsequent heartbeat. • BP: 220/110 mmHg – Confirm
contraction. •muscle hypertensive crisis before administration .
cramps . 4. Assess for history of heart failure,

107
 hypotension, or liver dysfunction .
• Nicardipine may worsen these conditions
5. Ensure proper IV access and infusion
rate (25cc/hr) .
• Prevents complications related to IV
administration .
6. Check for drug interactions (e.g., beta -
blockers, digoxin, antihypertensives) .
• Prevents excessive hypotension or
bradycardia.
During Administration
7. Administer via IV infusion at 25cc/hr as
prescribed.
• Ensures controlled BP reduction.
8. Monitor BP and HR every 5– 15 minutes
initially, then every 30 minutes once
stable. • Detects excessive hypotension
or tachycardia.
9. Observe for signs of dizziness, flushing,
or headache.
• Common side effects of vasodilation.

108
10. Assess for chest pain, palpitations, or
new arrhythmias.
• Nicardipine may cause reflex
tachycardia.
11. Monitor urine output and kidney
function.
• Prevents complications in patients with
renal impairment.
12. Ensure proper IV site monitoring for
signs of phlebitis or extravasation.
•Prevents IV-related complications.
After Administration
13. Document the administration, including
dose, route, time, and patient response.
• Ensures accurate recordkeeping and legal
documentation.
14. Continue monitoring BP and HR at
regular intervals.
• Ensures safe and gradual BP reduction.
15. Assess for signs of excessive
hypotension (dizziness, weakness,

109
 fainting).
• Prevents sudden drops in BP.
16. Observe for muscle cramps, fatigue, or
numbness.
• Identifies possible electrolyte imbalances.
17. Educate the patient on the importance
of slow position changes.
• Prevents orthostatic hypotension.
18. Evaluate effectiveness by monitoring
BP trends and patient symptoms.
• Determines the need for dose
adjustments.
Generic Therapeutic Dosage: For the Amlodipine is Headache, Before Administration
Name: Class: 5mg treatment of a calcium Fatigue, 1. Check the doctor's order:
Amlodipin Antihyperte high blood channel Dizziness, R: Ensures the correct medication,
e Brand nsive Time: OD pressure blocker that Nausea, dosage, and route are being
Name: Antianginal (hypertension) works by Bradycardia administered as prescribed.
Norvasc Route: and certain inhibiting the , Peripheral 2. Observe the 10 rights of drug
Pharmacol PO types of angina influx of Edema, administration
ogic Class: (chest pain). calcium ions Palpitation, R: Helps prevent medication errors and
Calcium into vascular Flushing ensures patient safety.

110
Channel smooth 3. Ask the client if allergic or has a history
Blocker muscle and of allergic reaction to the medication
cardiac cells, R: Identifying allergies prevents
leading to potential adverse reactions and ensures
vasodilation, patient safety.
reduced 4. Explain the purpose and side effects of
peripheral the medication to the client
resistance, R: Informed patients are more likely to
and adhere to treatment and report any side
decreased effects promptly.
myocardial During Administration
oxygen 5. Administer the drug at the right dosage
demand, and route at the right time
which helps R: Ensures therapeutic effectiveness
lower blood and minimizes the risk of adverse
pressure and effects.
alleviate 6. Provide a quiet and calm environment
angina. R: Reduces anxiety and stress, which
can positively affect blood pressure and
overall patient comfort.
7. Monitor vital signs regularly:

111
 R: Helps detect any changes in the
patient’s condition and ensures the
medication is having the desired effect.
8. Encourage the patient to rest in a
comfortable position:
R: Promotes relaxation and can help
lower blood pressure.
9. Encourage the patient to take
amlodipine with food
R: Taking the medication with food can
enhance absorption and reduce
gastrointestinal side effects.
10. Encourage small and frequent meals
R: Helps prevent gastrointestinal
discomfort and maintains stable blood
sugar levels.
11. Encourage fluid intake:
R: Adequate hydration can help prevent
hypotension and support overall health.
12. Encourage relaxation techniques such
as deep breathing through the mouth:

112
 R: Reduces anxiety and promotes
relaxation, which can help lower blood
pressure.
13. Provide cool compresses or fan the
patient if needed:
R: Helps alleviate discomfort and
manage any side effects such as
flushing.
After Administration
14. Document the drug administration:
R: Maintains accurate medical records
and ensures continuity of care.
15. Monitor vital signs and note for
irregularity and discomfort
R: Early detection of any adverse
effects or complications allows for timely
intervention.
16. Observe for any side effects of the
medication and report to the attending
physician:
R: Prompt reporting of side effects

113
 ensures appropriate management and
patient safety.
Generic Therapeutic Dosage: Relief minor Paracetamol Skin rashes Before Administration
Name: Class: 500mg aches/pain exhibits or minor 1. Check doctor’s order
Paraceta (tab) (Headache, analgesics gastrointes R: Ensures correct medication, dose,
mol Antipyretic, backache, and tinal route, and patient to prevent errors.
Analgesic Time: q6 menstrual antipyretic disturbanc 2. Observe the 10 rights of drug
Brand (6am- cramps, activity by es. administration
Name: 12nn- muscular inhibiting R: Promotes patient safety and proper
Biogesic 6pm- aches, minor prostaglandin Diarrhea medication administration following
12mn) activities pain, synthesis. Loss of standards.
toothache and This appetite During Administration
Route: pain that produces 3. Explain the procedure to the patient
PO associated and analgesia by Nausea R: Helps gain cooperation, reduces
pain that elevating the anxiety, and ensures understanding.
associated with pain Yellow eyes 4. Check the patient’s temperature
common cold threshold and or skin R: Provides baseline data, especially if
and flu. antipyresis the drug is for temperature control (e.g.,
through Right and antipyretic).
action on the stomach 5. Administer with a full glass of fluid or on
hypothalamic tenderness an empty stomach (as prescribed) R:

114
 heat Enhances drug absorption and prevents
regulating Stomach irritation (follow specific medication
center cramps instructions).
After Administration
Sweating 6. Monitor the patient’s temperature
Headache R: Assesses effectiveness of the
medication (e.g., fever reduction).
7. Observe for any side effects of the
medication
R: Early detection of adverse reactions
for prompt [Link] medication
Generic Pharmacol Dosage: To decrease Losartan ·Dizziness, · Before Administration
Name: ogical 50mg the risk of blocks the headache 1. Check the doctor's order:
Losartan Class: (Tab) stroke in binding of R: Ensures the correct medication,
·Fatigue, ·w
Potassiu patients with angiotensin II dosage, and route are being
eakness
m Antihyperte high blood to its receptor administered as prescribed, preventing
nsive Agent Time: pressure and (AT1), medication errors.
·Hypotensio
Once enlargement of preventing 2. Assess the patient's blood pressure and
n ·Hyperkal
Brand Daily the heart vasoconstricti heart rate:
emia· Renal
Name: on and R: Establishes a baseline to monitor the
impairment
Losaar aldosterone effectiveness of the medication and

115
Route: secretion. detect any potential hypotension.
PO This leads to 3. Review the patient's medical history for
blood vessel contraindications:
relaxation, R: Identifies any history of renal
reduced impairment, pregnancy, or
blood hypersensitivity to ARBs, which may
pressure, and affect the safety of administering
decreased Losartan.
workload on 4. Ask the patient about allergies:
the heart. R: Prevents allergic reactions by
ensuring the patient does not have a
known allergy to Losartan or similar
medications.
5. Educate the patient about the
medication:
R: Informs the patient about the
purpose, expected effects, and potential
side effects, promoting adherence and
awareness.

116
During Administration
6. Administer the medication at the right
dosage and route:
R: Ensures therapeutic effectiveness
and minimizes the risk of adverse
effects.
7. Monitor vital signs regularly:
R: Helps detect any changes in blood
pressure or heart rate, allowing for
timely intervention if hypotension
occurs.
8. Encourage the patient to take Losartan
with or without food:
R: While Losartan can be taken with or
without food, consistency in
administration can help maintain stable
drug levels.
9. Provide a calm and quiet environment:
R: Reduces anxiety, which can
positively affect blood pressure and
overall patient comfort.

117
10. Encourage fluid intake.
R: Adequate hydration can help prevent
hypotension and support overall health.
After Administration
11. Document the drug administration:
R: Maintains accurate medical records
and ensures continuity of care.
12. Monitor vital signs and observe for any
irregularities:
R: Early detection of hypotension or
other adverse effects allows for timely
intervention.
13. Assess for side effects:
R: Monitoring for common side effects
(e.g., dizziness, headache) ensures
patient safety and allows for appropriate
management.
14. Educate the patient about potential side
effects and when to seek help:
R: Informs the patient about what to
expect and encourages them to report

118
 any concerning symptoms promptly.
Generic Dosage: To treat Pantoprazole Common Before Administration:
Pharmacol
Name: 40mg damage from works by Side Effects: 1. Assess for indications (e.g.,
ogic Class:
Pantropa gastroesophag irreversibly • Headach GERD, peptic ulcer, Zollinger-Ellison
zole Proton eal reflux inhibiting e syndrome).
Pump Time: disease the H⁺/K⁺ • Nausea R: Ensures appropriate use of the
Brand Inhibitor (GERD) ATPase • Diarrhea medication.
Name: (PPI) enzyme • Abdomin 2. Check for allergies to
Pantobet system (also al pain pantoprazole or other PPIs (e.g.,
Plus Route: IV known as the • Flatulenc omeprazole, lansoprazole).
proton pump) e (gas)
Therapeuti R: Prevents allergic reactions.
in the gastric • Dizzines
c Class: 3. Evaluate the patient’s history of GI
parietal cells. s disorders, especially bleeding or
Antiulcer This action Less ulcers.
agent suppresses Common
the final step but R: Identifies conditions that may require
of gastric acid Possible additional interventions.
production, Side
leading to a 4. Assess for medication interactions,
Effects:
reduction in • especially with anticoagulants (e.g.,
Constipa
stomach warfarin), clopidogrel, or digoxin.
tion

119
acid. • Vomiting R: Pantoprazole can affect drug
• Dry absorption and increase the risk of
mouth bleeding.
• Rash or 5. Check baseline magnesium levels.
itching
R: Long-term PPI use can cause
hypomagnesemia, leading to muscle
cramps or cardiac issues.

During Administration

6. IV administration, give as a slow IV

push over 2 minutes or as an infusion
over 15 minutes.

R: Reduces the risk of irritation or

thrombophlebitis.

7. Monitor the patient for any immediate

hypersensitivity reactions (rash,
difficulty breathing, swelling).

R: Early detection of anaphylaxis

120
 prevents severe complications.

8. Observe for signs of GI discomfort,

nausea, or headache.

R: Common side effects that may

require symptom management.

121
After Administration
9. Monitor for improvement in
symptoms (e.g., reduced heartburn,
pain relief).
R: Evaluates the effectiveness of
treatment.
10. Assess for signs of potential side
effects like diarrhea (C. difficile risk),
dizziness, or headache.
R: Identifies adverse effects early for
appropriate intervention.
11. Monitor magnesium and calcium
levels in long-term therapy patients. R:
Prolonged use may cause electrolyte
imbalances, leading to muscle weakness
or arrhythmias.
12. Educate the patient on avoiding
alcohol, smoking, and NSAIDs, which
can worsen GI conditions R:
Lifestyle factors can impact treatment
effectiveness and healing.

122
 13. Instruct the patient to report any
signs of persistent diarrhea, bone pain,
or unusual bruising.
R: These may indicate serious side
effects
Generic Pharmacol Dosage: to help treat Furosemide ·Increased Before Administration:
Name: ogic Class: 40mg fluid retention inhibits the urination 1. Verify the doctor’s order (dose,
Furosemi (edema) and Na⁺-K⁺-2Cl⁻ frequency, and route).
Loop ·Dizziness
de Time: swelling that is cotransporte 2. Assess hydration status (skin turgor,
Diuretic or
caused by r in the loop mucous membranes, daily weight, urine
lightheaded
Brand congestive of Henle, output).
Therapeutic
ness
Name: Route: IV heart failure, preventing 3. Monitor baseline electrolyte levels
Class:
Rosemid liver disease, sodium and (potassium, sodium, magnesium,
·Dehydratio
e Diuretic kidney water calcium).
n
disease, or reabsorption. 4. Check blood pressure and heart rate
Antihyperte
other medical This leads to ·Electrolyte (hold if systolic BP <90 mmHg).
nsive conditions increased imbalances 5. Assess kidney function (BUN,
urine output (hypokalemi creatinine, GFR, urine output).
(diuresis), a, 6. Ensure IV patency and check for
reducing fluid hyponatremi infiltration or phlebitis.
overload and a, 7. Educate the patient about increased

123
blood hypomagne urination, dizziness, and possible
pressure. semia) electrolyte imbalances.

·Hypotensio During Administration:

n (low blood
1. Administer IV push slowly over 1–2
pressure)
minutes or infuse over 15–30
·Weakness minutes.
or fatigue 2. Monitor for immediate reactions
(hypotension, dizziness, tinnitus).
3. Observe urine output and diuretic
response.
4. Continuously monitor cardiac status,
especially in patients on digoxin or
antihypertensives.
5. Assess for ototoxicity symptoms
(ringing in ears, hearing loss), especially
in high doses.

After Administration:

1. Monitor blood pressure and

electrolyte levels regularly.

124
 2. Assess for signs of dehydration (dry
skin, weakness, confusion).
3. Monitor urine output to prevent over-
diuresis.
4. Check for hearing disturbances,
especially in long-term or high-dose
therapy.
5. Encourage potassium-rich foods or
supplements if needed.
6. Ensure proper documentation (dose
given, patient response, urine output,
side effects).
Generic Pharmaceu Dosage: Ranitidine is Ranitidine Before Administration
Common
Name: tical Class: 50mg indicated for works by 1. Assess medical history: Check for any
Ranitidin the treatment blocking H2 Headache history of liver or kidney disease, as
H2 receptor
e Time: q8 of receptors in Dizziness dosage adjustments may be needed.
antagonist
gastroesophag the stomach, Constipation R: Ranitidine is metabolized in the liver
Brand Therapeutic Route: eal reflux reducing acid Diarrhea and excreted via the kidneys, so
Name: Class: IVTT disease production impaired function can affect drug
Ranipen (GERD), and helping to Rare : metabolism
Antiulcer gastric and heal ulcers 2. Evaluate for any allergies: Ensure the
Confusion

125
agent duodenal and relieve (especially patient is not allergic to ranitidine or
Gastrointes ulcers, acid reflux in elderly other H2 blockers.
tinal agent Zollinger- symptoms. patients) R: Allergic reactions may lead to severe
Ellison side effects such as difficulty breathing
syndrome, as or swelling.
Arrhythmias
well as the 3. Review current medications: Be aware
prevention of of drug interactions, especially with
stress ulcers in Liver drugs like warfarin or antacids.
critically ill problems R: Some medications may interact with
patients and (jaundice, ranitidine, affecting its efficacy or
the relief of elevated increasing side effects.
heartburn and liver 4. Assess gastrointestinal symptoms:
acid enzymes) Document the patient's symptoms (e.g.,
indigestion. heartburn, acid reflux).
R: Provides a baseline for evaluating
the effectiveness of treatment.

During Administration:

5. Monitor vital signs: Check for any

abnormalities, especially heart rate and
blood pressure.

126
 R: While rare, ranitidine can cause
arrhythmias or hypotension in some
patients.
6. Administer with or without food:
Ranitidine can be taken with or without
food, but administering it with food may
help reduce stomach irritation.
R: Ensures patient comfort and
adherence to the treatment.
7. Observe for adverse effects: Monitor for
signs of confusion, dizziness, or
gastrointestinal upset.
R: These may indicate side effects such
as confusion (especially in older adults)
or gastrointestinal issues.

After Administration:

8. Monitor for effectiveness: Reassess

symptoms of acid reflux, heartburn, or
ulcer pain.
R: Helps evaluate the therapeutic

127
 response and adjust the treatment plan
if necessary
9. Assess for side effects: Watch for any
unusual symptoms like jaundice, dark
urine, or changes in mental status.
R: Identifying side effects early allows
for timely interventions.
10. Encourage hydration: Ensure the
patient drinks plenty of fluids to stay
hydrated, especially if experiencing
diarrhea.
R: Helps prevent dehydration and
promotes general well-being.
11. Provide patient education: Teach the
patient about potential side effects,
proper dosing, and the importance of
follow-up appointments.
R: Empowering the patient to manage
their treatment can improve adherence
and outcomes.

128
 Before Administration:
Generic Pharmaceu Dosage: Diphenhydrami Diphenhydra Common
[Link] the physician's order
Name: tical Class: 25mg ne is indicated mine works
Drowsiness R: Ensures the correct medication, dosage,
Diphenhy Antihistami for the by blocking
Time: Dizziness and route are being administered as
dramine ne treatment of histamine H1
Dry mouth prescribed.
Route: IV allergic receptors,
Brand Therapeutic Constipation [Link] the patient's medical history:
reactions, which
Name: Class: Blurred R: Important to check for any
motion prevents
Soniphen Antiallergic, vision contraindications such as allergies,
sickness, histamine
Antiemetic, asthma, glaucoma, or urinary retention,
insomnia, from binding Rare
Sedative, which may be worsened by
cough and causing
and diphenhydramine.
suppression, allergic Urinary
Antitussive [Link] the patient for allergies:
and as an symptoms retention
R: To ensure the patient is not allergic to
adjunct in like itching,
diphenhydramine or other antihistamines,
managing swelling, and Confusion
which could lead to an allergic reaction.
symptoms of runny nose. (especially
4Obtain baseline vital signs:
Parkinson's Additionally, it in elderly
R: Helps detect any changes in vital signs
disease. has sedative patients)
after administration and assists in
effects by
monitoring potential side effects like
crossing the Tachycardia
drowsiness, dizziness, or hypotension.
blood-brain (fast heart
5Review the patient's current medications:
barrier and rate)

129
blocking Seizures (in R: To check for any potential drug
histamine high doses) interactions, especially with other
receptors in sedatives, alcohol, or CNS depressants,
the brain, which may increase the sedative effects of
leading to diphenhydramine.
drowsiness. It During Administration:
also acts as 6Ensure correct medication and dosage:
an R: To provide the correct treatment and
anticholinergi minimize the risk of medication errors.
c to reduce 7Administer diphenhydramine as
motion prescribed:
sickness and R: Follow the prescribed route (oral, IV, or
nausea. IM) and instructions to ensure therapeutic
effectiveness and minimize the risk of
complications.
8Monitor the patient for any immediate
adverse effects (e.g., sedation, dizziness,
dry mouth, or difficulty breathing):
Rationale: Diphenhydramine can cause
CNS depression, so monitoring for sedation
and respiratory status is critical, especially

130
in the elderly or patients with respiratory
conditions.
9Check for IV compatibility if administering
intravenously:
Rationale: Some medications may not be
compatible with diphenhydramine IV
administration, so verifying compatibility
ensures safety.

After Administration 10 Monitor

for therapeutic effects: Rationale: Ensures
that the diphenhydramine is providing
relief from symptoms such as allergic
reactions, motion sickness, or insomnia.
11Observe the patient for any adverse
effects, such as drowsiness, dizziness,
confusion, or dry mouth:
Rationale: Diphenhydramine can cause
significant sedation or anticholinergic
effects, particularly in older adults, which
should be monitored closely.
12Assess the patient's response to the

131
 medication (e.g., reduction in allergic
symptoms or improvement in sleep):
Rationale: Helps determine the
effectiveness of the medication and
whether further doses are needed.
13Reassess vital signs and mental status
after administration:
Rationale: Ensures no significant changes
in blood pressure, heart rate, or respiratory
status, which could indicate an adverse
reaction or overdose.
Generic Pharmacol Dosage: Timetazidine is Timetazidine Dizziness Before Administration
Name: ogical 20mg indicated for works by 1. Verify the physician's order:
Headache
Trimetazi Class: Time: BID the treatment inhibiting fatty Rationale: Ensures the correct drug,
dine Fatty Acid Route: of chronic acid oxidation dosage, and route are being
Nausea
Brand Oxidation PO stable angina in the heart, administered according to the patient’s
Name: Inhibitor pectoris to shifting the Fatigue specific needs.
RiteMed Therapeutic reduce the myocardial 2. Assess the patient's medical history:
Abdominal
Class: frequency and metabolism Rationale: Timetazidine should be used
pain
Anti-anginal severity of toward with caution in patients with a history of
Agent angina attacks glucose movement disorders (e.g., Parkinson's

132
by improving oxidation, disease) due to potential exacerbation
myocardial which of symptoms. Identifying this before
efficiency improves administration helps to prevent adverse
during energy reactions.
ischemic efficiency and 3. Check for contraindications:
conditions. reduces the Rationale: Ensure the patient does not
heart's have contraindications, such as severe
oxygen liver impairment or hypersensitivity to
demand, the drug, which could lead to serious
thereby adverse effects.
helping to 4. Obtain baseline vital signs:
prevent Rationale: Monitoring baseline vital
angina signs (especially heart rate and blood
attacks. pressure) ensures any changes after
administration can be accurately
assessed.
5. Review current medications:
Rationale: Assess for possible drug
interactions, particularly with other
cardiovascular medications, which
could affect Timetazidine's efficacy or

133
 cause adverse effects.
6. Educate the patient about the drug:
Rationale: Educating the patient on
potential side effects (like dizziness or
movement disorders) helps them
recognize and report any adverse
reactions promptly.
During Administration:
7. Administer the drug with food:
Rationale: Taking Timetazidine with
food can help reduce the risk of
gastrointestinal upset (nausea or
vomiting).
8. Ensure the correct dosage and timing:
Rationale: Administering the drug at the
prescribed dose and schedule ensures
the medication's effectiveness and
minimizes the risk of adverse effects.
9. Monitor the patient for any signs of side
effects:
Rationale: Common side effects include

134
 dizziness, headache, and
gastrointestinal discomfort.
10. Provide comfort measures if the patient
experiences dizziness or headache:
Rationale: Dizziness and headache are
common side effects, and supporting
the patient with comfort measures (like
resting or hydration) can help manage
these symptoms.

135
After Administration:
11. Monitor for any adverse reactions,
particularly movement disorders (e.g.,
tremors or rigidity):
Rationale: Timetazidine can cause
Parkinsonism-like symptoms, which
may appear within days to weeks of
starting the medication.
12. Monitor vital signs (blood pressure
and heart rate):
Rationale: Timetazidine may cause
hypotension or bradycardia. .
13. Assess for improvement in angina
symptoms:
Rationale: Timetazidine is used to
manage angina.
14. Monitor for any signs of allergic
reactions (rash, itching, or difficulty
breathing):
Rationale: Although rare,
hypersensitivity reactions can occur.

136
 15. Educate the patient on potential side
effects and when to seek medical help:
Rationale: Ongoing education about
side effects such as dizziness, fatigue,
or movement problems is important for
patient safety.
16. Document the administration and
any observed effects:
Rationale: Accurate documentation
ensures continuity of care, helps track
the patient's response to the drug, and
serves as a legal record of medication
administration.
Generic Pharmaceu Dosage: As a Together, Constipation Before Administration
Name: tical Class: 300mg combination Ferrous Stomach 1. Assess Health History:
Fesoy + Iron and Time: tablet, it Sulfate and upset Rationale: Identify contraindications like
FA Vitamin Once provides Folic Acid in Nausea iron overload or gastric issues.
Brand Combinatio Daily Ferrous Sulfate the Fesoy+ Abdominal 2. Obtain Baseline Vital Signs:
Name: n Route: (iron) and Folic FA tablet pain Rationale: Monitor for abnormal signs
Ritemed PO Acid to support work Dark stools indicating anemia or other conditions.
Therapeutic the production synergisticall 3. Verify Lab Results:

137
Class: of red blood y to correct Rationale: Confirm need for
Hematopoi cells, treat or both iron and supplementation based on iron and folate
etic agent prevent iron folate levels.
and Vitamin and folate deficiencies. 4. Patient Education:
supplement deficiencies, The iron Rationale: Inform about potential side
and ensure restores effects (e.g., GI upset, dark stools).
proper fetal hemoglobin During Administration
development levels, while 1. Administer with Food (if needed):
during folic acid Rationale: Minimize GI upset, but avoid
pregnancy. supports dairy/antacids which reduce absorption.
proper red 2. Monitor for Side Effects:
blood cell Rationale: Watch for GI discomfort or
production allergic reactions.
and DNA 3. Ensure Proper Administration:
synthesis. Rationale: Confirm the tablet is taken orally
with water.
After Administration:
1. Monitor Side Effects:
Rationale: Check for constipation or
nausea; manage as needed.
2. Reassess Lab Values:

138
 Rationale: Monitor iron and folate levels for
treatment effectiveness.
3. Patient Education on Adherence:
Rationale: Emphasize completing the full
course for effectiveness.
Generic Pharmaceu Dosage: Hydrocortisone Hydrocortison Weight gain Before Administration
Name: tical Class: 100g is indicated for e works by 1. Assess medical history: Review history
Hydrocort Corticoster the treatment binding to Fluid for conditions like diabetes,
isone oid Time: BID of severe glucocorticoid retention hypertension, or infections, as
Brand Therapeutic allergic receptors, hydrocortisone may exacerbate these.
Name: Class: Anti- Route: IV reactions, leading to High blood 2. Monitor vital signs: Check blood
Hydrocort inflammator adrenal anti- pressure pressure, heart rate, and blood sugar
ibas y agent insufficiency inflammatory, levels, as hydrocortisone can affect
(such as in immunosuppr Increased these.
adrenal crisis), essive, and blood sugar 3. Evaluate for infections: Hydrocortisone
acute metabolic suppresses the immune system, so
inflammatory effects that Mood ensure there are no existing infections
conditions help reduce changes before administering.
(including inflammation During Administration
rheumatoid and regulate Insomnia 4. Monitor for adverse reactions: Watch for
arthritis and immune signs of side effects such as edema,

139
lupus), shock, responses. Osteoporosi weight gain, or mood changes.
and severe s (with long- 5. Ensure correct dosing: Administer as
dermatologic term use) prescribed, avoiding abrupt
conditions discontinuation to prevent adrenal
requiring Cataracts crisis.
potent anti- (with long- 6. Provide comfort measures: If the patient
inflammatory term use) experiences discomfort (e.g., stomach
treatment. irritation), offer guidance on taking the
Adrenal medication with food.
suppression After Administration
(with long- 7. Monitor for side effects: Observe for
term use) fluid retention, changes in blood
pressure, blood sugar levels, or mood
swings.
8. Reassess blood pressure and blood
glucose: Given the drug’s effects,
monitor these parameters regularly.
9. Educate patient: Inform about potential
side effects and the importance of not
abruptly stopping the medication.
Encourage regular follow-up visits.

140
Generic Pharmacol Dosage: Isosorbide Isosorbide Headache Before Administration:
Name: ogic Class: 5mg dinitrate is dinitrate Dizziness or 1. Assess blood pressure and heart rate:
Isosorbid Nitrate Time: BID indicated for works by lightheaded Ensure no contraindications like
e Therapeutic Route PO the prevention relaxing and ness hypotension or bradycardia.
Dinitrate Class: Anti- and treatment dilating blood Hypotension 2. Review medical history: Check for
Brand anginal of angina vessels, (low blood conditions like recent MI or glaucoma.
name: agent pectoris (chest particularly pressure) 3. Obtain baseline pain level: Helps
isordil pain) and to veins, which Tachycardia evaluate effectiveness after
manage heart reduces the (fast heart administration.
failure by amount of rate) During Administration:
reducing the blood Nausea 4. Monitor for side effects: Watch for
workload on returning to Flushing dizziness, headache, or hypotension.
the heart the heart. Weakness 5. Administer on schedule: Ensure correct
through This or fatigue dosing, especially for extended-release
vasodilation. decreases Fainting forms.
the heart's 6. Ensure proper positioning: Prevent
workload and dizziness or fainting by lying down if
oxygen needed.
demand, After Administration:
helping to 7. Monitor vital signs: Watch for
relieve angina hypotension or tachycardia.

141
and improve 8. Evaluate symptom relief: Assess
symptoms of effectiveness for angina or heart failure.
heart failure. 9. Educate patient: Advise on avoiding
It also dilates sudden position changes and not
coronary stopping medication abruptly.
arteries,
enhancing
blood flow to
the heart
muscle.

142
 XIII. SURGICAL PROCEDURE

Patient PC was admitted on March 18, 2025, presenting with elevated blood
pressure and was subsequently diagnosed with severe preeclampsia. Despite
repeated administration of antihypertensive medications, adequate control of blood
pressure was not achieved. Additionally, signs of fetal distress and oligohydramnios
were noted. Due to the combination of maternal and fetal complications, the attending
physician decided to proceed with an emergency Cesarean Section delivery.

The lower segment Cesarean section (LSCS)

The lower segment Cesarean section (LSCS) is the most commonly used type
of C-section. In this procedure, a horizontal incision is made in the lower part of the
uterus, just above where the bladder connects to it. This method is preferred because
it minimizes blood loss and allows for easier healing and repair compared to other
types of incisions.

Equipment and Tools/Equipment

• Scalpel
• Mayo scissors
• Kocher clamps
• Metzenbaum scissors
• Bandage scissors
• Needle holder
• Suture materials (Monocryl 1, 3, and Vicryl 1)

143
 • Sponges
• Plastic cord clamp
• Suction catheter
• Surgical drapes
• Antiseptic solution
• Sterile towels
• Surgical gowns and gloves
• Anesthesia machine
• IV catheter and administration set for anesthesia Anesthetic drugs
• Sponge forceps
• Tissue forceps
• Monitoring equipment (e.g., ECG, Pulse oximeter, blood pressure monitor)
• Intravenous fluids and administration sets
• Analgesic medication
• Postoperative garments (e.g., abdominal binder)
• Postoperative recovery area equipment (e.g., stretcher, monitoring)
Procedure
• Anesthesia was induced.
• The patient was positioned in the dorsal supine position, and the abdomen was
prepped and draped using sterile techniques.
• A midline infraumbilical incision was made with a scalpel and deepened to the
fascia.
• The fascial incision was extended bilaterally using Mayo scissors.
• Kocher clamps were used to grasp and elevate the fascia, which was dissected
superiorly and inferiorly from the rectus muscle using both sharp and blunt
dissection.
• The rectus muscles were separated at the midline, and the peritoneum was lifted
and incised with Metzenbaum scissors.
• The peritoneal incision was extended with clear visualization of the bladder.
• The vesico-uterine line was identified, elevated, and a vesico-uterine flap was
created.
• A transverse incision was made on the lower uterine segment and extended
cephalad with bandage scissors.

144
• The fetus’s nose and mouth were suctioned, and the umbilical cord was clamped
and cut.
• The newborn was handed to the pediatrician.
• The placenta was delivered, and the uterus was cleared of clots and debris.
• The uterine incision was closed in three layers:
◆ First layer: Continuous interlocking suture with Monocryl 1
◆ Second layer: Continuous suture with Monocryl 1
◆ Third layer: Continuous suturing with Monocryl 1
• Clots and debris were removed from both gutters and the cul-de-sac.
• The fallopian tubes and ovaries appeared normal and glossy.
• The abdominal closure was performed in layers:
◆ Peritoneum: Simple continuous suture with Monocryl 1
◆ Fascia: Continuous interlocking suture with Vicryl 1
◆ Subcutaneous tissue: Simple continuous suture with plain Vicryl 1
◆ Skin: Subcuticular suture with Monocryl 3
• Sponge, needle, and instrument counts were verified three times.
• A top dressing was applied, and vaginal evacuation of blood and clots was done.
Nursing Responsibilities
Before Procedure:
• Review the patient’s obstetric history, surgical history, allergies, and medications.
Assess vital signs and fetal status.
• Confirm the presence of signed informed consent for the cesarean section and
anesthesia.
• Provide preoperative teaching to the patient and family, addressing the procedure,
expected sensations, and recovery process.
• Promote emotional support to reduce anxiety and encourage relaxation
techniques.
Pre-operative Preparation:
• Establish an intravenous (IV) line for fluid and medication administration.
• Administer prescribed preoperative medications (e.g., antibiotics, antacids).
• Insert a urinary catheter to maintain bladder decompression.
• Apply compression devices or anti-embolism stockings to reduce the risk of venous
thromboembolism.

145
• Perform abdominal skin preparation using aseptic technique.
• Ensure accurate pre-op checklist completion, including surgical site marking and
NPO (nothing by mouth) status confirmation.
During the Procedure:
• Position the patient in a supine position with a left lateral tilt to prevent vena cava
compression.
• Continuously monitor maternal vital signs, fetal heart rate, and oxygen saturation.
• Assist the surgical team by maintaining a sterile field and passing necessary
instruments. Support the patient emotionally and explain each step of the
procedure if the patient is awake.
• Document intraoperative events, medications administered, and fetal delivery
time.
After the Procedure:
Post-Anesthesia Care Unit (PACU):
• Monitor maternal vital signs, pain level, and bleeding every 15 minutes for the first
hour.
• Evaluate the incision site for bleeding, drainage, or dehiscence.
• Administer pain relief and antiemetics as prescribed.
• Monitor urinary output from the Foley catheter.
• Encourage deep breathing and coughing exercises to prevent atelectasis and
pneumonia.
Postpartum Care:
• Encourage early ambulation within 6–12 hours post-surgery to prevent
thromboembolism.
• Support breastfeeding and educate on newborn care.
• Teach the patient about incision care, activity restrictions, and warning signs of
infection or complications.
• Monitor for signs of postpartum hemorrhage, infection, and bowel or bladder
complications.
• Provide emotional support, screen for postpartum depression, and address
concerns related to recovery and newborn care.

146
 XIV. NURSING THEORIES

This section highlights nursing theories that play a pivotal role in shaping nursing
practice by providing frameworks that guide clinical decision-making and foster
evidence-based research (Reed, 2025). The use of theories in nursing is long-
established, with concepts from natural and social sciences guiding practice, often
without nurses realizing their influence (McEwen & Wills, 2011)
Self-Care Deficit Nursing Theory (Dorothea Orem)
Orem’s Self-Care Deficit Nursing Theory focuses on the importance of supporting
patients who are unable to meet their own self-care needs. In the case of a
primigravida patient who underwent a lower segment cesarean section (LSCS) due to
cephalopelvic disproportion (CPD), arrest of cervical dilatation, fetal distress,
oligohydramnios, and severe preeclampsia, the mother faces physical and emotional
challenges in self-care. Postoperatively, she may experience pain, fatigue, mobility
limitations, and difficulty in newborn care. Nurses play a crucial role in assisting her
with wound care, pain management, mobility exercises, and monitoring for
complications such as infection or hypertensive crises. Education on proper nutrition,
hydration, and breastfeeding techniques further supports her recovery and promotes
self-care independence. By addressing these needs, nurses empower the mother to
regain control over her health and adjust to the demands of caring for her newborn.
Interpersonal Relations Theory (Hildegard Peplau)
Peplau’s Interpersonal Relations Theory emphasizes the significance of the nurse-
patient relationship in fostering health and emotional well-being. In the context of a
postpartum mother recovering from LSCS complicated by severe preeclampsia, the
nurse’s ability to build trust, provide reassurance, and facilitate open communication
is essential. This theory is particularly relevant as the patient navigates the stress of a
high-risk pregnancy, surgical recovery, and newborn care. By establishing a
therapeutic relationship, the nurse can alleviate anxiety, educate the patient about
postoperative care, and address concerns regarding newborn care and breastfeeding.
Additionally, assisting the mother in recognizing early warning signs of postpartum
complications, such as hypertensive crises or wound infections, fosters active
participation in her recovery. The nurse’s role extends beyond physical care to
providing emotional and psychological support, ensuring the mother feels confident
and supported during this critical period.

147
Adaptation Model of Nursing (Sister Callista Roy)
Roy’s Adaptation Model focuses on how individuals adjust to changes in health
and their environment. In the case of a mother recovering from LSCS due to severe
preeclampsia and CPD, adaptation is essential for both physical and emotional
recovery. The nurse helps facilitate adaptation by monitoring vital signs, assessing for
postpartum complications, and guiding the patient through lifestyle adjustments
necessary for long-term health. Given the stress and physical toll of her condition,
interventions include promoting adherence to antihypertensive therapy, encouraging
gradual mobilization, and ensuring proper nutritional intake to aid wound healing.
Emotional support is also crucial, as the patient adjusts to her new maternal role while
dealing with postpartum discomfort and potential anxiety regarding her newborn’s well-
being. Through patient-centered education and emotional reassurance, the nurse
plays a key role in helping the patient adapt effectively to her postpartum recovery and
transition into motherhood.

148
 XV. NURSING CARE PLAN

Nursing Nursing Intervention and

Date/ Shift Assessment Need Plan of Care Evaluation
Diagnosis Rationale

3/24/25
3pm- SUBJECTIVE: Acute Pain SHORT TERM Independent: After 8 hours of
PATIENT GOALS: After 8 nursing interventions
11pm VERBALIZED MASLOW’S related to hours of nursing Provide emotional support the Goal is Met the
“dili na kaayo sakit interventions the and active listening during patient is able to:
ma kaya raman” HIERARCHY surgical incision patient will: rounds
Rationale: Validates • Recover fully
OBJECTIVE: OF NEEDS. as evidenced by Patient will patient’s feelings and builds without
Post CS recover fully trust in the care team complications
Surgical site dry verbalized pain without and
and intact complications and Assist with proper independently
Infant stable and and protective independently positioning for care for her
roomed-in with the care for her baby breastfeeding and sleeping baby
mother movement. Rationale: Promotes
Pain score: 4/10 at Vital signs will comfort and reduces strain
surgical site remain stable and on the incision site
Ambulating with within acceptable • Vital signs
minimal assistance parameters Teach wound care, activity remained
pacing, and signs of stable and
VS are as follows: Patient will infection to watch for within
BP – demonstrate Rationale: Empowers the acceptable
130/100mmHg understanding of patient to participate in her parameters
Pr – 89bpm wound care and own recovery
Rr - 19cpm infection
Temp – 36.6°c prevention • Patient
O2 – 97% demonstrated

149
Dependent: understanding
of wound care
Administer prescribed and infection
analgesics and monitor prevention
response
Rationale: Reduces pain to
enable mobility and
newborn care

Monitor incision site for

signs of redness, swelling,
or discharge
Rationale: Ensures early
detection of infection or
delayed healing

Collaborative:

Coordinate with lactation

consultant for breastfeeding
support
Rationale: Helps build
maternal confidence and
supports infant nutrition

Involve family members in

newborn care education
Rationale: Reinforces

support system and eases

150
 the patient’s physical

burden

3/24/25 SUBJECTIVE: Readiness for SHORT TERM Independent:

3pm- PATIENT Enhanced GOALS: After 8 After 8 hours of
11pm VERBALIZED Parenting hours of nursing 1. Provide education on nursing interventions
"First time nko ni na Ramona T. related to interventions the newborn care practices the Goal is Met the
baby, gusto nako Mercer’s expressed patient will: including bathing, patient is able to:
mo uli para ma Theory of desire to care for breastfeeding, burping, and
ampingan si baby" Maternal newborn at Patient will swaddling. • Patient
Role home verbalize - Rationale: Builds verbalized
OBJECTIVE: Attainment understanding of maternal skills and understanding of
Post CS basic newborn confidence in newborn basic newborn
Surgical site clean care (feeding, handling. care (feeding,
and intact hygiene, safety) 2. Encourage skin-to-skin hygiene, safety)
Rooming-in with contact and verbal
infant, bonding Patient will interaction with the infant.
observed during demonstrate - Rationale: Enhances • Patient
care activities confidence and bonding and promotes demonstrated
Patient competence in emotional connection. confidence and
breastfeeding with caring for her 3. Address patient competence in
guidance, asks newborn prior to questions and validate her

151
frequent questions discharge. efforts in caring for her caring for her
about newborn baby. newborn prior to
care - Rationale: Reinforces discharge.
Patient will learning and supports
establish a routine emotional transition to
that promotes motherhood. • Patient
bonding and established a
newborn well- Dependent: routine that
being. promotes
1. Assist in setting up bonding and
newborn feeding schedule newborn well-
and monitor mother’s being.
breastfeeding technique.
- Rationale: Promotes
effective feeding and
maternal confidence.
2. Collaborate with
physician and pediatrician
to include patient in
newborn health
discussions.

152
 - Rationale: Keeps mother
informed and empowered in
decision-making.

Collaborative:

1. Refer to a lactation
consultant if difficulties in
breastfeeding persist.
- Rationale: Provides
expert support and ensures
infant nutritional needs are
met.
2. Include partner or family
in teaching sessions for
newborn care.
- Rationale: Strengthens
support system and
promotes shared
responsibility in caregiving.

153
3/24/25 SUBJECTIVE: Risk for SHORT TERM Independent Interventions:
3pm- PATIENT Decreased GOALS: After 8 After 8 hours of
11pm VERBALIZED Cardiac Output hours of nursing Create a calm and quiet nursing interventions
“medyo mahilo ko MASLOW’S related to interventions the environment, encourage the Goal was Met
sir pag mo bangon” HIERARCHY increased patient will: rest, and allow the patient to
OF NEEDS. vascular express concerns. Patient’s BP reduced
OBJECTIVE: resistance Patient will have Rationale: Reduces stress to 130/90 mmHg with
Slight dizziness secondary to reduced BP, and promotes recovery. treatment and rest.
Post CS preeclampsia, below 130/100
Surgical site dry as evidenced by mmHg with Monitor vital signs,
and intact elevated BP. treatment and particularly BP, every 2-4
Infant stable and rest. hours or as per protocol. Patient recovered
roomed-in with the Rationale: Early recognition without further
mother Patient will of changes helps prevent complications related
recover without complications. to preeclampsia.
VS are as follows: further
BP – complications Assess for signs of
130/100mmHg related to worsening condition such Patient and infant
Pr - 89bpm preeclampsia. as increased headache, was discharged in
Rr - 19cpm visual changes, or stable condition with
Temp – 36.6°c Patient and infant epigastric pain. proper education on

154
O2 – 97% will be discharged Rationale: These are early BP management and
in stable condition signs of eclampsia or warning signs.
with proper worsening preeclampsia.
education on BP
management and Dependent Interventions:
warning signs.
Administer prescribed
antihypertensive and
magnesium sulfate as
ordered.
Rationale: Controls BP and
prevents seizures.

Provide prescribed
analgesics to manage
incision pain.
Rationale: Effective pain
relief promotes mobility and
reduces stress.

Assist with ambulation as

155
tolerated.
Rationale: Promotes
circulation and reduces risk
of thromboembolism.

Collaborative Interventions:

Coordinate with physician

for continuous monitoring
and management of
postpartum hypertension.
Rationale: Timely
intervention prevents
complications like stroke or
eclampsia.

Work with a dietitian for a

low-sodium postpartum diet
plan.
Rationale: Diet plays a role
in long-term BP

156
management.

Encourage family support in

newborn care to reduce
maternal stress.
Rationale: Reduces
maternal workload and
promotes rest.

157
 XVI. DISCHARGE PLAN (M.E.T.H.O.D)

M – MEDICATION
• Instruct the patient to take prescribed medications exactly as directed, including
pain relievers, antibiotics (if any), and stool softeners.
• Educate about possible side effects and when to notify the doctor (e.g., rash,
nausea, or worsening pain).
E – EXERCISE
• Encourage light activities such as short walks to promote circulation and
prevent blood clots.
• Avoid lifting anything heavier than the baby and refrain from abdominal
exercises until cleared by the doctor (typically 6–8 weeks post-op).
• Emphasize gradual return to normal activity, with plenty of rest in between.
T – TREATMENTS
• Instruct patient on proper care of the incision site—keep it clean and dry, and
observe for signs of infection (e.g., redness, swelling, pus, or foul odor).
• Advise use of sanitary pads for postpartum bleeding; avoid tampons to prevent
infection.
• Remind patient to avoid sexual activity, douching, and swimming until cleared
by healthcare provider.
• Encourage hydration and a fiber-rich diet to prevent constipation, common after
surgery and due to pain medications.
H – HEALTH TEACHING
• Educate patient to monitor for warning signs: fever (>38°C), increased pain,
foul-smelling discharge, excessive bleeding (soaking >1 pad/hour), leg
swelling/pain, or shortness of breath.
• Teach how to support the incision when coughing, sneezing, or moving (e.g.,
with a pillow for support).
• Reinforce the importance of rest, accepting help from others, and gradual return
to daily tasks.
• Provide guidance on emotional health—mood swings are normal, but
prolonged sadness or detachment may require support or follow-up.
O – OUTPATIENT FOLLOW-UP

158
 • Ensure follow-up appointment is scheduled, usually within 1–2 weeks post-
discharge.
• Instruct to contact the doctor immediately for any concerning symptoms.
• Encourage the patient to seek emotional support through friends, family, or
professional counseling if feeling overwhelmed or anxious.
D – DIET
• Encourage a balanced diet rich in iron (e.g., leafy greens, red meat), protein
(e.g., lean meat, legumes), and whole grains to aid healing.
• Advise drinking plenty of fluids to stay hydrated and help with milk production if
breastfeeding.
• Recommend avoiding caffeine and alcohol during the recovery period,
especially if breastfeeding.
• Consider a gentle stool softener if constipation is a concern.

159
 XVII. RECOMMENDATION

To the Patient:
• Stay Hydrated – Drink plenty of fluids such as water, natural juices, and soups
to support tissue healing, reduce constipation, and aid breastfeeding (if
applicable).
• Prioritize Rest and Recovery – Take frequent breaks and avoid strenuous
activity. Allow your body the time it needs to heal after surgery.
• Eat Nutritious Foods – Include iron-rich foods (like leafy greens and red meat)
to replenish blood loss, and protein- and vitamin-rich foods to aid wound healing
and boost immunity.
• Monitor for Warning Signs – Contact your healthcare provider immediately if
you experience symptoms such as:
▪ Fever (>38°C)
▪ Severe abdominal or incision pain
▪ Foul-smelling vaginal discharge or pus from the incision
▪ Excessive bleeding (soaking more than 1 pad per hour)
▪ Redness, swelling, or warmth around the incision site
▪ Shortness of breath or chest pain
• Follow Doctor’s Orders – Attend scheduled follow-up appointments and
adhere to medication instructions, including pain management and wound care.
To the Client’s Family:
• Offer Emotional and Physical Support – Be patient, understanding, and
responsive to the mother's emotional and physical needs.
• Encourage Good Nutrition and Hydration – Support healthy eating habits
and fluid intake to promote healing and, if applicable, milk production.
• Be Vigilant for Danger Signs – Help monitor for signs of infection or
complications and assist in seeking timely medical care if needed.
• Assist with Daily Tasks – Lighten the patient’s load by helping with chores,
caring for the baby, and ensuring she has time to rest.
At Home:
• Create a Calm Healing Environment – Promote rest by minimizing stress,
noise, and demands.

160
 • Support Proper Hygiene – Encourage daily gentle cleansing, regular pad
changes, and proper wound care to avoid infection.
• Avoid Strain – Refrain from lifting heavy objects or engaging in intense
physical activities until cleared by the doctor.
• Support Emotional Health – Watch for signs of postpartum depression or
anxiety. If emotional struggles persist, encourage the patient to speak with a
professional.
To Fellow Student Nurses:
• Deepen Knowledge of Post-Cesarean Care – Understand the physical,
emotional, and surgical aspects of cesarean recovery to provide holistic care.
• Implement Targeted Nursing Interventions – Focus on pain control, wound
monitoring, infection prevention, and patient education.
• Educate on Postpartum and Surgical Care – Promote awareness of danger
signs, proper hygiene, breastfeeding support, and recovery pacing.
• Communicate Clearly and Compassionately – Use empathetic, non-
judgmental language to educate and emotionally support both the patient and
her family.
• Practice Holistic, Woman-Centered Care – Recognize that recovery involves
both body and mind. Treat each patient with respect, dignity, and sensitivity to
her experience.

161
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blood pressure during pregnancy. [Link]
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& von Dadelszen, P. (2022). The 2021 International Society for the Study of
Hypertension in Pregnancy classification, diagnosis & management
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preeclampsia. BMJ, 372, n123. [Link]
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Reference for Psychodynamic Nursing (2nd ed.). Springer Publishing
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Phipps, E., Prasanna, D., Brima, W., & Jim, B. (2021). Preeclampsia: Updates in
pathogenesis, definitions, and guidelines. Clinical Journal of the American
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Applications. Nursing Education Press.
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Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A.-B., Daniels, J., ... & Alkema, L.
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163
XIX. CURRICULUM VITAE

Name: John Llyod Julom

Age: 19

Birthdate: June 24, 2004

Address: Purok 4-B, Rizal, Binancian, Asuncion,

Davao del Norte

Name: Dannah Hanica B. Lanoy

Age: 20

Birthday: February 9, 2005

Address: Purok 7 [Link] 2, Sto. Tomas, Davao del

Norte

Name: Lazaro, Jane Claire D.

Age: 20

Birthdate: September 15, 2004

Address: Purok 7 Gk, Kinuban, Maco, Davao De

Oro

Name: Red B. Lepasana

Age: 20

Birthdate: November 25, 2004

Address: Purok 8A, Ising, Carmen Davao del

Norte

164
Name: Cyrille P. Molina

Age: 20

Birthdate: July 29, 2004

Address: Prk Popular Brgy East, Tagum City

Name: Kyth Jennelle A. Panganiban

Age: 23

Birthdate: October 17, 2001

Address: Purok Talisay 2 Visayan Village Tagum

City

Name: Trisha S. Purca

Age: 20

Birthdate: October 03, 2004

Address: Asuncion, Davao del Norte

Name: Kharl Vaughn Rodriguez.

Age: 20

Birthdate: September 26, 2004

Address: St. Therese, Subdv, VIsayan Village,

Tagum City

165
Name: Lou Jazrelle C. Salada

Age: 20

Birthdate:February 14, 2004

Address: Purok C Santan St. Suaybaguio Dist.

Tagum, Davao del Norte

Name: Dan B. Sarmiento

Age: 19

Birthdate: February 19, 2005

Address: Purok. Makugihon, Cuambog, Mabini

Davao de Oro

Name: Hannah Mae Rio

Age: 21

Birthdate: October 03, 2003

Address: Apokon, Tagum City

166